Test Information Test Name DAMS AIIMS Total Questions 250 Test Type Examination Difficulty Level Difficult Total 180 Marks 200 Duration minutes Test Question Language:-ENGLISH 1. A35 year old farmer presents with multiple discharging cervical sinuses . Which of these stains will be useful for the diagnosis ? Where does this organism normally colonise in the body ? a. Gramstain oropharynx b, PAS intestine c. AFB mouth d. Grocott methanamine silver skin Solution. A. Gram stain oropharynx + Actinomyces species are present as normal flora of the oral cavity and also in the lower gastrointestinal tract and female genital tract of human hosts. * Cervicefacial actinomyensis (MC), thoracic actnomycosis, and actisomyeasis ofthe abdomen and pelvis. + The specimens include sputum, bronchial secretions and discharges, and infected tissues. All these specimens may contain largo number of sulfur granules. + Intestinal Actinomyces - PAS & Gram stain are useful Answer. a2. A.40 year HIV positive male patient comes with odynophagia and watery diarrhoea. An endoscopy reveals oesophageal and gastric candidiasis. A wet mount of the stool of the patient reveal following picture . What is true about this helminth? a, Rhabditiform larvae is infective form for humans /b, Transmitted through contaminated food and water usually ©. Females of these species show parthenogenesis d. Drug of choice is triclabendazole Solution. c. Females of these species show parthenogenesis + This picture is rhabditiform larva which is diagnostic form + Mode of transmission is skin penetration + Drug of choice is Ivermectin Answer. c 3. In the following gram stained specimen, identify the bacteria seen? a, Neisseria gonorrhoeae b. Staphylococcus aureus . Streptococcus pneumoniae. . Haemophilus influenzae Solution. a. Neisseria gonorrhoeae + Gram Negative diplococci - Kidney shaped - Intracellular - Suggestive of Neisseria gonorrhoea Answer. a4. A 15 year old boy presented with fever and chills for 3 days. On examination he was found to have delayed skin pinch time and dry oral mucosa. A peripheral blood smear revealed the following picture. Identify the pathogen involved? a. Plasmodium falciparum b. Babesia c, Plasmodium vivax. d. Salmonella typhi Solution. a. Plasmodium falciparum + The early ring form in the erythrocyte is very delicate and tiny, measuring only a sixth(1/6) of the red cell diameter. + Rings are often seen attached along the margin of the red cell, the so-called form appliqué oraccole. + Binucleate rings (double chromatin) are commonresembling stereo headphones in appearance. + Severalrings may be seen within a single erythrocyte. Answer. a5. Why are schizont and late trophozoite stages of Plasmodium falciparum not seen in peripheral blood smear? a. They are sequestered in the spleen b, Due to adherence to the capillary endothelium, they are not seen in peripheral blood . Due to antigen- antibody reaction and removal 4. They are seen in mosquito blood Solution. b. Due to adherence to the capillary endothelium, they are not seen in peripheral blood + The trophozoites usually disappear from peripheralcirculation after about 24 hours. By then, membraneprotuberances appear in erythrocyte’s surface, 12-15hours after cell invasion. * These knobs extrude a high molecular weight, antigenically variant strainspecificerythrocyte membrane adhesive protein, Pf MP1, thatmediates attachment to receptors on venular capillary endothelium, an event termed ‘cytoadherence’. + Severalvascular receptors have been identified of whichintracellular adhesion molecule (ICAM- 1) is probablymost important in the brain, chondroitin sulfate B in theplacenta, and CD36 in most other organs. + The infected erythrocytes stick inside and eventuellyblock capillaries and venules. At the same stago, these P.falciparuminfected RBCs adhere to uninfected RBCs toform rosettes. The process of cytoadherence, resetting,and agglutination are central to pathogenesis offalciparum malaria. + They result in sequestration of RBCscontaining mature form of the paresite in vital organs likebrain, kidney, heart, lungs, spleen, intestine, bone marrow and placenta, where they interfere with microcirculatoryflow and metabolism and are responsible for many ofthe serious complications of falciparum malaria, such ascerebral malaria Answer. b6. A patient with benign hypertrophy of prostate was admitted in the hospital for 3 weeks. He subsequently developed suspected catheter associated-urinary tract infection. The Up of the catheter was sent for culture and was grown on blood agar. After 24 hours, the blood agar shows the following appearance. What is the likely causative agent for the UTI? a. Proteus mirabilis b, Pseudomonas . Escherichia coli . Klebsiella pneumoniae Solution. a. Proteus mirabilis + Swarming in blood agar suggestive of Proteus mirabilis growth. It is associated with catheter related UTI & Stag Horn renal calculi. Answer. a 7. In a child admitted with hemophilus influenzae meningitis. cefotaxime was started instead of ampicilin . which of these is the likely reason for this a. H.influenzae strains are known to produce Beta lactamase b, H.influenzae strains are known to have altered penicillin binding proteins c. Cefotaxime is easier to administer then ampicilin 4. Drug of choice for this condition is sulphamethoxazole Solution. A. H.influenzae stains are known to produce Beta lactamase - The treatment of choice for meningitis or other serious systemic infections caused by H. influenzae is ceftriaxone. - From 20% to 30% of H. influenzae type b isolates produce a B-lactamase that degrades penicillinase-sensitive f-lactams such as ampicillin but not ceftriaxone. - Its important to institute antibiotic treatment promptly, because the incidence of neurologicsequelae (e.g, subdural empyema) is high. - Untreated H. influenzae meningitis has a fatality rate of approximately 90%. - H. influenzae upper respiratory tract infections, such as otitis media and sinusitis, are tueatedwith either amoxicillin-clavulanate or trimethoprim-sulfamethoxazole Ref: Jawetz, Melnick, &Adelberg’s Medical Microbiology, 27/e, P -610 Answer. a8. Which of the following parasite’s life cycle is shown below? AO — ae a. Fasciolopsis buski b, Fasciola hepatica . Pargaonimus westermani 4. Clonorchis sinensis Solution. b. Fasciola hepatica + The above picture is the life cycle of Fasciola hepatica + Fasciola hepatica - Sheep liver fluke comes under Trematodes/flukes + Adult worms reside in the biliary passages of the liver of sheep, goat and Human. + Eggs are large, elliptical, operculate, light-yellowish brown coloured. + Infective form is Metacercariae encysted on water plants and mode of transmission is ingestion. + First Intermediate host: Snails &Second intermediate host: Aquatic vegetations + Infection: Fascioliasis + Lab diagnosis: Detection of operculated eggs in stool or in bile obtained by duodenal intubation + Treatment: Bithionol, Triclabendazole and dehydroemetine. Answer. b9. Papain cleaves the immunoglobulin molecule into a. 1 Fe and 2 Fab fragments b. 2 Fe and 1 Fab fragments cc. 1 Variable chain and 1 constant chain d. 1 Fab and one hyper variable region Solution. a. 1 Fc and 2 Fab fragments + Antibody molecule when treated with proteolytic enzyme like papain cleaves the molecule into two Fab fragments and 1 Fe fragment + Above the hinge region is broken Pepsin Flab’)2 ae a || Answer. a10. Which of the following staphylococcal infection is not toxin mediated? a. Toxic shock syndrome b, Staphylococcal scalded skin syndrome ©. Food poisoning i. Septicaemia Solution. d. Septicaemia + S. aureus produces many toxins like TSST, Exfoliative toxin, Enterotoxin. + Except septicaemia, all other choices are exotoxin mediated. + Diseases caused by staphylococcus aureus. emesis Impetige otk shock syndrome Ref. Levinson, Review of medical microbiology ~ 13/e P-256 Answer. d 123: Theme & Focus : Diarrhoea and dysentery 11. Case 1 Several children are hospitalized with bloody diarrhea and severe hematological abnormalities. A 4- year-old girl dies of kidney failure shortly after admittance. An epidemiological investigation establishes that all of the patients developed symptoms following consumption ofhamburgers from the same fast-food restaurant chain. What is the cause?a. EHEC b. EIEC ©. EPEC d. Rotavirus e. C.difficile £. Shigella g. ETEC h. C.perfringens Solution. A Escherichia coli 0157:H7 (EHEC) strains are classically associated with outbreaks of diarrhea after ingestion of undercooked hamburger at fastfood restaurants. Many cases of hemorrhagic colitis and its associated complications can be prevented by thoroughly cooking ground beef. Answer. a 12. Case 2 You isolate a virus from the stool ofa 1-year-old infant with signs of fever, vomiting, and diarrhea. Laboratory results show that the viral genome is composed of multiple segments of double-stranded RNA. What is the cause? a. EHEC b. EIEC ©. EPEC i. Rotavirus e. C.difficile £. Shigella g. ETEC hh. C.perfringens Solution. D Rotavirus is the most common cause of diarrhoea in infants. It is an RNA virus with segmented genome. Answer. d13. The phenomenon shown in the image below is inhibited by which of the following? a. Bile salts /b. Sulfonamides c. Sodium azide d. All of above Solution. d All the agents mentioned inhibit swarming, the phenomenon depicted in the image. Answer. d14, Match the following a. Prions p. Thymidine dimers b. Spores of Geobacillus Sir Joseph Lister stearothermophilus . Phenol r. Biological indicator of hot air oven d. UV rays s. Toughest to inactivate t. Biological indicator of plasma sterilisation u. Good penetrating power. Solution. Prions are the toughest agents to be inactivated by chemical agents followed by bacterial spores. Spores of Geobacillus stearothermophilus are used as Biological indicator of plasma sterilisation ad also autoclave. Phenol was the first chemical used in medical practice by Sir Joseph Lister, also known as father of Antiseptic surgery. UV rays act by causing formation of thymidine dimers thereby disrupting DNA structure. Answer. a-sb-t.o-q.d-p15. Assertion: Meningococcus has a protein capsule. Reason: Meningococcus has 5 serologic groups. a. Both Assertion and Reasons are independently true / correct statements and the Reason is the correct explanation for the Assertion b. Both Assertion and Reasons are independently true / correct statements, but the Reason is not. the correct explanation for the Assertion c. Assertion is independently ¢ true / correct statement, but the Reasons is independently a false / incorrect statement d. Assertion is independently a false / incorrect statement, but the Reasons is independently a true / correct statement e. Both Assertion and Reasons are independently false / incorrect statements Solution. Explanation: Both are false statements. N. meningitidis (meningococcus) has a prominent polysaccharide capsulethat enhances virulence by its antiphagocytic action and induces protectiveantibodies . Meningococci are divided into at least 13 serologic groupson the basis of the antigenicity of their capsular polysaccharides. Five serotypes cause most cases of meningitis and meningococcemia: A.B,C, Y, and W-135. Answer. 1234: The following statements are true / false regarding Picornaviruses. 16. Rhinoviruses are acid-stable. a. True b. False Solution. 1-False. Because Rhinoviruses are acid-labile, they are killed by gastricacid when swallowed. This explains why they do not infect the gastrointestinal tract,unlike the enteroviruses. Answer. b 17. Echoviruses are transmitted by respiratory route. a. True b. False Solution. False, Echoviruses are transmitted by the fecal-oral route and occur worldwide. Answer. b18. Picornaviruses have helical symmetry. a. True b. False Solution. False. Picornaviruses are small (20-30 nm) nonenveloped viruses composed of anicosahedral nucleocapsid and a single-stranded RNA genome. Answer. b 19. Coxsackie viruses are called so because they were discovered by Coxsackie. a. True b. False Solution. False. Coxsackie viruses are named for the town of Coxsackie, NY, where they were firstisolated. Answer. b 20. Enterovirus 70 causes acute hemorrhagic conjunctivitis. a. True b. False Solution. True. Enterovirus 70 is the main cause of acute hemorrhagic ‘conjunctivitis characterized by petechial hemorrhages on the bulbar conjunctivas. Answer. a 21. Card test is done for testing the function of a. lumbricals b, Palmar interossei c. Dorsal interossei d. Adductor pollicis Solution. B Ref: Apley'sorthopedics and fractures 9/e p 291 textbook of orthopedics by pp kotwal p 354 Answer. b22. Meralgia paresthetica is due to involvement of : a. Lateral cutaneous nerve of thigh b, Genitofemoral nerve ¢. Ilicinguinal nerve d. Saphenous nerve Solution. A Lateral cutaneous nerve of thigh Ref: Gray's Anatomy 40/e p 1382 Explanation- Meralgia paresthetica is due to compression of Lateral femoral cutaneous nerve against inguinal ligament. Answer. a 23. A 37 year old patient presented to you with hyperextension of 4th and 5th metacarpophalangeal joint with flexion at proximal interphlangeal joint. This deformity is due to injury to : a. Deep branch of ulnar nerve b, Median nerve ce. Radial . superficial branch of median nerve Solution. a. Deep branch of ulnar nerve Ref: Gray's Anatomy 40/e p888 Explanation- Hyperextension of 4th and 5th MCP joints with flexion of PIP joint is suggestive of claw hand involving the medial two digits, due to injury to deep branch of ulnar nerve with involvement of medial two lumbricals. Answer. a24. Portal Vein develops from which of these structures : aA bB cc aD Solution. C Portal vein develops from vitelline vein (Right) Ref: Langman’s Embryology 11/e p193 Answer. c25. The following diagram depicts the various parts from which the diaphragm develops Defects in which part most commonly leads to congenital diaphragmatic hernia : Fr Ean aA bB eC 4D Solution. D Pleuro peritoneal membranedefect Ref langman's embryology 11/e p161 Answer. d 26. Area marked by the arrow in the given figure contain all the following except : a. ZonulaOccludens b. Fasciaadherens ©. Macula adherens . Gap junction Solution. a. ZonulaOccludens Ref: Greys 40/e pg141 Answer. a27. As shown in the figure abnormal subclavian artery develops a. Persistenceof B b, Persistence of A c. Obliteration of A with persistence of B . Obliteration of B with persistence of A Solution. c. Obliteration of A with persistence of B Answer. c 28. Which of these nerve root is the control center for the stapedial reflex: a. Superior olivarycomplex b, Lateral lemniscus ¢. Inferior geniculate body . Medial geniculate complex Solution. A Superior olivary complex Ref: Greys 40/e pg 628 Answer. a29. A young patient with absent thymus and presented with hypoparathyroidism and tetany. Which of the following marked area in the picture is defective in this condition? 1e following mar aA b.B cc aD Solution. (a) Ref, Langman embryology 12, Page 88 The clinical scenario is that of a typical case of DiGeorge syndrome. The thymus and parathyroid both develops from 3rd pharyngeal pouch so answer in given image is A. Answer. a30. Read the Following statements regarding abduction at the shoulder joint A. Rotator cuff stabilizes shoulder during abduction B. Serratus anterior and trapezius involved in abduction C. Produced by multipennate fibres of deltoid D. Axillary nerve injury has no effect on abduction a. A,B, C are correct b. A& C are correct ec. B & Dare correct d. All are correct Solution. a) A, B, C are correct Exp: A. Rotator cuff stabilizes shoulder during abduction - T B. Serratus anterior and trapezius involved in abduction - T C. Produced by multipennete fibres of deltoid - T D. Axillary nerve injury has no effect on abduction - F Answer. a 31. Choose the correct sequence of the following embryonicevents: 1.Cortical reaction 2.Zona reaction 3, Acrosome reaction 4. Penetraion of corona radiata a. 2,3,4,1 Bb. 4,3,1,2 .4,3,2,1 4. 4,1,2,3 Solution. b. 4,3,1,2 Answer. b32. Assertion (A): Oropharyngeal Teratoma may arise from PGCs or from epiblast cells. Reason (R) : PGCs or epiblast cells are pluripotent. Tissues within these tumors include derivatives of all three germ layers and may include gut, bone, skin, teeth etc. a. Both A and Rare true and Ris correct explanation of A b, Both A and Rare true and R is NOT correct explanation of A c. Ais true Ris false d. Ris true A is false e. Both A and Rare false Solution. a) Both A and Rare true and Ris correct explanation of A Answer. a 2: Following statements regarding phrenic nerve are true/ false? 33. Motor peripheral nerve a.True b. False Solution. Motor peripheral nerve - F - Mixed Answer. b 34, Formed at lateral border of scalenus medius a. True b. False Solution. Formed at lateral border of scalenus medius - F - Scalenus Anterior Answer. b 35. Variable course on both sides a. True b. False Solution. Variable course on both sides - F - left side variable, right side usually constant Answer. b36. Passes anterior to the lung hilum a. True b. False Solution. Passes anterior to the lung hilum - T Answer. a 37. Root value is C345, a. True b. False Solution. Root value is C345 - T Answer. a 38, Vitamin C cannot be produced in humans due to lack of: a. L-gulonolactone oxidase b. Xylutitol reductase c. Pyruvate dehydrogenase . UDP glucose dehydrogenase Solution. A Due to lack of L-gulonolactone oxidase, Vit-C cannot be synthesised in human body by uronic acid pathway. In humans ,uronic acid pathway produces glucuronic acid which is a component of mucopolysaccherides and also helps in conjugation reactions. Essential pentosuria is associated with defect in this pathway, where L - Xylulose comes out in urine due to lack of LXylulose reductase enzyme Answer. a39. Klenow fragment lacks the activity of? a. 3’-5' exonuclease b, 5’-3' exonuclease c.5’-3’ DNA polymerase 4. 3'-5’ DNA polymerase Solution. B Kornberg enzyme is DNA polymerase I discovered by Kornberg in 1957. It has 3 catalytic activities + 5" -3 polymerase activity +3’ -5’ exonuclease activity +5’ - 3’ exonuclease activity The larger fragment of this enzyme shows the propeeties similar to DNA polymerase III ie +5" -3’ polymerase activity + 3-5’ exonuclease activity And he named this as klenow fragment Answer. b 40. Which of the following enzyme activity decreases in fasting? a. Hormone sensitive lipase b, Glycogen Phosphorylase c. Acetyl CoA Carboxylase 4. Phosphofructokinase I Solution. D>C Both C and D are correct answers. D is better answer + Acetyl CaA carboxylase enzyme is a rate limiting enzyme of fatty acid synthesis. It requires presence of insulin to undergo dephosphorylation to become active. In fasting state, insulin is absent. Hence activity of this enzyme is absent. + Phosphofructokinase I (PFK I) : in fasting state, the level of fructose 2,6 bisphosphate which is a positive allosteric modifier of PFKI reduces. Hence activity of PFK I is also reduced. Answer. d41. Alcoholic hepatitis, which of the following elevation is most characteristic a. AST b. ALT ©. GCT d. LDH Solution. C gamma glutamyl transferase present in biliray canaliculus is increased in alcoholic hepatitis Answer. ¢ 42. CG islands in our DNA are important fo! a. Acetylation b, Methylation c. tRNA synthesis 4. DNA replication Solution. b. Methylation Ref: Haprper 30/e pg 735 Answer. b 43. Cerebrohepatorenal syndrome. Which of the following substance accumulates in brain? a. Pyruvate b. Short chain FA c. Very long chain FA 4. Glycogen Solution. C cerebrohepato renal syndrome known as Zellweger syndrome is due to lack of peroxisomes or peroxisomes may be empty (absent enzymes). there is accumulation of very long chain fatty acids in liver, kidney, CNS and muscles. Answer. c44, Respiratory quotient of a patient exclusively on carbohydrate diet? a. 0.7 b. c.0.8 di Solution. B Respiratory quotient= CO2 produced/ 02 consumed RQ of various macronutrients are as follows + carbohydrate = 1 + fat = 0.7 + protein = 0.8 + mixed diet = 0.85 + Alcohol = 0.66 Answer. b 45. A young lady presented with tingling sensation in legs and hands. On examination she had fissure tongue and lesions in angle of mouth. On investigation, she had low RBC glutathione reductase activity. Diagnosis is deficiency of? a. Vitamin B2 b. Vitamin B6 ¢. Vitamin B12 d. Vitamin B1 Solution. (a) Vitamin B2 Ref. Textbook of biochemistry. Richard Harvey. Page. 242 Answer. a 46, Which of the following yields 3 molecules of ATP under anaearobic metabolism? a. Glucose b. Galactose ©. Glycogen . Amino acid Solution. (c ) Glycogen (as G6p is final product which saves one atp of hexokinase step) Ref.Textbook of biochemistry. Richard Harvey. Page. 123 Answer. c47. Match the following Vitamin Act as coenzyme for a. Thiamine p. PDH complex b. Methyl-cobalamine 4. Methyimalonyl coenzyme -A mutase ce. Calcitriol r. Transaminase . Menaquinone s. Glucose 6 phosphate dehydrogenase t. no coenzyme function u. y-glutamyl carboxylase v. methionine synthase Answer. a-pb-v,c-td-u 5: Which of the following statements are true/ false regarding mitochondrial DNA 48. Maternal transmission a. True b. False Answer. a 49. Introns are abundantly present a. True b. False Answer. b 50. Code all proteins of mitochondria a. True b. False Answer. b51. DNA polymerase y is required exclusively for mitochondrial DNA replication a. True b. False Answer. a 52. Double stranded and circular a. True b, False Answer. a 53. Arrange the following enzymes of hase excision repair in order of their utilization 1) Glycosylase 2) AP endonuclease 3) DNA Polymerase 4) Ligase a. 1234 b. 4321 ©. 2134 4.3124 Solution. a) 1234 Answer. a 54. Arrange the following urea cycle disorders in increasing order of severity of ammonia toxicity 1) Type 1 hyperammonemia 2) Type 2 hyperammonemia 3) Hyperargininemia 4) Citrullinemia a de3etel b, 4>2>1>3 ©. 31>2>4 Solution. C 3<4<2<1 Answer. c55. A 25-year old female presented with erythematous papules on the face as seen in the figure . The lesion were exacerbated on excessive sweating , sun exposure and emotional disturbance . What is the diagnosis ? a. SLE b, Rosacea . Acne vulgaris . Photodermatitis Answer. b 56. Match the following a. Herpes genitalis P. Profuse vaginal discharge b. LGV q. Red beefy ulcer c. Donovanosis r. Kissing ulcers d. Trichomonas vaginalis s. White curdy discharge t. Partner treatment not required u, Lymphatic involvement Answer. a-t.b-u.c-a.d-p 6: Pick true/false statements regarding erythema multiforme: 57. Most commonly due to herpes virus a. True b. False Answer. a58. Targetoid lesions are seen a. True b. False Answer. b 59. Koebner’s phenomenon is seen a. True b. False Answer. a 60. Steroids are the drug of choice a. True b. False Answer. b 61. Antimalarials can cause a, True b. False Answer. a62. A 35 year old male comes with complaints of hair loss. On examination, well defined bald patches were seen with no scarring. Small broken hairs were seen in the surrounding area. What is the likely diagnosis? a. Androgenic alopecia b, Alopecia areata c. Anagen effluvium 4. Telogen effluvium Solution. b. Alopecia areata Alopecia areata is characterized by repid and complete loss of hair in one or more round or oval patches, usually on the scalp, bearded area, eyebrows, eyelashes, and less commonly, on other hairy areas of the body. Broken hairs in the patch are the weakened hairs which have been damaged by the autoimmune damage in alopecia areata and are seen best on magnification by magnifying instruments like a dermatoscope. The disease causes non cicatricial patches and regrows fully. Androgenetic alopecia, Anagen efiluvium and telogen effluvium would be diffuse and not a patchy loss of hair. Answer. b 63. A patient presents with asymptomatic, gradually expanding, infiltrated plaque with central scarring as shown in image. Likely diagnosis is a. Lupus vulgaris b, Tinea corporis c. Discoid lupus erythematosus d. Fixed drug eruption Solution. (a) Lupus vulgaris. Ref:Read the text below Sol : + Lupus vulgaris is likely diagnosis. « Tinea has no scarring and is itchy. + DLE has carpet tack scales, follicular plugging and pigmented borders. + Fixed drug eruption is pigmented and may have blisters in center. Answer. a64. Which Vitamin deficiency can produce the typical skin change shown? a. Vitamin B1 b, Vitamin B2 c. Vitamin B3 4. Vitamin BE Solution. (c) Vitamin B3 Ref:Read the text below Sol: * Casal’s necklace pattern of skin lesion around the neck is a feature of Pellagra. + The recommended daily allowance of Niacin is 6mg/1000 kcal of energy intake. Answer. c65. A male, shyam aged 30 years presented with trismus, fever, swelling pushing the tonsil medially and spreading laterally posterior to the sternomastoid towards the middle. He gives history of excision of 3rd molar a few days back for dental caries. The diagnosis is a. Retropharyngeal abscess b, Ludwig's angina c. Submental abscess 4d. Parapharyngeal abscess Solution. (d) Parapharyngeal abscess Ref: Read the text below Sol: Trismus, fever, medial displacement of tonsil and involvement of neckindicates straightforward diagnosis of parapharyngeal abscess. In Ludwig's angina the swelling is in the submandibular region while in retropharyngeal abscess it is on the posterior pharyngeal wall. ‘The statement on 3rd molar excision points to a possible dental cause. Answer. d66. All of the following statement about malignant otitis externa are true except - a. Diabetic and immunocompromised people are more susceptible b, Severe hearing loss is the most common presenting symptom . Granulation tissue is seen on the floor of the external auditory canal on otoscopy . ESR is used for monitoring the disease Solution. (b) Severe hearing loss is the most common presenting symptom Ref:Read the text below S Severe ear pain (otalgia) is the most common presenting symptom. SKULL BASE OSTEOMYELITIS / MALIGNANT OTITIS EXTERNA- Malignant external otitis (MEO) is an infection that affects the external auditory canal and temporal bone. + The causative organism is usually Pseudomonas aeruginosa, PREDISPOSING FACTORS - 1, Diabetes (90% of patients) 2, AIDS 3. Aural irrigation CLINICAL FEATURES - Malignant external otitis has been reported in all age groups but is most common in patients who are elderly diabetics (age, >60 y). It is more common in males than in females. It is also more common in humid and warm climates. The patient usually presents with - Severe, unrelenting, deep-seated otalgia (ear pain) Temporal headaches Purulent otorrhea Possibly dysphagia, hoarseness, and/or facial nerve dysfunction. Inflammatory changes are observed in the external auditory canal and the periauricular soft -eoo°o: tissue. The pain is out of proportion to the physical examination findings. Marked tenderness is present in the soft tissue between the mandible ramus and mastoid tip. + Granulation tissue is present at the floor of the osseocartilaginous junction. ‘This finding is virtually pathognomonic of malignant external otitis. Otoscopic examination may also reveal exposed bone. Cranial nerves can be affected by inflammation along the skull base or by a neurotoxin produced by Pseudomonas species. ‘The facial nerve (VII) is affected most commonly, usually at the stylomastoid foramen. As the disease progresses, cranial nerves IX, X, and XI can be affected at the jugular foramen, followed by XII at the hypoglossal canal. Cranial nerves V and VI can be affected if the disease extends to the petrous apex. ‘The tympanic membrane is usually intact. Fever is uncommon. Answer. b67. A patient presents with traumatic head injury with CSF leak What is the next step in management a. Wait and watch for 3 - 5 days b. Dural catheter to control CSF leak c. Pack the nasal cavity d. Do an MRI to localise the leak and control the discharge endoscopically Solution. (a) Wait and watch for 3 - 5 days Ref:Read the text below Si TREATMENT OF CSF RHINORRHEA - Early cases of post-traumatic CSF rhinorrhea are managed conservativelyby ~ © Placing the patient in the semisitting position 0 Avoiding blowing of nose, sneezing and straining. Prophylactic antibiotics are also administered to prevent meningitis. Persistent cases of CSF rhinorrhea are treated surgically by nasal endoscopic or intracranial approach. ‘Nasal endoscopic approach is useful for leaks from the frontal sinus, cribriform plate, ethmoid or sphenoid sinuses. Answer. a 68. The high court has power to put a stay to the execution of a pregnant woman according to which section of criminal procedure code? a. 416 CrP.C b. 417 Cr.P.C ©. 418 CrP.C d. 419 Cr.P.C Solution. A - 416 Cr.P.C. Ref.: Criminal Procedure Code Explanation:{f a woman sentenced to death is found to be pregnant, the High Court shall order the execution of the sentence to be postponed, and may, if it thinks fit, commute the sentence to imprisonment for life. Amendment: In section 416 of the principal Act, the words "order the execution of the sentence to be postponed, and may, if it thinks fit" shall be omitied. That read as - “If a woman sentenced to death is found to be pregnant, the High Court shall commute the sentence to imprisonment for life”. Answer. a69. Segmentation of blood vessel after death is called as, a. Kevorkian sign b. Rokitansky sign cc. Taches noire d. Kennedy phenomenon Solution. A - Kevorkian sign Ref.: Reddy, The Essentials of FMT, 34th Ed. Page No. 145 Explanation: Fragmentation or segmentation of the blood columns in the retinal vessels appear within minutes after death and persists for about an hour after death; known as rail road. phenomenon or trucking or shunting or Kevorkian sign. Answer. a 70. Shoe polish smell is seen in? a. Mercaptans b, Lacquer c. Paraldehyde d. Nitrobenzene Solution. D. Nitrobenzene Ref.:RabindraNathKarmakar: FMT: Theory, oral & practical, page 71 Explanation: Nitrobenzene is yellow-brown liquid which smells like shoe polish. Answer. d 71. In assessing infant deaths, Plocquet's test involves- a. Change in specific gravity of lungs b, Presence of air in stomach and duodenum . Change in weight of lungs 4. Air in middle ear Solution. C - Change in weight of lungs Ref.:Reddy: The Essentials of FMT, 34th Ed. Page No. 411 Explanation:Plocquet’s Test: The ratio between the weight of the lung and body is 1:70 before respiration and 1:35 after respiration. Answer. c72. A middle aged lady was found in a robbed room lying in a pool of blood. On forensic examination, there was an entry wound of size around 1x1 cm on the left temporal region with tattooing and blackening around the wound. There was also an exit wound with bevelling at the right temporal region. On further examination, two bullet fragments were found inside the brain parenchyma. Which of the following could be used to determine the distance from which the weapon was fired? a. Hair b, Clothes . Bullet fragments d. Blood Solution. A- Hair Ref.: Reddy: The Essentials of FMT, 34th Ed. Page No. 210-213 Explanation: ‘Bullet fragments’ found inside the brain tell us that a rifled firearm wes used rather than a shotgun, Generally, clothes and skin around the wound is preserved to determine the range. Tattooing and blackening indicates that it is a near shot. But if singeing of hair is present, then we can say that it is a close shot. Answer. a 73. Copper sulphate poisoning manifests with a. Acute haemolysis b, High anion gap acidosis c. Peripheral neuropathy 4, Rhabdomyolysis Solution. A. Acute haemolysis Explanation: Acute poisoning by copper sulphate manifests by acute haemolysis. Answer. a74. Which of the following statements about the image shown are true a. bilateral in 80% b. low risk of malignancy ¢. all 3 germ layers . torsion 20% Solution. A The risk of bilaterality in dermoid is up to 10% cases and not in 80% Itis a benign ovarian tumour with 0.2-2% risk of malignancy Itis the most common ovarian tumour in reproductive age woman The incidence of ovarian torsion in a case of dermoid is 15-20% Answer. a 75. A G6POLO Lady with h/o recurrent early abortions comes to you with a missed abortion at 12 weeks . Which of the following test is not warrented a, Lupus anticoagulant b. TSH ©. VDRL 4d. Fetal karyotype Solution. C Ref.: Williams obstetrics 24/e p358 Syphilis does not cause recurrent early abortions as in syphilis the gestational age of pregnancy losses keops increasing with every pregnancy. The most common cause among known causes of RPL is APLA and hence testing for the APLA antibodies is done in these patients, these are lupus anticoagulant and anticerdiolipin antibodies. Chromosomal anomalies are responsible for 4% cases of RPL and it is an estblished cause of RPL so karyotype is important. The other causes of RPL are uterine structural anomalies and endocrinopathies. Answer. ¢76. Following fetaltocographic finding was seen in a 30- year old female patient in labor. what does it suggest? = - : 3 a. Early cord compression b. Fetal distross c. Head compression 4. FetalAnemia Solution. A Ref: Williams obstetrics 24/e p 340 These are variable decelerations seen due to cord compression Also the baseline shows normal beat to beat variability. Hence this is normal NST tracing Answer. a 77. which of the following is true with respect to prediction of risk of iugr a. increase PAPPA b. increaseSflt 1 . multiparity d. low AFP Solution. B Elevated level of AFP, small placental size, low estriol, low PAPPA and low HCG and small placental size are predictors of IUGR. Answer. b78. A 35-year-old female presents with an adnexal mass. CA-125 is slightly raised, CA-19-9 is normal and LDH is elevated. Tumor was resected and the gross and microscopic image were as given below. What is the likely diagnosis? a. Papillary serous cystadenocarcinoma b, Teratoma c. Dysgerminaoma . Choriocarcinoma Solution. Dysgerminoma Ref: Shaw 15/e pg 378, Robbins 8/e pg 1049 The characteristic cut surface of dysgerminoma is solid lobulated and pale or tan. Also the given tumour markers which is raised LDH and slighty raised CA125 tell us that this is dysgerminoma. Answer. c 79. Ureteric injury is most commonly associated with which of the following a. Anterior colporraphy b. Vaginal hysterectomy ©. Werthoim hysterectomy 4. Abdominal hysterectomy Solution. (c) Wertheim hysterectomy Ref. Textbook of obstetrics. SudhaSalhan Page 17 Ureteric injuries are more common with suregries done for malignancies as compared to surgeries done for benign conditions hence the answer is wertheims hysterectomy. Among surgeries done for benign conditions the risk is more with laparoscopic surgeries followed by abdominal route followed by vaginal Answer. c80. When is termination of pregnancy done in a diabetic mother who is on insulin a. 36 weeks b. 37 weeks c. 38 weeks . 40 weeks Solution. D Delivery in a diabetic female who is on treatment is done >39 weeks. Early term delivery ie 37 to 38+6 weeks is done in cases of DM associated with pre eclampsia or vasculopathy or fetal distress Answer. d 81. Identify the anomaly based on the image below- a. Twin-twin transfusion syndrome b, Monochorionic diamniotic pregnancy ©. Monochorionicmonoamniotic pregnancy 4. Dichorionic diamniotic pregnancy Solution. C There is no ridge between the two cords and this is a feature of monoamniotic twins This is monochorionicmonoamniotic twins ‘The most common complication of monoamniotic twins is cord entanglement. The monoamniotic twin is formed if division happens between 8-12 days after fertilization. Answer. c82. A 28-years-old female nearing her date has been admitted following regular contractions. The resident doctor did an examination and told the intern that the head is at + 1 station. What is the exact position of head? a. High up in the false pelvis b. Just above ischial spine . Just below ischial spine d. At the perineum Solution. (c ) Just below ischial spine Ref. Clinical practice guidelines obstetrics, Page. 213 Station of head is always described with respect to ischial spines and the level of ischial spine is taken as zero station. Station described as plus means below the spines and station above is described as minus, while the number represents centimeters from ischial spine. Answer. c 3. What is the drug of choice for precocious puberty in girls? a. GnRH analogues b, Danazol c. Cyproterone acetate d. Medroxy progesterone acetate Solution. a. GnRH analogues Ref: Shaw 15/e pg 56 The treatment of precocious puberty is GnRH agonist to be given in a continuous patter. Precocious puberty is more common in girls and the age criteria is development of secondary sexual characters before 8 years of age. Answer. a84, regarding second generation endometrial ablation device which is true a. risk of endometrial cancer increases b. risk of pregnancy is minimum c. second generation endometrial ablation is done under GA 4. ball rolling is second generation device Solution. B roller ball, transcervical resection and laser ablation are first generation endometrial ablation methods and these methods are done under direct hysteroscopic visualization. The second generation endometrial ablation are non hysteroscopic techniques which are safer, technically easier to perform, involve shorter hospital stays and performed under local anaesthesia and have become more common. These methods treat the whole endometrial cavity. The common second generation devices include high temperature fluids with a balloon or application of microwave or bipolar radiofrequency. The others are hydrothermablator cryoablation. The risk of endometrial cancer is not increased but there may a little delay in the diagnosis Chances of pregnancy are reduced after endometrial ablation and there will be complications like miscarriage, iugr, preterm delivery and adherent placenta in these pregnancies and hence use of contraception Answer. b 85. Modified BPP consists of : a. NST with AFI b, NST with fetal breathing c. NST with fetal movement . NST with fetal tone Solution. a. NST with AFI Ref: Williams obstetrics 24/e p 342-434 Modified BPP has only two components which are NST and AFI out of these two NST tells about acute injury to fotus while AFI tells about chronic uteroplacental insuificiency The complete BPP also called as manning score has 5 components out of which four are seen on ultrasound while ‘one component is NST. The four ultrasound parameters are fetal breathing movement, gross body movements fetal tone and amniotic Quid Answer. a86. true about HPV vaccine a. protect only from cancer cervix b. live vaccine c. cannot be taken with other vaccine 4d. protect from cervical, vaginal, anal, penile and vulvar cancer Solution. D The HPV vaccine is nota live vaccine, none of these vaccines do not contain the live virus and therefore do not cause infection and hence any other vaccine can be given with it. It will protect from cancers associated with HPV virus which include cervical, vulvar, vaginal, oral anal and penile cancers Answer. d 87. regarding pudendal nerve block correct statements are 1) 20 gauge needle 2) pierce1 cm medial and inferior to sacrospinous ligament 3) bilateral block 4) decreases pain in the first stage of labor a.1& 2only b. 12,3 only ©. 1,24 only @.1,2,3 and 4 Solution. B PUDENDAINERVE block is used to alleviate pain from minor surgical procedures involving the perineum and from events related to delivery like operative vaginal delivery amaintroital distension during second stage of labour. Pudendal nerve does not decrease pain from uterine contractions in first stage of labour . 18-20 gauge needle is used , 1% lidocaine without epinephrine is used , the woman is put in lithotomy position and the needle is directed 1 cm medial and inferior to ischial spine . the block is usually performed bilaterally In the transperineal approach the needle is directed 2.5 cm posteromedial to ischial tuberosity The average duration of block is 30-60 mins Answer. b88. Long acting reversible contraceptive are all except a. Lng IUD b. Implanon ce. Cut d. Lap tubal sterilisation Solution. D Tubal sterilization is considered as a permanent method of contraception The LNG iud is approved for 10 years The cut is approved for 10 years Implanon is effective for 3 years Answer. d 89. risk factors for macrosomia 1) Diabetes 2) Post term 3) Smoking 4) Multiparity a.1& 2only b. 12,3 only ©. 1,24 only @.1,2,3 and 4 Solution. C RISK FACTORS FOR MACROSOMIA ARE 1) Maternal obesity 2) Multiparity 3) Advanced maternal age 4) Maternal diabetes 5) Postterm pregnancy 6) Male infant 7) Previous macrosomia 8) Excessive gestational weight gain 9) Maternal birth weight over 4 kg Answer. c90. Assertion A woman with fetal heart rate decelerations is put in left lateral position Reason lef. lateral position causes improved circulation through the uteroplacental unit a. both A and Rare true and Ris the correct explanation of A b, both A and Rare true but R is not the correct explanation of A . Ais true but Ris false 4. A is false but R is true e. both A and Ris false Solution. A The supine position causes uterine compression on the vena cava, which decreases the venous return of blood to the heart, leading to supine hypotension. One important maneuver when encountering fetal heart rate abnormalities is a positional change, such as the lateral decubitus positionWhich relieves the compression of IVC improves venous return and cardiac output and improves uteroplacental circulation. Answer. a 7: Maich the single best treatment with the clinical scenario . 91. A 19-year-old G1P0 woman at 18 weeks’ gestation, who had a prior cervical conization procedure, stales that she has felt no abdominal cramping. She has a cervical lation of 2em and effacement of a, Laparoscopy b. Follow-up hCG level in 48 hours . Cervical cerclage d. Dilation and curettage of uterus e. Expectant management Answer. c92. A 33-year-old woman at 10 weeks’ gestation complains of vaginal bleeding and passage of a whitish substance along with something “meatlike.” She continues to have cramping, and her cervix is 2 cm dilated a. Laparoscopy b, Follow-up hCG level in 48 hours c. Cervical cerclage 4. Dilation and curettage of uterus e. Expectant management Solution. D. An open cervical os, a history of passing tissue, and continued cramping are all findings consistent with an incomplete abortion. If the cramping had stopped and the cervix closed, this would have been a complete abortion. The treatment of an incomplete abortion is dilation and curettage (D&C) of the uterus to prevent complications of retained tissue such as hemorrhage and infection. The products of conception obtained from the curettage are sent for pathology to confirm the diagnosis and to look for rare complications such as molar pregnancy Answer. d93. Match the types of haemorrhage with the correct etiology a. PPH in a woman with abruption p. uterine atony b. Late post partum haemorrhage q. retained placental lobe ¢, Haemorrhage with well contracted genital tract laceration uterus d. Bleeding after CS for CPD s. coagulopathy e. Primary PPH with placenta uterine subinvolution succenturiata Solution. abruption is the most ‘common cause of DIC and there is increased risk of PPH Late PPH canhappen because of subinvolution of the placental site, the other causes of secondary PPH are infection and retained products of conception, inherited or acquired bleeding diathesis, AVmalformations, choriocarcinoma, uterine diverticulum Common cause of PPH in the presence of well contracted uterus are genital tract trauma, lacerations and uterine rupture . CPD often results in prolonged labour which is risk factor for uterine atony Uterine atony is the most common cause of PPH With placenta succenturiata, many times the smaller accessory lobe can be left behind in the uterus and will result in intermittent uterine atonicity and PPH Answer. a-sb-te-r.d-p.e-a94. Match the following types of physeal injuries according to the Salter Harris Classification : a. Type V p. Crushing Injury to Physis b. Type IV : Slippage of Growth Plate ¢. Type III . Thurston Holland Sign d. Type! s. Injury of Necessity e. Type Il t. Physeal fracture extending into epiphysis, Solution. Normal Type | «Type Il «Typelli-Type IV «Type V. Aaaaa S——A——L—TE. Ee Seaght Above Lower Trroush Rush Eventing ‘Types of Salter-Harts Fractures Answer. apbs,ctd-qer95. Which of the following is true about fracture shown in children? a. Anterior displacement of the distal fragment is more common than posteriorb, Cubitus valgus is more common than cubitus varus during mal-union c. The neurological complications are transitory d. Weakness of elbow flexion is a common complication Solution. (c) The neurological complications are transitory Ref: Apley’s ‘Textbook of Orthopaedics and Fractures’; 9/e, Chap 24 Sol: SUPRACONDYLAR FRACTURES + These are among the commonest fractures in children. + The distal fragment may be displaced either posteriorly or anteriorly. MECHANISM OF INJURY: + Posterior angulation or displacement (95 per cent of all cases) suggests a hyperextension injury, usually due to a fall on the outstretched hand. + The humerus breaks just above the condyles. + The distal fragment is pushed backwards and (because the forearm is usually in pronation) twisted inwards. + The jagged end of the proximal fragment pokes into the soft tissues anteriorly sometimes injuring the brachial artery or median nerve. + Anterior displacement is rare (option ‘1’); it is thought to be due to direct violence (e.g. a all on the point of the elbow) with the joint in flexion. CLINICAL FEATURES: + Following a fall, the child is in pain and the elbow is swollen; with a posteriorly displaced fracture the S-deformity of the elbow is usually obvious and the bony landmarks are abnormal. + It is essential to feel the pulse and check the capillary return; passive extension + of the flexor muscles should be pain-free. + The wrist and the hand should be examined for evidence of nerve injury. + The fracture is seen most clearly in the lateral view. + In an undisplaced fracture the ‘fat pad sign’ should raise suspicions: there is a triangular lucency in front of the distal humerus, due to the fat pad being pushed forwards by a haematoma. + The radial nerve, median nerve (particularly the anterior interosseous branch) or the ulnar nerve may be injured. + Fortunately loss of function is usually temporary and recovery can be expected in 3 to 4 months (option ‘3’). + If there is no recovery the nerve should be explored. + However, if a nerve, documented as intact prior to manipulation, is then found to have failed after manipulation, then entrapment in the fracture is suspected and immediate exploration should be arranged. COMPLICATIONS: + Malunion is common. + However, backward or sideways shifts are gradually smoothed out by modelling during growth and they seldom give rise to visible deformity of the elbow. + Forward or backward tilt may limit flexion or extension, but consequent disability is slight. + Weakness of elbow extension is commonly observed (option ‘’). + Uncorrected sideways tilt (angulation) and rotation are much more important and may lead to varus (or rarely valgus) deformity of the elbow (option ‘2'); this is permanent and will not improve with growth (gun-stock deformity). + The fracture is extra-physeal and so physeal damage should not be blamed for the deformity; usually it is faulty reduction which is responsible. * Cubitus varus is disfiguring and cubitus valgus may cause late ulnar palsy. + If deformity is marked, it will need correction by supracondylar osteotomy usually once the child approaches skeletal maturity. Answer. c96. Identify the fracture below : a. Barton's fracture b. Chaueffer’s fracture . Smith's fracture . Colles’ fracture Solution. B Intra articular fracture of distal end radius with radial styloid fragment with intact radiocarpal joint anatomy :Chaueffer’s / Hutchinson / Backfire Fracture Answer. b 97. This 9 year old girl child came to the ER with shortness of breath, was given a medication and improved. Hl H What is your diagnosis? a. PSVT b. AF c. Sinus tachycardia . Normal Solution. (a) PSVT Ref: Read the text below : Paroxysmal supraventricular tachycardia (PSVI) is another type of “short-circuit” arrhythmia. It may result either from atrio-ventricular nodal re-entrant tachycardia (AVNRT) or from an. accessory pathway, which may occur as part of the Wolff-Parkinson-White (WPW) syndrome. Answer. a98. Identify the pedigree drawn below > — a. Autosomal Recessive b, Autosomal Dominant c.X linked recessive d. X linked dominant Solution. (a) Autosomal Recessive Ref: Read the text below99. A 5 years old child presented with continuous fever and features of sepsis with a BP of 90/60 mmHg, Pulserate 144/min and respiratory rate of 30min. What is the initial fluid of choice for management : a. 10 mL/Kg of hydroxyethylstarch b. 10mL Kg of 10 % dextrose c. 20 ml/Kg of0.9%Normalsaline d. 20 mL/ kg of0.45%normalsaline Solution. C20 ml/Kg 0f0.9%Normalsaline Ref :Nelson 20th Ed/517,524 Explanation: The child has features of sepsis with early shock. In case of shock, aggressive fluid management in the form of normal saline bolus is recommended as per AHA/PALS guidelines. The bolus is 20 ml/kg, to be repeated 3-4 hrly if shock doesn’t improve. As perNelson 20th Ed, “Rapid IV administration of 20 mL/kg isotonic fluid should be initiated in an attempt to reverse the shock state”. As per AAP guidelines, rapid isotonic bolus should be given within 5 minutes of presentation of a child in shock 1 T 1 ‘ago he 2g 0M wm. Yon yo Mee Answer. c100. 101. Identify the fracture below : a. Coxsakie virus b. Avianinfluenzae c. Parainfluenzae d. Respiratory syncytial virus Solution. B Intra articular fracture of distal end radius with radial styloid fragment with intact radiocarpal joint anatomy :Chaueffer’s / Hutchinson / Backfire Fracture Answer. d APGAR stands for a. Appearance, Pressure, Grimace, Activity respiration b, Appearance, Pulse, grimace, Activity, Respiration . Appearance, Pressure, Grimace, activity, Respiration d. Awareness, Pulse, Grimace, Activity, Respiration Answer. b102. Correct order of suctioning during neonatal resuscitation is? a. Mouth-Nose b, Nose-Mouth c. Mouth-Nose-Trachea d. Trachea-Nose-Mouth Solution. A Firstly the mouth should be suctioned as it is a hig cavity. Later the nose is suctioned and then baby starts breathing. Indications of bag and mask ventilation with 100% 02 are + Apnoes/ gasping + HR<100 / min after 30 sec of PPV * Central cyanosis Answer. a 103. THEME : Patterns of dysmorphology and congenital malformations For Each of the following case scenarios select the most likely diagnosis from the list above. each option may be used once, more than once , or not at all. Term baby, birth weight 3.2 kg, facial dysmorphism with cleft lip and palate, heart murmur aA b.B Cc aD eE LF g.G hH Answer. c 8: A. VACTERL association B. CHARGE association C. Trisomy 13 D. Trisomy 18 E. 22q deletion F. Noonam syndrome G. Fetal alcohol syndrome H. Goldenhar syndrome104. THEME : Patterns of dysmorphology and congenital malformations For Each of the following case scenarios select the most likely diagnosis from the list above. each option may be used once, more than once , or not at all. Term baby, birth weight 3.2 kg, facial dysmorphism with cleft lip and palate, heart murmur aA b.B eC aD eE LF g.G he Answer. h 105. THEME : Patterns of dysmorphology and congenital malformations For Each of the following case scenarios select the most likely diagnosis from the list above. each option may be used once, more than once , or not at all. Baby born at 30 weeks, birth weight 700 g, microcephaly, complex congenital heart disease, congential diaphragmatic hernia, facial dysmorphism, abnormal fingers. aA b.B eC aD eE LF g.G hH Answer. d106. Match the following lesion with the site of origin in breast tissue a. Phyllodestumour p. TDLU ee wae c. Small duct papilloma . Intra lobular stroma d. Squamous Metaplasia_ s. Inter lobular stroma u. Ribs Solution. == | “ee eae |S ere eee a Answer. a-rbtjc-p.d-qe-s 107. A- Porcelain gall bladder is seen in chronic cholecystitis R - Calcification in the wall of gall-bladder makes it thick a. Both A and Rare true and R is the correct explanation of A. b, Both A and Rare true but Ris not the correct explanation of A. . A is true but R is false. d. Ais false but R is true. e. Both A and Rare false Solution. A. Extensive dystrophic calcification within the gallbladder wall may yield a porcelain gallbladder, notable for @ markedly increased incidence of associated cancer Answer. a108. A7-year-old girl is brought in by her parents for poor weight gain and recurrent diarrhea. They have tried eliminating dairy from her diet with no improvement in symptoms. She reports 3-5 loose stools per day for the last 6 months. The condition improves when she fasts and is usually worse when she eats fast food like pizza. On examination, you notice several excoriated areas on the girls arms which she states are very itchy. Duodenal biopsy shows the following. What is your diagnosis? a. Crohn's disease b, Abetalipoproteinemia c. Celiac disease d. Whipple’s disease Solution. C History of malabsorption especially worse after wheat/barley/rye products indicates celiac disease. Skin manifestation is dermatitis herpetiformis. Biopsy shows villous blunting and increased intra epithelial lymphocytes. Answer. c 9: TRUE or FALSE 109. Mast cells secrete histamine a. True b. False Answer. a 110. The primary source of serotonin is Lungs a. True b. False Answer. b111. The complement proteins C3a and C5a help in the process of adhesion a. True b. False Answer. b 112, Platelet activating factor primarily causes vasoconstriction a. True b. False Answer. b 113. Leukotriene B4 is a chemo attractant. a. True b. False Answer. a 11: EMQ ‘A. Membranous nephropathy B. Alport’s disease C. Benign nephrosclerosis D. Minimalchangedisease E. Goodpasture’s syndrome F. Focal segmental glomerulosclerosis G. Acutetubularnecrosis H. Amyloidosis Match the description of the patient with the most likely diagnosis 114. The likely diagnosis in a 5-year-old boy who develops facial swelling. Urinalysis reveals heavy proteinuria, but no blood. A kidney biopsy shows no abnormality on light microscopy.eE £F 9G hu Solution. D. Minimal change disease. Most common cause of nephrotic syndrome in children. Changes only seen on renal biopsy if examined by electron microscopy. Answer. d 115. The likely diagnosis in a 25-year-old man who is being investigated for renal failure. He is complaining that he is having to change the prescription for his glasses every few weeks to see clearly and that he is struggling to hear some sounds. aA bB ©.C aD eE £F g.G hu Solution. B. Alport's syndrome. A hereditary glomerulonephritis that commonly causes renal failure in the second decade of life in males affected by the X-linked form. Ocular disease and deafness to high-pitched sounds are associated features. Answer. b116. Which of these complement factor is a marker of Humoral rejection : a.C3d b.C5a ©. C3b d.C4d Solution. (d) C4d Ref: Robbins andCotran, 9th edition Acute antibody-mediated rejection is manifested mainly by damage to glomeruli and small blood vessels. Typically, the lesions consist of inflammation of glomeruli and peritubular capillaries, associated with deposition of the complement breakdown product C4d, which is produced during activation of the complement system by the antibody dependent classical pathway Answer. d 117. In this Hematoxylin and Eosin stained slide of inflammation, identify the cell marked with an arrow : a. Macrophage b, Plasma cell . Lymphocyte 4. Eosinophil Solution. b. Plasma cell Ref: Robbins and Cotran: pathological basis of disease 9th edition Deep staining cytoplasm with eccentric nucleus and clock like chromatin is seen in plasma cells Answer. b118. The resected specimen of a kidney is shown below . What is the diagnosis : .) DS a. Amyloidosis b, Acute post streptococcal glomerulonephritis . Flea bitten kidney of malignant hypertension 4. Chronic glomerulonephritis Solution. C Flea bitten kidney of malignant hypertension Ref: Robbins andCotran: Pathological basis of disease 9/e Answer. c 119. Fine needle aspiration cytology is not enough to diagnose. a. Papillary carcinoma of thyroid b. Carcinoma breast c. Adenocarcinoma lung 4. Follicular carcinoma of thyroid Solution. d. Follicular carcinoma of thyroid FNAC cannot demonstrate vascular or capsular invasion needed to diagnose follicular carcinoma of thyroid Ref: Robbins S/epg 1123 Answer. d120. All of the following are seen in the development of T lymphocyte at a point except a. Tdt b. CD34 cc. PAXS: d.Cdla Solution. (c ) PAXS: Robbins basic pathology 10th edition PAXS is a B cell transcription factor and is found in B cells, not T cells. Answer. c 121. Which of the following neoplasms shows ALK positivity? a. Ewing sarcoma b, Inflammatory myofibroblastictumor . Synovial sarcoma 4. Fibromatosis Solution. (b) Inflammatory myofibroblastictumor Robbin Basic Pathology, Oncogene table ALK gene mutations are seen in neuroblastoma and rearrangements in ALCL, lung adenocarcinoma and inflammatory myofibroblastic tumor. Answer. b 122, A 5-years-old child was presented with proptosis. Microscopic examination of the mass revealed a round cell tumor positive for Desmin immunohistochemical marker. Most likely diagnosis is? a. Leukemia b, Embryonal rhabdomyosarcoma c. Lymphoma 4. Primitive NeuroectodermalTumor (PNET) Solution. B + Desmin positive on IHC suggests that the tumour is muscle in originiemyosarcoma. Hence option B is correct answer. + Leukemia is positive for many IHC markers + Lymphoma is positive for LCA/CD30 + PNET is positive for CD99 Answer. b123. Which of the following is not a provisional entity as per WHO 2016 classification of Acute leukemia? a. AML with hyperploidy b, B-ALL with BCR-ABL like mutation cc. AML with BCR-ABL d. Early T-cell precursor leukemia/Lymphoma Solution. A WHO 2016 classification of acute leukemia includes + B-ALL with BCR-ABL like mutation + AML with BCR-ABL + Early T_cell precursor leukemia + NK cell lymphoblastic leukemia + B-ALL with iAMP 21 + AML with mutated RUNX1 Answer. a 124. A60-years-old male with complaints for frothy urine and facial puffiness. The DIF and electron microscopic picture of the patient is given below. Diagnosis is: a. Membranoproliferative nephritis b, Membranous glomerulopathy c. Minimal change disease d. FSGS Solution. (b) Membranous glomerulopathy Ref. Robbins and Cotran Pathological Basis of Disease, 9th edition Granular IF is seen in the immunofluorescence picture and the electron microscopy shows subepithelial deposits along with spike formation (new basement membrane material). Answer. b125, All of the following are true concerning hemophilia except: a. Antihemophilic globulin is present in normal amounts in some patients b, Bleeding time is normal c. Clot retraction does not occur 4. Coagulation time is prolonged Solution. (c) Clot retraction does not occur Ref:Read the text below s » Hemophilia is inherited as a recessive sex-linked characteristic and occurs almost always in males. + Most patients have very low levels of coagulation factor VIII (antihemophilic globulin, AHG). In about 10 percent of cases, even though the amount of AHG is normal, a functionally defective form is found. + In hemophilia, the coagulation time is prolonged, and the bleeding time is normal. * Clot retraction is prompt, once coagulation occurs. Answer. c 126, After performing satisfactorily for a month, « transplanted kidney began to show signs of rejection. A biopsy showed an interstitial infiltrate of T-lymphocytes and macrophages. There was only slight vasculitis. The type of hypersensitivity reaction in this acute rejection is a. Type I (immediate) b, Type Il (antibody dependent) c. Type III (immune complex) d. Type IV (cell-mediated) Solution. (d) Type IV (cell-mediated) Ref:Read the text below : Development of a cell-mediated hypersensitivity reaction is mainly responsible for acute rejection , although circulating antibodies to tissue antigens may play a role by causing a vasculitis. Answer. d127. 128. All of the following are characteristic of DiGeorge’s syndrome except: ‘a. Hypoparathyroidism b. Hypoplasia of T-dependent areas in lymph nodes, c. Inheritance as autosomal recessive . Recurrent viral and fungal infections Solution. (c) Inheritance as autosomal recessive Ref:Read the text below Si + Thymic aplasia(DiGeorge’s syndrome) is due to failure of formation of the 3rd and 4th pharyngeal pouches. It is characterized by absence of the thymus and parathyroid glands. + Lymph nodes show depletion in the T-dependent subcortical regions. The affected child has a deficient cell-mediated immune response. Immune globulins are normal or somewhat decreased. + Viral and fungal infections are common, as tetany from the parathyroid deficiency. Death usually glands. + Distant metastasis is usually in carcinoma of the esophagus. Answer. c The phenomenon which most definitely indicates that a neoplasm is malignant is a. Autonomous cell proliferation b, Central necrosis c. Lack of encapsulation d. Metastasis Solution. (d) Metastasis Ref:Read the text below Sol: + Malignancy often involves appearance of discrete tumor nodules in parts of the body separated from the primary site. + This phenomenon (metastasis) is due to the detachment of tumor cells from the site of origin and their transport in the lymph or blood streams to other tissues, especially lymph nodes, liver, and lungs. + While this phenomenon is proof of malignancy, the absence of metastasis does not establish benign behavior. Answer. d129, A 76-year-old woman suffers a massive myocardial infarct and dies in cardiogenic shock 20 hours after its onset. Microscopic examination of her infarcted myocardium would be expected to demonstrate which of the following? a. Abundant neutrophils and monocytes b, Coagulative necrosis with few neutrophils c. Fibrosis and collagen deposition 4d. Monocytes and neovascularization Solution. (b)Coagulative necrosis with few neutrophils Ref:Read the text below Sol: + A 20-hour-old ischemic infarct of the myocardium should demonstrate coagulative necrosis without much of an inflammatory response. + Abundent neutrophils and monocytes typically are seen about 2-4 days after an infarction. Fibrosis and collagen deposition (are late healing phenomena that do not begin until at least 1 week after the infarct has occurred. + Monocytic infiltration and neovascularization usually occur about 3-6 days after an infarction. Plasma cells and caseous necrosis are not seen with ischemic myocardial damage. + Plasma cells are typically seen in areas of chronic inflammation and caseous necrosis is found in granulomas produced in response to tuberculosis and certain fungal infections. Answer. b 130. A adult woman complains of the acute onset of anuria, purpura, and mental confusion.Her peripheral blood film displays marked thrombocytopenia and abundant schistocytes. Laboratory studies reveal elevations of bilirubin,creatinine, and lactose dehydrogenase. A skin biopsy shows numerous intravascular thrombi within the dermal microvasculature. What is the most likely diagnosis? a. Thrombotic thrombocytopenic purpura b. Acute idiopathic thrombocytopenia c. Bernard-Soulier syndrome d. Glanzmann thrombasthenia Solution. (a)Thrombotic thrombocytopenic purpura Ref:Read the text below Sol: + Thrombotic thrombocytopenic purpura is an acute microangiopathic hemolytic anemia. The clinical picture usually includes mental alterations, anuria, mucosal bleeding, and purpura. + An abnormal platelet-aggregating substance is the likely initiating event. Acute idiopathic thrombocytopenia does not have a hemolytic component, lacks renal failure, and does not display thrombi in the skin biopsy. + Bernard-Soulier syndrome and Glanzmann thrombasthenia are hereditary disorders of platelet aggregation.Clinical symptoms of a coagulopathy usually occur in infancy. Answer. a131. A pregnant female is on anti-epileptic drug. She had no episode of seizure after starting drug therapy. EEG and Brain CT are normal. What should be the further management of this patient a. Gradually taper off the treatment b, Continue the treatment for minimum of 2 years c. Continue treatment life long 4. Stop treatment due to teratogenic risk with regular EEG monitoring Solution. B Anti epileptic drugs should not be stopped during pregnancy due to the risk of rebound seizures. Any ant epileptic which has been started should be continued upto 2 years of seizure free interval before tapering and stopping the drug. Answer. b 132. Lithium during pregnancy increases the risk of following: a. Facial defects b. Cardiac defects c. Neural tube defects d. Urogenital defects Solution. B Lithium used during pregnancy causes Ebstein anomaly in the fetus. This condition involves tricuspid valves. Answer. b 133. Role of nitrate in acute angina ? a. Decrease preload b, Decrease afterload c. Coronary vasodilation . Vasospasm Solution. A Nitrates increase NO causing venodialation. Thus it reduces preload to the heart. When preload reduces, the duration of systole reduces and duration of diastole increses. During diastole, the coronaries suppl blood to the heart and thus ther is increase in total coronary blood flow to heart Answer. a134, A paediatrician attended an infant with serum bilirubin values of 33mg/dl. Which drug mother might have taken during her 3rd trimester a, Choloroquine b. Cotrimoxazole ¢. Azithromycin d. Amoxicillin Solution. B Cotrimoxazole belongs to class sulphonamides. Sulphonamides are known to displace bilirubin from their binding sites in albumin. Thus bilirubin levels in blood increase leading to kernicterus. Answer. b 135. Acetylcholinedecreses heart rate by a. Makes the RMP more negative b, Delays diastolic repolarization c. Prolonging plateau phase d. Decrease rate of conduction Solution. A Acetyl choline is relesased by vagus and it acts on M2 receptor on heart. M2 receptors are Gi receptors present on SA node and Av node. They cause opening of K+ channels and K+ moves out of the cell causing hyperpolarization. Hyperpolarisation leads to decrease in impulse generation and decreased conduction in AV node. Answer. a 136. Loading dose of a drug depends upon- a. Volume of distribution b. Clearance c. Half life 4. Bioavailability Solution. A Loading dose = volume of distribution x target plasma concentration Answer. a137. Which of the following gives the rate of drug absorption in plasma concentration graph? a. Tmax and Cmax b. Tmax alone c. Area under the curve d. Cmax alone Solution. B Time of maximum ‘deug concentration fe Maximum (peak) ‘drug concentration 3 Plasna dug concentration — ‘© Tiuax gives me taken for adrugto reich its max cone absorption of the drug, ‘Cmax denotes max concentration of drug in plasma + Area under the curve gives extent of drug sbsorption( bioavailability) Answer. b 138. Lente insulin is a, 30% amorphous 70% crystalline b. 70% amorphous 30% crystalline c. Other name of NPH insulin 4. Only 70% amorphous Solution. (a) 30% amorphous 70% crystalline Ref. KD.Tripathi, Essentials of medical Pharmacology. Pg.264 Answer. a