AIIMS PG May 2019

Ans.C. Middle finger

• 1st: largest; lateral side of index finger
• 2nd and 3rd: both attach to either side of 3rd (middle) finger
• 4th: medial side of 4th (ring) finger

Answer: c->d->a->b

Auditory pathway: SC-SLIM-41,42

• S– Spiral ganglia (cochlea)
• C– Cochlear nuclei (ponto-medullary junction)
• S-Superior olivary nucleus (pons)
• L-Lateral lemniscus (brain stem)
• I-Inferior colliculus (mid-brain)
• M-Medial geniculate body (meta-thalamus)
• 41,42 – Brodmann area (cerebral cortex)

Ans. D. anterior ethmoidal

The nasal septum also derives its blood supply from :

• Branches from the external carotid artery are the sphenopalatine artery, the greater palatine artery, the superior labial artery, and the angular artery.
• The main branches from the interior carotid are the anterior ethmoidal artery, and the posterior ethmoidal artery that supplies the septum, and these derive from the ophthalmic artery.

Ans.A. i) B. ii)  C. i) D. i) E. i)

The carotid sheath also is a tubular fascial investment that extends superiorly between the cranial base and inferiorly to the root of the neck. The carotid sheath contains the common and internal carotid arteries, internal jugular vein, and vagus nerve [cranial nerve (CN) X]. In addition, the carotid sheath contains deep cervical lymph nodes, sympathetic fibers, and the carotid sinus nerve. The cervical sympathetic trunk lies behind the sheath but is not included within it.

Ans. C. Superior border of thyroid cartilage

Common carotid artery divides into internal and external branches at the level of fourth cervical vertebra which also corresponds to the upper border of thyroid cartilage.

Branches of External carotid artery are:

• Superior thyroid artery
• Lingual artery
• Facial artery
• Ascending pharyngeal artery
• Occipital artery
• Posterior auricular artery
• Maxillary artery
• Superficial temporal artery

Branches of Internal carotid artery: 

• Cervical portion has no branches

Branches from other portions are: 

• Tympanic branch
• Artery of the pterygoid canal
• Cavernous branches
• Hypophyseal branches
• Anterior meningeal branch
• Ophthalmic artery
• Anterior cerebral artery
• Middle cerebral artery
• Posterior communicating artery
• Anterior choroidal artery

Ans. d. Attached to pelvic brim

The levator ani is made up of three parts:

• Iliococcygeus muscle
• Pubococcygeus muscle
• Puborectalis muscle

ORIGIN & Insertion:

• The levator ani arises, in front, from the posterior surface of the superior pubic ramus lateral to the symphysis; behind, from the inner surface of the spine of the ischium; and between these two points, from the obturator fascia.
• The fibers pass downward and backward to the middle line of the floor of the pelvis; the most posterior are inserted into the side of the last two segments of the coccyx; those placed more anteriorly unite with the muscle of the opposite side, in a median fibrous ridge called the anococcygeal body or raphe, which extends between the coccyx and the margin of the anus.

Action:Supports the viscera in pelvic cavity

Ans. B) Hepatic vein

• The Couinaud classification divides the liver into 8 functional segments.
• The hepatic veins are found at the periphery of each segment, whereas the center has branches of the portal veins, hepatic arteries, and bile ducts.
• The middle hepatic vein divides the liver into left and right lobes. The left hepatic vein divides the left lobe into lateral (2, 3) and medial (4a, 4b) segments. The right hepatic vein divides the right lobe into anterior (5, 8) and posterior (6, 7) segments. The caudate lobe (1) has hepatic veins that often drain directly into the IVC.

Ans. d) Abduction

• Attachments of Gluteus Medius: Origin & Insertion. Outer surface of ilium, between the posterior and anterior gluteal lines. Lateral and superior surfaces of the greater trochanter of femur
• The function of the gluteus medius muscle is to work with other muscles on the side of the hip to help pull the thigh out to the side in a motion called hip abduction.

Ans. D. Reason is true but assertion is false

• The main blood supply to the scaphoid enters through the non-articular dorsal ridge at the waist of the bone and the volar tubercle at the distal aspect of the bone.
• A dorsal branch of the radial artery accounts for 80% of the blood supply of the scaphoid.
• A separate volar arterial branch to the scaphoid enters the tubercle and accounts for 20–30% of the scaphoid’s blood supply, mainly to the distal portion.
• The proximal pole of the scaphoid relies entirely on intramedullary blood flow.
• The unusual retrograde nature of the scaphoid’s blood supply renders it especially prone to non-union and proximal pole avascular necrosis

Ans. A. ii) Cusps of valves

B. i) Papillary muscle

C. iv) Membranous IVseptum

D. iii) Left ventricle

Ans. D. Superior oblique muscle

The trochlear nerve supplies only the superior oblique muscle.

Ans. C. Tension of muscle

The Golgi tendon organ (GTO) (also called Golgi organ, tendon organ, neurotendinous organ or neurotendinous spindle) is a proprioceptive sensory receptor organ that senses changes in muscle tension. It lies at the origins and insertion of skeletal muscle fibers into the tendons of skeletal muscle.

Ans. C. Preganglionic parasympathetic nerve begin in inferior petrosal nucleus

Nerve supply:

• PARASYMPATHETIC:auriculo temporal nerve
• SYMPATHETIC SUPPLY- plexus around the external carotid artery.
• SENSORY NERVES: auriculotemporal nerve, except for parotid fascia & overlying skin which are innervated by Great auricular nerve (C2, C3).

Ans. C. Right atrium border

Ans.A ->D-> C -> B

The epidermis is composed of 4 or 5 layers, depending on the region of skin being considered.Those layers in descending order are:

• Cornified layer (stratum corneum)
  • Composed of 10 to 30 layers of polyhedral, anucleated corneocytes (final step of keratinocyte differentiation), with the palms and soles having the most layers.

• Clear/translucent layer (stratum lucidum, only in palms and soles)
  • This narrow layer is found only on the palms and soles. The epidermis of these two areas is known as “thick skin” because with this extra layer, the skin has 5 epidermal layers instead of 4

• Granular layer (stratum granulosum)
  • Keratinocytes lose their nuclei and their cytoplasm appears granular. Lipids, contained into those keratinocytes within lamellar bodies, are released into the extracellular space through exocytosis to form a lipid barrier. Those polar lipids are then converted into non-polar lipids and arranged parallel to the cell surface.
• Spinous layer (stratum spinosum)
  • Keratinocytes become connected through desmosomes and start produce lamellar bodies, from within the Golgi, enriched in polar lipids, glycosphingolipids, free sterols, phospholipids and catabolic enzymes.
  • Langerhans cells, immunologically active cells, are located in the middle of this layer.
• Basal/germinal layer (stratum basale/germinativum).
  • Composed mainly of proliferating and non-proliferating keratinocytes, attached to the basement membrane by hemidesmosomes.
  • Melanocytes are present, connected to numerous keratinocytes in this and other strata through dendrites.
  • Merkel cells are also found in the stratum basale with large numbers in touch-sensitive sites such as the fingertips and lips.

Ans. C. [Na⁺ – [HCO₃ ^–+ Cl^–]

• Formula for calculating anion gap =  Na+ -( HCO3 -+ Cl-)
• Normal anion gap is (in mEq/L) = 10-12 mEq/L

Ans. B. Pre botzinger complex

[Ref: Ganong 25Ie p656, 24Ie p658]

• Rhythmic respiration is initiated by a small group of synaptically coupled pacemaker cells in the pre-Botzinger complex (pre-BOTC) on either side of the medulla between the nucleus ambiguus and the lateral reticular nucleus.
• The main components of the respiratory control pattern generator responsible for automatic respiration are located in the medulla.
• Rhythmic respiration is initiated by a small group of synaptically coupled pacemaker cells in the pre-Botzinger complex (pre-BOTC) on either side of the medulla between the nucleus ambiguus and the lateral reticular nucleus.

Ans. D. DHEA

• DHEA is an endogenous steroid hormone. This means it is naturally made by the body, and it spurs specific tissues or cells into action.
  • It is also known as androstenolone, 3ß-hydroxyandrost-5-en-17-one and 5-androsten-3ß-ol-17-one.
• DHEA is one of the most abundant steroid hormones in the human body. It is produced by the adrenal glands, the gonads, and the brain.
  • It is normally found in the form of dehydroepiandrosterone sulfate (DHEAS).
• The body holds DHEAS in reserve and converts it to specific hormones when needed.
  • It is important for creating estrogen and androgen sex hormones and contributes to the development of so-called androgenic effects, or masculinization.
  • These changes include the production of oilier skin, changes in body odor, and the growth of armpit and pubic hair.

Ans. C. XII, XI, IX, X

Ans. D. Tubulin

• The building block of a microtubule is the tubulin subunit, a heterodimer of a- and ß-tubulin.

Ans. A. Muscle Tension

(Ref.: Ganong 25/e p232; Guyton 13/e p697, 701).

• Golgi tendon organ senses muscle tension.
• The Golgi organ (also called Golgi tendon organ, GTO, tendon organ, neurotendinous organ or neurotendinous spindle) senses changes in muscle tension.
• It is a proprioceptive sensory receptor organ that is at the origin and insertion of skeletal muscle fibers into the tendons of skeletal muscle.
• It provides the sensory component of the Golgi tendon reflex.

Ans. A. Thyroxine

• Intracellular receptors are transcription factors that have binding sites for the hormone (ligand) and for DNA and function as ligand (hormone)-regulated transcription factors.
• Steroid hormones and the steroid derivative vitamin D3 fulfill this requirement.
• Thyroid hormones must be actively transported into the cell.

Ans. A. ADH

• Osmolarity and volume status are the two greatest factors that affect ADH secretion.
• However, a variety of other factors promote ADH secretion as well.
• These include angiotensin II, pain, nausea, hypoglycemia, nicotine, opiates, and certain medications.
• ADH secretion is also negatively affected by ethanol, alpha-adrenergic agonists, and atrial natriuretic peptide.
• Ethanol’s inhibitory effect helps to explain the increased diuresis experienced during intoxicated states as well as increased free water loss; without appropriate ADH secretion, more water is excreted by the kidneys.

Ans. D. Single breath nitrogen test

(Ref: Ganong 25/e p633, 634, 24/e p633, 634)

Anatomical dead space – Calculation:

• By Bohr’s equation – Uses single breath nitrogen inhalation technique.

Xenon/Helium dilution technique:

• Used to measure functional residual capacity of lung.

Spirometry:

• Cannot measure residual or dead space volumes.

Ans. D. All of the above

Determinants of GFR:

• Increase glomerular capillary hydrostatic pressure increases GFR. Glomerular hydrostatic pressure is determined by the following variables : i) Arterial pressure, ii)Afferent arteriolar resistance; iii) Efferent arteriolar resistance.
• Contraction of mesangial cells (therefore decrease in GFR) is produced by : – Endothelin, angiotensin II, vasopressin, norepinephrine, PAF, PDGF, thromboxane A2,PGF2, Leukotrienes C4 & D4, Histamine.

Ans. A. Nucleus Ambiguus

• The nucleus ambiguus in its “external formation” contains cholinergic preganglionic parasympathetic neurons for the heart.
• These neurons are cardioinhibitory.
• This cardioinhibitory effect is one of the means by which quick changes in blood pressure are achieved by the central nervous system (the primary means being changes in sympathetic nervous system activity, which constricts arterioles and makes the heart pump faster and harder).

Answer-A-change in A1-A4

• A6-A11 is intra disulphide bonds.A7-B7,A20-B19 are interchain bonds
• So A1-A4 is the only amino acid not involved in insulin formation, so the best Answer is change in A1-A4

Answer-(A) Succinyl-CoA

• All the carbon and nitrogen atoms of the porphyrin molecule are provided by glycine
• (a nonessential amino acid) and succinyl coenzyme A (an intermediate in the citric acid cycle) that condense to form ALA in a  reaction catalyzed by ALA synthase(ALAS)
• Heme synthesis also requires a functional tricarboxylic acid cycle and an oxygen supply.
• Heme synthesis starts in mitochondria with the condensation of succinyl-CoA with the amino acid glycine,  activated by pyridoxal phosphate.
• ALA synthase is the rate-limiting enzyme of heme synthesis. ALA molecules enter the cytoplasm, where their union in the presence of ALA dehydratase yields porphobilinogen(PBG) and water molecules.

Ans-D-Mitocondrial inheritance , it  is the only non-chromosomal DNA in human cells.

• Mitochondria! DNA, is always maternally inherited.
• Mitochondrial and nuclear DNA are located in different places in the cell. During fertilization, the sperm and egg cell nuclei fuse to form an embryo.
• The egg cell is very large compared to the sperm, so although the cells nuclei fuse, the rest of the cell mass in the embryo comes from the egg only.
• Nuclear DNA is therefore co-inherited but the mitochondrial DNA, which is located outside of the nucleus, is always maternally inherited because all mitochondria in a foetus and later adult are derived from the mitochondria in the mother ‘s egg.
• So, in diseases showing mitochondria! inheritance all children from affected mother will inherit the disease but it will not be transmitted from an affected father to his children.

Ans- C- Pyruvate Carboxylase

• aminoacids in raw eggs are more easily accessed by the body. When aminoacids enter the bloodstream, they stimulate the hormone insulin, which is an anabolic hormone that drives them into the cells.
• Raw egg contain avidin which is antagonist of biotin, so this person is deficient in biotin,
• Carboxylase reaction need biotin, so answer is pyruvate carboxylase.

Answer- C- point mutation.

• Sickle-cell anemia is caused by a point mutation in the ß-globin chain of hemoglobin, causing the hydrophilic amino acid glutamic acid to be replaced with the hydrophobic amino acid valine at the sixth position.
• It is caused by a point mutation (Base substitution mutation) at the sixth position of the ß-globin chain leading to subsitution of a valine residue for a glutamic acid residue resulting in sickle hemoglobin (HbS).
• Sickle cell anemia is an autosomal recessive disorder.

Ans -C- RNA editing

• In rna editing editosome can edit only in 3? 5 direction, along with primary rna transcript.
• DNA replication goes in the 5′ to 3‘ direction because DNA polymerase acts on the 3′-OH of the existing strand for adding free nucleotides.
• In transcription the complementary RNA is created in the opposite direction, in the 5′ ? 3′ direction, matching the sequence of the sense strand with the exception of switching uracil for thymine.
• When the strand containing the mis-match is identified, an endonuclease nicks the strand and the mis-matched nucleotide(s) is/are removed by an exonuclease.

Ans – B- Ferroportin

• By inhibiting ferroportin, hepcidin prevents enterocytes from allowing iron into the hepatic portal system, thereby reducing dietary iron absorption.
• The iron release from macrophages is also reduced by ferroportin inhibition.

Ans-B-Transketolase level in blood

• Pyruvate dehydrogenase in carbohydrate metabolism, which catalyzes the conversion of pyruvate to acetyl CoA.
• a-Ketoglutarate dehydrogenase in citric acid cycle, which catalyzes the conversion of a-ketogluta rate to succinyl CoA.
• Branched-chain keto acid dehydrogenase which catalyzes the oxidative decarboxylation of branched chain keto amino acids, i.e. leucine, isoleucine and valine.
• Thiamine diphosphate is also the coenzyme for transketolase, in the pentose phosphate pathway. There­fore, thiamine nutritional status is best assessed by erythrocyte (preferred) or whole blood transketolase activity.

Answer-A-Enzyme  efficiency

• “The  Km of  an  enzyme  is  the  concentration  of  the  substrate  that  enables  the  enzyme  to
• Function at  half maximum  activity and is therefore  a measure  of the  specificity  of a substrate for the  enzyme” .
• Actually  enzyme  specificity is  not measured  by alone.
• It  is  measured  by the  ratio  Kcat  /Km  which  is  a second  order  rate constant  for  the  reaction between  substrate  and  free  enzyme.
• This  ratio  is  important,  for  it  provides  a direct  measure of  enzyme  eficiency and  specificity.
• Note:  Km, is  turnover  number  and  measures  tJre  rate  of  the  catalytic  process

Answer-C-Pyruvate kinase

• Mitochondrial  pyruvate  carboxylase catalyzes  the carboxylation  of  Pyruvate  to  Oxaloacetate, It  is  an  ATP-requiring  reaction, Biotin  is  the  coenzyme.
• Phosphoenolpyruvate  Carboxykinase: Catalyzes  the  decarboxylation  and phosphorylation of oxaloacetate  to  phosphoenolpyruvate(PEPCK)  (Cytosol)  using  GTP as the  phosphate  donor.
• The conversion of glucose-6-phosphate  to  glucose  is catalyzed  by glucose  6-phosphatase

Answer-B-Decrease in activation  energy

• The enzymes  speed  up chemical  reactions by  lowering  the  magnitude  of the  activation  energy  banier,  i.e.,free energy  of Activation.

Answer-C-Point C represents the region where the net charge on glycine is zero

• C represents the isoelectric  point or pI, and as such is midway between pK1
• and pK2 for this monoamino monocarboxylic acid.
• Glycine is fully protonated at Point A. Point B represents a region of maximum buffering, as does Point D.
• Point E represents the region where glycine is fully deprotonated.

Answer: B. If both assertion and reason are true but the reason is not the correct explanation of the assertion

• Biosynthesis of protein is under direct control of DNA in most cases or else under the control of genetic RNA where DNA is absent. Sequences of bases in a particular segment of a polynucleotide chain will determine the sequence of amino acids in a particular polypeptide.
• The relationship is popularly known as central dogma. Flow of information is one way i.e., from DNA, information is transferred to RNA (mRNA) and from RNA to protein.
•  Temin (1970) reported that retroviruses operate a central dogma reverse or teminism inside host cells. Genomic RNA of these viruses first synthesizes DNA through reverse transcription. DNA then transfers information to messenger RNA which takes part in translation of the coded information to form polypeptide.

(i) One way flow of information (central dogma)

DNA(transcription) ? RNA (translation) ? proteins

(i) Reverse flow of transcription information

DNA(transcription) ?RNA(translation) ? proteins

Answer-A-Gention violet ? IodinE ? Carbol fuchsin

1. Application of the primary stain (crystal violet). Gention violet also known as crystal violet stains all cells blue/purple
2. Application of mordant: The iodine solution (mordant) is added to form a crystal violet-iodine (CV-I) complex; all cells continue to appear blue.
3. Decolorization step: The decolorization step distinguishes gram-positive from gram-negative cells. The organic solvent such as acetone or ethanol, extracts the blue dye complex from the lipid-rich, thin-walled gram-negative bacteria to a greater degree than from the lipid-poor, thick-walled, gram-positive bacteria.  The gram-negative bacteria appear colorless and gram-positive bacteria remain blue.
4. Application of counterstain (safranin): The red dye safranin stains the decolorized gram-negative cells red/pink; the gram-positive bacteria remain blue.

NOTE ? If you are struggling to remember the staining reagents used in this procedure and their order you can remember this sentence “Come In And Stain” i.e. the order is Crystal violet, Iodine, Alcohol/Acetone and the final one is Safranin.

Answer-D-IgE

• When someone has allergies, their immune system makes an antibody called immunoglobulin E (IgE). These antibodies respond to allergens. The symptoms that result are an allergic reaction.
• IgE also has an essential role in type I hypersensitivity, which manifests in various allergic diseases, such as allergic asthma, most types of sinusitis, allergic rhinitis, food allergies, and specific types of chronic urticaria and atopic dermatitis.

Answer- B-i.e., Filariasis , the given image is of culex mosquito.

Ans. is ‘a’ i.e., Early relapsing syphilis

• Chancre redux is the appearance of relapsing lesion at the site of the healed lesion, it is due to relapse of original infection (not due to reinfection)

Answer-C-Herpes simplex virus

• Herpes simplex is the primary cause of erythema multiforme, and the virus is present in 70 percent of recurrent erythema multiforme cases. Both types of herpes simplex virus (HSV) can cause the condition, but HSV-1, which also causes cold sores, is responsible for most cases.

Causes of Erythema multiforme

• Idiopathic ? Most common cause
• Viral ? HSV (most important) HBV, Mumps, Adenovirus
• Bacteria ? Streptococci, tuberculosis
• Fungal ? Coccidioidomycosis, Histoplasmosis.
• Drugs ? Antibiotics (Sulphonamide), Phenytoin, NSAIDS.
• Autoimmune disease ? SLE, thyroiditis, RA
• Others ? Sarcoidosis, Pregnancy, Malignancy.

Answer-D-fluoroquinolones,

• Clostridium difficile colitis results from a disturbance of the normal bacterial flora of the colon, colonization by C difficile, and the release of toxins that cause mucosal inflammation and damage.
• It is a spore-forming bacillus that is responsible for the development of antibiotic-associated diarrhea and colitis.
• The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins,penicillins and clindamycin. Once established, C. difficile can produce toxins that attack the lining of the intestine

Answer-D- Histoplasma capsulatum

• Dimorphic fungi are fungi that can exist in the form of both mold and yeast. An example is Penicillium marneffei, a human pathogen that grows as a mold at room temperature, and as a yeast at human body temperature.

Mnemonics: Body Heat Probably (Changes) Shape

• Blastomyces dermatitidis, Histoplasma capsulatum, Paracoccidioides brasiliensis, (Coccidioides immitis) is in parentheses because it changes to a spherule of endospores, not yeast, in the heat), Sporothrix schenckii.

Answer-B-Leishmania

• It is a disease caused by protozoan parasites of the genus Leishmania and spread by the bite of certain types of sandflies.
• The disease can present in three main ways: cutaneous, mucocutaneous, or visceral leishmaniasis(Kala azar/Black fever).
• The cutaneous form presents with skin ulcers, while the mucocutaneous form presents with ulcers of the skin, mouth, and nose, and the visceral form starts with skin ulcers and then later presents with fever, low red blood cells, and enlarged spleen and liver.
• Microscopic examination:direct visualization of the intracellular Amastigotes (Leishman-Donovan bodies).Amastigotes( formed after the macrophage phagocytizes an infective promastigote) are seen within blood and spleen monocytes or, less commonly, in circulating neutrophils and in aspirated tissue macrophages. They are small, round bodies 2–4 µm in diameter with indistinct cytoplasm, a nucleus, and a small, rod-shaped kinetoplast.
• Culture:Growth of Promastigotes in days to weeks.Promastigotes are characterized by a flagellum and a kinetoplast anterior to the nucleus. They are the infective stage to humans.

Answer-B-scrub typhus

• It is a form of typhus caused by Orientia tsutsugamushi first isolated and identified in 1930 in Japan
• Scrub typhus is transmitted by some species of trombiculid mites (“chiggers”, particularly Leptotrombidium deliense), which are found in areas of heavy scrub vegetation.
• The bite of this mite leaves a characteristic black eschar that is useful for making the diagnosis.
• Scrub typhus is endemic to a part of the world known as the “tsutsugamushi triangle” (after the name “Orientia tsutsugamushi” (formerly “Rickettsia tsutsugamushi”), the obligate intracellular gram-negative bacterium causing same), which extends from northern Japan and far-eastern Russia in the north, to the territories around the Solomon Sea into northern Australia in the south, and to Pakistan and Afghanistan in the west.

Answer-C-M. Indicus pranii

• Killed Mycobacterium indicus pranii (previously known as Mycobacterium w, popularly known as Mw) vaccine has earlier been investigated in genital warts with encouraging results
• Mycobacterium w vaccine, a useful adjuvant to multidrug therapy in multibacillary leprosy.

Answer-B-malaria

• The possession of the sickle cell allele protects these individuals against malaria because the parasite dies when potassium leaks out of RBCs as they become sickle shaped.
• Types,of anemia that have protective effect against P. falciparum malaria : – G6PD deficiency, Sickle cell anemia, Thalassemia, HbC, Pyruvate kinase deficiency

Answer- A-Plasmodium falciparum

• Plasmodium falciparum REF: Harrison^‘s 17^th edition, chapter 203
• Cerebral Malaria: Coma is a characteristic and ominous feature of falciparum malaria and, despite treatment, is associated with death rates of 20% among adults and 15% among children. Any obtundation, delirium, or abnormal behavior should be taken very seriously. The onset may be gradual or sudden following a convulsion

Ans. A. Chlorthalidone 

• Thiazide diuretics are inexpensive, are generally well tolerated, and are recommended as a first-line therapy in the treatment of hypertension in the elderly population.
• Thiazide diuretics are as effective as any drug for first-line treatment of hypertension in the elderly population is the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study.
• Patients who received the diuretic had a lower incidence of CV events (secondary outcomes) compared with the other groups. The diuretic treatment group had lower HF rates compared with the CCB group

Ans. A. Ulcerated infantile hemangioma

[Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3800297/]

• Infantile hemangiomas (IHs) are the most common benign pediatric soft-tissue tumors.
• Ulceration—the most frequent complication of IH—tends to heal poorly and is associated with pain, bleeding, infection, and scarring.
• Mainstay treatment modalities include propranolol (ß-blocker) and corticosteroids, whose effectiveness is countered by a need for long-term medication and risk of systemic adverse effects and ulcer recurrence.

Ans. B. Dinoprostone

• Postpartum hemorrhage, the loss of more than 500 mL of blood after delivery, occurs in up to 18 percent of births and is the most common maternal morbidity in developed countries.

Dinoprostone:

• Naturally occurring prostaglandin E2 (PGE2). It has important effects in labour.
• It also stimulates osteoblasts to release factors which stimulates bone resorption by osteoclasts.
• As a prescription drug it is used as a vaginal suppository, to prepare the cervix for labour and to induce labour.

Indication:

• For the termination of pregnancy during the second trimester (from the 12th through the 20th gestational week as calculated from the first day of the last normal menstrual period), as well as for evacuation of the uterine contents in the management of missed abortion or intrauterine fetal death up to 28 weeks of gestational age as calculated from the first day of the last normal menstrual period.
• In the management of nonmetastatic gestational trophoblastic disease (benign hydatidiform mole).
• Other indications include improving the cervical inducibility (cervical “ripening”) in pregnant women at or near term with a medical or obstetrical need for labor induction, and the management of postpartum hemorrhage.

Ans. A. Paracetamol 

• Acute liver failure after administration of paracetamol at the maximum recommended daily dose in adults.
• Paracetamol is the most commonly used analgesic and antipyretic in the world; it can be bought without prescription in most countries despite being the commonest cause of acute liver failure in western Europe.
• Prescribing information suggests that it is safe to use in adults in divided doses that total 4 g daily.
• Malnutrition, starvation, chronic alcohol misuse, and concomitant use of drugs that induce cytochrome P450 enzymes increase the risk of hepatotoxicity induced by paracetamol.

Ans. A. Topical bacitracin

• MRSA (methicillin-resistant Staphylococcus aureus) infection is a life-threatening bacterial infection caused by Staphylococcus aureus that is resistant to the antibiotic methicillin. Severe cases usually require hospitalization for treatment.
• MRSA infections are usually treated with systemic antibiotics, either orally or intravenously.
• Topical bacitracin in combination with neomycin and polymyxin B might be added to the therapy.

Ans. B. Sulfonamide

Drugs causing fixed drug eruption

• Paracetamol (Phenacetin)
• Sulfonamides
• NSAIDs
• Aspirin
• Barbiturates
• Dapsone
• Tetracyclines
• Phenylbutazone

Ans. D. Fixclot 

• Topical hemostatic agents are used when surgical hemostasis is inadequate or impractical. The majority of routine, elective operations are performed in patients with normal hemostasis and with minimal blood loss.
• The two main categories of topical hemostatic agents are physical agents, which promote hemostasis using a passive substrate, and biologically active agents, which enhance coagulation at the bleeding site.

Ans. A. By binding with trivalent Fe3+

• Deferoxamine works in treating iron toxicity by binding trivalent (ferric) iron (for which it has a strong affinity), forming ferrioxamine, a stable complex which is eliminated via the kidneys.
• 100 mg of deferoxamine is capable of binding approximately 8.5 mg of trivalent (ferric) iron.
• Deferoxamine works in treating aluminum toxicity by binding to tissue-bound aluminum to form aluminoxamine, a stable, water-soluble complex.
  • The formation of aluminoxamine increases blood concentrations of aluminum, resulting in an increased concentration gradient between the blood and dialysate, boosting the removal of aluminum during dialysis.
• 100 mg of deferoxamine is capable of binding approximately 4.1 mg of aluminum.

Ans. C. Sialorrhea

• Escitalopram belongs to a class of drugs known as selective serotonin reuptake inhibitors (SSRI).
• Improves your energy levels and feelings of well-being and decrease nervousness.
• Used to treat depression and anxiety.

MOA:

• Works by helping to restore the serotonin balance in the brain.

S/E:

• Headache, Nausea, Ejaculation disorder, Somnolence, Insomnia, Dry mouth, Constipation, Fatigue, Libido decreased, Inability to achieve orgasm, Gas (flatulence), Toothache, Weight gain, Menstrual disorder, Neck/shoulder pain, Runny nose & Flu-like syndrome.

Ans. A. 1, 3 and 4 are correct

Chlorpromazine:

• Chlorpromazine is a psychotropic agent indicated for the treatment of schizophrenia. It also exerts sedative and antiemetic activity.
• Chlorpromazine has actions at all levels of the central nervous system-primarily at subcortical levels-as well as on multiple organ systems.
• Chlorpromazine has strong antiadrenergic and weaker peripheral anticholinergic activity; ganglionic blocking action is relatively slight.
• It also possesses slight antihistaminic and antiserotonin activity.
• Traditional antipsychotic agent with anti-emetic activity. 

MOA:

• Exerts its antipsychotic effect by blocking postsynaptic dopamine receptors in cortical and limbic areas of the brain, thereby preventing the excess of dopamine in the brain.
• This leads to a reduction in psychotic symptoms, such as hallucinations and delusions.
• Chlorpromazine appears to exert its anti-emetic activity by blocking dopamine receptors in the chemical trigger zone (CTZ) in the brain, thereby relieving nausea and vomiting.

Ans. B. 1, 2 and 3 are correct

Sodium glucose co-transporter-2:

• Sodium  glucose co-transporter-2 [SGLT-2] present in proximal tubules.
• Glucose is freely filtered across glomerulus & is 100% reabsorbed in proximal tubules, via SGLT-2.

Sodium glucose co-transporter-2 inhibitors (SGLT-2 inhibitors):

• SGLT-2 inhibitors acts by inhibiting this transporter ? Causing glucosuria in diabetics ? causes weight loss.
• Effective orally.
• Efficacy reduced in renal failure.

Side effects:

• Ketoacidosis, Urosepsi, Fournier’s gangrene, Increased incidence of UTI & genital infections.

Ans. A. Both Assertion and Reason are true and Reason is correct explanation of Assertion

ACYCLOVIR

• Antiviral drug.
• Requires virus-specific enzyme for conversion to active metabolite inhibiting DNA synthesis & viral replication.
• Varicella-zoster viruses are not as sensitive as herpes simplex viruses.

INDICATIONS:

Herpes simplex:

• For genital primary infections.
• Oral acyclovir – Faster healing rate than acyclovir ointment.

For herpes simplex keratitis:

• Local/oral therapy successful.
• Herpes simplex encephalitis & herpes simplex neonatorum:

• Must be treated intravenously.

Frequently relapsing herpes simplex (labial/genital):

• Long-term, prophylactic acyclovir administration.

Ans. All are true about digoxin toxicity.

DIGOXIN TOXICITY:

Features:

• Generally unwell & lethargy.
• Nausea & vomiting.
• Confusion.
• Yellow-green vision.
• Arrhythmias (e.g. AV block, bradycardia)
• Dizziness.

Precipitating factors:

• Renal disease   
• Hypokalaemia
• Hypomagnesemia     
• Hypoalbuminemia
• Hypothermia
• Hypothyroidism
• Hypercalcemia.
• Hypernatremia
• Acidosis.
• Myocardial ischaemia.
• Partial AV block.

Drugs:

• Amiodarone.
• Quinidine.
• Verapamil.
• Spironolactone.
• Furosemide.
• Hydrochlorothiazide  – Compete with DCT secretion, hence reducing excretion.

Management

• Digibind.
• Correct ventricular arrhythmia by lignocaine.

• Bradyarrhythmias by propanolol.
• Atrial tachyarrhythmias by atropine.

• Phenytoin.
• Monitor K+

Ans:  A, B & C are True

A & C are false.

Multidrug resistance of P. Falciparum is seen when the parasite is resistant to more than two operational antimalarial compounds of different chemical classes and modes of action.

Ans. C. 1-G, 2-C, 3-F, 4-E

• Amiodarone – Corneal microdeposits.
• Hydroxychloroquine – Retinopathy
• Systemic steroids – Cataract
• Digoxin – Yellow vision.

Ans: A, B & C are True

D & E are false

• Acidic drugs with pKa 3.5:
  • Largely unionized at acid gastric pH & absorbed from stomach.
  • Eg: Aspirin.
• Basic drugs with pKa 10:
  • Largely ionized & are absorbed only in intestines.
  • Eg: Atropine
• Unionized form is lipid soluble & ionized form is water soluble.
  • Medium is same, hence drugs cross membrane.

Acidic drugs are lipid soluble (un-ionized form) in acidic medium.

• Eg: In acidic gastric pH these acidic drugs are more likely to be absorbed from stomach.
  • Due to presence of unionized (lipid soluble) form.
• Hence, aspirin is more likely to be absorbed in stomach than morphine or atropine (basic drugs).
  • This is reason for aspirin-induced gastric mucosal irritation. 

Ion trapping:

• Unionized drugs reverts back to ionized form within cell (pH 7.0) before passing to ECF.
  • Referred as “ion trapping”.
  • Ie., Weak electrolyte crossing a membrane to encounter a pH from which it is not able to escape easily.
• Basic drugs attain higher concentration intracellularly (pH 7.0 vs 7.4 of plasma).

Ans. B. 1-D, 2-A, 3-B, 4-F

• Praziquantel – Tapeworms
• Diethylcarbamazine – Filaria
• Nitazoxanide – Giardia
• Mebendazole – Ascaris lumbricoides

Ans. A. 1-C, 2-A, 3-D, 4-B 

• Propofol – Avoided in patients with egg Allergy
• Fentanyl – Rigid chest syndrome
• Midazolam – Hypotension
• Nitrous oxide – Pulmonary vasoconstriction

Ans. D. 1-F, 2-E, 3-B, 4-A

• HCN – Amyl nitrite
• Paracetamol  – N-acetylcysteine
• Morphine  – Nalorphine
• Nicotine – Trimethadione

Answer- C’- hypostasia-(suggligation)

• The accumulation of fluid or blood in the lower parts of the body or organs under the influence of gravity, as occurs in cases of poor circulation or after death.
• hypostasis or suggillation, is the fourth stage of death and one of the signs of death. It is a settling of the blood in the lower, or dependent, portion of the body postmortem, causing a purplish red discoloration of the skin.
• When the heart stops functioning and is no longer agitating the blood, heavy red blood cells sink through the serum by action of gravity. The blood travels faster in warmer conditions and slower in colder conditions.

Answer- C-Fracture or dislocation of a bone or tooth is the seventh clause of grievous hurt 

Sec-320 ? following kinds of hurt only are designated as “grievous”:-

1. Firstly.-Emasculation
2. Secondly.-Permanent privation of the sight of either eye.
3. Thirdly.-Permanent privation of the hearing of either ear.
4. Fourthly.-Privation of any member or joint.
5. Fifthly.-Destruction or permanent impairing of the powers of any member or joint.
6. Sixthly.-Permanent disfiguration of the head or face.
7. Seventhly.-Fracture or dislocation of a bone or tooth.
8. Eighthly.-Any hurt which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain, or unable to follow his ordinary pursuits.

Ans- C-hypothermia

• Paradoxical undressing is a term for a phenomenon frequently seen in cases of lethal hypothermia. Shortly before death, the person will remove all their clothes, as if they were burning up, when in fact they are freezing.

Ans. A. Drug ingestion

• Parasuicide is a suicide attempt or gesture and self-harm where there is no result in death. It is a non₇fatal act in which a person deliberately causes injury to him or herself or ingests any prescribed or generally recognized therapeutic dose in excess.
• It is considered to be a serious public health issue. Parasuicide is the strongest known indicator for a future successful suicide attempt.
• Examples of suicidal gestures include cutting, where the cut is not deep enough to cause significant blood loss, or taking a non-lethal overdose of medication.’- http://en.wikipedia.org/wiki/Parasuicide
• `Maximum cases of near-suicides are due to drug overdose. In India, wrist cutting is equally common, but drug overdose is by far the most common cause of parasuicide in the world.’- Methods used for parasuicide: results of the WHO/EURO Multicentre Study on Parasuicide.

Ans.  is’B’i.e.,Corrosive poison

• Corrosives  fix,  destroy  and erode  the  surface  with  which  they  come  in contact.  Thus, they  cause  extensive  tissue damage.
• Irritants  produce  less  severe  damage  than  corrosives  and  produces ‘symPtoms simulating  gastroenteritis’

Answer B. Evisceration by sharp weapon

• In blunt rupture of eye the complete eye will not be missing. Also since the blood is present in the socket so post mortem artifact is ruled out.
• Evisceration by Sharp object  the eye ball will be completely missing. Some injury to mouth or nose can be due to trauma in those areas.

Answer-C- prothrombin time

The PT measures the time necessary to generate fibrin after activation of factor VII. It measures the integrity of the “extrinsic” and  “common” pathways (factors VII, V, X, prothrombin, and fibrinogen).

Answer-A-24 hrs and 48hrs

There are 3 appointments,  marks must be visible at the third appointment, usually 24–48 hours later (72–96 hours after application).

Answer- A, B, C, D

1. Dohle bodies-  dilated rough ER
2. Auer rodes- aurophilic
3. Flame cells- HbF
4. Howel jolly body- DNA remnants

Answer- D- Necrosis

Direct injury to the endothelium causes cell necrosis and appearance of physical gaps at the sites of detached endothelial cells.

In necrosis phospholipase activation occurs that leads to cell damage and leakage of enzymes outside the cell is followed by inflammatory cells resulting in inflammation.

Answer- D. Keratocyte

Types of cells found within the stratum basale are melanocytes (pigment-producing cells), Langerhans cells (immune cells), and Merkel cells (touch receptors).

Answer- B. DENS DEPOSITION OF MITOCHONDRIA

The ultrastructural charges (seen on electron microscopy) are :-

1. Plasma membrane alterations ? Blebbing blunting loss of microvilli.
2. Mitochondrial changes ? Swelling, small amorphous densities.
3. Dilatation of ER and detachment of ribosome
4. Nuclear alterations

Answer- B. Post-infectious Glomerulonephritis

• Focal segmental glomerulosclerosis is characterised by a sclerosis of segments of some glomerules. It is likely to present as a nephrotic syndrome.
• Membranous glomerulonephritis may cause either nephrotic or a nephritic syndrome.
• Post-infectious glomerulonephritis- present with malaise, a slight fever, nausea and a mild nephritic syndrome of moderately increased blood pressure, gross haematuria, and smoky-brown urine.
• Membranoproliferative GN (MPGN), also known as mesangiocapillary glomerulonephritis- present with the nephritic syndrome, hypocomplementemia.

Answer- D. Organ transplantation case

Chimerism can occur in animals is by organ transplantation, giving one individual tissues that developed from a different genome. For example, transplantation of bone marrow often determines the recipient’s ensuing blood type.

Answer- C. CD 4 & CD 25 marker

Tregs express the biomarkers CD4, FOXP3, and CD25.

Answer- D. Myostitis ossificans

Myositis Ossificans (MO) is an unusual pathological entity still largely unknown, characterized by dystrophic calcification leading to heterotopic ossification of intramuscular connective tissue.

Answer- A, B, C, D

1. Bullous Pemphigoid
2. Epidermolysis Bullosa
3. Pemphigous Vulgaris
4. IgA pemphigus

Answer-C. ??– 2 microglobulin

Hemodialysis-associated amyloidosis-

Associated disease is Chronic renal failure

Major fibril protein is A??2m

Clinically related precurosr protein- Beta- 2 microglobulin

Answer- C. Apple green birefringence

Congo red staining shows an apple-green birefringence under polarized light, a diagnostic feature of amyloid.

Answer- D. Anti HbcAg IgG

• Best marker for diagnosing acute hepatitis B is IgM anti-HBc as it is found only in the acute phase of hepatitis B (In chronic hepa­titis IgG anti-HBc is found).

Answer- B. Chromoblastomycosis

Medlar bodies, also known as sclerotic or muriform cell.

When present in skin or subcutaneous tissue, the cells are indicative of chromoblastomycosis.

Answer-A-p53

Cell cycle inhibitors

1. CIP/KIP family ? p21, p27, p57
2. INK4a/ARF family ? p161 NK4a, pl4ARF

• A G1 arrest can result simply by the p53 induced expression of p21 WAF1/CIP1/Sdi1
• P53 also down regulates the expression of cyclin A, providing a secondary break on cell cycle progression into the through the S phase.

Ans: B.  Incision and drainage is the treatment of choice 

Thyroglossal cyst is a fluid filled sac resulting from a persistent thyroglossal duct.

Excision of the thyroglossal cyst along with the track and the body of the hyoid bone is the treatment of choice (Sistrunk’s operation).

Ref: Problem Based Approach in Pediatric Surgery By Rao, Page 108; Bailey and Love’s Short Practice of Surgery, 24th Edition, Pages 777-78.

Answer-B- stapedial otosclerosis

• In otosclerosis the normal dense endochondral layer of the bony otic capsule gets replaced by irregularly laid spongy bone. Most common site is fissula ante fenestram (anterior to
• the oval window)
• Age group affected is 20-45 years (maximum between 20-30 years). Male:female ratio is 1:2.
• meniere’s  disease i.e Endolymphatic  hydrops     leads  to  SNHL  and  not  conductive  hearing  loss.
• Tuning ForkTests in Otosclerosis: Rinnes test-negative ,Weber’s test-lateralized to ear with greater conductive loss.

Answer-:A: photoreceptor

• Rods and cones are the first-order receptor cells that respond directly to light stimulation.
• Bipolar neurons are the second-order neurons that relay stimuli from the rods and cones to the ganglion cells.
• Ganglion cells third-order neurons that form the optic nerve (CN II).

Answer A. IOL should be removed in case of Posterior Capsule ossification [PCO]

1. The indications for removing an intraocular lens (IOL) are:

• Chronic uveitis
• Endothelial corneal dystrophy
• Uncontrollalbe glaucoma
• Metal loop cutting pupillary sphincter
• Gross decentration of IOL (fibrous bands)
• Extraocular dislocation of IOL G. Recurrent severe hyphema
• Development of rubeosis iridis
• Removal of iris (1) Iris tumor (2) Epithelial downgrowth
• Endophthalmitis
• Unilateral IOL in pending bilateral aphakia 

2. The following may be indications for removing and/or replacing and/or replacing an IOL:

• Wrong dioptric power
• Foreign body attached to IOL
• IOL covered with pigment
• Repair retinal detachment after extracapsular cataract extraction
• Choyce lens too short
• Dannheim IOL with absorbed supramid loop tips
• Dislocated Ridley IOL
• Sclero-conjunctival erosion of Strampelli’s “external-fixation” IOL loop

Reference – https://www.ncbi.nlm.nih.gov/pubmed/904866

Answer-A-Marcus gun pupil

• RELATIVE AFFERENT PATHWAY DEFECT (RAPD) OR MARCUS GUNN PUPIL It is the paradoxical response of a pupil to light in the presence of a relative afferent pathway defect (RAPD). Caused by an incomplete optic nerve lesion or a severe retinal disease. It is best tested by ‘swinging flashlight test’.
• Normally, both pupils constrict equally and the pupil to which light is transferred remains tightly constricted.
• In the presence of RAPD in one eye, the affected pupil will dilate (paradoxical response) when the flashlight is moved from the normal eye to the abnormal eye.
• This response is called Marcus Gunn Pupil.
• It is the earliest indication of optic nerve disease even in the presence of a normal visual acuity

Answer A. Streopsis Test

• Stereopsis is the ability to perceive depth and 3- d structure obtained on the basis of visual information deriving from two eyes by individual with normally developed binocular vision stereopsis is usually reserved for the impression of depth arising from binocular disparity
• stereopsis is measured at near as part of clinical assessment of patients disorders of ocular motility and strabismus • stereopsis can be measured near and distance

Answer- B- Cover Uncover Test

Since the diagnosis is strabismus the correct answer is B

The forced duction test is performed in order to determine whether the absence of movement of the eye is due to a neurological disorder or a mechanical restriction. The anesthetized conjunctiva is grasped with forceps and an attempt is made to move the eyeball in the direction where the movement is restricted.

Since the diagnosis is strabismus the correct answer is B

Answer– A i.e.  As  early  as  feasible

• All  diabetic  (IDDM  & NIDDM both)  aged  over 12  years  and/or entering puberty  should  be  screened (visual activity measurement  and fundus examination by  ophthalmoscopy)
• For retinopathy. and those  with risk  for visual loss  referred  to  an  ophthalmologist.
• Type I  DM  (IDDM)  require  ophthalmoscopic  examination within  3  years of diagnosis  and annual  review.  (If  lt is  diagnosed  before  the  age  of puberty).
• Type II  DM (NIDDM)  require  ophthalmoscopic  examination  at the  time of  diagnosis (because  it  is usually  diagnosed after  the  age  of 12 years)  and annual  review.

Answer C. removal of foriegn body

Removal of The nail should not be done at first rather the patient should be immediately referred to an ophthalmologist for further management.

Reference – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790160/

Ans.B. Laqshya

‘LaQshya’ programme of the Ministry of Health and Family Welfare aims at improving quality of care in labour room and maternity Operation Theatre (OT).

Objective: 

• To reduce maternal and newborn mortality & morbidity due to APH, PPH, retained placenta, preterm, preeclampsia & eclampsia, obstructed labour, puerperal sepsis, newborn asphyxia, and sepsis, etc.
• To improve Quality of care during the delivery and immediate post-partum care, stabilization of complications and ensure timely referrals, and enable an effective two-way follow-up system.
• To enhance satisfaction of beneficiaries visiting the health facilities and provide Respectful Maternity Care (RMC) to all pregnant women attending the public health facility.

Ans. A. B. C. 

ROLES OF ASHA WORKERS:

• ASHA create awareness and provide information to the community on determinants of health such as proper diet and nutrition, basic sanitation and hygienic practices, healthy living and working conditions, information on existing health services and the need for timely utilization of health and family welfare services at doorsteps.
• Conduct home visits of the pregnant women/mother/newborn under Home Based Post Natal Care (HBPNC), and they are supposed to counsel pregnant women on birth preparedness, importance of safe delivery, breastfeeding and complementary feeding, immunization, contraception and prevention of common infections including Reproductive Tract Infection/Sexually Transmitted Infection (RTIs/STIs) and care of the young child.
• Mobilize the community and facilitate them in accessing health and health related services available at the village/sub-center and other public health facilities, such as Routine Immunization (RI), Ante Natal Check-ups (ANCs), Post Natal Check-ups (PNCs), sanitation and other services being provided by the Government.  ASHA have to work with the Village Health Sanitation Nutrition Committee/Village Level Committee (VHSNC/VLC) of the Gram Panchayat to facilitate a comprehensive village health plan with ANM, AWWs and PRI members.
• Mobilize targeted community once in a month for the celebration of Village Health Nutrition Days (VHND) at their Aanganwadi Centre.
• ASHA have to arrange escort/accompany pregnant women & children requiring treatment/ admission to the nearest pre- identified health facility i.e. Primary Health Centre/Community Health Centre/ First Referral Unit (PHC/CHC /FRU).
• ASHA have to provide primary medical care for minor ailments such as diarrhoea, fevers, and first aid for minor injuries.
• Dot Providers of Directly Observed Treatment Short-course (DOTS) under Revised National Tuberculosis Control Programme (RNTCP).
• ASHA are also acting as a Depot Holder for essential provisions being made available to every habitation like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet (IFA), chloroquine, Disposable Delivery Kits (DDK), Contraceptives (Condoms, Oral Pills, Emergency Pills), etc. Provision of Drug Kit and HBPNC Kit has been made for ASHA. Contents of the Drug/HBPNC Kits are based on the recommendations of the expert/technical advisory group set up by the Govt of India.
• ASHA are expected to provide first information about the births and deaths in her village and any unusual health problems/disease outbreaks in the community to the SC/PHC/CHC or directly to the District Authorities or even to the State HQ at the NRHM Help Line.

Answer: D. IV. C. III A. I B. II 

HOSPITAL WASTE CATEGORIES: 

 COLOR CODING & TYPES OF CONTAINER:

Ans. A. Measles

Vaccines recommended in disasters

• Following vaccines are recommended

1. Children < 10 years :- DPT, inactivated polio (IPV), H.influenzae type b (Hib), hepatitis B, pneumococcal conjugate vaccine (PCV), measles-mumps-rubella (MMR), varicella vaccine, influenza, hepatitis A and rotavirus.
2. Children and adolescents (11-18 years):- Tetanus, diphtheria, pertussis, meningococcal conjugate vaccine (MCV), Influenza.
3. Adults (>18 years):- Tetanus, diphtheria, pertussis, pneumococcal polysaccharide vaccine (PPSV23), and influenza.

• Vaccination against typhoid and cholera is not recommended.

Ans.C.225

IMR = Number of deaths of children less than 1 year of age in a year X 1000/number of live births in the same year.

IMR=56+34 X1000/400= 225

Ans.b). Variance of DBP > 4 times Vitamin D

• Coefficient of Variance (CV) is a tool to compare variability of two different characteristics (eg. BP, serum creatinine, height weight etc.) in the same group of subjects or compare variability of the same character in two or more different groups.

• Thus it is a measure used to compare relative variability.
• For example, coefficient of variance measures

1. whether weight varies more than height in a group of student
2. whether weight varies more in girls of boys.

Calculation:

• CV=  standard deviation x 100/ mean

For Blood pressure- 110×100/11=1000

For Vitamin D- 3X100/18= 16.7

Ans. C. Blue

COLOR CODING & TYPES OF CONTAINER: 

Ans.B) 5

• An odds ratio (OR) is a statistic that quantifies the strength of the association between two events, A and B.
• Two events are independent if and only if the OR equals 1: the odds of one event are the same in either the presence or absence of the other event.
• If the OR is greater than 1, then A and B are associated (correlated) in the sense that, compared to the absence of B, the presence of B raises the odds of A, and symmetrically the presence of A raises the odds of B.
• Conversely, if the OR is less than 1, then A and B are negatively correlated, and the presence of one event reduces the odds of the other event.
• Most Importantly Odds ratio does not demonstrate causality .
• But we can say that they are positively correlated. Since 5 Factors have odds ratio more than 1 so the answer will be B

Ans. A. Since there is a comparison between fat content of EBM in preterm vs term infant the best study design will be, Case control.

Prospective Cohort study will be appropriate if we want to see the change in the fat content of EBM in preterm infants.

Ans.d) At least one case of non-polio AFP per year per 100000 population of under 15 years 

The number of AFP cases reported each year is used as an indicator of a country’s ability to detect polio, even in countries where the disease no longer occurs.

Polio surveillance

• It is the most important part of whole polio eradication intiative. It has two components:-
• Acute flaccid paralysis (AFP) surveillance
• Acute flaccid paralysis is defined as acute onset (< 4 weeks) of flaccid paralysis (reduced tone) without other obvious cause in children WHO recommends the immediate reporting and investigation of every case of AFP in children less than 15 years.

Answer C. X = Y/2

The Values of X, Y are

5,10

10,20

15, 30

20,40 ..

So The Correct Regression equation is X = Y/2

Ans. D. Nothing can be concluded as the information given is inadequate 

Ans. A. Positive correlation between birth weight and gestational age

Scatter plot of bone SOS vs gestational age, r=0.569, p<0.001 (y=2161+26.2x). (b) Scatter plot of bone SOS vs birth weight, r=0.420, p<0.001 (y=2800+0.113x).

This shows a significant (p=0.001) positive correlations between SOS and gestational age, birth weight, length, head circumference and tibial length.

Ans. A. Case control study 

• Matching is most useful in case control studies (though it can also be used in cohort studies, but benefit is not assured if exposure is not randomized).

Method Used to Control Confounding

Ans. B.Paired T-test

Paired test : Is applied to paired data, when each individual gives a pair of observations such as : when observations are made before and after the play of a factor e.g. pulse rate before and after a drug. Further, it proceeds similar to the unpaired test.

Ans. A. To determine when infections have been reduced below these target thresholds

• WHO recommends the transmission assessment survey (TAS) to determine when infections have been reduced below these target thresholds and MDA can stop.
• Once MDA has stopped, TAS is used as a surveillance tool to determine that infection levels are sustained below target thresholds.
• Mass drug administration (MDA) is needed to reduce infection in the community to levels below a threshold at which mosquitoes are unable to continue spreading the parasites from person to person and new infections are prevented.

Ans. C. PV

• Pemphigus vulgaris (PV) is a rare and serious (potentially life-threatening) condition that causes painful blisters to develop on the skin and lining of the mouth, nose, throat and genitals.
• The blisters are fragile and can easily burst open, leaving areas of raw unhealed skin that are very painful and can put you at risk of infection.
• H&E: Subepidermal bullae

• DIF: linear IgG and C3 deposition at the basement membrane zone

Ans. A. Tardieu spots

• Asphyxial petechial haemorrhages do occur on the serosal surfaces of internal organs eg.heart and lung as shown in the pictures.
• They were first described by Tardieu in the 19th century and were named after him as tardieu spots.
• It were considered at that time and for a long period after as pathognomonic  sign of asphyxial deaths.
• Such petechial haemorrhages do occur in deaths related  to infections,blood coagulopathy disorders and micro emboli.
• It can also occur due to rupture of engorged capillaries in the dependent parts.
• It can also be noticed in some cases of natural deaths, so it is by no means are pathognomonic of asphyxial deaths.

Ans. A. Intracellular inclusion bodies

(Ref: Robbins 9/e p1176; Fitzpatrick 6/e p2347)

• All findings are highly suggestive of Molluscum contagiosum, which is caused by the poxvirus.

Molluscum contagiosum:

• On microscopic examination, lesions show cuplike verrucous epidermal hyperplasia. The diagnostically specific structure is the molluscum body, which occurs as a large, ellipsoid, homogeneous, cytoplasmic inclusion in cells of the stratum granulosum and the stratum corneum.
• In H&E stain, these inclusions are eosinophilic in the blue-purple stratum granulosum and acquire a pale blue hue in the red stratum corneum.
• Numerous virions are present within molluscum bodies.

Ans. C. Togaviridae

• Vesiculobullous lesions were common cutaneous manifestation of chikungunya fever in infants.
• Pigmentary lesions were generalized, brownish black and predominantly involved face and extremities.
• Generalized maculopapular eruption or erythema with islands of normal skin were noted, mostly 2-3 days after onset of fever.
• It started on trunk and then spread centrifugally involving face, palms and soles.
• Mucosal regions were spared.
• Mostly it subsided in 4-5 days, but in 5 cases there was peeling of the skin over body, palms and soles, resembling staphylococcal scalded skin syndrome (SSSS).

Ans. A. Langerhans cells

• The stratum basale is primarily made up of basal keratinocyte stem cells, which can be considered the stem cells of the epidermis.
• They divide to form the keratinocytes of the stratum spinosum, which migrate superficially.
• Other types of cells found within the stratum basale are melanocytes (pigment-producing cells), and Merkel cells (touch receptors).

Ans. A. Depersonalization disorder

Depersonalization:

• Depersonalization is a sense of unreality or strangeness concerning the self, manifested by feeling detached from and being an outside observer of one’s mental processes or body.
  • A patient who experiences depersonalization may describe feeling like things “I have stepped outside of myself and am watching myself doing things”.

Derealization:

• Derealization  refers to feeling detached from one’s environment so that the sense  of the reality of the external world is lost.

• E.g, I feel as if everything is unreal and those around me are actors in a play or two dimensional cardboard figures.

Ans. D. Judgemental

• Neziroglu and Stevens Proposed four different levels of insights:
  • True emotional insight.
  • Intellectual insight
  • Partial internally and externally based insight
  • Denial Of Illness.
• True emotional insight Is representative of the highest level of insight possible.
• In it the patients’ awareness and understanding Of their own thoughts, feelings and motives can be used to change behavior.

Ans. A.  Lewy body dementia –

• Lewy body dementia, also known as dementia withLewy bodies, is the second most common type of progressive dementia after Alzheimer’s disease dementia.
• Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory and movement (motor control).

Ans. A. 2 minutes

• Proparacaine and tetracaine are indicated to produce local anesthesia of short duration for ophthalmic procedures including measurement of intraocular pressure (tonometry), removal of foreign bodies and sutures, and conjunctival and corneal scraping in diagnosis and gonioscopy.
• Onset of action:
  • Proparacaine—Within 20 seconds.
  • Tetracaine—Approximately 15 seconds.
• Duration of action:
  • Proparacaine—15 minutes or longer.
  • Tetracaine—10 to 20 minutes; average 15 minutes.

Answer- A. Chikungunya

Symptoms of the disease include:

• Fever
• A petechial or maculopapular rash of the trunk and occasionally the limbs
• Arthralgia or arthritis affecting multiple joints.
• The pain associated with CHIKV infection of the joints persists for weeks or months.
• Typical macules over the nose.
• Typically, the fever lasts for two days and then ends abruptly.
• Ocular inflammation may present as iridocyclitis and have retinal lesions as well.
• Pedal edema (swelling of legs) is observed in many patients.

Answer- B. Southampton score

Southampton score and ASEPSIS criteria are used for wound infection.

Answer- D. Poor Preoperative preparation of the patient

• Commonest reason for thyroid storm is poor pre operative preparation of the patient.
• Acute illness (stroke, infection, trauma, diabetic ketoacidosis)
• Surgery
• Inadequate control of hyperthyroidism
• Radioactive treatment of hyperthyroidism

Answer- A, B, C, D

The “a” wave is approximately synchronous with the first heart sound (S1) and just precedes the carotid upstroke.

Shortly after the a-wave there is a second peak , the c-wave.  The c-wave immediately follows the r wave of the ECG waveform.

The v-wave corresponds to the end of the t wave in the ECG waveform.

Answer- D. Gastric inhibitory polypeptide

CCK-  As chyme floods into the small intestine, cholecystokinin is released into blood and binds to receptors on pancreatic acinar cells, ordering them to secrete large quantities of digestive enzymes.

Secretin-

• The predominant effect of secretin on the pancreas is to stimulate duct cells to secrete water and bicarbonate.
• Gastrin- Stimulate acid secretion by the parietal cell, gastrin stimulates pancreatic acinar cells to secrete digestive enzymes.

Answer- D. PEP carboxylase

Answer- A. Neurogenic

the most common mediastinal masses are neurogenic tumors (23%), thymomas (21%), lymphomas (13%) and germ cell tumors (12%). Mediastinal masses are most frequently located in the anterosuperior mediastinum (54%), with the posterior (26%) and middle mediastinum (20%) being less frequently involved

Answer- D. Pancost tumor

MRI: An MRI is generally more accurate than a CT scan at uncovering the extent to which a tumor has invaded other structures

Answer- D. Thyroxine

Classic hormones that use intracellular receptors include thyroid and steroid hormones.

Answer- D. Needle insertion in 2nd ICS

This is a case of tension pneumothorax. Although the new ATLS update is 5th intercostal space in mid maxillary line, but in this question we will go with a time tested method of needle in 2nd intercostal space.

Answer- C. Tricuspid area & Mitral area

Answer- A. Cutaneous larva margins

The most common species causing this disease is Ancylostoma braziliense.

Answer- C. transfusion related acute lung injury (TRALI)

Transfusion-related acute lung injury (TRALI) is a serious blood transfusion complication characterized by the acute onset of non-cardiogenic pulmonary edema following transfusion of blood products.

Hypotension, and fever that develop within 6 hours after transfusion and usually resolve with supportive care within 48 to 96 hours. Although hypotension is considered one of the important signs in diagnosing TRALI, hypertension can occur in some cases.

Answer- B. Duration of murmur

Duration depends on severity of MS.

In severe MS, the mid diastolic murmur is long and merges with the presystolic murmur to produce holodiastolic murmur..

Answer- D .EBV

The most important risk factors for developing HNSCC are tobacco smoking and alcohol consumption.

Consumed in betel quids containing areca nut  increases the risk of developing HNSCC.

HNSCCs of the oral cavity and oropharynx, are becoming more prevalent, which may be related to an increase in oral and oropharyngeal HPV infection.

Answer- A. Osteoporosis

• Having osteoporosis
• Having a history of other bone problems or fractures
• Having low bone density and low muscle mass

Answer- B. Auriculotemporal nerve

Answer- B. Gastrinoma

Insulinoma is the most common functional tumour but if that wasnt there in the optios then gastrinoma is the next answer.

Answer- B. Serum lipase

Serum amylase and lipases are the initial investigations done in patients with acute pancreatitis.

CECT is the investigation of choice but the initial investigation in such patients.

Answer- B. Nothing is to be done

Nothing is to be done. Absent testicular vessels denotes that there has been intra- uterine torsion and in that case further exploration is required.

Answer- A. Sublingual

Structures removed during radical neck dissection-

• Level 1-5 In
• Sternocleidomastoid, IJV, spinal accessory nerve
• Submandibular gland
• Tail of parotid

Answer- A. RR> 24 & Paco2 <22mm hg

Answer- B. PCNL

PCNL is the best answer as the patient has hydronephrosis and in an obstructed system ESWL is not useful as stone fragments don’t get cleared.

Answer- D. Needle insertion in 2nd ICS

This is a case of pneumothorax. Although the new ATLS update is 5th intercostal space in mid axillary line but in this question we will go with a time tested method of needle in the 2nd ICS.

Answer- B. <10%

• Clean wound- 1- 2%
• Clean contaminated- 7- 10%
• Contaminated- 10- 20%
• Dirty- >20%

Answer- A. Tumour more than 4cm

Locally advanced breast cancer-

T4 N2 N3 M0

Answer- A. Bilateral undilated pupils

Answer- A. SBP fall by 20 mm hg, DBP fall by 10 mm hg within 3 minutes

Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position.

Answer- D. Bone nibbler

The GPC straight & curved bone nibbler (double action) is used for nibbling the bone.

The straight nibbler is used for general use and the curved nibbler is used for spinal surgery.

Answer- B. Prevent transfusion related reactions

It is a leuko- reduction filter which prevents transfusion related reactions

Answer- A. Cleaning & dressing

Answer- C. Hypertension

A previous diagnosis of gestational diabetes or prediabetes, impaired glucose tolerance, or impaired fasting glycaemia.

Being overweight, obese

A previous pregnancy which resulted in a child with a macrosomia.

Answer- A. Infected thyroglossal cyst from sinus

Thyroglossal cysts are the most common cause of midline neck masses and are generally located caudal to (below) the hyoid bone.

Thyroglossal Duct Cysts are a birth defect.

A thyroglossal cyst is lined by pseudostratified, ciliated columnar epithelium while a thyroglossal fistula is lined by columnar epithelium.

A thyroglossal duct cyst may rupture unexpectedly, resulting in a draining sinus known as a thyroglossal fistula.

Answer- A. Mondor’s disease

The condition shown in the picture above represents Mondor’s disease.

Mondor’s disease (also known as “Mondor’s syndrome of superficial thrombophlebitis”) is a rare condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall. It sometimes occurs in the arm or penis. In axilla, this condition is known as axillary web syndrome.

Ans. b) 2years

GROSS MOTOR MILESTONES:

Ans. D. Orogastric tube insertion

Answer A. Rectal diazepam

• Benzodiazepines are Drug of Choice and in pediatric patients rectal route should be preffered.

Reference – https://www.uspharmacist.com/article/emergent-treatment-of-status-epilepticus-in-children

Ans. In this case the First Line has failed . So for second line therapy I/V Phenobarbital is preffered

Reference – https://www.uspharmacist.com/article/emergent-treatment-of-status-epilepticus-in-children

Ans: d,b,c,a….

The NT scan must be done between 11 and 14 weeks pregnant, because this is when the base of baby’s neck is still transparent. (The last day for scan is  13 weeks and 6 days pregnant.)

Triple marker test is performed in pregnant women at the end of first trimester and the beginning of the second trimester.

The anomaly scan, also sometimes called the anatomy scan, 20 week ultrasound, or level 2 ultrasound, is a pregnancy ultrasound performed between 18–22 weeks

A growth scan is an ultrasound scan that determines whether your baby’s growth is normal. Doctors typically recommend it for women during the third trimester of pregnancy; one of the reasons it is also a fetal growth scan between 28 weeks and 32 weeks of pregnancy.

Ans. D. Inguinal approach

• Cryptorchidism is the most common congenital abnormality of the genitourinary tract.
• Cryptorchidism means hidden testis.
• An absent testis may be due to agenesis or atrophy secondary to intrauterine vascular compromise also known as the “vanishing testis syndrome”.
• Bilaterally absent testes is anorchia which is 10% cases.
• More common on Right Side.
• Complications of undescended testes
• Torsion can be seen in incomplete testicular descent
• Sterility is seen in bilateral cases (especially intra-abdominal testes)
• Incomplete testicular descent predisposes to malignant disease; cancer is more common in an incompletely descended testes-orchidopexy may or may not diminish the risk.
• Atrophy of an inguinal testes before puberty may possibly be caused by recurrent minor trauma.
• In patients with a unilateral nonpalpable testis, a descended testis that is larger than expected suggests an atrophic undescended testis; confirmation requires surgical intervention typically via diagnostic laparoscopy to seek an intra-abdominal testis or confirm testicular agenesis. However, scrotal or inguinal exploration is sometimes done if a testicular remnant distal to the internal inguinal ring is suspected.

Ans. D. Subepithelial electron dense humps

The disease is poststreptococcal glomerulonephritis, which can follow either streptococcal pharyngitis (one to two weeks after the infection) or skin infection (three to six weeks after the infection).

The child is showing signs of both nephritis (hematuria) and nephrosis (puffy face and swollen ankles).

The characteristic feature of this disease on renal biopsy is the presence of subepithelial humps, visible either by light or electron microscopy.

Fusion of podocyte foot processes suggests minimal change disease.

IgA in the mesangium suggests Berger’s disease.

Linear IgG deposits suggests anti-glomerular basement membrane disease, which is called Goodpasture’s disease if it is accompanied by pulmonary damage.

Onion-skinning of renal arterioles suggests malignant hypertension.

Ans. a. Pyogenic meningitis (ReJ: Harrison l9/e p887, 891, llll, l8/e p1029, 1692, 3414)

The classic CSF abnormalities in bacterial meningitis are:

• Elevated opening pressure (> 180 mm H2O in 90%)
• Polymorphonuclear leakocytosis (>100 cells/ul in 90%)
• Decreased glucose concentration (
• Elevated protein concentration (>45 mg/dl)

Ans.E>D>C>A>B

Within a week of birth, the neonate’s umbilical vein is completely obliterated and is replaced by a fibrous cord called the round ligament of the liver (also called ligamentum teres hepatis).

Closure of the umbilical vein usually occurs after the umbilical arteries have closed

Ans-b)Spermatogonium> a)Spermatocyte >d)Spermatid >c)Spermatozoa

Ans. C. 28-37weeks

• Before 28 weeks pregnant: there’s no evidence you are at increased risk of suffering a miscarriage. However, there’s a small risk baby could develop foetal varicella syndrome (FVS). FVS can damage the baby’s skin, eyes, legs, arms, brain, bladder or bowel.
• Between weeks 28 and 36 of pregnancy: the virus stays in the baby’s body but doesn’t cause any symptoms. However, it may become active again in the first few years of the baby’s life, causing shingles.
• After 36 weeks of pregnancy:  baby may be infected and could be born with chickenpox.

Ans. A. Mife pristone

Ans. A.MgSo4

Antenatal magnesium sulfate for both tocolysis and fetal neuroprotection in premature rupture of the membranes before 32 weeks’ gestation.

Other tocolytic drugs:

• Ritodrine, salbutamol and magnesium sulphate are tocolytic drugs used to terminate preterm labour and delivery.
• Other tocolytic drugs are isoxsuprine, indomethacin, calcium channel blockers, glyceryl trinitrate, atosiban and glyceryl trinitrate.

Ans.A. Both assertion and reason are true and reason is the correct explanation of assertion

• Hot Flushes : They are the ‘hallmark’ of menopause. Hot flushes are described as recurrent transient period of flushing, sweating and a sensation of heat often accompanied by palpitations, feelings of anxiety and sometimes followed by chills.
• The entire episode lasts no more than 1-3 minutes and recurs 5-10 times / day (can occur upto 30 times a day).
• Short term estrogen therapy results in resolution of hot flushes.

Ans. d. After 65 years

NOF recommends:

Bone density test :

• In woman age 65 or older.
• In man age 70 or older.

Ans. D. Start magnesium sulphate

• This patient has severe preeclampsia. Preeclampsia is diagnosed on the basis of hypertension, edema, and proteinuria.
• Severe preeclampsia may be diagnosed when the patient has one of the following: a headache that does not respond to analgesics, visual changes, seizure, very elevated blood pressures, pulmonary edema, elevated liver function tests, severe proteinuria, oliguria, an elevated creatinine, thrombocytopenia, hemolysis, intrauterine growth restriction, or oligohydramnios.
• The management of severe preeclampsia after 32 weeks is with delivery.
• Prior to 32 weeks, consideration may be given to expectant management of the patient depending on the clinical circumstances. This patient is at 35 weeks’ with headache, visual changes, elevated blood pressures, thrombocytopenia, and elevated liver function tests. She, therefore, needs to be delivered.
• She appears to already be in labor as she is contracting every two minutes and her cervix is dilated and effaced.
• At this point, magnesium sulfate should be started.
• Magnesium sulfate has consistently been demonstrated to be the most effective medication for seizure prophylaxis in women with preeclampsia.
• To administer oxytocin would not be necessary for this patient. She appears to already be in labor with contractions every two minutes.
• To discharge the patient would absolutely be incorrect. Severe preeclampsia need to be delivered or, at the very least, admitted to the hospital. There is no role for discharging a patient home in the management of severe preeclampsia.
• To encourage ambulation would also be incorrect. Severe preeclampsia should be kept on bed rest.

Ref:  Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 34. Pregnancy Hypertension. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

Ans. A. CA cervix

SYMPTOMS:

• Arises from: Squamo-columnar junction
• Earliest symptom: Post-coital bleeding

As the cancer progresses, symptoms may include:

• Unusual vaginal discharge
• Vaginal bleeding between periods
• Bleeding after menopause
• Pyometra
• Bleeding or pain during sex
• MC site: Ectocervix
• Lymph nodes affected: Obturator, hypogastric and external iliac
• Time taken for conversion of CIN to invasive Ca: 10 years
• MC type: Squamous cell Ca
• 100% cure rates are seen in: CIS
• Uremia: altered sensorium and is having hiccups
• MC cause of death: Renal failure
• Ca cervix can be prevented by screening

Both positive Pap smear and VIA test is suggestive of CA cervix

Ans. A. Pap smear and colposcopy

• Postcoital bleeding (PCB) has many causes, including vaginitis, cervicitis, cervical dysplasia and malignancy, uterine lesions, and pregnancy.
• Some women with postcoital bleeding may have pathologic lesions identified at colposcopic evaluation that had been missed by Pap smear screening.
• Thus, colposcopic examination is considered for women with unexplained postcoital bleeding.

Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 8. Abnormal Uterine Bleeding. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.

Ans.D. Endometriosis

• In endometriosis, cause of infertility is
• Immobility of tubes
• Anovulation
• Tubal block
• Male factor: 30%
• Tubal, uterine & peritoneal factor: 25%
• Ovarian factor: 25%
• Cervical factor: 10%
• Unexplained factor: 10%

Ans. a). SLE

Congenital heart block is a rare disorder that occurs in about one out of 22,000 live births.

In most cases, the cause is not known, but babies of mothers with lupus or other autoimmune diseases, or babies with congenital heart disorders, are at higher risk.

Pregnant women who have autoimmune diseases, such as lupus or Sjogren’s syndrome, are at an increased risk of having a baby with congenital heart block.

Also, a tumor on the baby’s heart can cause heart block.

Ans. D. Coronary heart disease

Benefits and Risks of Postmenopausal Hormone Therapy (HT): 

Definite Benefits

• Symptoms of menopause (e.g, Flushing, vaginal atrophy)
• Osteoporosis

Definite Risks

• Endometrial cancer
• Venous thromboembolism
• Breast cancer
• Gallbladder disease

Probable or Uncertain Risks and Benefits

• Coronary heart disease
• Stroke
• Ovarian cancer
• Colorectal cancer
• Diabetes mellitus
• Cognitive dysfunction

Ref: Manson J.E., Bassuk S.S. (2012). Chapter 348. The Menopause Transition and Postmenopausal Hormone Therapy. In Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J, Loscalzo J (Eds), Harrison’s Principles of Internal Medicine, 18e.

Answer- A. A-2, b-3, c-4, d-1

• Pilons – fracture of the distal part of the tibia
• Chauffeur- fracture of radial styloid process.
• cotton- Lateral malleolar #
• Runners fracture- Trimalleolar #

Answer- D. Bone biopsy

Answer- C. Sacroileitis

Answer- A. Proximal

• Most common site of scaphoid fracture is Waist.
• Fractures can occur essentially anywhere along the scaphoid, but distribution is not even:

1. waist of scaphoid: 70-80%
2. proximal pole: 20%
3. distal pole (or so-called scaphoid tubercle): 10%

Answer- A.  It is the most common type of shoulder dislocation

Most common type of shoulder dislocation is anterior dislocation (subcoracoid being most common).

Patient keeps his arm by the side of the body in  a position of abduction and internal rotation.