AIIMS PG May 2018

Ans. b. Cartilage

• Ref: Ross & Pawlina, 7h ed., Histologt A Text and Atlas, pg. 160-167 and Junqueira’s Basic Histologt, 13’h ed-, pg. 106-108

Ans. b. Synaptic vesicles

Ref: Z. Taoufiq, OIST 2013

• An ultramicroscopic image shows an isolated synapse from a brain sample before mass spectrometry analyses.
• The pre-synapse typically shows many vesicles containing neurotransmitters kept attached to the post-synapse.

Ans. d. Superficial posterior

Ref: Grays Anilomy, 4l” ed, pg, 1406-1412 and Last anatomy I2’h ed-, pg. 142

Contents of flexor (posterior) compartment:

Superficial part:

• Gastrocnemius, plantaris and soleus muscles

Deep part:

1. Popliteus, Flexor digitorum longus, flexor hallucis longus and Tibialis pos-terior muscle
2. Posterior tibial and peroneal vessels
3. Tibial nerve

Ans. b. L1 
Ref: Grays Anatomy, 4l” ed., pg. 762-763

• In the adult, the spinal cord terminates on average at the level of the middle third of the body of the first lumbar vertebra which corresponds approximately to the transpyloric plane.
• Spinal cord extends from C I to L I (lower border) in adults.
• Filum terminale extends from lower end of spinal cord to the tip of coccyx.
• Dural sheath extends up to 52 vertebrae.
• Subdural space extends up to 52.
• Subarachnoid space extends up to 52.
• Piamater extends up to tip of coccyx.

Ans. A. Thyrocervical trunk
Ref: Grays Anatomy,4Ia ed., pg. 455458

• Inferior thyroid artery is branch of thyrocervical trunk of subclavian artery.
• The thyrocervical trunk arises fiom the front of the first part of the subclavian artery near the medial border of scalenus anterior, and divides into the inferior thyroid, suprascapular and superficial cervical arteries.

Ans. D. Proprioception
[Ref: Barr’s the haman nervons system, I0’h ed., pg. 127 & Snell’s neurounatomy 7’t’ed., pg. 342-343]

• The trigeminal nerve is the largest cranial nerve and contains both sensory and motor fibres.
• Sensory nerve to greater part of the head.
• Motor nerve to several muscles, including the muscles of mastication.
• The trigeminal nerve has four nuclei:
• (1) the main sensory nucleus, (2) the spinal nucleus, (3) the mesencephalic nucleus, and (4) the motor nucleus.
• Proprioceptive impulses from the muscles of mastication and from the facial and extraocular muscles are carried by fibres in the sensory root of the trigeminal nerve that have bypassed the semilunar or trigeminal ganglion.
• The fibres cells of origin are the unipolar cells of the mesencephalic nucleus.

Ans. A. Dentate nucleus
[Ref: Barr’s human nervous system 10^th ed., pg. 164 and Snell’s neuroanatomy, 7 e4, W.235]

• The cerebellum is composed of an outer covering of gray matter called the cortex and inner white matter.
• There is a large amount of white matter in each cerebellar hernisphere.
• The efferent fibres constitute the output of the cerebellum and commence as the axons of the Purkinje cells of the cerebellar cortex.
• The great majorify of the Purkinje cell axons pass to and synapse with the neurons of the cerebellar nuclei (f’astigial, globose, embolifbrm, and dentate).

Ans. C. Meningeal branch of anterior and posterior ethmoidal artery
[Ref Grays Anatomy, 41″ ed., pg. 439 und Snell’s neuroanatomy, Vt’ed., pg. 175-477]
Anterior cranial fossa:

• Anterior rneningeal branches of the anterior and posterior ethmoidal and internal carotid arleries and a branch of the nriddle meningeal artery.

Middle cranial fossa:

• Middle and accessory meningeal branches of the maxillary artery, a branch of the ascending pharyngeal artery (entering via the tbrarnen lacerum), branches of the internal carotid and a recurrent branch of the lacrimal artery.

Posterior fossa:

• Meningeal branches of the occipital artery, posterior meningeal branches of vertebral artery, occasional small branches of the ascending pharyngeal artery, hypoglossal canal & dorsal meningeal and tentorial arteries arising from the meningohypophysial trunk.

Ans. B. Preganglionic fibres from lower thoracic and lumbar vertebra come via sympathetic chain to supply adrenals
[Ref: Grays Anatomy, 41″ ed., pS. 439]

• Suprarenal gland – Greater autonomic supply than any other organ.
• The nerves are distributed throughout the gland around blood vessels (regulating blood flow), in the medulla (stimulating the release of catecholamines from chromaffin cells), and in the cortex (where they may influence steroid hormone production).
• A suprarenal plexus lies between the medial aspect ofeach gland and the coeliac and aorticorenal ganglia.
• It contains predominantly preganglionic syrnpathetic fibres that originate in the lower thoracic spinal segments, reach the plexus via branches of the greater splanchnic newes, and synapse on clusters of large medullary chromaffin cells.

Ans. d. Superficial posterior

[Ref: Grays Anilomy, 4l” ed, pg, 1406-1412 and Last anatomy I2’h ed-, pg. 142]

Contents of flexor (posterior) compartment:

Superficial part:

• Gastrocnemius, plantaris and soleus muscles

Deep part:

1. Popliteus, Flexor digitorum longus, flexor hallucis longus and Tibialis pos-terior muscle
2. Posterior tibial and peroneal vessels
3. Tibial nerve

Ans. C. Renal stone in ureter
[Ref: Ganong’s Review of Medical Physiologt, 2!n ed., ch -7, pg. 677-78]

• GFR = Kf [(PGC – PT) – (nGC – ztT)]

• K.: Glomerular Ultrafiltration coelicient
• P: Hydrostatic pressure,
• lI: Oncotic Pressure,
• CC: GIomerular capillaries
• T: tubule
• lncreased Renal blood flow. efferent arteriole constriction : Increase GC hydrostatic pressure
• Decrease oncotic pressure in plasma : increased GFR

Renal stones:

• Tubular Obstruction can lead to increased hydrostatic pressure in tubule (bowman’s capsule).

Ans. A. Negative feedback
[Ref: Ganong’s Review of Medical Physiologlt, 25n ed., ch-32, pg. 587]

• Baroreflex senses arterial pressure by means ofwall stress at the baroreceptors and acts in a feedback way to control bp.

Examples of various control systems:
Positive Feedback

• Estrogen control of GnRH release at ovulation

Negative Feedback

• Blood pressure
• Plasma osmolarity.
• Plasma CO2, pH.
• Endocrine gland secretion

Feed forward Control:

• Temperature regulation

Ans. A. Depolarisation
[Ref: Guyton & Hall 13′ ed., ch-5, pg. 61-63]

• In this question if Z has a reversal potential or original RMP was more negative (e.g., -70 or -90 mV) then closure of C ion channels would shift the RMP closer to reversal potential of A, B thus depolarising the cell

Ans. C. Ascending thick loop Henle
[Ref: Ganong’s Review of Medical Physiology, 2lh ed., ch-37, pg. 684]

• TAL is permeable to solutes like Na+ and Cl- and impermeable to water.
• The tubular fluid is diluted and becomes hypotonic as it reaches the top of the TAL.

Ans. C. Connexons are involved in electrical synapse
[Ref: Ganong’s Review of Medical Physiologt, 25’h ed., ch-2, pg. 4l-42]

• Electrical synapses are composed of gap junctions which establish intercellular cytoplasmic continuity between cells for the flow of ions and messengers.
• Transmission across electrical synapses is faster as chemical synapses are associated with a synaptic delay created by neurotransmitter release, binding and activation of second messenger systems.
• Electrical synapses are bidirectional in nature.
• Gap junctions are made of connexons which compose 6 connexin subunits.
• Two connexons aligned opposite to each other form a gap junction.

Ans: A. L-gulonolactone oxidase
[Ref: Harper’s illustrated biochemistry, 30’h ed., pg. 200-201]

• In liver, the uronic acid pathway catalyzes the conversion of glucose to glucuronic acid, ascorbic acid (except in human beings and other species for which ascorbate is a vitamin, vitamin C), andpentoses.
• In human beings and other primates, as well as guinea pigs, bats, and some birds and fishes, ascorbic acid cannot be synthesized because of the absence of l-gulonolactone oxidase’

Ans: B. 5′-3’exonuclease
Ref: Lehninger principles of biochemistry, vh ed, pg. 994 and Lippincott’s illustrated reviews 6th ed, pg. 74-75

• DNA polymerase I is not the primary enzyme of replication; instead it performs a host of clean-up functions during replication, recombination, and repair.
• When the 5′-3′ exonuclease domain is removed, the remaining fragment (Mr 68,000), the large fragment or Klenow fragment, retains the polymerization and proofreading activities.
• Klenow fragment is a large protein fragment produced when DNA polymerase I from E. coli is enzymatically cleaved by the protease subtilisin.

Ans: A. RT PCR
[Ref: Harper’s illustrated biochemistry,3Oh ed, pg. 29,457 and Tietz Fundamental of clinical chemistry and molecular diagnostics, Vh ed.]
RT-PCR:

• Reverse transcription polymerase chain reaction (RT–PCR) is a laboratory technique combining reverse transcription of RNA into DNA (in this context called complementary DNA or cDNA) and amplification of specific DNA targets using polymerase chain reaction (PCR).
• It is primarily used to measure the amount of a specific RNA. This is achieved by monitoring the amplification reaction using fluorescence, a technique called real-time PCR or quantitative PCR (qPCR). Combined RT-PCR and qPCR are routinely used for analysis of gene expression and quantification of viral RNA in research and clinical settings.
• A method used to quantitate mRNA levels that rely upon a first step of cDNA copying of mRNAs catalysed by reverse transcriptase prior to PCR amplifi cation and quantitation.

 Sanger sequencing,

• Also known as the chain termination method, is a technique for DNAsequencing based upon the selective incorporation of chain-terminating dideoxynucleotides (ddNTPs) by DNA polymerase during in vitro DNA replication.

Ans: A. tRNA of alanine
[Ref: Nature Reviews Molecalar Cell Biologt, volume 8, pg. 209-220 (2007) and Harper’s illustrated biochemistry 3Ah ed.]

• Small nuclear RNAs contain unique 5′-caps.
• mRNAs do have a 7-methylguanylate cap, abbreviated m7G.
• tRNAsand rRNAs don’t require 5′ capping.
  • They have other modifications.

Ans: A. Methylation
[ref: Harper’s illustruted biochemistry, 3Ah ed., pg. 560.]

• Methylation of cpG sites in the promoter of a gene may inhibit gene expression.
• There is also evidence that low folate status results in impaired methylation of cpG islands in DNA, which is a factor in the development of colorectal and other cancers.

Ans: C. 27 minutes
[Ref: Lehninger principles of biochemistry, 6t’ ed., pg. 204]

• During derivation of Michaelis-Menten equation,
• If total enzyme concentration is reduced by 1/3 and [S] is very high then Vmax also become l/3.
• So in this question same amount of product will be fbrmed in 27 rninutes (3 x 9min)

Ans: B. Vitamin 82
[Ref: Harper’s illustrated biochemistry, 3Oh ed., pg. 556]

• Deficiency of riboflavin (vitamin B2) is characterized by cheilosis, desquamation and inflammation of the tongue, and a seborrheic dermatitis.

Ans: B. Vitamin C
[Ref: Harper’s illustrated biochemistry, 3Ah ed., pg. 541]

• Inorganic iron is absorbed in the Fe2+ (reduced) state, and hence, the presence of reducing agents enhances absorption.
• The most effective compound is vitamin C, and while intakes of 40 to 80 mg of vitamin C per day are more than adequate to meet requirements, an intake of 25 to 50 mg per meal enhances iron absorption, especially when iron salts are used to treat iron deficiency anemia.

Ans: D. Phosphofructokinase I
[Ref: Harper’s illustrated biochemistry,3a,ed., pg. I88 and Lippincott’s illustratet! reviewsr 6’t’ ed., pg. 107]

Ans: D. Phosphorylase enzyme
[Ref: Harper’s illustrated biochemistry, 3A” ed., pg. 178]

• It is Mc Ardle disease.
• Deficiency of muscle glycogen phosphorylase enzyme.
• So the first step of glycogen breakdown will not occur.
• Thus intact glycogen is seen in muscle biopsy.

Ans: A. TCA cycle
[Ref Harper’s illustrated biochemistry, 3A” ed, pg. 162, I7l’133 ]

• Read the question carefully, it says fluoride from fluoroacetate and not sodium fluoride.
• The poison fluoroacetate is found in some of plants, and their consumption can be fatal to grazing animals.
• Some fluorinated compounds used as anticancer agents and industrial chemicals (including pesticides) are metabolized to fluoroacetate.
• It is toxic because fluoroacetyl-CoA condenses with oxaloacetate to form fluorocitrate, which inhibits aconitase, causing citrate to accumulate.

Ans: D. Epoxide reductase
[Ref: Harper’s illustrated biochemistry, 3Ah ed., pg. 555]

• Vitamin K is the cofactor for the carboxylation of glutamate residues in the postsynthetic modification of proteins to form the unusual amino acid y-carboxyglutamate (Gla).
• Vitamin K epoxide is reduced to the quinine by a warfarin-sensitive reductase, and the  uinone is reduced to the active hydroquinone by either the same warfarin-sensitive reductase or a warfarin-insensitive quinone reductase.

Ans: C. Complementation
[Ref Ninfab Fundamental laboratory approachesfor biochemistry und biotechnology pg. 355-356 and Harper’s illustrated biochemistry,3Oh ed., pg’ 456]

• This is schematic representation of the Blue-white assay, used to screen for recombinant vectors.
  • The method is based on the principle of o-complementation of the B-galactosidase gene.
  • So phenomenon is complementation. 

Ans: B. Tandem mass spectrometry
[Ref: Tietz Tertbook of clinical chemistry and molecular biologt, 5’h ed,, pg. 2052]
Diagnosis of patients with inborn errors of metabolism:

• Relies on specific tests such as ion-exehange chromatography and liquid chromatography with tandem mass spectrometry (LC-MS/MS) for amino acid analysis, gas chromatography/mass spectrometry (GC/MS) for organic acid analysis, tandem mass spectrometry (MS/MS) with (LC-MS/MS) or without liquid chromatographic separation for acylcamitine profiles, and LC-MS/MS or GC/MS for acylglycine profiles

Ans: B. White patch of hair due to tryptophan deficiency
[Ref: DM Vasudevsn Textbook of Biochemistry for medical student, Vh ed, pg. 236-237. Devlin’s textbook of Biochemistry, Vh ed, pg. 769]

• Deficiency ofphenyl alanine hydroxylase is the cause for this disease.
• The genetic mutation may be such that either the enzyme is not synthesized, or a non-functional enzyme is synthesized.
• The classical PKU child is mentally retarded with an Ie of 50.
• About 200% inmates of lunatic asylum may have PKU.
• Guthrie test is a rapid screening test.

Ferric chloride test:

• Urine of the patient contains phenylketones about 500 3000 mg/day.
• This could be detected by adding a drop of ferric chloride to the urine.
• A transient blue-green colour is a positive test.

Ans: C. Ion exchange chromatography
[Ref: Tietz T*tbook of clinical chemistry and molecular biologt, lh ed^, pg. 1443-1444]

• Techniques based on charge differences (ion-exchange chromatography, HPLC, electrophoresis, and isoelectric focusing), structural differences (affinity chromatography and immunoassay), or chemical analysis (photometry and spechophotometry).

Ans. A. Acinetobacter
Ventilator-associated pneumonia (VAP) :

• Study from AIIMS Surgicul Department and ICUs shows that the Acinetobacter is nowadays the most common and most specific cause for Ventilator Associated Pneumonia (VAP).

Ans. D. T-cell leukemia

• Human Herpes Virus-8 Aka Kaposi’s sarcoma-associated herpes virus (KSHV).
• Manifestations: In immunocompromised individuals (e.g., HIV), HHV-8 causes:
• Kaposi sarcoma
• Primary effusion lymphoma (body cavity based lymphomas)
• Castleman’s disease (lymphoproliferative disorder of B-cells)

Ans. C. 10-30 days

Ans. D-First line defense against bacterial peptides
y6 T cell:

• (?d) T cell: gamma delta (?d) T cells have a TCR that is made up of one ? (gamma) chain and one d (delta) chain. This group of T cells is usually much less common than aß T cells, but are at their highest abundance in the gut mucosa, within a population of lymphocytes known as intraepithelial lymphocytes (IELs).

• Constitute 5% of total r-cells, express y/6 chains of TCR chains; instead of ?/ß chains..
• They lack both CD4 and CD8 molecules.
• They do not require antigen processing and MHC presentation of peptides.

• They lack both CD4 and CD8 molecules.
• They do not require antigen processing and MHC presentation of peptides.
• They are part of innate immunity as the(?d) receptors exhibit limited diversity for the antigen.
• They are usually found in the gut mucosa, as intraepithelial lymphocytes (IELs).
• The function of (?d) T-cells is not know, they may encounter the lipid antigens that enter through the intestinal mucosa.

Ans. A. H2O2

• The Sterrad Sterilization System by Advanced Sterilization Products (ASP) exploits the synergism between peroxide and low temperature gas plasma (an excited or ionized gas) to rapidly destroy microorganisms.

Ans. B. HSV causing temporal encephalitis
[Ref: “Diagnosis ofherpesvirus infections ofthe central nervous system.’, Herpes : the journal of the IHMF I1 Suppl 2 2004, pp. 48A-564.]

• The question simply asks in which of the given conditions calculation of Viral load is not required. In HSV causing temporal encephalitis the role of PCR is just to detect HSV DNA and make a diagnosis of the disease.
• There is no role of detection of the viral load copies in the management or diagnosis of the disease.

Ans. A. NSP4

• Rotavirus nonstractural protein 4 (NSP4) is known to function as an intracellalar receptor at the endoplssmic reticalam (ER) critical to virul morphogenesis and is the first characterized virul enterotoxin.
• The associntion of NSP4 snd cuveolin-I contributes to NSP4 intrqcellular trfficking from the ER to the cell surfuce and speculate that exogenously added NSP4 stimulutes sigaaling molecules located in caveola microdomains.

Ans. B. HAV

• All the above given viruses except HAV are enveloped, so the HAV infection will spread even if the SD plasma destroys lipid envelope of the virus.

Ans: A. Ach Muscarinic receptors
[Ref: Lippincott, 6’t’ed., Pg. 27-28]

• Ml, M2, M3, M4 and M5 are Ach Muscarinic receptors.
• They are G protein coupled receptors

Ans: D. Liposomal AmPhotericin B
[Ref Katzung, I3’h ed, Pg. 901-902]

• RK39 dipstick test is a rapid immunochromatographic test being widely used in the diagnosis of visceral leishmaniasis.
• Out of the given options Liposomal Amphotericin B is the only drug which is used to treat visceral leishmaniasis.

Ans: A. Griseofulvin
[Ref: Katzung, I3’t’ed., pg.832 and https://www.ncbi.nlm.nih.gov/pmc/articles/%5D

• PMC4804599/
• Among various options, topical terbinafine for 4 weeks appears to be the treatment of choice for lirnited disease (tinea corporis/cruris/pedis).
  • For more extensive disease, the choice is less clear.
• It is also effective orally.
• Both terbinafine (250 500 mg/day tbr 2 6 weeks) and itraconazole (100- 200 mglday for 24 weeks) appear to be effective.
• Voriconazole is also an effective drug for these conditions.

Ans. is ‘c’ i.e., Schedule H

Ans: A. Tmax and Cmax
[Ref: Sharma & Sharma’s Principles of Pharmacolog, j’d ed., pg. 30-31 and hup:// whrw. e a r op e a n r ev i ew. o r g/wp /wp – c o n t e nt/ up I o a d s/6. p df]

• From the plasma concentration graph, we obtain three important parameters
• Cmax is the peak plasma concentration
• Tmax i.e. time to attain the peak plasma concentration or Cmax
• AUC (Area under the curve) of plasma concentration time graph
• The 1^st two parameters i.e. Cmax and the Tmax are the indicators of the rate of absorption.

Ans: B. Intravenous
[Ref: Lippincott, 6th ed., pg. 3-4 and sharma & shatma’s Principles of Pharmacologt, 3’d ed., pg. 18-20]

• lntravenous (iv) route, the drug enters the systemic circulation directly, bypassing the l” pass metabolism, so there is 100% bioavailability by this route.

Ans: A. Oral
[Ref: Goodman & Gilman, I3’h ed., pg. 16-17 and sharma & sharms’s Principles of Pharmacologt, 3’d ed., pg. I8-20]

• Oral route has certain disadvantages notably the 1^st pass metabolism in liver before reaching the systemic circulation.

Ans: B. Flucytosine: Inhibit microtubulesynthesis thus preventing mitosis
[Ref: Lippincott, 6h ed, pg. 535-541 and KatTung, l3th ed., pg. 926-g33]

• Flucytosine is a pyrimidine anti-metabolite anti-fungal drug.
• It enters the fungal cell via permease enzyme and then converted into compounds like 5-Fluorouracil, S-Fluorodeoxyuridine and 5′-monophosphate.
• It then inhibits nucleic acid synthesis by inhibiting the enzyme thymidylate synthase.

Ans: C. Edaravone
[Ref https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5737249/and https://www.br ai ntrop ic. c om/noo t rop ics/p i rac etam/]

• Edaravone is a novel neuroprotective agent for the treatment of amyotrophic lateral sclerosis (ALS)

Ans: C. Febuxostat
[Ref: Goodman antl Gilman, I3’1′ ed., pg. 704 antl Sharma & Sharma’s Principles o./ Pharmacology, 3’t ed., pg’ 383, 385-387]

• Febuxostat is used for the treatment of chronic gout.
• It is non-purine inhibitor (allopurinol is a purine analogue) of xanthine oxidase.
• lt is more potent and selective than allopurinol.

Ans: B. 18
500 mg/ 5 ml means 100 mg/l ml. Since 100 mg is present in 1 ml, therefore, 180 mg of drug is present in 1.8 ml.
Now it is clear that we must administer 1.8 ml of the above solution to administer the desired amount of drug.
Last thing is to calculate the divisions to administer 1.8 ml.
10 division per ml means each 0. 1 ml is equal to 1 division.
Therefore, 1 .8 ml will be equal to l8 divisions.

Ans: A. Amikacin
[Ref: Sharma & Sharma’s Principles of Pharmacologt, 3d ed., pg. 74t-749 and htrys://www.uplodate.com/contents/treatment-and-prevention-of-enteric-typhoid-und-paratyphoid-fever#HS]

• Amikacin is a commonly used aminoglycoside.
• Antimicrobial spectrum of aminoglycosides does not include salmonella.
• It is used in gentamycin and tobramycin resistant infections.
• It is used for organisms like Pseudomonas, Proteus, and Serratia. It is also effective in MDR-TB.

Ans: A. Artemether plus lumefantrine
Ref: http://www.nvbdcp.gouin/Doc/Guidelines-Malaria-Diagnostic-Treatment-2014 pdf

• Artemisinin Combination Therapy (ACT) should be given to all the confirmed P. falciparum cases.
• The ACT recommended in the National Program all over India except northeastern states is artesunate (AS) daily for3 days and Sulfadoxine-pyrimethamine (SP) on Day 0.
• Northeastern states presently recommended ACT in national drug policy is fixed dose combination of Artemether-lumefaritrine.
• Hence, the clear-cut answer of this question is Artemether plus lumefantrine.

Ans: A. Low molecular weight heparin

• Current guideline-endorsed therapy options for cancer-associated thrombosis include low molecularweight heparin (LMWH), unfractionated heparin (UFH), warfarin & fondaparinux.
• All current guidelines recommend LMWH for at least 3-6 months in cancer-associated VTE.

Ans. D. 1, 2, 3 and 4 are correct
All the statements are correct and are self explanatory regarding typhus fever. Weil Felix test is not in common use now. Indirect immunofluorescence assay is used commonly. Doxycycline 200 mg/day is given for 7-15 days.

Ans: A. Decrease the secretion of insulin
[Ref: https://www.sciencedirect.com/science/article/pii/0304416578903008 and http://www. ej e-o nline. o rg/co nte nt/8 8/I / I | 3]

• Valinomycin interferes with the insulin releasing effect of glucose by increasing the potassium permeability of the B cell membrane.

Ans. is ‘d’ i.e., Hypoglycemia
Inhaled ß-agonists have very few side effects. These are : (i) Muscle tremer & palpitation most common;(ii) hypokalemia; (iii) hyperglycemia; (iv) Tolerance; (v) Throat irritation; (vi) Ankle edema; and (vii) others (anxiety, headache, muscle cramps, dry mouth, arrhythmias , flushing & vasodilatation, hypoxemia, MI, sleep disturbance).

Ans: A. Bleomycin
[Ref: Goodman and Gilman, I3,h ed., pg. 1193]

• Few case reports of bleomycin induced flagellate dermatitis and pigmentations are available in literature.

Ans: C. Azithromycin
[Ref: https://www.uptodate.com/contents/trcatment-of-community-aquired-p n e u m o n ia- i n- a d u I t s -in -t h e – o u tp atie n t – s e tt in g# H 4]

• Only one drug which is active orally i.e. Azithromycin.
• We require OPD based treatment; hence Azithromycin is the best answer here.

Ans: A. Metoclopramide
[Ref: Katzung, I3’h ed, pg. 1070 md Lippincott, 6’t’ ed, pg. 408]

• This is a typical case of metoclopramide induced extrapyramidal side effect (EPS) in the form of DYSTONIAS.
• Metoclopramide crosses BBB and blocks central D2 receptors.
• The major side effects of metoclopramide include EPS, such as those seen with the phenothiazine antipsychotics

Ans: A. Counterfeit drug
Ref:https://www.fda.gov/Drugs/ResourcesForYou/Consamets/BuyingUsingMedicineSafely/CounterfeitMedicine/ and hxp://www.globalforumljdorg/sites/default/files/docs/tibrary/lllflO-Evolution%20of/o20Definitions%20Definition.pdfand http://www.cdsco.nic.in/writereaddata/Gaidelines%20under%20new9620penal%20provi-sions9.pdf

• According to the US FDA Counterfeit medicine is fake medicine.
• It may be contaminated or contain the wrong or no active ingredient.
• They could have the right active ingredient but at the wrong dose.
• Counterfeit drugs are illegal and may be harmful to your health.

Ans: A. Venlafaxine
Ref: Katzung, I3’h ed., pg. 524-525 and Goodman & Gilman, l3’h ed-, pg. 27372.

• Sudden withdrawal of Shorter acting antidepressants particularly SSRIs (paroxetine and sertraline) and SNRI (venlafaxine) can lead to discontinuation syndrome and troublesome side effects.
• These symptoms may include dizziness, headache, nervousness, nausea, anxiety and insomnia.
• Out of the options provided Venlafaxine is the best answer.

Ans: A. Antithrombin III
[Ref: Goodman & Gilman, 13th ed, pg. 588]

• Heparin binds to antithrombin III (AT-lll) and accelerate the rate at which it inhibits various coagulation proteases.

Ans. B: Safety Margin

It signifies safety margin.

Quantitatively, it is the ratio given by the lethal dose divided by the therapeutic dose.

A therapeutic index is the lethal dose of a drug for 50% of the population (LD50) divided by the minimum effective dose for 50% of the population (ED50).

A high therapeutic index is preferable to a low one: this corresponds to a situation in which one would have to take a much higher dose of a drug to reach the lethal threshold than the dose taken to elicit the therapeutic effect

Generally, a drug or other therapeutic agent with a narrow therapeutic range (i.e. with little difference between lethal and therapeutic doses) may have its dosage adjusted according to measurements of the actual blood levels achieved in the person taking it.

Ans. is ‘a’ i.e., Volume of distribution
Loading dose is governed by volume of distribution and volume of distribution is affected by lipid solubility.
Maintenance dose is governed by clearance (excretion) of drug and half life.

Ans: B. To do a complete physical examination

• The first step after suspecting s case of abuse is to do a complete detailed history taking & physical examination of the patient to see sny other injuries which can confirm the findings.
• Coming to conclusion just by seeing a burn which looks like cigarette burn on forearm can be misleading at times so a thorough examination of whole body is mandatory to confirm the above finding to child abuse.

Ans: C. Common witness

• “Except common witness option all other options are expert witnesses.
• Only common witness can be considered as first-hand knowledge in court of law”.

Ans: B. A-4 B-2 C-1 D-3
Cantharides (Spanish Fly)

• Active principle: CcintharidinQ
• Local application on skin: Vesicle or blister formation

Opium/Afim

• Opium (poppy) is derived from Popover somniferum.
• Toxic part: Unripe fruit capsule, latex juiceQ.

Ans: C. Selenium
Prolonged oral exposure of cattle to elevated dietary selenium (Se) is associated historically with 2 clinical syndromes:

• Alkali disease.
• “Blind staggers”

Ans: C. Doctor assisting a surgeon for fee in OT
Borrowed servant doctrine:

• The common law principle that the employer of a borrowed employee’ rather than the emp|oyee’s regular employer is liable for employees actions that occur while the emptoyee is under the control of the temporary employer.
• Sometimes referred to as borrowed employee doctrine.

Ans: D. 2l-22 years

• In figure 1, all the ossification centres are fused around elbow, so the age must be> 16 years.
• In figure 2, lower end of radius and ulna are fused, so the age must be atleast 18 years.
• In figure 3, Ischial tuberosity isfused, so the age must be around 20-22 years.
• So the best answer for this question would be option (d) 21-22 years

Ans: C. 7 months

• Gestational age can be determined fiom maturation of chorionic villi; foot length and ossification centres.

Seventh month:

• Length 35 cm; crown-rump length 23 cm; foot length 8 cm; weight 900 to 1200 g.
• Nails are thick.
• Eyelids open and pupillary membrane disappears.
• Skin is dusky-red, thick and fibrous.
• Meconium is found in the entire large intestine.
• Testes are found at external inguinal ring.
• Gallbladder contains bile and caecum is seen in the right iliac fossa.
• Ossification centre is present in the talus.

Ans. C. Doctor assisting a surgeon for fee in OT
Borrowed servant doctrine:

• The common law principle that the employer of a borrowed employee’ rather than the emp|oyee’s regular employer is liable for employees actions that occur while the emptoyee is under the control of the temporary employer.
• Sometimes referred to as borrowed employee doctrine.

Ans: D. Larger fronta eminence

Ans. A. Fractures
[Ref Clinical Outcomes of Elastin Fibre DeJbcts, J Cytol Histol 201 3, 4: I]

• Abnormality in elastin protein can lead to abnormality in nrany systern.
• It can lead to aortic aneurysm, joint laxity and subluxation of lens.

Ans. A. Basal Cell Carcinoma
[Ref: Robbins & Cotran, 9” ed., pg. I155-l I 57]

• Basal cell carcinoma is a locally aggressive cutaneous tumor.
• The rest of three tumors in the options have more tendency for lymphatic spread compared to BCC.

Ans. B. Stable adhesion ?  Activation of integrins? Rolling ?-migration viaendothelium
[Ref: Robbins & Cotran, th ed., pg. 74, 75]
Acute inflammation process involved are:
In the lumen-

• Margination,
• Rolling,
• Activation of Integrin and
• Adhesion to endothelium

Ans. B. Embryonal rhabdomyosarcoma
[Ref: Robbins & Cotran, lh ed., pg. 1220-1222]

• ln the four options provided , all four show morphology of a round cell tumour.
• However Desmin positivity is seen only in cases of rhabdomyosarcoma.
• In Embryonal rhabdomyosarcoma, the tumor cells mimic skeletal muscle at various stages of embryogenesis and consist of sheets of both prirnitive round and spindled cells in a myxoid stroma.
• Immunohistochemistry for desmin and Myogenin confirm the rhabdomyoblastic differentiation.

Ans. A. Alcian blue
[Ref: Quick Reference Handbookfor Surgical Pathologists,20II, pg. 69-74]

• Alcian blue stain is used for acidic mucin.
• Acid mucins are present in goblet cells and esophageal submucosal glands.
• They are Alcian Blue (AB.-positive (blue color).

Ans. D. Increased FDPs
[Ref: Essentials of Haematology by Shirish Kawathalkar, 2″d ed., pg. 442-147]

• Two types of DIC are acute (decompensated and chronic cornpensated).

Acute DIC:

• Findings in acute DIC are low platelet, prolonged PT & APTT, low fibrinogen, and increased FDP and D-dimer.

Chronic DlC:

• Findings are normal platelet count, normal PT & APTT.
• However, FDP and D-dimer are increased.
• So in acute DIC, all the four options are correct, while if we consider the question as chronic DIC, then best possible answer is increased FDP.

Ans. C. FISH

• FISH is a molecular cytogenetic technique that uses fluorescent probes that bind to only those parts of the chromosome with a high degree of sequence complementarity.

Ans. B. Should be completed within 4 hours of receiving from blood bank
[Ref: Essentials of’Haematology hy Shirish Kawathalkar, 2″d ed., pg. 487-4Bg.]

• Whole blood after storing at 2-6 C loses functionally active platelets, Factor V and Factor VIII.
• It has shelf lif’e of 35 days (CPDA- I ).
• Transfusion of blood should be commenced within 30 minutes after removing it fiom refrigerator and should be completed within 4 hours of starting transfusion.
• Indication for transfusing whole blood is fbr correction of both hypovolemia and red cell mass, such as acute massive blood loss.

Ans. A. RBC 2-6’C, Platelet 20-22″C, FFP -30’C
[Ref: Essentials of Haematologlt by Shirish Kawathalkar, 2″u ed]

• Whole blood and packed RBC is stored at 2-6 “C.
• One unit of whole blood increase hemoglobin by l gm/dl and Hematocritby 3%.
• Platelet is stored at20-24″C with shelf life of 5 days.
• Fresh frozen plasma (200m1) is collected from single donor and frozen within 6 hours from collection.
• Stored at -30 oC and has shelf life of 1 year.

Ans. A. AML with hyperploidy
[Ref: ,yHO Classification of Tumours of Haematopoetic and lymphoid tissue, Revised fourth ed. 2017]

• The classification of Hematolymphoid neoplasms was revised tn2016.

In this revision, followingprovisional entities were introduced:

1. Myeloproliferative neoplasms (MPN): Myeloid/lymphoid neoplasms with PCMI-JAK2
2. Myelodysplastic syndromes (MDS): Refractory cytopenia of childhood
3. Acute myeloid leukemia (AML) and related neoplasms: AMI- with BCR-ABLl
4. Acute myeloid leukemia (AML) and related neoplasms: AML with mu- tated RLINXl
5. B-lymphoblastic leukemia / lymphoma: B-lymphoblastic leukemia/lym- phoma, BCR-ABLI-like
6. B-ymphoblastic leukemia/lymphoma: B-lymphoblastic leukemia/lym- phoma with iAMP2l
7. T-lymphoblastic leukemia/lymphoma: Early T-cell precursor lympho- blastic leukemia
8. T-lymphoblastic leukemia/lymphoma: Natural killer (NK) cell lympho- blastic leukemia/lymphoma

Ans: A. Otosclerosis
[Ref Dhingra Text book of ENT, 6″ ed., ch-4]
Gelle’s test:

• Test of bone conduction and examines the effect of increased air pressure in ear canal on the hearing.
• It was a popular test to find out stapes fixation in otosclerosis but has now been superceded by tympanometry.

Ans: A. Labyinthectomy
(Ref Glasscock-Shambaugh Surgery of the Ear 6′ ed., pg. 573).

• Labyrinthectomy is the most destructive procedure in the treatment of Meniere’s as it destroys both hearing and vestibular function.

Ans: A. Biopsy is done for diagnosis
[Ref: Scotl Brown, Vt’ ed., pg. 2438]

• Nowadays, thediagnosis is based on the CT and MR appearances that are sometimes confirmed by angiography.
• A trans-nasalbiopsy is not necessary and can provoke brisk haemorrhage.

Ans: C. Eyes move slowly to left
[Ref: Glasscock-Shambaugh Surgery ofthe Ear 6’h ed., pg. 124]

• Endolymph will flow toward the ampulla of the horizontal canal (resulting in an increase in afferent discharge rate) for warm irrigations and away from the ampulla (resulting in a decrease in afferent discharge rate) for cold irrigations.

Ans: A. T2N0M0
[Ref: AJCC Cancer staging munual I’h ed., ch-7, pg. 79,90]
Cancer of the lip and oral cavity TNM staging AJCC UICC 2017

Ans: D. Nucleus of Cajal
[Ref: Conjugate Gaze Palsies – Neurologic Disorders.,, Merck Manuals professional, Ed,,2015 and Merck Sharp & Dohme Corp, I Mar. 2014. lleb. 8 Oct. 2015].

• The three key structures in the control of the vertical gaze includes,
• Rostral interstitial nucleus of medial longitudinal fasciculus (riMLF).
• Interstitial nucleus of Cajal (INC)
• Posterior commissure (PC).

Ans: A. Drusen
[Ref: American Academy of Ophthalmologt, 20 t 7]

• Above retinal histopathology image is of Drusen characteristic feature of ARMD i.e. Age related macular degeneration.
• Drusen are a hallmark of ARMD.
• On histopathology, nodular drusen appear as eosinophilic dome-shaped structures situated between Bruch’s membrane and the displaced, attenuated RPE overlying the drusen.

Ans: C. Corneal tattooing
[Ref: A, K. Khurana Comprehensive Ophthalmologt,4,h ed]

• Stenopic slit is useful in finding out the axis of the cylinder.
• (option b) stenopic slit is used in cases of corneal opacities to find out the optimal site for optical iridectomy.
• After dilating the pupil with a mydriatic, the slit is rotated in front of the eye and the axis which gives maximum clarity is chosen for optical iridectomy

Ans: A. Atropine eye drops

• Treatment usually includes antifungal medications depending on sensitivity.
• Atropine eye drops are given to release ciliary spasms & to give symptomatic reliel.

Ans: B. Post capsular opacification lens

• Posterior capsular opacification of lens is responsible for glare in eye at night.
• At night pupil dilates usually & hence more light enters in the eye, so more light creates more aberrations in the eye, hence more glare.
• In early posterior subcapsular cataract visual acuity canbe 6/12

Ans: B. Internuclear ophthalmoplegia
Demyelination
Ref Bilateral Internuclear ophthalmoplegio in Multiple sclerosis,iejm journal,20l6
Typically, symptoms & examination findings i.e. diplopia on looking towards left in the right eye is characteristic of internuclear ophthalmoplegia. 

Ans: A. Pupil dilation
Ref: American Academy of Ophthalmolog 2018, third nerve palsy

• The pathway for pupillary constriction for each eye has an afferent limb taking sensory information to the midbrain, and two efferent limbs (one to each eye).

Ans: B. 100
Ref: K Park, 23d ed., pg. 524, 567

• Estimated no. of infants in a health sub centre covering 5000 population can be calculated as follows:
• No. of live birth = Birth rate x Population/ 1000
  • = 20.4 x 5000/1000 = 102
• Infant mortality for sub centre = No. of live birth x IMR/1000
  • = 102 x 34/1000
  • = 3.5 (for calculation purpose we assume it 4)
• Therefore, total number of infants = 102 — 4
  • = 98
• Hence correct answer is 100 (nearest value).

Ans: C. Village health sanitation and nutrition committee (VHSNC)
Ref: K Park, 23’d ed,, pg. 450-451 and Health Policies and Programmes in India, DK Taneja, I2’h ed., pg. 82
VHSNC:

• Sub-committee or a standing committee of the Gram Panchayat.
• The VHSNC acts as a platform for convergence between different departments & committees at village level.
• The VHSNCs shall be supported to develop village health plans to ensure convergent action on social determinants of health, ensure access to health services, especially of the more marginalised sections in the village, and support the organization of the Village Health and Nutrition Day.

Ans: B. Heart rate/min and Age
Ref: Biostatistics Principles and Practice by B Antonisamy, Mc graw hitt publication,pg. I17.

• In given question, all options except heart rate/minute and age are of qualitative variables (nominal or ordinal).
• Qualitative variables are usually presented in frequencies or count.
• Chi square test is used to compare any difference or association between two qualitative variables.
• Heart rate/minute and age are quantitative variables where chi square test cannot be applied.
• Hence correct answer is b here.

Ans: A. VVM
[Ref: K Park, 23’d ed, pg. 110]

• VVM (Vaccine Vial Monitor)
• VVM is a label containing a heat-sensitive material which is placed on a vaccine vial to register cumulative heat exposure over time.
• It has outer blue circle and inner white square.

Ans : C Chikungunya
[Ref: Hypapigmqtdion and &ilangurwfetEn &hasnw A” An has Demaor 20 I 6;9 I :g60-I r]

• Chikungunya fever (cF) is an acute febrile illness presenting with symptoms like intense asthenia, arthralgia, myalgia and headache and is caused by chikungunya virus (CV).
• Among the skin lesions, maculopapular rash is common, but seen in several viral illnesses, therefore, not useful in suspecting CF.
• Hyperpigmentation is a unique feature noted in CF.
• Hyperpigmentation associated with CF is macular and most commonly affects nose and cheeks.

Ans: C: Radial Cutaneous Nerve
[Ref: Kumar B, Dogra S. ch- 15, Case definition and clinical types of leprosy, pg. 259.IAL Tixtbook of leprosy. 2d ed,]

• Ref: Ponnaiya J. Chapter 19: Laboratory diagnosh, pg. 285. AL Textbook of Leprosy,7d ed.,
• Ref: Rao PN, Suneetha S. Parc neuritic leprosy: Cunent status and relevance Indian J Dermatol Venereol Leprol 2 0 I 6 ; I 2 : 2 5 2-6 I ).
• Pure neuritic Hansen is characterised by an area of sensory loss along the distribution of an involved nerve trunk with or without motor deficit.
  • In the absence of any Skin patch.
• The suitable nerves include supraorbital branch of the fifth cranial nerve, supra clavicular nerve, great auricular nerve in the neck, radial cutaneous nerve at the wrist, a cutaneous nerve ofthe forearm or thigh, sural nerve at the back of the leg or superficial peroneal nerve on the dorsum ofthe fbot.
• The nerves usually chosen for biopsy are a branch of sural nerve at the level just above the ankle, or a branch ofradial cutaneous nerve at the wrist resion.

Ans : D: Chromium

• Most common allergen is hexavalent chromium salts.
• Allergic contact dermatitis more than irritant contact dermatitis.
• Level of exposure needed for allergic contact dermatitis 100-400 nglcm2.
• Tartarate, glycine, silicone, dapsone, ferrous sulphate causes conversion from chromium (VI) to chromium (III), which is less allergenic.

Ans. A : TCAs are better than MAO and SSRI for treatment

(Ref: Complete review ofpsychiatry by Dn Prashant Agrawal, ed-, 201g, ch – 3, pg, 60)

Ans. A: Schizoid personality disorder
[Ref Complete review of psychiatry by Dr. Prashant Agrawal, ed., 2018, ch – 14, pg. 280]
Personality disorders are organized into three “clusters” in both the DSM-IVTR and DSM-5.
The “cluster A” personality disorders include:

• Schizotypal Personality Disorder
• Paranoid Personality Disorder
• Schizoid Personalitv Disorder 

Schizoid Personalitv Disorder:

• 2 striking features.
• Lack of interpersonal relationships and the lack ofdesire to obtain such relationships .
• Presence of ‘negative symptoms’in the absence of psychotic- like cogritive and perceptual distortions.

Ans: D: Sialorrhoea
[Ref: Complete review of psychiatry by Dr. Prashant Agrawal, ed., 2018, ch – 3, pg. 61]
SSRIs side effects:

• Based on onset, duration and severity.
• Nausea & giddiness – Early, mild, time-limited.
• Sexual Dysfunction – All SSRIs.
• Most common adverse effect on long-term treatment.
• Anorgasmia, inhibited orgasm & decreased libido.
• Most frequent are nausea, diarrhea, anorexia vomiting, flatulence, and dyspepsia.
• Sertraline and fluvoxamine – Most intense GI symptoms.

Paroxetine:

• Pronounced weight gain in young women.
• Constipation – Anticholinergic activity.

Ans: C: Venous air embolism
[Ref Millers anesthesia &h ed-, pg. 2170]

• Diagnosis standard of care is precordial doppler (left or right parastemal, between 2^nd and 3rd ribs) + ETC02 monitoring although this is not the most sensitive test – TEE is most sensitive.
• Pulmonary artery pressure will rise, and CO2 will fall alter VAE.

Ans: D. Ice cream

Ans: D. Check blood glucose

• Quick assessment of Blood sugar should be done to rule out hypo or hyperglycemia is needed.
• In hypoglycemic coma, the eyeball tension is normal, there is profuse sweating and the plantar responses are extensor always either normal or subnormal in uncomplicated cases of either condition.
• It is well to remember that although a comatose patient is a known diabetic, the diagnosis is not always one of ‘hyper- or hypo-glycaemia.

Ans: B. AntiHAV, HBsAg, IgM antiHBc, AntiHCV
Ref: Harrison, I8’t’ ed., pg. 328, 2549-2552, 2550t, 2551t

Ans. B: Atrial contraction

Waves

• a – presystolic; produced by right atrial contraction
• c – bulging of tricuspid valve into the right atrium during ventricular systole (isovolumic phase)
• v – occurs in late ventricular systole; increased blood in right atrium from venous return

Descents

• x – combination of atrial relaxation, downward movement of the tricuspid valve and ventricular systole
• y – tricuspid valve opens and blood flows in to the right ventricle 

Abnormal waveform causes

Dominant a wave

• Pulmonary stenosis
• Pulmonary hypertension
• Tricuspid stenosis

Cannon a wave

• Complete heart block
• Paroxysmal nodal tachycardia

Ventricular tachycardia

Dominant v wave

• Tricuspid regurgitation

Absent x descent

• Atrial fibrillation

Exaggerated x descent

• Cardiac tamponade
• Constrictive pericarditis

Sharp y descent

• Constrictive pericarditis
• Tricuspid regurgitation

Slow y descent

• Right atrial myxoma

Ans: C. Respiratory acidosis with renal compensation
pH-7.12 so its acidosis.
PCO2 is 5o mmHg (normal range 35-45 mmHg) which is higher than the normal s/o respiratory acidosis.
HCO3- is 28 mmol/L (18-24 mmol/L) which is higher than the normal range s/o metabolic compensated alkalosis.

Ans: A. Myxedema Coma
Ref: Harrison, I8’t’ ed., pg. 2922.

• Myxedema coma is a state of decompensated hypothyroidism.
• A person may have lab values identical to a “normal” hypothyroid state, but a stressful event (such as an infection, myocardial infarction or stroke) precipitates the myxedema coma state, usually in the elderly.
• Primary symptolns of myxedema coma are altered rnental status and low body ternperature.
• Low blood sugar, low blood pressure, hyponatrereria, hypercapnia, hypoxia, slowed heart rate, and hypoventilation may also occur. 

Ans: A. A rare complication of Rapid and aggressive sodium correction
[Ref Harrison, I8’t’ ed., pg. 347, 2259, 2260J]

• Central pontine myelinolysis (CPM) or osmotic demyelination syndrome (ODS) is a neurological disorder caused by severe damage of the myelin sheath of nerve cells in the area of the brainstem termed the pons, predominately of iatrogenic, treatrnent-induced cause Rapid and aggressive sodium correction.
• It is characterized by acute paralysis, dysphagia (difficulty swallowing), and dysarthria (difficulty speaking), and other neurological symptoms.
• Na correction to be done in a slow manner.

Ans: A. Takotsubo cardiomyopathy
[Ref Harrison, 18’t’ ed., pg, 1964]

• Takotsubo cardiomyopathy, also known as stress cardiomyopathy, is a type of non-ischemic cardiomyopathy in which there is a sudden temporary weakening of the muscular portion of the heart.
  • This weakening may be triggered by emotional stress, such as the death of a loved one, a break-up, rejection from a partner or constant anxiety.
• “Broken heart syndrome”.
• Stress cardiomyopathy is now a well-recognized cause of acute heart failure, lethal ventricular arrhythmias, and ventricular rupture.

Ans: D. Patent subarachnoid space
[Ref: Text book ofneurology (By Navneet), pg, 605]

• The narrowed fspinal] channel impedes movement of fluid with an increase in pressure above the compression site.
• The increment in pressure above the obstruction can be demonstrated by compression of the neck which produces an increase in venous blood in the cranial cavity, with concomitant reduction in space for the cerebrospinal fluid.
• The increased fluid pressure immediately transnritted throughout the systern normally can be demonstrated with a. manometer attached to a lumbar puncture needle.
• In lesions of the cord the anometric change is greatly retarded.
  • Referred as Queckenstedt’s maneuver.
• Rise in opening pressure is suggestive of patent spinal canal.

Ans. A.Tension pneumothorax
[Ref: Bailey and Love’s short practice ofSurgery, 26″‘ ed., pg. 354]

• Beck’s triad describes symptoms commonly associated with tension pneumothorax.

The three components of Beck’s triad are:

• Distended neck veins
• Muffied heart sounds. and
• Hypotension.
• Other symptoms include tachypnoea, dyspnoea, tachycardia, and hypoxia.

Ans. A. Medially vas deferens, laterally gonadal vessel, inferiorly peritoneum
[Ref: Master techniques in surgery Hernia, Josef E. Fischer, 2013, pg. l6l-162]
Boundaries of Triangle of Doom (Content – External iliac vessels)

• Vas deferens medially
• Spermatic vessels laterally
• Peritoneal fold inferiorly

Boundaries of Triangle of Pain (Content – Lateral femoral cutaneous nerve)

• Laterally iliopubic tract
• Medially Gonadal vessels

Ans. A. Superior mesenteric artery is compressed by third part of duodenum at the ligament of Treitz attachment
[Ref: Mastery of surgery,6tt’ ed., ch-95, pg. 1089-/,091]

• Normally, the aortomesenteric angle and aortomesenteric distance are 38-65’and 10-28 mm, respectively.
• lmaging studies suggest compressionof the third portion of the duodenum as it passesbetween the superior mesenteric artery and the aorta.

Ans. C. Blood loss between 30%-40%
[Ref: Sabiston textbook ofsurgery,20t’ ed., ch-4, pg. 50]

Ans. C
[Ref Greenbergb Hundbook of neurosurgery, S’t’ ed., ch-18′ pg, 296]

Ans. C. Sitting with flexed neck
[Ref: Shackelfurd’s Surgery of the ALIMENTARY TRACT, th ed., ch-58, pg. 665]

• For patients who are awake, alert, and cooperative, Fowler position is helpful with a 90- degree angle preferred.
• A chair may be used, but a stretcher or bed may provide better patient comfort.
• The patient’s neck should be slightly flexed to avoid endotracheal placement.

Ans. B. In ICU
[Ref: Sabiston furtbook of surgery, 2Ah ed., ch-L6, pg. 417]
Damage Control Sequence

Ans. C. High inguinal orchidectomy
[Ref: Sabiston textbook of surgery,2AI’ ed., ch-72, pg. 2102-2104]

• Initial treatment of suspected testicular tumour is radical inguinal orchiectomy, which involves removal of the testicle and sperrnatic cord at the level of the inguinal ring.
• Because of the characteristic and well-described lymph drainage of the testicle there is no role or trans-scrotal biopsy or orchiectomy.

Ans: B. Wait and watch
[Ref: NBIH Button bsttery ingestion triage and treatment guideline]

• The management of a Button battery ingestion depends upon the anatomical site of the impacted battery.
• Button batteries that have cleared the stomach usually pass through the gastrointestinal tract within one week without complications.
• Follow-up radiographs should be performed in asymptomatic patients who have not passed the battery by 10 to l4 days, regardless ofsize or earlier if patient becomes symptomatic.

Ans: C. Feeding by spoon
[Ref: Ghai Essentiul Pediatrics, 8″‘ ed., pg. 49]

• Hopping on one leg – Should be attained by 4 years ofage
• Drawing a square – Should be attained by 4Il2 years of age
• Feeding by spoon Should be attained by l8 months of age
• Passing a ball to someone- Should be attained by 3 years

Ans: C. Serum calcium
[Ref Ghai Essential Pedistrics 8,h ed, pg. 181 und Nelson Textbook of Pediatrics 20h ed” pg. 897]

• Infants of a diabetic mother are ata higher risk of metabolic complications as compared to normal infants.

These complications include:

1. Hypoglycemia
2. Hypocalcemia
3. Hypomagnesemia

• Hence the infant needs to be checked for these as soon as possible.

Ans: D. OPV 3 doses, 3 IPV 3 DPI : Hep-B
[Ref:https://mohfw.gouin/sites/default/files/245453521061489663573.pdf; hup://www.acv ip. o rg/file s/I A P-imm unizution-sc he du le- 2 0 I 6- I P- 2 0 I 6-E p u b. p df]

• The latest schedule of immunization under NIS is as follows:
• National Immunization Schedule (NIS) for Infants, children and Presnant women –
  • OPV 3 doses, 3 IPV 3 DPI : Hep-B

Ans: A. Mouth-Nose
[Ref: Ghai Essential Pediatrics, S’t’ ed., pg. 127]
At the time of birth, if the baby is:

• Not of term gestatton
• Not breathing or crying
• Not having good tone.
• Then the baby requires resuscitation

Ans: A. Till 24 hours after starting antibiotics
Ref: Ghai Essentisl Pediatrics, 8’t’ ed,, pg. 565′ https://www.cdc.gov
Prevention of transmission:

• Droplet precautions for the first 24 hours of antimicrobial therapy is sufficient

Ans: D. Decorticate and decerebrate posturing
[Ref Dhanwate AD. Brainstem death: A comprehensive review in Indian perspective’ [ndian Journal o/ Critical Care Medicine : Peer-reviev,ed, o.fficiat pul.tlicalion of Indian Society of Critical Care Medicine. 2014;18(9):596-605. doi:10.4103/0972-5229.140151. Goila AK, Pawar M. The diagnosis of brain death. Indian Jrurnal of Critical Care Medicine; Peer-reviewed, o.fficial publication of Indian Society of Critical Corc Madicine. 2009;I 3(I ):7-11. doi: I 0.4103/0972-5229.53 I0t]
Diagnosis of brain death in India:
Who should diagnose:

• Team of four medical experts including
• Medical Administrator In charge of the hospital.
• AuthorizedSpecialist
• Authorized Neurologist/Neuro-Surgeon
• Medical Officer treating the patient.

Ans: B. Growing fracture
[Ref: Growing skull fractures: classiJication and management. Naim-UFRahman etsl. Br J Neurosurg. (1994)]
Growing Fractures:

• Also known as traumatic encephaloceles or leptomeningeal cysts
• Skull fractures associated with an underlying dural tear may fail to heal properly.

Ans: B. Head only
[Ref: Coran Pediatric Surgery 7u ed., pg. 1728]
Craniopagus:

• Extent of union:Cranial neuropore
• Skull venous sinus &meninges l00%
• Cerebral cortex 37%

Ans: A. Juvenile myoclonic epilepsy
[Ref: Nelson Textbook of Pediatrics, 20′ ed., pg. 2836]
Juvenile myoclonic epilepsy (Janz syndrome):

• Starts in early adolescence with 1 or more of the following manifestations:
• Myoclonic jerks in the morning, often causing the patient to drop things
• Generalized tonic–clonic or clonic–tonic–clonic seizures upon awakening; and Juvenile absences.
• Sleep deprivation, alcohol (in older patients), and photic stimulation, or, rarely, certain cognitive activities (such as exams) can act as precipitants.

Ans. C. Urgent visit to hospital and check for pregnancy
[Ref IIHO guidelines; CDC guidelines]
After ruling out pregnancy, next cycle of OCPs can be started.

Ans. B. Replace warfarin with heparin in First trimester
[Ref: Williams Obstetrics, 24’h ed]

• Warf’arin has a low molecular weight and readily crosses the placenta.
• Exposure between the 6th and 9th weeks may result in warfarin embryopathy characterized by stippling of the vertebrae and femoral epiphyses and by nasal hypoplasia with depression ofthe nasal bone.

Ans. is ‘a’ i.e., Bronchitis

• Kartagener syndrome is a subset of primary ciliary dyskinesia, an autosomal recessive condition characterized by abnormal ciliary structure and/or function leading impaired mucociliary clearance.
• Kartagener is a primary ciliary disorder and as such the sperms have abnormal/reduced motility (Asthenozoospermia).
• Blockage of epididymis is a feature of Young syndrome (But there is no Situs inversus like Kartagener syndrome and patients tends to have normal sperm motility)

Clinical presentation

• Kartagener syndrome is characterised by the clinical triad of 1
• Situs inversus
• Chronic sinusitis and/or nasal polyposis
• Bronchiectasis

Other features include

• Telecanthus: widened interpupillary distance by a nasal polyp
• Infertility in males
• Subfertility in females

Ans. C. Continue the surgery with careful monitoring of fluid status
[Ref. BSGE/ESGE guideline on manage,nent of fluid disrension metlia in operative hysteroscopy]

• Asymptomatic hypervolemia can be managed by fluid restriction with or without diuretics.
• Patient should be observed for symptoms of hyponatremia and continued electrolyte monitoring should be done.

Ans. C. Lift endopelvic fascia by putting fingers in vagina

• Burch colposuspension (retropubic urethropexy) involves the attachment of the fascia at the level of the bladder neck to the iliopectineal ligament (Cooper’s ligantent).
• lt is an abdorninally perfbrmed surgery for stress urinary incontinence .

Ans. B. Concentration
[Ref: Clinical Gynecologic Endocrinology Infertility, 8′ ed]
Sperm concentrationand progressive motility is important in distinguishing fertile from infertile men but strict sperm morphology is one of the most discriminating value.

Ans. A. Preterm labour
[Ref: Williams Obstetrics 24′ ed]

• Fibronectin can be detected in cervicovaginal secretions before membrane rupture and is a marker for impending preterm labour.
• It reflects stromal remodelling of the cervix before labour.
• It is measured using an enzyme-linked immunosorbent assay, and values exceeding 50 ng/mL are considered positive

Ans. A. 5mm

[Ref: RCOG guidelines 2012]

Ans. B. Radical vulvectomy with bilateral LN dissection
[Ref: Bereks and Novaks gtnuecologt, I5’t’ ed., RCOG guidelines FIGO staging 2009]
Locally advanced vulvar cancer (bulky stage III and stage IV)

• Radical surgery (radical vulvectomy plus bilateral lymphadenectomy):
• If partial removal of other involved structures is needed (e.g., urethra, vagina, anus, bladder, rectum) and/or pelvic exenteration is necessary, consider preoperative chemoradiation

Chemoradiation (with or without subsequent completion surgery):

• This approach has been shown to decrease the need for exenterative surgery.

Ans. A. Unmotivated person
[Ref: ACOG guideline 187, November 2017]

• CuT is MEC I in ectopic pregnancy, previous history of abortion so it is safe.
• Unmotivated person is absolute contraindication for any procedure.

Ans. A. Gonadal dysgenesis
[Ref: Clinical Gynecologic Endocrinoktgt Infertility, 8″ ed]
Gonadal dysgenesis (Swyer Syndrome):

• Uncommon form of gonadal dysgenesis, characterized by a 46,XY karyotype.

Ans: A. Retrieve follicles
[Ref: Berek and Novak’s Gynaecologt]

• Day of analysis of above measurements and size of fbllictes are not specified in the question. So, presuming these parameters to be treasured on the mid cycle, next step according to the options would be to retrieve follicles.

Ans: A. USG to see cervical length
[Ref NICE guidelines; ACOG guidelines; SOGC guidelines]
The current review fromACOG recommends cervical cerclage for women with a current singleton pregnancy, prior spontaneous preterm birth at less than 34 weeks of gestation, and cervical length less than 25 mm.

Ans: B. Semi fowlers
[Ref DC Dutta’s textbook of Obstetrics, gtt’ ed]
In caesarean section, patient is placed in supine position. In order to prevent venocaval compression, l5-degree tilt is given by placing a wedge under the right hip till delivery of the baby

Ans: A. TVS
[Ref: Williams Obstetrics 24h ed”]

• Most common cause of second trimester abortion is cervicouterine abnormalities.
• Next step would be to do an ultrasound and look for any structural uterine anomaly.
• Chromosomal abnormalities are common cause of aboftions in first trimester.

Ans: A. Placenta succenturiata
[Ref: DC Dutta’s turtbook of Obstetrics, gh ed]

• Placenta succenturiata has one (usual) or more small lobes of placenta placed at a varying margin from the main placental margin.
• A leash of vessels connects the small lobe with the main lobe.
• Many times, succenturiate is retained and it presents as postpartum hemorrhage which may be primary or secondary.

Ans: C. Clear colorless to Pale Yellow

[Ref: DC Dutto’s textbook of Obstetrics, 9’t’ ed]

• Green yellow with flakes (meconium stained)- Fetal distress
• Golden color- Rh incompatibilityGreenish Ye11ow (saffron)- postmaturity
• Dark colored – concealed accidental hemorrhage
• Dark brown (tobacco juice)- Intruterine demise

Ans: A. Wait for another I week and repeat TVS
[Ref: Williams ohstetrics, 24’h ed]

• An intrauterine gestational sac is reliably visualized with transvaginal sonography by 5 weeks, and an embryo with cardiac activity by 6 weeks.
• The embryo should be visible transvaginally once the mean sac diameter has reached 20 mm, otherwise the gestation is anembryonic.
• Cardiac motion is usually visible with transvaginal imaging when the embryo length has reached 5 mm. If an embryo less than 7 mm is not identified to have cardiac activity, a subsequent examination is recommended in 1 week.

Ans. D. Blue cells in Nile Blue Test
[Ref: DC Dutla’s textbook of Obstetrics,9’t’ ed]
All of the above are correct except that it is the presence of more than 50 % orange coloured cells in Nile Blue test that suggests fetal pulmonary maturity.

Ans: C: Cauda equine syndrome
[Ref: Apley!c system of orthopaedics and fracture 9″ ed., pg. 246,480]
Cauda equina is tuft of fibres which begins at the end of spinal cord.
Compression over this part may cause cauda equina syndrome.
Causes of Cauda equina syndrome are:

• Lumbar disc herniation, Spinal canal stenosis, Trauma, Abscess etc.

Ans : B : Thomas test
[Ref. Apley’s system of orthopaedics and fracture 9’h ed., pg. 495]

• Full name of test is Hugh owen well leg hip flexion Thomas test. This test is to find out fixed flexion deformity of hip joint.
• Other test to determine Iliotibial band contracture.
• Trendelenberg test is to find out abductor weakness of hip joint
• Allis test or Galleazi sign is used to diagnose DDH in children

Ans: C: AIN
[Ref: Apley’s system of orthopaedics and fracture 9’h ed., pg. 750,758-760]

• Flexion at IP joint of thumb is caused by Flexor Pollicis Longus which is supplied by Anterior Interooseous Nerve a pure motor branch of Median nerve.
• Also AIN is most common nerve to be injured in supracondylar fracture of humerus while ulnar nerve is least common.
• But in Flexion type of injury to supracondylar fracture most common nerve to be damaged is ulnar nerve.

Ans. b. Synaptic vesicles

[Ref: Z. Taoufiq, OIST 2013]

• An ultramicroscopic image shows an isolated synapse from a brain sample before mass spectrometry analyses.
• The pre-synapse typically shows many vesicles containing neurotransmitters kept attached to the post-synapse.

Ans. A. Hippocampus
[Ref: Grays Anatomy, 41″‘ ed, pg. 439. Snell’s neuroanator?E 7h ed, pg. 310. Barr’s neuroanatomy, IAh ed”, pg. 273]

• The marked structure is fomix.
• The human fornix contains more than I million myelinated axons.
• Most of these axons originate in the subiculum.
• The rest of the axons originate in the hippocampus or are afferent to the hippocampal formation.

Ans.A. Na, k
[Ref: Ganong’s Review of Medical Physiologt,25h ed., ch-4, pg.9I]

• Na channels are fast activating and are responsible for depolarisation phase of action potential
• K channels are responsible for repolarisation phase of action potential.

Ans. A. B has done more work than A

• A: Preload
• B: Afterload.
• In preloaded condition, the relaxed state.
• In afterloaded condition, the load acts on the muscle only when its actively contraction and is supported during the relaxed state.
• External work done: Load x displacement
• In this diagram displacement is higher in B so more work is done there.

Ans. A. ESV decreases

• During exercise there is an increase in preload (end diastolic volume)- increased venous return.
• Increase in afterload – increased Mean BP and increased stroke volume due to improved myocardial contractility.
• Theretbre, the ESV is decreased in exercise

Ans. D. CMV pneumonia
[Ref. Robhins & Cotran,9’L ed., pg. 687, 705 & 717]

• The history of immune compromise is provided in the history.
• In the given image, many cells with intranuclear inclusions, suggestive of cytomegalovirus are seen.

Ans. A. Asbestosis
[Ref: Robbins & Cotran,9t’ ed., pg. 691,692]

• In the given microphotograph, there is diffuse interstitial fibrosis with presence of asbestos body.
• In asbestosis, after phagocytosis by macrophages asbestos fibers activate the inflammasome and stimulate the release of proinflammatory factors and fi brogenic mediators.
• Diffuse pulmonary interstitial fibrosis, indistinguishable from diffuse interstitial fibrosis resulting from other causes, except for asbestos bodies which are golden brown, fusiform or beaded rods with a translucent center consisting of asbestos fibers coated with an iron- containing proteinaceous material.

Ans. A. Mast cell
[Ref: Quick Reference Handbookfor Sargical Pathologists, 2011, pg. 75]

• Toluidine blue stains the Mast cells. Their cytoplasm contains metachromatic granules composed of heparin and histamine.
• It stains the mast cells violet with blue background.

Ans. A. C

• In the given image, C corresponds to condenser of microscope.
• Different parts of microscopes are marked in the following image.

Ans. C. Type 3
[Ref: Robbins & Cotran,9h ed., pg. 23 & I0B]

• Granulation tissue fill in the gaps ofwound and provide the underlyingframework for the regrowth of tissue epithelium.
• During wound healing, first a provisional matrix containing fibrin, plasmafibronectin, and type III collagen is formed, but in about2 weeks this is replaced by a matrix composed primarily of type I collagen.

Ans. A. Influenza Virus

Influenza virus life cycle:

Ans. A. Streptococcus pyogenes

• Bacitracin test is used to determine the effect of a small amount of bacitracin (0.04 IU or 0.05 IU not higher) on an organism.
• Streptococcus pyogenes (Group A Streptococci/ is inhibited by the small amount of bacitracin in the disk; other beta-hemolytic streptococci usually are not.

Ans. A. Cystoisospora

• Comparison of Coccidian Parasites Causing Diarrhea in Immunocompromised Host.

Ans. C. Praziquintal
Treatment of Cestodes:

• Praziquantel is the DOC of all cestodes followed by Niclosamide. Except, Hydatid disease and neurocysticercosis: Albendazole.

Ans. A. Dark field microscopy

• Leptospira are extremely thin, hence seen under dark ground microscope.
• They are tightly and regularly coiled, with characteristic hooked ends like umbrella handle.
• They are highly motile; exhibit spinning and translational movements.

Ans. A. EPEC
Enteropathogenic E.coli (EPEC)

• EPEC frequently cause infantile diarrhea.
• Nontoxigenic and noninvasive

Mechanism of diarrhea:

• Adhesion to intestinal mucosa mediated by plasmid coded bundle-forming pili.
• A/E lesions (attaching & effacing lesions) on the intestinal epithelium.

Ans. A. Germ tube formation
Tests for species identification:
Germ tube test:

• Reynolds Braude phenomenon, specific test for C. albicans.
• It is differentiated from pseudohyphae as there is no constriction at the origin.
• Though the test is specific for c.albicans. it may also be positive for c. dubliniensis.

Ans: D. First symptom is sweet taste

• Aconite roots are usually mistaken for horseradish root., Active principles: Aconitine⁰, pseudo-aconitine, indaconitine, picraconitine and aconine., No odour, sweet taste (mitha bish)
• The initial signs are gastrointestinal, including nausea, vomiting, and diarrhea. This is followed by a sensation of burning, tingling, and numbness in the mouth and face, and of burning in the abdomen.^[3] In severe poisonings, pronounced motor weakness occurs and cutaneous sensations of tingling and numbness spread to the limbs 
• Given flower belongs to the plant Aconite which is a cardiac poison.
• Aconitine binds with the voltage-dependent sodium-ion channels.
• Aconitine first stimulates and then paralyze the peripheral terminations of sensory, secretory and motor nerves.
• Tingling followed by numbness of mouth and throata is characteristics ymptom of aconite poisoning

Ans: D. A-4 B-3 C-2 D-l
Correct matching is below: 
Livor Mortis – Postmortem Staining:

• Marbling (Linear Branching Patterns on the Skino)

• Adipocere (Saponification):

• Mummification (Drying and Dehydration of the Body):

Ans. D. 21-22 years

• In figure 1, all the ossification centres are fused around elbow, so the age must be> 16 years.
• In figure 2, lower end of radius and ulna are fused, so the age must be atleast 18 years.
• In figure 3, Ischial tuberosity isfused, so the age must be around 20-22 years.
• So the best answer for this question would be option (d) 21-22 years

Ans: A. 3>2>l
[Ref Biostatistics Principles and Prsctice by B. Antonisamy and Mc graw hill publication, pg. 44-45]

• Given image shows three normal distribution curve of different sample size.
• All three curves have same mean but different standard deviation.
  • As the sample size is decreasing, flatness of curve increasing and peak of curve diminishing which signifies wider confidence interval for given mean.
• Narrower the base of curve, lesser the margin of error will be.
• ln given question, curve I has least margin of error followed by curve 2 and curve 3 shows highest margin of error.
  • Hence correct answer is 3>2>1.

Ans: D. Malleus
The other structures in the image shown are

• Incus
• Stapes

Ans: A. CME
[Ref 2017 Jul 28, medicine, Baltimore journal of ophthalmology]

• Most probably leakage around macula shown in given image is most likely due to CME.
• Macular hole is different entity having no association with rheumatoid arthritis & have different fundal picture.
• Choroiditis shows healed scars or oatches in retina which have more likely infectious causes.

Ans: A. Rheumatoid Arthritis
[Ref: Harrison, 18tL Ed., pg. 2738-274 1 , 2739f, 2740]
Common Joint Deformities in RA
Boutonniere deformity:

• The middle finger joint bends toward the palm while the outer finger joint may bend opposite the palm.

Swan-neck deformity:

• The base of the finger and the outermost joint bend, while the middle joint straightens.

Hitchhiker’s thumb:

• The thumb flexes at the metacarpophalangeal joint and hyperextends at the interphalangeal joint below your thumb nail.
• It is also called Z-shaped deformity of the thumb.

OA most commonly affects three parts of the hand:

• The trapeziometacarpal [TMC] or carpometacarpal [CMC] joint
• The distal interphalangeal [DIP]joint
• The proximal interphalangeal [PIP]joint

Ans: A. AF
[Ref Harrison, 18’t’ ed., pg. 1878-1879, 1878f]

• RR intervals are not regular.
• Also, P wave is not appreciable.
• So, it’s the ECG of atrial fibrillation with fast ventricular rate.

Ans: C. Doxycycline
[Ref: Harrison Iff ed”, pg. 1408t, I4I3]

• The presence of rash over the chest is typically an eschar, which is black necrotic, painless.
• Usually it is present in axilla, groin region.
• Rickettsial infections are caused by various bacterial species from the genera Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia, and Anaplasma.
• The drug most commonly used is doxycycline or tetracycline, but Azithromycin or chloramphenicol is an altemative.

Ans: B. B
[Ref: Harrison, I&h ed., pg. j236]
Patient comprehension is intact in this case, but he has difficulty in speech, resulting in development of  Broca’s aphasia.

Ans. A. Sentinel lymph node biopsy
[Ref: Master of surgery,6’t’ ed., ch-49, pg. 591-594]

• Sentinel node biopsy is based on the concept that an afferent lymphatic from a primary tumour drains first to the “‘sentinel” node befbre reaching second-tier (non-sentinel) nodes in the regional nodal basin.
• Because this sentinel node is the first node encountered by tumour cells as they metastasize to the regional nodal basin.
• It represents the tumour status of the entire nodal basin. Selective identification removal.
• And histopathologic analysis of sentinel nodes therefore can be used to identify occult nodal metastasis without undertaking complete lymph node dissection.

Ans. A. Surgical repair
[Ref: sabiston textbook ofsurgery 2Ah edition, ch-61, pg. 1746-1747 and Kaufman J & Lee M Vascular & Intementional Radiologt: The Requisites, Mosby 2004]

• The given CT Scan shows Type A Aortic Dissection.
• Type A dissection may also result in coronary artery occlusion, aortic regurgitation and pericardial tamponade and therefore management of this type of dissection is usually emergency surgical repair.
• Type B dissections are usually managed with aggressive brood pressure control unless there are complications.

Ans. B. Give steroid cover and monitor with doppler and BPP, and plan delivery

• Doppler shows absent blood flow during diastole in the brain.
• In the normal situation, the fetal MCA has a high resistance flow which means there is minimal antegrade flow in foetal diastole.
• In pathological states this can turn into a low resistance flow mainlv as a result ofthe fetal head sparing theory

Ans. A. Episiotomy scissor

• It is Braun episiotomy scissor.
• It is non-ratcheted, finger ring scissors, angled with smooth, blunt/blunt tips, and has a length of 5-1/2 inches.

Ans. A. NST
[Ref: William’s Obstetrics, 24’h ed]

• Answer should be CTG as the picture shown has tocoprobe but since that’s not in the option then the next best answer will be NST since both measure the same parameters.
• nonstress test (a procedure that measures the fetal heart rate in response to fetal movements)

Ans: C. Monochorionic monoamniotic pregnancy
[Ref: Williams’s Obstetrics, 24’h ed]
Two umbilical cords are seen arising from the same placenta and there is no intervening amniotic membrane, it is monochorionic monoamniotic placenta.

Ans: A. Renal agenesis

• EHBA/ Extra Hepatic Biliary Atresia is characterized by obliteration or discontinuity of the extrahepatic biliary system, resulting in obstruction to bile flow.
• Roux-en-Y hepatic portoenterostomy procedure (Kasai Procedure) – Standard initial operation for treatment of infants with biliary atresia

Ans: A. Rickets
[Ref Essential Orthopaedics, 5’h ed”; pg. 311]
The history of painless genu varum along with the given X-ray findings are suggestive of Rickets.

Ans: B. Diagnostic laparotomy and proceed
[Ref: Corun Pediatric Surgery, Vh ed., pg. 961]

• The given image and history is suggestive of umbilical polyp.

Umbilical polyp:

• Fine masses comprised of intestinal epithelium or uroepithel ium, which are omphalomesentenc remnants. They usually present with discharge.
• Umbilical polyps are rare and often larger than granulomas, do not respond to silver nitrate therapy
• Surgical exploration is the definitive diagnostic test.

Ans: D. Maternal and Fetal IgG

Ans: A. Tension band wiring
Tension band principle

• Distractive forces are converted into compressive forces to heal fracture site. Here distractive forces caused by quadriceps pull convert into compression at fracture site.
• There are two types of Tension band wiring
• Dynamic e.g. Fracture at Patella, Olecranon etc
• Static e.g. Fracture at medial malleolous, GT of femur

Ans: A. Supracondylar fracture of humerus
[Ref: Apley’s system of orthopaedics and fracture 9′ ed. pg. 750,758-760]

• The deformity shown in above picture is cubitus varus deformity.
• Most common cause of cubitus varus deformity is malunited supracondylar fracture of humerus .

Ans: A. Monophasic

Triphasic: forward flow in systole reverse flow in late systole / early diastole forward flow in late diastole
Biphasic: having two phases or variations having forward and reverse flow 7 reverse flow in diastole steady positive flow in the diastole, or forward flow in systole
Monophasic: single phase with slow (dampened flow) acceleration/deceleration low velocity high velocity