KERALA PGMEE 2015 PG Medical Entrance MCQs Discussion

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KERALA PGMEE 2015 PG Medical Entrance MCQs Discussion

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ANATOMY

1. Moderator band is (Kerala PGMEE 2015)

A. Chordae tendinae attached to the anterior papillary muscle

B. A prominent trabecular carnea in the infundibulum

C. A trabecular carnea conveying a right branch of the atrioventricular bundle

D. A papillary muscle attached to the septal cusp of the tricuspid valve

The Correct Answer is: C

  • The moderator band (also known as septomarginal trabecula) is a muscular band of heart tissue found in the right ventricle of the heart. It extends from the base of the anterior papillary muscle to the ventricular septum.

  • The moderator band is important because it carries part of the right bundle branch of the AV bundle of the conduction system of the heart to the anterior papillary muscle. This shortcut across the chamber of the ventricle seems to facilitate conduction time, allowing coordinated contraction of the anterior papillary muscle.

2. The superior mesenteric artery , all are true except (Kerala PGMEE 2015)

A. Supplies the jejunum, ileum, vermiform appendix, ascending colon and transverse colon

B. Is the artery of the hind gut

C. Anastomoses with the ileal branch of the ileocolic artery

D. Traverses behind the body of the pancreas

The Correct Answer is: b

The branches of the superior mesenteric artery are numerous and are accompanied by veins and by offsets of the superior mesenteric plexus of nerves. They supply the lower parts of the head of the pancreas and duodenum, the jejunum, and ileum, and vermiform appendix, the cecum, and the ascending and transverse colon. The jejunal and ileal branches arise from its convex or left border; the others form its concave border.

The ileocolic artery is the lowest branch arising from the concavity of the superior mesenteric artery.

  • It passes downward and to the right behind the peritoneum toward the right iliac fossa, where it divides into a superior and an inferior branch; the inferior gives rise to the appendicular artery and anastomoses with the end of the superior mesenteric artery, the superior with the right colic artery.
  • Supplies the cecum, ileum, and appendix.

Marginal artery of Drummond

  • The terminal branches of the ileocolic, right colic and middle colic arteries – along with the terminal branches of the left colic artery and sigmoid branches of the IMA – form a continuous arterial circle or arcade along the inner border of the colon known as the marginal artery of Drummond.
  • From this marginal artery, straight vessels (also known as vasa recta) pass to the colon.

Actual MCQ was given like this and the Key given

The superior mesenteric artery

A. Supplies the jejunum, ileum, vermiform appendix, ascending colon and transverse colon

B. Is the artery of the hind gut

C. Anastomoses with the ileal branch of the ileocolic artery

D. Traverses behind the body of the pancreas

The Correct Answer is: C

Throughout its course, the superior mesenteric artery is surrounded by the superior mesenteric plexus of sympathetic nerves, which springs from the lower part of the celiac plexus; and it is accompanied by its vein, which lies close along its right sid. At its origin, it is behind the body of the pancreas, and is closely related to the two large veins that cross the front of the aorta from the left to right – namely, the splenic vein, which passes above its origin, and the left renal vein, which passes below it. As the artery begins its descent, it crosses in front of the left renal vein, and, after escaping from behind the body of the pancreas, it crosses in front of the uncinate process of the pancreas to reach the third part of the duodenum. Beyond that point, its posterior relations are the same as those of the root of the mesentery.

3. The brain area that controls motor skills of patterned nature and serves as a bank for skilled motor activities is (Kerala PGMEE 2015)

A. Frontal eye field

B. Premotor cortex

C. Somatomotor cortex-I

D. Visual association area

The Correct Answer is: B

Motor area

  • Primary motor cortex – controls skilled voluntary movements of muscles; pyramidal cells
  • Premotor cortex – controls learned motor skills of a repetitious or patterned nature; “memory  bank” for skilled motor activities (some pyramidal cells; involved in planning movements 
  • Broca’s area – present in only one hemisphere (usually left); motor speech area (if damaged,  patient is unable to speak)
  • Frontal eye field – voluntary movements of the eyes

4. With regard to the elastic cartilage, which one of the following is FALSE? (Kerala PGMEE 2015)

A. Chondrocytes are housed in lacunae

B. It consists of elastic fibres

C. It is found in epiglottis

D. Cannot retain its histologic characters throughout life

The Correct Answer is: D

Elastic Cartilage

  • occurs in the epiglottic cartilage, the corniculate and cuneiform cartilage of the larynx, the cartilage of the external ear and the auditory tube.
  • corresponds histologically to hyaline cartilage, but, in addition, elastic cartilage contains a dense network of delicately branched elastic fibres.
  • In contrast to other cartilage types, collagen type I is dominant in fibrous cartilage

Hyaline or articular cartilage.

Chondrogenic activity of the perichondrium is limited to the period of active growth before adulthood. Although chondrocytes are able to produce matrix components throughout life, their production can not keep pace with the repair requirements after acute damage to hyaline or articular cartilage. If these cartilages are injured after the period of active growth, the defects are usually filled by connective tissue or fibrous cartilage. The extracellular matrix of these “repair tissues” is only poorly integrated with the matrix of the damaged cartilage.

 

5. Rotator cuff muscles are (Kerala PGMEE 2015)

A. Subscapularis, Supraspinatus, Infraspinatus, Teres minor

B. Subscapularis, Supraspinatus, Infraspinatus, Teres major

C. Serratus anterior, Supraspinatus, Infraspinatus, Teres minor

D. Supraspinatus, Infraspinatus, Teres minor, Teres major

The Correct Answer is: A

PHYSIOLOGY

6.    In pseudohypoparathyroidism (Kerala PGMEE 2015)

(A)    PTH receptors fail to respond to PTH

(B)    Circulating PTH levels are decreased

(C)    Serum calcium levels are high due to underlying bone pathology

(D)    PTH synthesis is decreased

The Correct Answer is: A

7.     Which one of the following binds Z line to plasma membrane (Kerala PGMEE 2015)

(A)    Actinin

(B)    Tittn

(C)    Desmin

(D)     Sarcoglycan

The Correct Answer is: c

Thin filaments

– Microfilaments (Actin)

– Troponin (C- binds Ca++; T- binds tropomyosin; I- binds to actin) – Tropomyosin

Thick filaments

  • Myosin II: 2 Heavy / 4 light chains

Accessory Proteins: alignment of thick and thin filaments –

  • Titin: anchors thick filaments to Z line
  • Alpha-actinin: arranges and anchors thin filaments at Z line
  • Nebulin: anchors thin filaments to Z line and regulates their length
  • Tropomodulin: caps and regulates length of thin filament
  • Desmin: binds sarcomeres to each other and plasma membrane
  • Myomesin and C-protein: Align thick filaments at M line

8.     Heparin acts as an anti-coagulant by (Kerala PGMEE 2015)

(A) Inhibiting the clotting factors II, VII, IX and X directly

(B) Inhibiting the action of anti-thrombin III

(C) Promoting the binding of anti-thrombin III with the clotting factors

(D)      Inhibiting protein C

The Correct Answer is: C

 

Without Anticoagulant , Antiplatelet  MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given

9.    Alpha block is when the attention is focused on something, the alpha rhythm gets replaced by (Kerala PGMEE 2015)

(A) Beta rhythm

(B) Ganima rhythm

(C) Delta rhythm

(D) Theta rhyflim

The Correct Answer is: A

Without EEG MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given

ALPHA BLOCK

  • When the subject’s eyes are closed, the alpha rhythm is generated.
  • As soon as the eyes are open, alpha disappears and is replaced with the beta rhythm. This is called alpha block and may be elicited also by mental activity, e.g., by a mathematical task and by any form of sensory stimulation.
  • This replacement of the alpha rhythm is also called desynchronization because it represents a change of the synchronized activity of neural elements. This state is also called arousal or alerting response.
  • The state of increased awareness to a novel stimulus, arousal, is accompanied by a behavioral orienting reaction that involves several physiological components – pupillary dilation, startle response, decrease in auditory threshold, rise in muscle tone, increased respiration, temporary slowing of heart rate and activation of sweat glands.

10.    The time resolving ability of the eye is determined by measuring (Kerala PGMEE 2015)

(A) Dark adaptation lime

(B) Light adaptation time

(C) Critical fusion frequency

(D) Principal axis

The Correct Answer is: C

Decrease in the critical fusion frequency has often been used as an index of central fatigue

BIOCHEMISTRY

11. An abnormal lipoprotein pattern with elevated cholesterol with no measurable cholesterol esters is seen in (Kerala PGMEE 2015)

A. LCAT deficiency

B. ACAT deficiency

C. Fish eye disease

D. Familial hypercholesterolemia

The Correct Answer is: A

Without Lipoprotein disorder MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given .

Lecithin cholesterol acyltransferase catalyzes the formation of cholesterol esters in lipoproteins.

The disease has two forms:

  • familial LCAT deficiency in which there is complete LCAT deficiency.
  • fish eye disease in which there is a partial LCAT deficiency.
  • Both are autosomal recessive disorders caused by mutations of the LCAT gene located on chromosome 16q22.
  • A deficiency of LCAT causes accumulation of unesterified cholesterol in certain body tissues.
  • Cholesterol effluxes from cells as free cholesterol and is transported in HDL as esterified cholesterol. LCAT is the enzyme that esterifies the free cholesterol on HDL to cholesterol ester and allows the maturation of HDL.
  • LCAT deficiency does not allow for HDL maturation resulting in its rapid catabolism of circulating apoA-1 and apoA-2.
  • The remaining form of HDL resembles nascent HDL.
  • Symptoms of the familial form include diffuse corneal opacities, target cell hemolytic anemia and proteinuria with renal failure.
  • Fish eye disease only causes progressive corneal opacification.
  • Lipid profile, these patients have very low HDL cholesterol and high triglyceride level, High free cholesterol and low cholesterol esters levels.

ACAT deficiency

  • Acyl- coenzyme A (CoA): cholesterol acyltransferase (ACAT) is responsible for the storage of cholesteryl ester (CE) within neutral lipid droplets in macrophage foam cells.  The ACAT1 isoform is found at high levels in macrophages and steroido- genic tissues.
  • The ACAT2 isoform is expressed only in the liver and the small intestine and is involved in the assembly of lipoproteins.
  • Inhibition of cholesterol esterification in macrophages is expected to slow down foam cell formation and decrease lesion size by blocking the storage of choles- terol and facilitating cholesterol efflux

12. Choose the INCORRECT statement, Lesch-Nyhan syndrome (Kerala PGMEE 2015)

A. Affects young boys

B. Presents with gouty arthritis

C. The enzyme defect enhances the reutilization of purine bases

D. Bizarre behaviour of self mutilation

The Correct Answer is: C

 

HGPRT is the “salvage enzyme” for the purines: it channels hypoxanthine and guanine back into DNA synthesis.

Failure of this enzyme has two results:

  • Cell breakdown products cannot be reused, and are therefore degraded. This gives rise to increased uric acid, a purine breakdown product.
  • The de novo pathway is stimulated due to an excess of PRPP (5-phospho-D-ribosyl-1-pyrophosphate or simply phosphoribosyl-pyrophosphate).

13. Porphyria cutanea tarda is caused by deficiency of (Kerala PGMEE 2015)

A. Porphobilinogen deaminase

B. Uroporphyrinogen decarboxylase

C. Copro porphyrinogen oxidase

D. Protoporphyrinogen oxidase

The Correct Answer is: B

Without Porphyria MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given .

14. Vitamin K is necessary for the carboxylation of all of the following clotting system factors EXCEPT (Kerala PGMEE 2015)

A. Protein C

B. Factor VII

C. Protein S

D. Factor XIII

The Correct Answer is: D

Vitamin K (in animals) is involved in the carboxylation of certain glutamate residues in proteins to form gamma-carboxyglutamate (Gla) residues. The modified residues are often (but not always) situated within specific protein domains called Gla domains. Gla residues are usually involved in binding calcium, and are essential for the biological activity of all known Gla proteins.[33]

At this time, 16 human proteins with Gla domains have been discovered, and they play key roles in the regulation of three physiological processes:

  • Blood coagulation: prothrombin (factor II), factors VII, IX, and X, and proteins C, S, and Z
  • Bone metabolism: osteocalcin, also called bone Gla protein (BGP), matrix Gla protein (MGP), periostin, and the recently discovered Gla-rich protein (GRP).
  • Vascular biology: growth arrest-specific protein 6 (Gas6)
  • Unknown function: proline-rich g-carboxy glutamyl proteins (PRGPs) 1 and 2, and transmembrane g-carboxy glutamyl proteins (TMGs) 3 and 4

15. The chief regulator of systemic iron homeostasis is (Kerala PGMEE 2015)

A. Ferroportin

B. Hepcidin

C. Hemojuvelin

D. Duodenal cytochrome b

The Correct Answer is: B

 

Hepcidin is a protein that in humans is encoded by the HAMP gene. Hepcidin is a key regulator of the entry of iron into the circulation in mammals, including humans.

  • In states in which the hepcidin level is abnormally high such as inflammation, serum iron falls due to iron trapping within macrophages and liver cells and decreased gut iron absorption. This typically leads to anemia due to an inadequate amount of serum iron being available for developing red cells.
  • When the hepcidin level is abnormally low such as in hemochromatosis, iron overload occurs due to excessive ferroportin mediated iron influx.

MICROBIOLOGY

16. Bacteriophage mediated gene transfer is (Kerala PGMEE 2015)

(A) Mutation

(B) Transduction

(C) Transformation

(D) Conjugation

The Correct Answer is: B

17. C1-inhibitor deficiency leads to (Kerala PGMEE 2015)

(A) Systemic lupus erythematosus

(B) Toxoplasmosis

(C) Angioneuroticedema

(D) Recurrent pyogenic infections

The Correct Answer is: C

18. Rapid test for diagnosis of Helicobacter pylori is (Kerala PGMEE 2015)

(A) ELISA

(B) Urease test

(C) Culture

(D) Polymerase chain reaction

The Correct Answer is: B

19. Asteroid body is a characteristic feature of (Kerala PGMEE 2015)

(A) Rhinosporidiosis

(B) ChromomYcosts

(C) Sporotrichosis

(D) Zygomycosis

The Correct Answer is: C

 

They consist of the spore of the fungus, Sporothrix schenckii with radiating filamentous spicules arranged around it. The ray-like asteroid structures

20. Elution is found in (Kerala PGMEE 2015)

(A) Herpesv irus

(B) HePatitisB virus

(C) Poxvirus

(D) Orthomyxovirus

The Correct Answer is: D

Elution

  • Detachment of virus from cell surface resisting Hemagglutination is called elution.
  • Caused by enzyme neuraminidase
  • Act on cell receptor splits off N – Acetylneuraminiase

21. The vector of Chagas’ disease is (Kerala PGMEE 2015)

(A) Sandfly

(B) Culex mosquito

(C) Black fly

(D) Reduviid bug

The Correct Answer is: D

  • The presence of T. cruzi is diagnostic of Chagas disease. It can be detected by microscopic examination of fresh anticoagulated blood, or its buffy coat, for motile parasites; or by preparation of thin and thick blood smears stained with Giemsa, for direct visualization of parasites. Microscopically, T. cruzi can be confused with Trypanosoma rangeli, which is not known to be pathogenic in humans. Isolation of T. cruzi can occur by inoculation into mice, by culture in specialized media (for example, NNN, LIT); and by xenodiagnosis, where uninfected Reduviidae bugs are fed on the patient’s blood, and their gut contents examined for parasites.
  • Chagas disease or American trypanosomiasis, is a tropical parasitic disease caused by the protozoan Trypanosoma cruzi.It is spread mostly by insects known as Triatominae or kissing bugs

 

PHARMACOLOGY

22. Which of the following has least narcotic analgesic opioid effects? (Kerala PGMEE 2015)

A. Morphine

B. Codeine

C. Heroin

D. Papaverine

The Correct Answer is: D

  • Codeine is the least habit-forming of the opioids
  • Opium contains two groups of alkaloids: with phenantrene structure (morphine, codeine, thebaine) and with isochinoline structure (papaverine, noscapine).
  • Morphine and codeine are narcotic analgesics; papaverine is a vasodilatation; noscapine is antitussive agent which is suspected of genotoxicity.
  • Opium contains ≈10% morphine.

23. Which of the following statements best describes an orphan drug? (Kerala PGMEE 2015)

A. It is a drug which acts on orphanin receptors

B. It is a drug required for treatment or prevention of a rare disease

 (C) It is a very cheap drug

(D) It is a drug which has no therapeutic use

The Correct Answer is: B

An orphan drug is a pharmaceutical agent that has been developed specifically to treat a rare medical condition, the condition itself being referred to as an orphan disease.

24. All of the following agents are used in glaucoma treatment EXCEPT (Kerala PGMEE 2015)

(A) Metoprolol

(B) Timolol

(C) Pilocarpine

(D) Apraclonidine

The Correct Answer is: A

Without Glaucoma drugs MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given

25. Male gynaecomastia is seen with (Kerala PGMEE 2015)

(A) Clomiphene

(B) Testosterone

(C) Spironolactone

(D) Tamoxifen

The Correct Answer is: C

26. Which of the following is a skeletal muscle relaxant that acts as central alpha 2 adrenergic agonist? (Kerala PGMEE 2015)

(A) Tizanidine

(B) Brimonidine

(C) Chlormezanone

(D) Quinine

The Correct Answer is: A

a. Tizanidine and brimonidine are alpha 2 adrenergic agonists. Tizanidine is used as a centrally acting muscle relaxant whereas brimonidine is used topically for the treatment of glaucoma.

b. Chlormezanone is a centrally acting muscle relaxant that acts by inhibiting the spinal internuncial neurons.

c. Quinine is a directly acting peripheral muscle relaxant.

27. Anti-coagulant of choice in pregnancy is (Kerala PGMEE 2015)

(A) Phenindione

(B) Warfarin

(C) Dicoumarol

(D) Heparin

The Correct Answer is: D

PATHOLOGY

28. The most characteristic feature of apoptosis is (Kerala PGMEE 2015)

(A) Cell shrinkage

(B) Chromatin condensation

(C) Chromosomal DNA fragmentation

(D) Formation of cytoplasmic blebs

The Correct Answer is: B

Without Apoptosis MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given

Pyknosis is the result of chromatin condensation and this is the most characteristic feature of apoptosis

29. Von-GierkeType I disease is caused by deficiency,of (Kerala PGMEE 2015)

(A) Acid maltase

(B) Glucose 6 Phosphatase

(C) Muscle phosphorylase

(D) Phosphofructokinase

The Correct Answer is: B

Without Glycogen storage disorder MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given

30, The diagnosis of acute myeloid leukaemia is based on the presence of at least …..

myeloblasts in the bone marrow (Kerala PGMEE 2015)

(A) 20%

(B) 15%

(c) 10%

(D) 5%

The Correct Answer is: A

Without Lukemia,Lymphoma MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given

According to the widely used WHO criteria, the diagnosis of AML is established by demonstrating involvement of more than 20% of the blood and/or bone marrow by leukemic myeloblasts.

  • The French–American–British (FAB) classification is a bit more stringent, requiring a blast percentage of at least 30% in bone marrow (BM) or peripheral blood (PB) for the diagnosis of AML.
  • AML must be carefully differentiated from “preleukemic” conditions such as myelodysplastic or myeloproliferative syndromes, which are treated differently.

31. Byssinosis is a type of pneumoconiosics aused by (Kerala PGMEE 2015)

(A) Cotton

(B) Bagasse

(C) Moldy hay

(D) Beryllium

The Correct Answer is: A

32. The most common malignancy of the stomach is (Kerala PGMEE 2015)

(A) Adenocarcinoma

(B) Lymphoma

(C) Leiomyosarcoma

(D) Gastro intestinal stromal tumour (GIST)

The Correct Answer is: A

33. Predominantly conjugated hyperbilirubinemia is seen in (Kerala PGMEE 2015)

(A) Breast milk jaundice

(B) Gilbert’s syndrome

(C) Hemolytic anemia

(D) Dubin-Johnson syndrome

The Correct Answer is: D

FORENSIC MEDICINE

34. Fatal dose of strychnos nux vomica is (Kerala PGMEE 2015)

(A) 0.5 mg to 1.0 mg

(B) 5 mg to 10 mg

(C) 50 to 100 mg

(D) 100 to 200 mg

The Correct Answer is: C

Strychnine is a deadly poison with a lethal dose to humans of about 30 to 120 mg

35. The greenish discolouration seen in a bruise in a living person is due to (Kerala PGMEE 2015)

(A) Haemochromogen

(B) Bilirubin

(C) Haematoidin

(D) Haemosiderin

The Correct Answer is: C

Age of the bruise is calculated as

1. At first : Red

2. Few hrs to 3 days : Blue

3. 4th day : Bluish- black to brown (hemosiderin)

4. 5 – 6 days : Greenish (Haematoidin)

5. 7 – 12 days : Yellow (Bilirubin)

6. 2 weeks : Normal skin colour.

SPM

39. Positive health (Kerala PGMEE 2015)

(A) Is the essence of happy life

(B) Is central to the concept of quantum of life

(C) Is a fundamental human right

(D) Is integral part of social life

The Correct Answer is: C

Right to health is considered as a fundamental human right

40. When water contains substances or impurities that affect its physical qualities, it

is said to be (Kerala PGMEE 2015)

(A) Contaminated

(B) Polluted

(C) Contaminated and polluted

(D) Pathogenic

The Correct Answer is: B

41. The area which drains the pollutants or pathogens to a particular well is the (Kerala PGMEE 2015)

(A) Zone of concentration

(B) Zone of contamination

(C) Zone of infiltration

(D) Zone of influence

The Correct Answer is: D

42. Economically non-productive population corresponds to (Kerala PGMEE 2015)

(A) 0- 14 years and 45 years and more of female population

(B) 0-14 years and 65 years and more of male and female population

(C) 0-14 years and 65 years and more of female population

(D) 0-14 years and,45 years and more of male and female population

The Correct Answer is: B

43. For radiological analysis of water, water is preferably collected in (Kerala PGMEE 2015)

(A) Winchester quart boffle

(B) Sterile bottle sterilized in an autoclave

(C) Polythene bottle

(D) Clean glass bottle

The Correct Answer is: C

44. The very frst planned human trial was conducted in l747 by (Kerala PGMEE 2015)

(A) James Lind

(B) Edward Jenner

(C) Finlay and Reed

(D) Goldberg

The Correct Answer is: A

James Lind FRSE FRCPE (4 October 1716 – 13 July 1794) was a Scottish physician. He was a pioneer of naval hygiene in the Royal Navy. By conducting the first ever clinical trial, he developed the theory that citrus fruits cured scurvy. He argued for the health benefits of better ventilation aboard naval ships, the improved cleanliness of sailors’ bodies, clothing and bedding, and below-deck fumigation with sulphur and arsenic. He also proposed that fresh water could be obtained by distilling sea water. His work advanced the practice of preventive medicine and improved nutrition.

45. The standard colour coding for the bags / bins for disposal of incineration ash as

per the Biomedical Waste( Handling and Management) Rules 1998 is (Kerala PGMEE 2015)

(A) Red

(B) Yellow

(C) Blue

(D) Black

The Correct Answer is: D

Without Color coding of Biomedical waste MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given

46. In a slow sand filter, mechanical straining of turbid materials takes place (Kerala PGMEE 2015)

(A) In the interstices of the sand particles

(B) In the collection tank

(C) In the flocculation chamber

(D) In the perforated underdrains

The Correct Answer is: A

Without Slow sand filter vs Rapid sand filter  MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given

47. In the middle ages the Arabs were the pioneers in (Kerala PGMEE 2015)

(A) Mathematics

(B) Astronomy

(C) Pharmacology

(D) Surgery

The Correct Answer is: C

In mathematics, the Arab sifr, or zero, provided new solutions for complicated mathematical problems

Arabs were not merely the transmitters of existing knowledge; they were also the pioneers in medieval medicine, physics, chemistry and mathematics

48. In India the time limit for registration of births and deaths is (Kerala PGMEE 2015)

(A) 28 days

(B) 21 days

(C) 14 days

(D) 7 days

The Correct Answer is: B

Every Birth/Still birth and Death is to be reported and registered within 21 days at the place of its occurrence in the prescribed reporting formats.

Babumoshai, zindagi aur maut uparwale ke haath hai jahanpanah. Usse na toh aap badal sakte hain na main. Hum sab toh rangmanch ki kathputhliyan hain jinki dor uparwale ki ungliyon main bandhi hain. Kab, kaun, kaise uthega yeh koi nahi bata sakta hai. Ha, ha, ha.

49. The only bacteriostatic drug in primary anti-tuberculous drugs is (Kerala PGMEE 2015)

(A) Rifampicin

(B) Pyrazinamide

(C) Streptomycin

(D) Ethambutol

The Correct Answer is: D

50. In superchlorination double the usual dose of chlorine is added get free residual chlorine of more than (Kerala PGMEE 2015)

(A) 2.0 ppm

(B) 2.5 ppm

(C) 3.0 ppm

(D) 4.0 ppm

The Correct Answer is: A

Superchlorination is adding 7 to 10 times the normal dose of chlorine to the swimming pool

MEDICINE

51. The most common histological type of lung cancer in non-smokers is (Kerala PGMEE 2015)

(A) Adenocarcinoma

(B) Large cell carcinoma

(C) Small cell carcinoma

(D) Squamous cell carcinoma

The Correct Answer is: A

Without Bronchgenic carcinoma  MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given

52. The diffusing capacity of the lung is measured by using (Kerala PGMEE 2015)

(A) Body plethysmograph

(B) Pulse oximetry

(C) Vital capacity

(D) Carbon monoxide

The Correct Answer is: D

53. Which of the following is a mast cell inhibitor? (Kerala PGMEE 2015)

(A) Zafrlukast

(B) Omalizumab

(C) Nedocromil sodium

(D) Ipratropium bromide

The Correct Answer is: C

Without Asthma drugs  MCQ – no PG Medical entrance . Same MCQ repeated in JIPMER Nov 2014, PGI Nov 2014 , Maharashtra PG MAT 2015 , Kerala PG MEE 2015 . Don’t forget to revise Top 30% of 1132 High yield topic list given

Nedocromil sodium is a medication considered as mast cell stabilizer which act to prevent wheezing, shortness of breath, and other breathing problem

54. The following are features of hypersensitivity pneumonitis EXCEPT (Kerala PGMEE 2015)

(A) Presence of serum precipitins

(B) Eosinophilia

(C) Elevated ESR

(D) Upper lobe fibrosis

The Correct Answer is: B

Hypersensitivity pneumonitis – DIAGNOSTIC CRITERIA

  • Exposure to a known offending antigen
    • Confirmed history of exposure
    • Positive precipitating antibodies to the offending antigen
    • Recurrent episodes of symptoms
  • Clinical signs and symptoms on physical examination and history
    • Crackles
    • Weight loss
    • Wheezing (generally less prominent feature)
    • Febrile episodes
    • Symptoms occurring within 4-8 hours of exposure
  • Radiographic evidence on chest radiograph or CT
  • Bronchoscopic alveolar lavage (BAL) evidence
    • Lymphocytic predominance
  • Pathologic evidence
    • Often evidence of poorly formed noncaseating granulomas
    • Mononuclear cellular infiltrates
    • Fibrotic scarring

55. The following are true of cystic fibrosis EXCEPT (Kerala PGMEE 2015)

(A) Elevated sweat chloride is pathognomonic

(B) Nasal epithelial electric potential difference measurements can be diagnosis

(C) Infection with pseudomonas common

(D) CFTR gene is located on chromosome 6

The Correct Answer is: D

The gene that encodes the human CFTR protein is found on chromosome 7, on the long arm at position q31.2

56. The Westermark sign on chest X-ray occurs in (Kerala PGMEE 2015)

(A) Pulmonary embolism

(B) Pulrnonary lymphangioleiomyomatosis

(C) Goodpasture’ssy ndrome

(D) Sarcoidosis

The Correct Answer is: A

Westermark sign is a sign of pulmonary embolus (PE) seen on chest radiographs.

Along with Fleishner sign and Hampton hump it makes one of the one of the three described signs of pulmonary embolus on plain film.

Radiographic features

Plain film

  • focal peripheral hyperlucency secondary to oligaemia 2, 3, 4
  • central pulmonary vessels may also be dilated

57. A pleural fluid NT-pro BNP > 1500p g/ml is diagnostic of effusion due to (Kerala PGMEE 2015)

(A) Diabetes mellitus

(B) Congestive heart failure

(C) Rheumatoid pleuritis

(D) Pancreatic pleural effusion.

The Correct Answer is: B

In the study by Porcel et al  a cutoff of NT-proBNP of 1500 pg/mL was highly specific and sensitive for the diagnosis of CHF related pleural effusion, it was also noted that this marker was not elevated in transudates related to hepatic hydrothorax.

58. Which of the following is a transudative pleural effusion? (Kerala PGMEE 2015)

(A) Urinothorax

(B) Chlothorax

(C) Haemothorax

(D) Meigs’syndrome

The Correct Answer is: A

Harrison table

Transudative Pleural Effusions

1. Congestive heart failure

2. Cirrhosis

3. Pulmonary embolization

4. Nephrotic syndrome

5. Peritoneal dialysis

6. Superior vena cava obstruction

7. Myxedema

8. Urinothorax

59. The following lesions are common in the anterior mediastinum EXCEPT (Kerala PGMEE 2015)

(A) Neurofibroma

(B) Thyrnomas

(C) Thyroid masses

(D) Lymphomas

The Correct Answer is: A

60. The following are features of cryptic miliary tuberculosis EXCEPT (Kerala PGMEE 2015)

(A) Hepatosplenomegaly

(B) Leukaemoid reaction

(C) Millet seed lesions on chest X -ray

(D) Negative tuberculin test

The Correct Answer is: C

Disease was termed “cryptic” because its usual clinical and radiographic features were absent

61. Which of the following genes indicates rifampicin resistance? (Kerala PGMEE 2015)

(A) 165r RNA gene

(B) FMR 2 gene

(C) RET gene

(D) rpoB gene

The Correct Answer is: D

The rpoB gene encodes the β subunit of bacterial RNA polymerase. It is the site of mutations that confer resistance to the rifamycin antibacterial agents, such as rifampin.[1] Mutations in rpoB that confer resistance to rifamycins do so by altering residues of the rifamycin binding site on RNA polymerase, thereby reducing rifamycin binding affinity for rifamycin

62. The following are true of interferon-gamma release assays EXCEPT (Kerala PGMEE 2015)

(A) Gives false positive for BCG vaccinated individuals

(B) The antigens involved are ESAT-6 or CFP-10

(C) Interferon gamma is released by sensitized T cells

(D) Quantiferon TB gold is done by ELISA

The Correct Answer is: A

The presence of IFN-G can then be quantified using a single step enzyme-linked immunosorbent assay (ELISA) using anti-IFN-G antibodies.

 

Interferon Gamma Release Assays are a class of assays for viral and infectious diseases that measure the cell mediated response in infected individuals through the levels of interferon gamma released. During an infection, T cells from the individual will be senstized (via MHC proteins) to the antigens presented by cells of the infecting organism. T cells will thus be able to bind to foreign infecting cells, releasing interferon-gamma.

Interferon Gamma Release Assays take advantage of this natural process in infected immunocompetent individuals. When antigens specific for a given infecting agent (often in the form of purified protein derivatives) are applied to whole-blood samples from infected individuals, T cells sensitized to the antigens will be present in the blood, and will bind to the antigen. The T cells will then release Interferon-Gamma; the presence of sensitized T-cells in infected individuals will result in far higher levels of IFN-G release than among uninfected individuals

63. Which of the following is NOT a feature of cryptogenic organizing pneumonia? (Kerala PGMEE 2015)

(A) Radiological pneumonia

(B) Finger clubbing very common presenting feature

(C) Biopsy positive for Masson bodies

(D) Dramatic response to steroids

The Correct Answer is: B

High magnification micrograph of a Masson body. H&E stain. Masson bodies are seen in organizing pneumonia, which is seen in: Cryptogenic organizing pneumonia (abbreviated COP), previously known as bronchiolitis obliterans organizing pneumonia (abbreviated BOOP).

  • Organising pneumonia (OP) is a histologic pattern of alveolar inflammation with varied aetiology (including pulmonary infection). The idiopathic form of OP is called cryptogenic organising pneumonia (COP) and it belongs to idiopathic interstitial pneumonias (IIP’s).
  • COP was previously termed bronchiolitis obliterans organising pneumonia (BOOP),
  • On clinical examination, crackles are common, and more rarely, patients may have clubbing (<5% of cases). Laboratory findings are nonspecific.
  • Almost 75% of people have symptoms for less than two months before seeking medical attention.
  •  A flu-like illness, with a cough, fever, a feeling of illness (malaise), fatigue, and weight loss heralds the onset in about 40% of patients. Doctors do not find any specific abnormalities on routine laboratory tests or on a physical examination, except for the frequent presence of crackling sounds (called rales) when the doctor listens with a stethoscope. Pulmonary function tests usually show that the amount of air the lungs can hold is below normal. The amount of oxygen in the blood is often low at rest and is even lower with exercise.
  • About two thirds of patients recover with corticosteroid therapy: the usual steroid administered is prednisolone in Europe and prednisone in the USA; these differ by only one functional group and have the same clinical effect. The steroid is initially administered in high dosage, typically 50 mg per day tapering down to zero over a six-month to one-year period. If the steroid treatment is halted too quickly the disease may return.

64. Lofgren syndrome is a type of (Kerala PGMEE 2015)

(A) Hypersensitivity pneumonitis

(B) Pneumoconiosis

(C) Eosinophilic pneumonia

(D) Sarcoidosis

The Correct Answer is: D

65.Orange tonsils are characteristic of (Kerala PGMEE 2015)

A) Tangiers disease

B) Loey’s-Dietz syndrome

C) Carney syndrome

D) Osler-Weber Rendu  symdrome

The Correct Answer is:A

Tangier disease (also known as Familial alpha-lipoprotein deficiency or Hypoalphalipoproteinemia is a rare inherited disorder characterized by a severe reduction in the amount of high density lipoprotein (HDL), often referred to as “good cholesterol,” in the bloodstream.

In 1959, a five year old patient named Teddy Laird from Tangier Island, Virginia, presented with strikingly large and yellow-orange tonsils which were removed by armed forces physicians.

 

66. Osborn waves on ECG occur in (Kerala PGMEE 2015)

(A) Myocarditis

(B) Hypothermia

(O LBBB

(D) Acute pulmonary embolism

The Correct Answer is:B

67. The most common type of ASD is (Kerala PGMEE 2015)

(A) Sinus venosus type

(B) Ostium secondum type

(C) Ostium primum type

(D) Patent foramen ovale

The Correct Answer is:B

68. The most common toxin implicated in chronic dilated cardiomyopathy is (Kerala PGMEE 2015)

(A) Traztuzumab

(B) Amphetamine

(C) Alcohol

(D) Chloroquine

The Correct Answer is:C

69. All of the following constitute Beck’s triad EXCEPT (Kerala PGMEE 2015)

(A) Hypotension

(B) Soft or absent heart sounds

(C) Jugular venous distension with prominent  ‘X’ descent

(D) Pericardial knock

The Correct Answer is:D

70. The following drugs are used in the treatment of acute severe asthma EXCEPT (Kerala PGMEE 2015)

(A)  IV Beta 2 agonists

(B) Aminophylline

(C) Inhaled anticholinergics

(D) Omalizumab

The Correct Answer is:D

  • Omalizumab is a humanized antibody originally designed to reduce sensitivity to inhaled or ingested allergens, especially in the control of moderate to severe allergic asthma, which does not respond to high doses of corticosteroids.
  • Omalizumab is a recombinant DNA-derived humanized IgG1k monoclonal antibody that specifically binds to free human immunoglobulin E (IgE) in the blood and interstitial fluid and to membrane-bound form of IgE (mIgE) on the surface of mIgE-expressing B lymphocytes.
  • Unlike an ordinary anti-IgE antibody, it does not bind to IgE that is already bound by the high affinity IgE receptor (FcεRI) on the surface of mast cells, basophils, and antigen-presenting dendritic cells

71. The following are features of pulmonary lymphangioleiomyomatosis EXCEPT (Kerala PGMEE 2015)

(A) Spontaneous pneumothorax

(B) Chylopericardium is a complication

(C) Renal angiomyolipoma common

(D) Oophorectomy aggravates disease

The Correct Answer is:D

  • General care for patients with lymphangioleiomyomatosis (LAM) addresses the following findings :
    • Pleural effusions – Consider chemical pleurodesis; surgical obliteration of the pleural space; medium-chain triglyceride (MCT [not a component of chyle]), lipid-free diet to reduce chyle flow (utility unknown)
    • Ascites – Paracentesis, MCT diet (utility unknown)
    • Airways disease and hypoxemia – Bronchodilators may be of benefit supplemental oxygen, pulmonary rehabilitation, smoking cessation
    • Standard vaccination for respiratory infections
    • Osteoporosis – Standard surveillance and treatment; avoid exogenous estrogens[
    • Lung transplantation
  • Possible options for hormonal manipulation include the following:

    • Medroxyprogesterone – Utility not known; recent case series does not support its use
    • Gonadotropin-releasing hormone agonists – Utility not known; few case reports support their use
    • Tamoxifen does not appear to be effective[19] and is not recommended due to estrogen receptor agonist activity
    • Rate of decline in lung function trends to be less in postmenopausal women (eg, surgical oophorectomy, age)
  • New experimental therapies include the following:
    • Rapamycin – Improves lung function in patients with LAM. Also reduces the size of angiomyolipomas, lymphangioleiomyomas, and chylous effusions. The therapeutic response to rapamycin, however, is generally not sustaine
    • Chloroquine – Inhibitor of autophagy
    • Aromatase inhibitors – Antiestrogenic effects

72. Ventilator associated pneumonia caused by MRSA is treated with (Kerala PGMEE 2015)

(A) Moxifloxacin

(B) Ceftriaxone

(C) Linezolid

(D) Clarithromycin

The Correct Answer is:C

Patients with MRSA VAP who are treated with linezolid have a significantly higher clinical success rate compared with patients treated with vancomycin.

73. In alpha I antitrypsin deficiency, complete absence of any alpha 1 antitrypsin

      production occurs in individuals who inherit (Kerala PGMEE 2015)

(A) Null allele

(B) M allele

(C) S allele

(D) Z aIIeIe

The Correct Answer is:A

The most common deficiency allele of the plasma protease inhibitor alpha 1-antitrypsin (alpha 1AT) is PI*Z.

  • Some rare deficiency alleles of alpha 1AT produce low but detectable amounts of plasma alpha 1AT (1-20% of normal), which can be differentiated by isoelectric focusing.
  • Others, designated null (QO) alleles, produce no alpha 1AT detectable by routine quantitative methods
  • nullallele1 causes decreased, severely deficient, or a complete absence of AAT

74. Hyperekplexia occurs due to mutations in (Kerala PGMEE 2015)

(A) Glycine receptor

(B) Acetylcholiner eceptor

(C) Serotonin receptor

(D) Dopamine receptor

The Correct Answer is:A

Hyperekplexia (“exaggerated surprise”) is a neurologic disorder classically characterised by pronounced startle responses to tactile or acoustic stimuli and hypertonia.

  • The hypertonia may be predominantly truncal, attenuated during sleep and less prominent after a year of age.
  • Classic hyperekplexia is caused by genetic mutations in a number of different genes, all of which play an important role in glycine neurotransmission.
  • Glycine is used by the central nervous system as an inhibitory neurotransmitter. Hyperekplexia is generally classified as a genetic disease, but some disorders can mimic the exaggerated startle of hyperekplexia
  • The most commonly effective treatment is clonazepam, which leads to the increased efficacy of another inhibitory neurotransmitter, GABA.[1] There are anecdotal reports of the use of Levetiracetam in genetic and acquired hyperekplexia.[15] During attacks of hypertonia and apnea, the limbs and head may be flexed towards the trunk in order to dissipate the symptoms. This is named the Vigevano maneuver after the doctor who invented i

75. The-most common site of hypertensive intracranial bleed is (Kerala PGMEE 2015)

(A) Corona radrata

(B) Putamen

(C) Midbrain

(D) Occipital lobe

The Correct Answer is:B

76. In spinal muscular atrophy which set of neurons is affected? (Kerala PGMEE 2015)

(A) Upper motor neurons of brain stem

(B) Lower motor neurons of brain stem

(C) Lower motor neurons of spinal cord

(D) Upper motor neurons of spinal cord

The Correct Answer is:C

  • Proximal spinal muscular atrophy (SMA)
  • It is an autosomal recessive disease caused by a genetic defect in the SMN1 gene, which encodes SMN, a protein widely expressed in all eukaryotic cells.
  • SMN is apparently selectively necessary for survival of motor neurons, as diminished abundance of the protein results in loss of function of neuronal cells in the anterior horn of the spinal cord and subsequent system-wide muscle wasting (atrophy).

  • Spinal muscular atrophy manifests in various degrees of severity, which all have in common progressive muscle wasting and mobility impairment. Proximal muscles and lung muscles are affected first. Other body systems may be affected as well, particularly in early-onset forms.
  • SMA is the most common genetic cause of infant death.

77. Which of the following is usually present in neuromyelitis optica? (Kerala PGMEE 2015)

(A) Serum antibody to alpha 3 chain of type IV collagen

(B) Antibody to proteinase 3

(C) Antibody to sphingomyelin

(D) Serum autoantibodies against aquaporin 4

The Correct Answer is:D

Neuromyelitis optica (NMO) is a rare CNS inflammatory disorder that predominantly affects the optic nerves and spinal cord. Recent serological findings strongly suggest that NMO is a distinct disease rather than a subtype of multiple sclerosis. In NMO, serum antibodies, collectively known as NMO-IgG, characteristically bind to cerebral microvessels, pia mater and Virchow–Robin spaces. The main target antigen for this immunoreactivity has been identified as aquaporin-4 (AQP4). The antibodies are highly specific for NMO, and they are also found in patients with longitudinally extensive transverse myelitis without optic neuritis, which is thought to be a precursor to NMO in some cases.

78. The only approved treatment for primary biliary cirrhosis is (Kerala PGMEE 2015)

(A) Ursodeoxycholic acid

(B) Interferon u

(C) Telbivudine

(D) Acamprosate calcium

The Correct Answer is:A

Cochrane review looking at primary biliary cirrhosis found that although ursodeoxycholic acid showed a reduction in liver biochemistry, jaundice, and ascites, it did not decrease mortality or liver transplantation.

Ursodiol is the only FDA approved drug to treat primary biliary cirrhosis.

79.  The best therapy for hepatorenal syndrome is (Kerala PGMEE 2015)

(A) Dopamine

(B) Liver transplantation

(C) Prostaglandin analogues

(D) IV globulin

The Correct Answer is:B

Liver transplantation

Liver transplantation is the ideal treatment of HRS but is limited by the availability of donors.

  • In a matched-pair study by Goldaracena et al, living (LDLT) and deceased donor liver transplantation (DDLT) led to comparable long-term outcomes in patients with HRS.[39] The investigators evaluated outcomes between 30 patients with HRS who received LDLT and 90 patients with HRS who received a full-graft DDLT. They did not identify any differences in graft survival and patient survival at 1, 3, and 5 years, and the incidence of postsurgical chronic kidney disease was similar between the two groups.[39]
  • Patients with HRS have a higher risk of postoperative morbidity, early mortality, and longer hospitalization. Gonwa et al reported that at least one third of patients require hemodialysis postoperatively, with a smaller percentage (5%) requiring long-term hemodialysis.
  • Because renal dysfunction is common in the first few days following transplantation, avoiding nephrotoxic immunosuppressants generally is recommended until recovery of renal function. However, the GFR gradually improves and reaches an average of 40-50 mL/min by the sixth postoperative week. The systemic and neurohumoral abnormalities associated with HRS also resolve in the first postoperative month.
  • Long-term survival rates are excellent, with the survival rate at 3 years approaching approximately 60%. This is only slightly lower than the 70-80% survival rate of transplant recipients without HRS and is markedly better than the survival rate of patients with HRS not receiving transplants, which is virtually 0% at 3 years.

80. The oral drug used in the treatment of micro or macroprolactinomas is (Kerala PGMEE 2015)

(A) Risperidone

(B) Verapamil

(C) Dobutamine antagonist

(D) Cabergoline

The Correct Answer is:D

PAEDIATRICS

81. At what age is object permanence achieved as a major milestone? (Kerala PGMEE 2015)

(A) 4 months

(B) 6 months

(C) 9 months

(D) 15 months

The Correct Answer is:C

Children around 8 months have object permanence

Object permanence is the understanding that objects continue to exist even when they cannot be observed (seen, heard, touched, smelled or sensed in any way). T

82. Which of the following is NOT TRUE about Tourette’s syndrome? (Kerala PGMEE 2015)

(A) Characterized by multiple motor tics

(B) Three times more common in girls

(C) Coprolalia is characteristic

(D) Has its onset before 18 years of age

The Correct Answer is:B

Tourette’s syndrome is about three times more common in boys than in girls

83.W hich of the following is true as a hallmark of refeeding syndrome? (Kerala PGMEE 2015)

(A) Hypophosphatemia

(B) Hypokalemia

(C) Hypernatremia

(D) Hypocalcemia

The Correct Answer is:A

Refeeding syndrome usually occurs within four days of starting to feed. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications.

84.Which of the following statements is true regarding single acute toxic dose of

acetaminophen in children? (Kerala PGMEE 2015)

(A) More than 200 mg/kg

(B) More than 150 mg/kg

(C) More than 100 mg/kg

(D) More than 7 5 mg/kg

The Correct Answer is:A

85. Which of the following is true as a diagnostic criterion for severe malnutrition? (Kerala PGMEE 2015)

(A) Weight for age below – 3SD of the median WHO growth reference

(B) Weight for age below – 2SD of the median WHO growth reference

(C) Mid upper arm circumference less than 125mm

(D) Height for age below – lSD of the median WHO growth reference

The Correct Answer is:A

World Health Organization (WHO) and United Nations Children’s Fund proposed diagnostic criteria for severe acute malnutrition in children aged 6 to 60 months include any of the following:

  • weight for height below –3 standard deviation (SD or Z scores) of the median WHO growth reference ;
  • visible severe wasting;
  • (iii) presence of bipedal edema; and
  • mid upper arm circumference below 115 mm

 

The Indian Academy of Pediatrics recommended diagnostic criteria (2007), adapted from the earlier WHO guidelines, are weight for height/length below 70% or £3SD of NCHS median and/or visible severe wasting and/or bipedal edema; mid upper arm circumference criteria may also be used for identifying severe wasting

86. Which of the following drugs is NOT used for prophylaxis of neisseria

meningitidis? (Kerala PGMEE 2015)

(A) Rifampicin

(B) Ceftriaxone

(C) Ampicillin

(D) Ciprofloxacin

The Correct Answer is:C

87. Most common pathogen isolated in bacterial tracheitis in children is (Kerala PGMEE 2015)

(A) H. influenza

(B) Staphylococcus aureus

(C) Streptococcups neumoniae

(D) Anaerobic bacteria

The Correct Answer is:B

Staphylococcus aureus was the most commonly implicated bacterial organism in bacterial tracheitis in children

88. Which of the following statements is FALSE in ventricular septal defect? (Kerala PGMEE 2015)

(A) Development of AR is greatest in membranous VSD

(B) Non restrictive VSD have equal right and left ventricular pressure

(C) Supracristal VSD of any size should be referred for surgery

(D) Following VSD repair, the thrills and murmurs disappear

The Correct Answer is:A

  • Defects in the area of the septum adjacent to the arterial valves are termed as subarterial infundibular defects. These defects are also called supracristal defects and because of the complete deficiency of the infundibular septum, allow prolapse of the aortic valve cusps into the right ventricular outflow tract. This can result in development of aortic regurgitation. These defects account for 5% to 7% of all defects in the western world but about 30% in far eastern countries.

  • Muscular defects are most likely to close as the child grows.
  • A perimembranous inlet VSD may close by adherence of the septal leaflet of the tricuspid valve to the right side of the defect.
  • A perimembranous outlet VSD bordered in part by arterial valves will not close.
  • Likewise, supracristal VSDs are bordered by semilunar valve tissue and do not close

The spontaneous closure of a perimembranous VSD can create an aneurysm of the membranous septum.

  • Complications of an aneurysm of the membranous septum in the absence of persistent VSD include infective endocarditis, conduction abnormality, thrombosis in the aneurysm, aortic regurgitation, tricuspid regurgitation, and perforation of the aneurysm

Classification of VSDs still remains a matter for debate.

 However, the most widely accepted classification which is useful both clinically and surgically describes VSDs based on their location in the ventricular septum.

 

  • The ventricular septum is divided into a small membranous portion and a large muscular portion. The muscular septum has three components: the inlet septum, the trabecular septum, and the outlet (or infundibular) septum.
  • Defects in the membranous septum often extend into different parts of the muscular septum and are labelled as perimembranous defects. These include inlet, trabecular and infundibular perimembranous defects. Perimembranous defects are the most common.
  • Defects confined to the muscular septum are called muscular defects and further described according to their location in the muscular septum. Muscular defects can be found in or between the inlet septum, trabecular septum or infundibular septum.
  • Inlet or AV canal VSDs lie beneath the septal leaflet of the tricuspid valve. They are not associated with defects in the atrioventricular (AV) valves and account for 5% to 8% of all VSDs.
  • Acquired VSD can occur as a result of a septal myocardial infarct but such a finding is much rarer than congenital lesions and prognosis tends to be poor.

89. Whtch of the following mucopolysaceharidosis type is most likely to have

moderate mental retardation? (Kerala PGMEE 2015)

(A) Scheie

(B) Morquio

(C) Hurlers

(D) Maroteaux-Lamy

The Correct Answer is:C

Characteristics of Hurler Syndrome are:

  • Growth deficiency – with growth often stopping by age 2
  • Coarse facial features – prominent forehead, thick earlobes, full lips,

and low nasal bridge Stiff joints

  • Cloudy corneas

  • Severe mental retardation

  • Hepatosplenomegaly (enlargement of the spleen and liver)

90. Which of the following is NOT TRUE of congenital hypothyroidism? (Kerala PGMEE 2015)

(A) Epiphysis often have multiple foci of ossification

(B) Blood sample for T3, T4 and TSH should be collected between 0-48 hours

(C) Most cases result frbm thyroid dysgenesis

(D) ECG may show evidence of poor LV function

The Correct Answer is:B

In the majority of the centers, blood is obtained from a heel prick after 24 hours of age to minimize the false positive high TSH due to the physiological neonatal TSH surge that elevates TSH levels and causes dynamic T4 and T3 changes in the first 1 or 2 days after birth. Early discharge of mothers postpartum has increased the ratio of false positive TSH elevations.

DERMATOLOGY

91. Pastia’s lines are seen in (Kerala PGMEE 2015)

(A) Rheumatic fever

(B) Scarlet fever

(C) Erythrasma

(D) Cryptococcal infection

The Correct Answer is: B

 

92.Erysipelas is caused by (Kerala PGMEE 2015)

(A) Staphylococcus

(B) Candida

(C) Streptococcus

(D) Mycobacterium

The Correct Answer is: C

93.Staphylococcal scalded skins syndrome is caused by (Kerala PGMEE 2015)

(A) Exfoliative toxin

(B) Protein M

(C) Lipoteichoic acid

(D) Lipopolysaccharide

The Correct Answer is: A

94. Erythrasma is caused by (Kerala PGMEE 2015)

(A) Nocardia minutissimum

(B) Trichophyton rubrum

(C) Bacillus pyocyaneus

(D) Corynebacterium minutissimum

The Correct Answer is: D

95.Green nail syndrome is caused by (Kerala PGMEE 2015)

(A) Streptococcus

(B) Trauma

(C) Pseudomonas aeruginosa

(D) Klebsiella

The Correct Answer is: C

Green nail syndrome, also known as chloronychia,is a paronychial infection caused due to Pseudomonas aeruginosa that can develop in individuals whose hands are frequently submerged in water It may also occur as transverse green stripes that are ascribed to intermittent episodes of infection

ANAESTHESIA

96. Xenon provides rapid induction and recovery from anaesthesia because (Kerala PGMEE 2015)

(A) It has a MAC of 50%

(B) It is more potent than nitrous oxide

(C) It does not undergo biotransformation

(D) It hasa blood gas partition coefficient of 0.14- 0.2

The Correct Answer is: D

The partition coefficient(Solubility) is the ratio between the number of the molecules of an anesthetic gas existing in two phases (solvent/gas).

  • It indicates the solubility of an anesthetic gas in a particular tissue, blood or inert material. An inhalant anesthetic with a low numeric partition coefficient will quickly saturate the blood and tissues; thus the induction and recovery times will be rapid.
  • An inhalant anesthetic with a high numeric partition coefficient will be slow to saturate blood and tissues; thus the induction and recovery times will be slow
  • Xenon is an inert gas with many of the characteristics considered important for an ideal inhaled anesthetic. Its MAC is 71% in humans, suggesting that this gas is more potent than nitrous oxide (MAC 104%). It is nonexplosive, nonpungent and odorless, and extremely unreactive and produces only minimal cardiac depression. Unlike other inhalation anesthetics, it is not harmful to the environment because it is prepared by fractional distillation of the atmospheric air. Nitrous Oxide is less potent in animals than in human beings. The MAC for nitrous oxide in animals is close to 200%, leading low decrease in inhalation anesthetic MAC. Because xenon is almost twice as potent than nitrous oxide in human beings, it is fair to speculate that xenon could be used in animals in the same manner that it is in man (i.e. to decrease inhalant MAC and provide intra-operative analgesia). Higher potency of an anesthetic gas could permit a decrease in the inhalant MAC. Production cost is a concern but this disadvantage may be offset to some degree by using low fresh gas flow rates and development of a xenon-recycling system. Xenon has a blood:gas partition coefficient of 0.14%, which is lower than that of other clinically useful anesthetics and even lower than that of nitrous oxide (0.46), sevoflurane (0.69), and desflurane (0.42). Emergence from xenon anesthesia is two to three times faster than that from equal-MAC nitrous oxide plus isoflurane or sevoflurane. A risk of recall would seem to be present but has not been observed in small numbers of patient

97. Mechanism of action of local anaesthetics is by (Kerala PGMEE 2015)

(A) Blocking membrane depolarisation

(B) Blocking membrane repolarisation

(C) Binding to plasma proteins

(D) By sequestrationin the lungs

The Correct Answer is: A

98. The following are the safety features of modern anaesthesia machine EXCEPT  (Kerala PGMEE 2015)

(A) Pin index system

(B) Colour coded cylinders

(C) Oxygen flow meter upstream in flow meter assembly

(D) Non-return valves

The Correct Answer is: C

99. Levobupivaacine is (Kerala PGMEE 2015)

(A) Less cardiotoxic than racemic mixture

(B) Less potent than ropivacaine

(C) Less potent than bupivacaine

(D) Neurotoxic

The Correct Answer is: A

The levogyrous enantiomer (levobupivacaine) is less cardiotoxic as compared to the racemic mixture

100. measurement of end-tidal carbon dioxide during cardiopulmonary resuscitation (Kerala PGMEE 2015)

(A) Has high predictive value of restoration of spontaneous circulation

(B) Does not reflect cardiac output

(C) Does not reflect pulmonary artery pressure

(D) Does not signify adequacy of resuscitation

The Correct Answer is: A

ETCO2  is a hot topic in PG Medical entrance , routinely asked in exam

An ability to predict cardiac arrest outcomes would be useful for resuscitation. Changes in expired end-tidal carbon dioxide levels during cardiopulmonary resuscitation (CPR) may be a useful, noninvasive predictor of successful resuscitation and survival from cardiac arrest, and could help in determining when to cease CPR efforts.

PSYCHIATRY

101. Blood concentration level of alcohol for diagnosis of intoxication is (Kerala PGMEE 2015)

(A) 160-200 mg of ethanol per dL of blood

(B) 80-100 mg of ethanol per dL of blood

(C) 20-40 mg of ethanol per dL of blood

(D) 300-500 mg of ethanol per dL of blood

The Correct Answer is: B

102. Malignant neuroleptic syndrome is characterized by (Kerala PGMEE 2015)

(A) Subnormal temperature and muscle rigidity

(B) No muscle rigidity and normal temperature

(C) High temperature and muscle rigidity

(D) Subnormal temperature

The Correct Answer is: C

103. Symptoms of pregnancy in non pregnant woman is called (Kerala PGMEE 2015)

(A) Pathological gambling

(B) Pseudocyesis

(C) Dementia precox

(D) Dyslexia

The Correct Answer is: B

104. Adult dose of lorazepam for oral use is (Kerala PGMEE 2015)

(A) 0.5mg-6mg

(B) 25 mg -7 5 mg

(C) 10 mg – 100 mg

(D) 0.2 mg- 0.5 mg

The Correct Answer is: A

Usual Adult Dose for Anxiety

Oral:
Initial dose: 1 mg orally 2 to 3 times a day.

Maintenance dose: 1 to 2 mg orally 2 to 3 times a day.

The daily dosage may vary from 1 to 10 mg/day orally.

105. Fear of high spacesis called (Kerala PGMEE 2015)

(A) Acrophobia

(B) Macrophobia

(C) Europhobia

(D) Pyrophobia

The Correct Answer is: A

Acrophobia is an extreme or irrational fear of heights, especially when one is not particularly high up. It belongs to a category of specific phobia

RADIOLOGY

106. Most radio sensitive tumor among the following is (Kerala PGMEE 2015)

(A) Squamous cell carcinoma

(B) Adenocarcinoma

(C) Seminoma

(D) Sarcoma

The Correct Answer is: C

107. Radical external beam radiotherapy dose for head and neck epithelial malignancy is (Kerala PGMEE 2015)

(R) 50 Gv

(B) 70 GY

(C) 30 GY

(D) 80 GY

The Correct Answer is: B

Indications for Brachytherapy (BRT):

o Accessible lesions

o Small (preferably < 3cm) tumours

o Lesions away from bone

o N0 nodal status

Radical Radiotherapy:

o Tumour suitable for brachytherapy

o T1-2 N0: Radical BRT: 60-70Gy Low Dose Rate 192Iridium

o Or equivalent doses with fractionated high dose rate.

o T1-3 N0-1: External RT: 56-60Gy/ 28-30#/ 6 wks

o Boost BRT: Low dose rate 192Iridium: 15-20Gy or

o High Dose Rate: 14Gy in 4 fractions over 2 days (4-3-3-4 Gy)

o Tumours not suitable for brachytherapy:

o T1-4 N0-2: Concomitant Chemoradiation: 66-70Gy/33-35# /6-7 wks + concomitant weekly Cisplatinum, 30mg/m2 for 6-7 wks

Or

o External RT: 66-70Gy/33-35# /6-7 wks (reducing fields)

o Post-operative radiotherapy:

o Primary and nodal disease: 50 – 60 Gy/25-30 fr/5-6 weeks, using reducing fields.

o Site of residual disease, positive cut margins: 4-10 Gy Boost

108.Treatment of choice for limited stage small cell lung cancer is (Kerala PGMEE 2015)

(A) Surgery

(B) Chemoradiation

(C) Chemotherapy

(D) Radiotherapy

The Correct Answer is: B

Standard treatment options for patients with limited-stage small-cell lung cancer (SCLC) include the following:

o Chemotherapy and radiation therapy.

o Combination chemotherapy alone.

o Surgery followed by chemotherapy or chemoradiation therapy.

o Prophylactic cranial irradiation (PCI).

Chemotherapy and radiation therapy

o Combined-modality treatment with etoposide and cisplatin with thoracic radiation therapy (TRT) is the most widely used treatment for patients with limited-stage disease (LD) SCLC.

109. Which one of the following comprises particle radiation? (Kerala PGMEE 2015)

(A) Cobalt therapy

(B) Caesium therapy

(C) Iridium brachytherapy

(D) Proton therapy

The Correct Answer is: D

Proton beam radiotherapy can deliver therapeutic radiation doses with great precision

Particle therapy, in particular proton therapy, is an advanced method of applying cancer radiotherapy by using proton beams. It is a superior but costlier alternative to conventional therapy, which is usually applied with photon beams.

110.Brachytherapy is NOT an established component in the treatment of (Kerala PGMEE 2015)

(A) Bronchial malignancy

(B) Esophageal malignancy

(C) Cervical cancer

(D) Retroperitoneal tumor

The Correct Answer is: D

SURGERY

111. Which is INCORRECT regarding sliding hernia? (Kerala PGMEE 2015)

(A) May contain large bowel on posterior aspect

(B) Large bowel wall can be damaged as it is not covered by peritoneum all around

(C) It is direct type when it contains large bowel

(D) It is indirect type when it contains large bowel

The Correct Answer is: C

• From 2 per cent to 5 per cent of all indirect inguinal hernias are of the sliding variety. (Sliding hernias are those in which part of the wall of the sac is formed by a viscus.)

• The proportion of sliding hernias is even higher in the aged. Hernias of this kind are found almost exclusively in males and usually on the left side.

• Preoperative diagnosis is not essential if the surgeon can recognize the lesion at operation and knows how to repair it properly. The LaRoque technique in which the peritoneal cavity is entered above the internal ring allows accurate definition of the pathological anatomy and effective repair of the hernia. It should be used in all true sliding indirect inguinal hernias.

112. Which is INCORRECT regarding spigelian hernia? (Kerala PGMEE 2015)

(A) Most common in elderly

(B) It is subumbilical near the edge of the rectus sheath

(C) The defect in spigelian fascia is almost always below arcuate line

(D) The defect in spigelian fascia is almost always above arcuate line

The Correct Answer is: C

113. All the following are true about desmoid tumour EXCEPT (Kerala PGMEE 2015)

(A) More common in women

(B) Have been reported in familial adenomatous polyposis

(C) Responds to chemoradiotherapy

(D) Can undergo central myxomatous change

The Correct Answer is: C

 
• Desmoid tumors most commonly occur in women after childbirth.

• Desmoid tumors are twice as common in females than in males; however, 60 patients were described and the female-to-male ratio was 1.2:1.

• Primary surgery with negative surgical margins is the most successful primary treatment modality for desmoid tumors. Positive margins after surgery reflect a high risk for recurrence

• In those patients who refuse surgery or are not surgical candidates, the options below may be considered.

• Radiation therapy may be used as a treatment for recurrent disease or as primary therapy to avoid mutilating surgical resection. It may be used postoperatively, preoperatively, or as the sole treatment

• Pharmacologic therapy with antiestrogens and prostaglandin inhibitors may also be used.

• In cases of recurrent extra-abdominal desmoid tumors in which surgery is contraindicated or in cases of recurrence, a chemotherapeutic regimen of doxorubicin, dacarbazine, and carboplatin may be effective. Intra-abdominal desmoid tumors as a part of Gardner syndrome may respond to systemic doxorubicin, and ifosfamide can be useful for patients with complications from the tumor

• Polychemotherapy has been use and can be combined with targeted therapy with imatinib

• Expanded knowledge of familial adenomatosis polyposis–desmoid tumor molecular underpinnings may aid in the development of novel therapeutic strategies

• Gardner syndrome or familial adenomatous polyposis (FAP) is characterized by colorectal adenomatous polyps and soft and hard tissue neoplasms. The former may number in the hundreds to thousands. Gardner syndrome was regarded as a separate disease until the identification of the APC (adenomatous polyposis coli) gene, at which point mutations in the APC gene were recognized as the underlying cause of both Gardner syndrome and FAP. Some authors regard Gardner syndrome as a subset of FAP, and some have even suggested that the term Gardner syndrome be replaced by FAP. Additionally, evidence also exists for a genetic predisposition to desmoid tumors in FAP, independent of the APC mutation.

114. In sportsman’s hernia, most useful diagnostic tool is (Kerala PGMEE 2015)

(A) CT scan

(B) Herniography

(C) Ultrasound of abdomen

(D) MRI scan

The Correct Answer is: D

Athletic pubalgia, also called the sports hernia, hockey hernia, hockey groin, Gilmore’s Groin, or groin disruption is a medical condition of the pubic joint affecting athletes.

• It is a syndrome characterized by chronic groin pain in athletes and a dilated superficial ring of the inguinal canal.

• Football and ice hockey players are affected most frequently, and both recreational and professional athletes may be affected

Athletic pubalgia is a diagnosis of exclusion. Other more important cause of groin pain must first be ruled out. The symptoms are usually very non specific and include:

tenderness on palpation of the medial inguinal floor

tenderness on palpation over the pubic ramus

exacerbated pain with resisted hip adduction

This diagnosis can only be made on MRI and findings are usually very subtle. Specific protocol for this pathology must be done to give a proper diagnosis.

The most specific finding is a hyperintense T2WI signal involving the anteroinferior aspect of the pubic symphysis.

Other findings include :

• osteitis pubis

• tenoperiosteal disruption of the aponeurosis or frank tear

• marrow oedema at the pubic tubercle

115. Which is untrue regarding post-operative complications of inguinal hernia? (Kerala PGMEE 2015)

(A) Urinary retention may require catheterization

(B) Substantial risk of developing a femoral hernia

(C) Among sutured hernia techniques, shouldice has got high risk of recurrence

even in expert hands

(D) Groin pain may occur because of neuralgia due to nerve injury or irritation

The Correct Answer is: C

“Shouldice repair” has been reported to have a low recurrence rat

Shouldice repair remained the gold standard of hernia repair for the last 4 decades and has produced the best and most enduring results of any other pure tissue repair.

• Recurrence rate at 7 years was 2%

• The main advantage of the Shouldice technique remains the relatively low report of chronic pain (10% incidence), as compared with mesh-based open repair (Lichtenstein) (20% incidence)

116. Hernia development is more common in all EXCEPT (Kerala PGMEE 2015)

(A)In pregnancy due to hormonally induced laxity in pelvic ligaments

(B)In elderly due to degenerative weakness of muscles and fibrous tissue

(C) In women than in men

(D) In smokers

The Correct Answer is:C

Original MCQ in Kerala PGMEE

Hernia development is more common in all EXCEPT

(A)In pregnancy due to hormonally induced laxity in pelvic ligaments

(B)In elderly due to degenerative weakness of muscles and fibrous tissue

(C) In obese patients due to positive correlation to BMI

(D) In smokers

The Answer given was :C

Age, smoking and obesity are three of the primary risk factors for developing hernias

117. lncarcerated hernia represents (Kerala PGMEE 2015)

(A) Irreducible unobstructed hernia

(B) Irreducible obstructed hernia

(C) Strangulate hernia with obstruction

(D)Irreducible painful hernia with vascular compromise progressing to

strangulation

The Correct Answer is:D

118. Following are true about early dumping EXCEPT (Kerala PGMEE 2015)

(A) Occurs immediately after meals

(B) Due to reactive hypoglycemia

(C) Relieved by lying down

(D) Aggravated by food

The Correct Answer is:B

• Early” dumping begins concurrently within 15 to 30 minutes from ingestion of a meal

o Symptoms of early dumping include nausea, vomiting, bloating, cramping, diarrhea, dizziness, and fatigue.

o Rapid emptying of gastric contents into the small intestine or colon may result in high amplitude propagated contractions and increased propulsive motility, thereby contributing to the diarrhea seen in persons with the dumping syndrome

o The emptying of liquids is fast relative to persons without distal gastrectomy with Billroth-I reconstruction

• “Late” dumping happens one to three hours after eating.

o Symptoms of late dumping include weakness, sweating, and dizziness

o Late dumping occurs 1-3 hours after a meal.

o The pathogenesis is thought to be related to the early development of hyperinsulinemic (reactive) hypoglycemia.

o Rapid delivery of a meal to the small intestine results in an initial high concentration of carbohydrates in the proximal small bowel and rapid absorption of glucose. This is countered by a hyperinsulinemic response. The high insulin levels stay for longer period and are responsible for the subsequent hypoglycemia.

o Intrajejunal glucose induces a higher insulin release than does the intravenous infusion of glucose. The serum glucose levels were the same in both experiments. This effect of enhanced insulin release after an enteral glucose load as compared to intravenous glucose administration is called the incretin effect

119. Following are true about late dumping EXCEPT (Kerala PGMEE 2015)

(A) Occurs in the second hour after meals

(B) Relieved by food

(C) Aggravated by exercise

(D)High osmolic load leading to sequestration of fluid from circulation to Gl

tract

The Correct Answer is:D

120. Following duodenal ulcer Surgery recurrent ulceration is least with (Kerala PGMEE 2015)

(A) Billroth II gastrectomy

(B) Truncal vagotomy with drainage

(C) Highly selective vagotomy

(D) Truncal vagotomy with antrectomy

The Correct Answer is:D

121. Following duodenal ulcer surgery recurrent ulceration is most with (Kerala PGMEE 2015)

(A) TV with GJ

(B) GJ alone

(C) Selective vagotomy with drainage

(D) Highly selective vagotomy

The Correct Answer is:B

122. Significant side effects are most following (Kerala PGMEE 2015)

(A) Gastrectomy

(B) GJ alone

(C) TV with GJ

(D) TV and antrectomy

The Correct Answer is:A

123. Common sites of peptic ulcer include all EXCEPT (Kerala PGMEE 2015)

(A) First part of duodenum

(B) Lesser curvature of stomach

(C) Stoma following gastric surgery

(D) Proximal stomach

The Correct Answer is:D

the antrum is the smaller distal one-fourth to one-third of the stomach

antrum-corpus TZ, this is the site of predilection for gastric ulcers.

124. More than one defect or compartment may be present in all EXCEPT (Kerala PGMEE 2015)

(A) Epigastric hernia

(B) Umbilical hernia in adults

(C) Large midline incisional hernias

(D) Femoral hernia

The Correct Answer is:D

125. Pathognomonic of achalasia cardia is (Kerala PGMEE 2015)

(A) Abnormal pH in 24 how pH monitoring

(B) Complete absence of peristalsis in manometry and raised resting pressure

(C) Endoscopy showing stasis

(D) Barium radiology shows birds beak appearance

The Correct Answer is:B

Achalasia is a primary esophageal motility disorder characterized by the absence of esophageal peristalsis and impaired relaxation of the lower esophageal sphincter (LES) in response to swallowing. The LES is hypertensive in about 50% of patients. These abnormalities cause a functional obstruction at the gastroesophageal junction (GEJ).

126. Calot’s triangle is bordered by the following EXCEPT (Kerala PGMEE 2015)

(A) Cystic duct inferiorly

(B) Superior border of cystic artery

(C) Common hepatic duct medially

(D) Common hepatic artery medially

The Correct Answer is:d

Answer given in Kerala PGMEE official key was c

The hepatobiliary triangle (or cystohepatic triangle) is an anatomic space bordered by the common hepatic duct medially, the cystic duct laterally and the [cystic artery]] superiorly

Calot’s triangle, containing the cystic artery, may also contain an accessory right hepatic artery or anomalous sectoral bile ducts. As a result dissection in the triangle of Calot is ill-advised until the lateral-most structures have been cleared and identification of the cystic duct is definitive. According to SESAP 12 (produced and distributed by the American College of Surgeons) dissection in the triangle of Calot is the most common cause of common bile duct injuries

127. The following are true about arterial supply of gall bladder EXCEPT (Kerala PGMEE 2015)

(A) Supplied by a branch of right hepatic artery

(B) Usually arises behind common hepatic duct

(C) In l5% of cases may cross in front of common hepatic duct

(D) An accessory cystic artery arises from superior mesenteric artery

The Correct Answer is:D

The common hepatic artery usually arises from the celiac trunk (85% of cases)

Variations in origin of a single cystic artery have been reported as follows. There is only one cystic artery in 88% of individuals. Of these individuals, the cystic artery arises from the the right hepatic artery in 82%; from the proper hepatic artery in 3%; from the left hepatic artery, distal to the origin of the right hepatic artery, in 2%; and from the gastroduodenal in 1%, crossing the common bile duct to reach the neck of the gallbladder.

In cases of two cystic arteries, their origins have been reported as follows. Two cystic arteries occur in 12% of individuals according to one author and in 18% by another author; we can assume here a frequency of about 15%. Of these individuals, both cystic arteries arise from the the right hepatic artery in 9%; one cystic artery arises from the right hepatic and the second from the gastroduodenal artery in about 3%; one artery arises from the right hepatic and the second from the proper hepatic artery in 1.5%; and both cystic arteries arise from the left hepatic artery in 1.5%.

128. The following are true about porcelain gall bladder EXCEPT (Kerala PGMEE 2015)

(A) May be seen in plain X-ray

(B) More commonly seen in CT

(C) Is an indication for cholecystectomy

(D)It always denotes benign etiology and never carcinoma

The Correct Answer is:D

Patients with a porcelain gallbladder are often asymptomatic, but are at increased risk for the development of gallbladder carcinoma

129. The following are true about incidence of carcinoma gall bladder except (Kerala PGMEE 2015)

(A) Pre-existing gall stone disease or chronic inflammation may play a role

(B) Calcification of gall bladder wall is also associated with increased risk of cancer

(C) Chronic infection or typhoid carriers have significant risk

(D) Majority of gall bladder polyps which are adenomyomatosis have malignant potential

The Correct Answer is:D

Actual wron grame of the MCQ in Kerala PGMEE 2015

The following are true about incidence of carcinoma gall bladder

(A) Pre-existing gall stone disease or chronic inflammation may play a role

(B) Calcification of gall bladder wall is also associated with increased risk of cancer

(C) Chronic infection or typhoid carriers have significant risk

(D) Majority of gall bladder polyps which are adenomyomatosis have malignant potential

The Correct Answer is:D

People with a history of gallstones have an increased risk of gallbladder cancer

People chronically infected with salmonella (the bacterium that causes typhoid) and those who are carriers of the disease are more likely to get gallbladder cancer than those not infected.

Adenomyomatosis of the gallbladder is a hyperplastic cholestosis of the gallbladder wall. It is a relatively common and benign cause of focal gallbladder wall thickening. It is most easily seen on ultrasound and MRI . It is most often an incidental finding, has no intrinsic malignant potential, and usually requires no treatmen

130. The following are true about gall bladder disease EXCEPT (Kerala PGMEE 2015)

(A) In HIDA scan non visualization of gall bladder is suggestive of acute cholecystitis

(B) In HIDA scan delayed or reduced visualization is due to contracted gall bladder

(C) Biliary scintigraphy is useful in biliary leaks and iatrogenic ,biliary obstruction

(D) Best option in treating cystic duct leak will be laparascopic clipping

The Correct Answer is:D

Spontaneous resolution of bile leakage has been described in patients with external drains . Some have therefore advocated a ‘wait-and-see’ policy in these patients and this seems justified in clinically stable patients without evidence of sepsis or peritonitis. However, if percutaneous bile leakage persists or the patient’s clinical condition deteriorates, an ERCP is indicated. This will establish the diagnosis in all patients with types A, B, and C lesions and will allow for effective therapeutic intervention in most of them

• Type A injury (peripheral leaks)

o Patients with bile leakage from the cystic duct or peripheral hepatic radicles are treated by insertion of a short biliary stent to lower the pressure of the biliary system by bypassing the biliary sphincte

• Type B injury (main duct leaks)

o In case ERCP fails, PTC and rendezvous procedure should be the next step Endoscopic treatment is successful in approximately 75% of patients with leakage from major bile ducts

• Type C injuries (postoperative biliary strictures

o Most postoperative bile duct strictures are short (less than 10 mm in length) and situated distal to the confluence of right and left hepatic ducts. Postoperative strictures are usually classified according to Bismuth by their position relative to the hepatic confluence

o Options for therapy include surgery, percutaneous balloon dilation and stenting, and endoscopic stenting, if necessary combined with balloon dilation

• Type D injury (transections)

o Patients with complete transection of the bile duct are not amenable to endoscopic treatment because the distal and proximal biliary systems are not in continuity (Fig. 6). These patients should undergo reconstructive surgery: Roux-en-Y-hepaticojejunostomy is the procedure of choice

131. Black or green discharge is most commonly seen in (Kerala PGMEE 2015)

(A) Duct papilloma

(B) Duct ectasia

(C) Retention cyst

(D) Fibroadenosis

The Correct Answer is:B

132. Triple assessment for CA breast includes (Kerala PGMEE 2015)

(A) History, clinical examination and mammogram

(B) History, clinical examination and FNAC

(C) USG, mammogram and FNAC

(D) Clinical examination, mammogram and FNAC

The Correct Answer is:D

133. Treatment of choice in duct papilloma of breast is (Kerala PGMEE 2015)

(A) Simple mastectomy

(B) Micro ductectomy

(C) Wide local excision

(D) Chemotherapy

The Correct Answer is:B

Intraductal papillomas of the breast are benign lesions with an incidence of approximately 2-3% in humans.

• Two types of intraductal papillomas are generally distinguished. The central type develops near the nipple. They are usually solitary and often arise in the period nearing menopause. On the other hand, the peripheral type are often multiple papillomas arising at the peripheral breasts, and are usually found in younger women. The peripheral type are associated with a higher risk of malignancy.

• They are the most common cause of bloody nipple discharge in women age 20-40 and generally do not show up on mammography due to their small size, so the next step in treatment would be a galactogram to guide the subsequent biopsy.

• The masses are often too small to be palpated or felt. A galactogram is therefore necessary to rule out the lesion.

• Excision is sometimes performed.

• Microdochectomy/microdochotomy (removal of a breast duct) is the treatment of choice.

134. The most probable malignancy that develops in a case of long standing goiter is (Kerala PGMEE 2015)

(A) Follicular carcinoma

(B) Anaplastic carcinoma

(C) Papillary carcinoma

(D) Medullary carcinoma

The Correct Answer is:A

135. The common sites of oral cancer among Indian population include all EXCEPT (Kerala PGMEE 2015)

(A) Lateral border of anterior tongue

(B) Floor of the mouth

(C) Soft palate

(D) Retromolar trigone

The Correct Answer is:C

Typical Bailey and Love MCQ in Keral PGMEE 2015

136. A distressing complication of radical mastectomy is (Kerala PGMEE 2015)

(A) Paralysis of the fifth finger of hand

(B) Edema of the arm

(C) Loss of sensation of medial side of arm

(D) Hematoma of chest wall

The Correct Answer is:B

137. Cobblestone appearance is seen in (Kerala PGMEE 2015)

(A) Ulcerative colitis

(B) Crohn’s disease

(C) Appendicitis

(D) Carcinoma rectum

The Correct Answer is:B

138. The following are true about surgical treatment of Meckel’s diverticulum

EXCEPT (Kerala PGMEE 2015)

(A) If the base is indurated resection od small bowel and anastomosis is done

(B) A broad based diverticulum should be excised and the defect is sutured

(C) A broad based diverticulum should be excised and the defect is stapled

(D) A broad based diverticulum should be amputated at its base and invaginated

The Correct Answer is:D

139. All are true about pelvic abscess EXCEPT (Kerala PGMEE 2015)

(A) Most common intra-peritoneal abscess

(B) Presents with diarrhea and mucuss tools

(C) Drainage requires laparotomy

(D) Drainage tubes can be inserted percutaneously under ultrasound guidance

The Correct Answer is:C

Laparoscopic drainage of intraabdominal abscess after appendectomy: an alternative to laparotomy in cases not amenable to percutaneous drainage

140. What is true about peritoneal mice? (Kerala PGMEE 2015)

(A) Seen in carcinomatosis peritonei

(B) Seen in pseudomyxoma peritonei

(C) Attain large size

(D) May be associated with sub-acute pancreatitis

The Correct Answer is:D

giant loose bodies ( > 5 cms) are very rare, and the process of their development has not yet been fully elucidated

Peritoneal loose bodies or “peritoneal mice” are asymptomatic incidentalomas predominantly found at abdominal surgery or autopsy. They usually are from 0.5 to 2.5cms in diameter. Giant peritoneal mice (> 5 cms) can be associated with symptomatology due to a mass effect. They are thought to evolve from torsion and separation of the appendices epiploicae. Others have suggested that large loose bodies can be formed by the accumulation of peritoneal serum in the appendices epiploicae

ORTHOPAEDICS

141. Radionuclide bone scanning is most useful in (Kerala PGMEE 2015)

(A) Avascular necrosis

(B) Malignancy

(C) Rheumatoid arthritis

(D) Acute osteomyelitis

The Correct Answer is: B

The bone scan is often done as part of a check-up to be sure that the bones are free of cancer and to determine the effects of cancer treatment

142. What is the earliest indication of Volkmann’s ischemia? (Kerala PGMEE 2015)

(A) Pain

(B) Pallor and poor capillary filling

(C) Paraesthesia in median nerve area

(D) Gangrene of tips of fingers

The Correct Answer is: A

143. All of the following are true about medial epicondyle fracture of the humerus

EXCEPT (Kerala PGMEE 2015)

(A) It does not contribute for growth of distal humerus

(B) It may be associated with ulnar nerve injury

(C) The fracture is commonly associated with anterior dislocation of elbow

(D) Open reduction and internal fixation is the treatment of choice

The Correct Answer is: D

On AP-view the avulsed medial epicondyle projects over the trochlea. Lateral view shows the fragment to be trapped within the joint.

The medial epicondyle is an apophysis since it does not contribute to the longitudinal growth of the humerus. It is located on the dorsal side of the elbow.

Non-displaced fractures are treated with 1-2 weeks cast or splint. There is disagreement about the amount of displacement of the medial epicondyle that requires operative fixation.There is support for both operative aswell as non-operative management of medial epicondyle fractures with 5-15mm displacement.

144. First treatment priority in a patient with multiple injuries is (Kerala PGMEE 2015)

(A) Airway maintenance

(B) Bleeding control

(C) Circulatory volume restoration

(D) Splinting of fractures

The Correct Answer is: A

145. Which one of the following is NOT a cause for non-union? (Kerala PGMEE 2015)

(A) Interposition of soft tissue

(B) Intact fellow bone

(C) Impaired vascularity

(D) Axial micromotion at fracture site

The Correct Answer is: D

micromotion in the axial plane promote healing during the union phas

146. Which of the following injury is called ‘Aviator’s fracture’? (Kerala PGMEE 2015)

(A) Bimalleolar fracture

(B) Total dislocation of talus

(C) Subtalar dislocation

(D) Fracture neck of talus

The Correct Answer is: D

147. Best treatment for a sixty five year old patient with four week old displaced

intracapsular femoral neck fracture is (Kerala PGMEE 2015)

(A) Internal fixation

(B) Internal fixation with muscle pedicle graft

(C) McMurray’s osteotomy

(D) Hemi replacement arthroplasty

The Correct Answer is: D

Hemiarthroplasty is a quick and highly standardised procedure that allows for early weight bearing and recovery. However, most patients with a hip fracture have osteoarthritis, which may necessitate secondary conversion to total hip replacement, especially in active elderly people with higher physical demands. Single stage surgery with acetabular replacement seems straightforward to avoid secondary admission to hospital and operation with its possible risks and extra costs. These potential benefits, however, must be traded off against the potential harms of prolonged and more invasive surgery.

148. Which is the deformity produced by Colle’s fracture? (Kerala PGMEE 2015)

(A) Madelung’s deformity

(B) Swan neck deformity

(C) Boutonniere deformity

(D) Dinner fork deformity

The Correct Answer is: D

149. All of the following are premalignant conditions EXCEPT (Kerala PGMEE 2015)

(A) Paget’s disease

(B) Diaphyseal aclasis

(C) Osteoid osteoma

(D) Enchondromatosis

The Correct Answer is: C

Diaphyseal aclasis

 

150. Most commonly fractured bone in the hand is (Kerala PGMEE 2015)

(A) Harnate

(B) Triquetrum

(C) Lunate

(D) Scaphoid

The Correct Answer is: D

OPHTHALMOLOGY

151. Visual field abnormalitiesin the Bjemrm’s area is seen most commonly in (Kerala PGMEE 2015)

(A) Cataract

(B) Keratitis

(C) Glaucoma

(D) Proptosis

The Correct Answer is: C

152. Colour vision is recorded by which one of the following? (Kerala PGMEE 2015)

(A) Snellen’sc hart

(B) Goldman’s three mirror lens

(C) Slit lamP biomicroscope

(D) Ishihara’s isochromatic charts

The Correct Answer is: D

153. Donor cornea is harvested from cadaveric donors within what time interval after death? (Kerala PGMEE 2015)

(A) 3 hours

(B) 6 hours

(C) 2 days

(D) 16 hours

The Correct Answer is: B

ideal time to collect the donated eye is within 6 hours.

154. Lens changes resembling snow storm called snow flake catatact is seen in (Kerala PGMEE 2015)

(A) Comlicated cataract

(B) Traumatic catatact

(C) Diabetes mellitus

(D) Retinitis pigmentosa

The Correct Answer is: C

155. Purulent inflammation of the tissues of the orbit is called (Kerala PGMEE 2015)

(A) Orbital cellulitis

(B) Endophthalmitis

(C) Enophthalmos

(D) PanoPhthalmitis

The Correct Answer is: A

156. Glaucoma, trauma or infection of cornea can result in loss of vision which comes under (Kerala PGMEE 2015)

(A) Treatable blindness

(B) Preventable blindness

(C) Avoidable blindness

(D) Mandatory blindness

The Correct Answer is: B

157. Retinopathy of prematurity is a retinal disease seen in premature infants who

have been given high concentrations of oxygen and is confined to birth weight of (Kerala PGMEE 2015)

(A) More than 1000 gm

(B) less than 1500 gm

(C) More than 5000 gm

(D) More than 3000 gm

The Correct Answer is: B

158. Abnormally low position of the upper eyelid is called (Kerala PGMEE 2015)

(A) Ptosis

(B) Endophthalmitis

(C) Entopion

(D) Ectropion

The Correct Answer is: A

159. Which of the following drugs is a mydriatic? (Kerala PGMEE 2015)

(A) Ciprofloxacin

(B) Pilocarpine 1 %

(C) Timolol maleate 0 .5%

(D) Cyclopentolate 0.5 %

The Correct Answer is: D

160. Dehiscence of the iris from ciliary body at its root causes D shaped pupil. It is

termed as (Kerala PGMEE 2015)

(A) Cyclodialysis

(B) Hemodialysis

(C) Iridodialysis

(D) Iridencleisis

The Correct Answer is: C

ENT

161. Catenary lever provides ……..  gain in sound pressure at the level of the malleus (Kerala PGMEE 2015)

(A) 4 times

(B)  3 times

(C)  6 times

(D)  2 times

The Correct Answer is: D

The transformer system of middle ear can be divided into three stages:

1. That provided by the eardrum (catenary lever.

2. That provided by the ossicles (ossicular lever).

3. Provided by the difference in surface area between the tympanic membrane and the stapes footplate (hydraulic lever).

1. Catenary lever

  • Helmholtz was first to propose a concept of a catenary lever to the action of the tympanic membrane. A familiar example of this type of lever is tennis net. The tighter a tennis net is stretched, the greater the force exerted on the posts holding it. Because the bony annulus is immobile, sound energy applied to the tympanic membrane is amplified at its central attachment, the malleus. It is estimated that even though the curvature of the tympanic membrane is variable, the catenary lever provides at least a two times (2x) gain in sound pressure at the malleus. Forces exerted on the stretched curved fibers of the tympanic membrane are amplified at its point of attachment, the annular bone and the malleus handle. The annular bone is immobile, so that the malleus is the recipient of this magnified energy, directing it into the ossicular chain for transmission to the perilymphatic fluid.

2. Ossicular lever

  • Handle of malleus is 1.3 times longer than long process of the incus, providing a mechanical advantage of 1.3. The catenary and ossicular levers, acting in concert provide an advantage of 2.3.

3. Hydraulic lever

  • Helmholtz’s third concept of impedance matching is referred as areal ratio. The effective vibratory area of tympanic membrane is 55 mm sq. whereas foot plate area is 3.2 mm sq. Hence effective areal ratio is 14: 1. This is a mechanical advantage provided by tympanic membrane. The product of areal ratio into lever ratio is known as transformer ratio. i.e., 14 x 1.3 = 18: 1.

162. BERA is a reliable indicator in the diagnosis of (Kerala PGMEE 2015)

(A) Otosclerosis

(B) Vestibular neuronitis

(C) Acoustic schwannoma

(D) Migraine

The Correct Answer is: C

163. Phantosmia is (Kerala PGMEE 2015)

(A) Complete loss of smell

(B) Partial loss of smell

(C) Altered sensation of smell

(D) Continuous perception of unpleasant odor

The Correct Answer is: D

Phantosmia is an olfactory hallucination. A hallucination is the sensory perception of something with no basis in reality, as opposed to an olfactory illusion, which is a misinterpretation of a physical stimulus; in the case of an odor it is known as parosmia. Phantosmia is the perception of a smell in the complete absence of any physical odor. The perceived odor can range from pleasant to disgusting. Although the causes of phantosmia are uncertain, it often occurs with neurological and psychological disorders such as schizophrenia, mood disorders, Parkinsons disease, epilepsy, neuroblastoma, and frequent migraines.

 

164. The artery of epistaxis is (Kerala PGMEE 2015)

(A) Anterior ethmoidal artery

(B) Posterior ethmoidal artery

(C) Sphenopalatine artery

(D) Greater palatine artery

The Correct Answer is: C

The sphenopalatine artery (nasopalatine artery) is an artery of the head, commonly known as the artery of epistaxis.

  • The sphenopalatine artery is a branch of the maxillary artery which passes through the sphenopalatine foramen into the cavity of the nose, at the back part of the superior meatus. Here it gives off its posterior lateral nasal branches.
  • Crossing the under surface of the sphenoid, the sphenopalatine artery ends on the nasal septum as the posterior septal branches. Here it will anastomose with the branches of the greater palatine artery.

 

165. Tissue density in CT imaging is measured in (Kerala PGMEE 2015)

(A) Hounsfield unit

(B) Omega unit

(C) Tesla unit

(D) Rad unit

The Correct Answer is: A

166. Drug induced rhinitis is caused by (Kerala PGMEE 2015)

(A) Aspirin

(B) Paracetamol

(C) B-complex

(D) Amoxycillin

The Correct Answer is: A

167. Feature of atrophic rhinitis include (Kerala PGMEE 2015)

(A) Watery nose

(B) Anosmia

(C) Swelling of turbinates

(D) Swelling over dorsum of nose

The Correct Answer is: B

168. Mucocele commonly involves (Kerala PGMEE 2015)

(A) Maxillary sinus

[B) Sphenoid sinus

(C) Frontoethmoidal region

(D) Inferior turbinate

The Correct Answer is: C

169. The most reliable method of detecting otitis media with effusion is (Kerala PGMEE 2015)

(A) Pure tone audiometry

(B) Otoscopic examination

(C) X-ray mastoids

(D) Tympanometry

The Correct Answer is: D

 

Sample tympanograms. (A) Results suggest middle ear effusion. (B) Results correlate with retracted tympanic membrane.

 

Flat (type B) tympanogram was related to otitis media with effusion

170. The only aspect of salivary secretion that can reliably be attributed to protection against infection is (Kerala PGMEE 2015)

(A) Amount of lysosomal concentration

[B) pH of saliva

(C) Salivary flow rate

(D) Mucin content of saliva

The Correct Answer is: C

GOB

171. The most frequently experienced symptom of ectopic pregnancy is (Kerala PGMEE 2015)

(A) Gastrointestinal symptoms

(B) Amenorrhoea with abnormal uterine bleeding

(C) Dizziness or syncope

(D) Pelvic and abdominal pain

The Correct Answer is:D

172. Causes of preterm labour include all EXCEPT (Kerala PGMEE 2015)

(A) Chorioamnionitis

(B) Pyelonephritis

(C) Cervicail  incompetence

(D) Human papilloma virus

The Correct Answer is:D

173. Hypofibrinogenemia in mother occurs after (Kerala PGMEE 2015)

(A) One week of fetal demise

(B) One month of fetal demise

(C) Ten days of fetal demise

(D) 15 days of fetal demise

The Correct Answer is:B

A retained IUFD greater than 3 to 4 weeks can lead to hypofibrinogenemia

174. Regarding internal iliac artery ligation all of the following are true EXCEPT (Kerala PGMEE 2015)

(A) Done for obstetric haemorrhage

(B) Does not interfere with subsequent reproduction

(C) Ligation done using absorbable suture

(D) Reduces the pulse pressure in the arteries distal to the ligation

The Correct Answer is:C

Using a non- absorbable suture (silk3-0), internal iliac artery is ligated

175.Treatment of acute inversion of uterus includes all EXCEPT (Kerala PGMEE 2015)

(A) Call anaesthetist for help

(B) Start 2 intravenous infusion lines

(C) Immediate repositioning

(D) Immediate oxytocin administration

The Correct Answer is:D

  • Principles of management are to treat the shock and replace the uterus. The patient should be moved rapidly to the OR to facilitate anesthesia monitoring during this procedure.
  • Usually this complication is only recognized after delivery of the placenta, wherein pitocin has already been started, which just exacerbates the problem. The uterus clamps down around the inversion making it very difficult to perform a replacement. This is a true obstetrical emergency, so extra doctors, nurses, anesthesiologists should be summoned to the room to assist.
  • The pitocin should be turned off immediately. Giving tocolytics such as terbutaline or magnesium sulfate have a lower success rate. Halothane and Nitroglycerine (100mcg to 200 mcg intravenously)have a higher success rate. Once you have achieved uterine relaxation, place your fist into the vagina. Find the biggest part of the inversion and push with your fist cephalad to replace the uterus. This takes firm steady force, so keep your fist in the vagina if you need to rest your hand. Then continue more force toward the fundus to replace the uterus. You can use your left hand on the outside of the abdomen to help you feel where the fundus should be replaced. This helps guide the angle of your fist in replacing the uterus.
  • Once it is replaced, give the patient Misoprostol 1000 mcgs rectally to help with increasing uterine tone. Other medications such as Methergine and Hemabate can be used. If you have heavy bleeding, consider inserting a Bakri balloon into the uterine cavity to tamponade the bleeding.
  • These patients have usually sustained heavy blood loss, and should be monitored in the ICU postoperatively. If you have given nitroglycerine, they must have cardiac monitoring postoperatively.
  • Other personnel should be monitoring vital signs, ordering blood products, assisting the anesthesiologist, drawing labs, and stablizing the patient. Remember that nitroglycerine can cause hypotension, which can be reversed with ephedrine.
  • If external replacement fails, a laparotomy may be required, in which the uterus is gently pulled the right way round using forceps.

176. Appropriate investigation for recurrent miscarriage include the following

EXCEPT (Kerala PGMEE 2015)

(A) Chromosomal karyotyping of both parents

(B) Hysterosalpingogram

(C) Semen analysis

(D) Screening for anti-phospholipid antibody and lupus anticoagulant

The Correct Answer is:C

177. 20 year old primigravida of 36 weeks gestation presents with a BP of

160/110.What is the next step of management? (Kerala PGMEE 2015)

(A) Emergency C section

(B) Induction with syntocinon

(C) Epidural analgesia

(D) Hospitalisation, evaluation and control of BP

The Correct Answer is:D

178. 30 year old primigravida has prolonged labour lasting for 18 hours. Cervix is

Dilated to 8 cm. Fetal monitoring shows late deceleration. Fetal scalp pH is 7.2.

The next course of action is (Kerala PGMEE 2015)

(A) Mid forceps rotation

(B) Vacuum suction delivery

(C) Emergency C section

(D) Syntocinon infusion

The Correct Answer is:C

179. A 35 year old multiparous lady of 39 weeks gestation is found to have a fetus in

Transverse lie, confirmed by ultrasonography. The most appropriate management is (Kerala PGMEE 2015)

(A)  Caesarian section

(B)  Mid forceps rotation

(C) Syntocinon infusion

(D) Admit and perform external cephalic version

The Correct Answer is:D

External cephalic version is a procedure that externally rotates the fetus from a breech presentation to a vertex presentation. External version has made a resurgence in the past 15 years because of a strong safety record and a success rate of about 65 percent. Before the resurgence of the use of external version, the only choices for breech delivery were cesarean section or a trial of labor. It is preferable to wait until term (37 weeks of gestation) before external version is attempted because of an increased success rate and avoidance of preterm delivery if complications arise. After the fetal head is gently disengaged, the fetus is manipulated by a forward roll or back flip. If unsuccessful, the version can be reattempted at a later time. The procedure should only be performed in a facility equipped for emergency cesarean section. The use of external cephalic version can produce considerable cost savings in the management of the breech fetus at term. It is a skill easily acquired by family physicians and should be a routine part of obstetric practice.

Exclusion Criteria for External Cephalic Version

Multiple pregnancy

Evidence of uteroplacental insufficiency

Significant third-trimester bleeding

Suspected intrauterine growth restriction

Amniotic fluid abnormalities

Uterine malformation

Placenta previa

Maternal cardiac disease

Pregnancy-induced hypertension

Uncontrolled hypertension

A nonreassuring fetal monitoring pattern

Major fetal anomaly

180. Follow up procedures of gestational trophoblastic disease includes all EXCEPT (Kerala PGMEE 2015)

(A) Prevent pregnancy during the follow up period-minimum of 1 year

(B) Measure serum B HCG every 2 weeks

(C) Use IUCD as method of contraception

(D) Use estrogen progestin as the method of contraception

The Correct Answer is:C

Patients with gestational trophoblastic neoplasia (GTN) should have follow-up serum hCG levels measured once per week until 4 normal values are obtained. Then, hCG levels should be obtained once per month for 1 year. Patients with stage IV disease are observed with monthly serum hCG level monitoring for 2 years after 3-4 consecutive weekly normal levels. Patients should use a reliable method of contraception.

 

During the period of follow-up care, patients with GTN should use a reliable method of contraception, such as oral contraceptives or depot progesterone. The serum hCG levels are critical in monitoring the status of the disease, and a normal intrauterine pregnancy interferes with this critical monitoring tool.

181. Causes of fetal distress in a case of placental abruption are all EXCEPT (Kerala PGMEE 2015)

(A) Cord compression

(B) Maternal haemorrhage

(C) Fetal haemorrhage

(D) Uterine hypertonus

The Correct Answer is:A

182. Precise and safe method of diagnosis of placenta praevia is (Kerala PGMEE 2015)

(A) Digital examination

(B) CT scan

(C) Transabdominal ultrasonography

(D) Magnetic resonance imaging

The Correct Answer is:C

Transvaginal ultrasonography is the most useful and inexpensive study in identifying a placenta previa. This imaging modality provides 100% accuracy and is considered safer and more accurate than transabdominal ultrasonography. In one study, 26% of placental localization diagnosed by transabdominal ultrasonography was later changed using transvaginal ultrasonography.

Transabdominal ultrasonography is a simple, precise, and safe method to visualize the placenta that can be 95% accurate (range, 93-98%). This imaging modality can be an alternative to transvaginal ultrasonography; however, the false-positive and false-negative rates can range from 2 to 25%, due to focal uterine contractions or bladder distention.

183. A 20 year old primi who had eclampsia, was started on magnesium sulphate.

detect magnesium toxicity which of the following is monitored? (Kerala PGMEE 2015)

(A) Blood pressure

(B) Temperature

(C) Fetal heart rate

(D) Respiratory rate

The Correct Answer is:D

184. All of the following indicate severe preeclampsia EXCEPT (Kerala PGMEE 2015)

(A) Proteinuria 3+

(B) Diastolic BP 100 or higher

(C) Thrombocytopenia

(D) Fetal growth restriction

The Correct Answer is:B

Actual MCQ in Keral PGMEE 20125

All of the following indicate severe preeclampsia EXCEPT (Kerala PGMEE 2015)

(A) Proteinuria 2+

(B) Diastolic BP 100 or higher

(C) Thrombocytopenia

(D) Fetal growth restriction

The Correct Answer is:B

 

High blood pressure greater than or equal to 160 mm Hg systolic or greater than or equal to 110 mm Hg diastolic is a feature of severe preeclampsia.

According to the new ACOG 2012 guidelines, the diagnosis of preeclampsia no longer requires the detection of high levels of protein in the urine (proteinuria). Evidence shows organ problems with the kidneys and livers can occur without signs of protein, and that the amount of protein in the urine does not predict how severely the disease will progress

Severe preeclampsia is diagnosed by the presence of one or more of the following:

A systolic blood pressure of 160 mm Hg or higher or a diastolic blood pressure of 110 mm Hg or higher on two occasions six or more hours apart in a pregnant woman who is on bed rest;

  • Proteinuria, with excretion of 5 g or more of protein in a 24-hour urine specimen or 3+ or greater on two random samples collected four or more hours apart;
  • Oliguria, with excretion of less than 500 mL of urine in 24 hours;
  • Pulmonary edema or cyanosis;
  • Impairment of liver function;
  • Visual or cerebral disturbances;
  • Pain in the epigastric area or right upper quadrant;
  • Decreased platelet count;
  • Intrauterine growth restriction.

185. Effects of gestational diabetes mellitus include all EXCEPT (Kerala PGMEE 2015)

(A) Fetal anomalies

(B) Macrosomia

(C) Neonatal hypoglycemia

(D) Shoulder dystocia

The Correct Answer is:A

Long standing diabetes can only cause fetal anomalies

186.  All the following drugs cross the placenta E XCEPT (Kerala PGMEE 2015)

(A) Heparin

(B) Warfarin

(C) Tetracycline

(D) Carbimazole

The Correct Answer is:A

187. A 25 year old woman with type I diabetes mellitus wants to start a family. One of

the most important measures to be initiated is (Kerala PGMEE 2015)

(A) Commence a statin

(B) Start an oral hypoglycemic drug

(C) Reduce the dose of insulin

(D) Commence folic acid

The Correct Answer is:D

The American Academy of Pediatrics committee on genetics issued its guidelines and included the recommendations that all women capable of becoming pregnant should consume 0.4 mg of folic acid per day; that if there has been a previously affected pregnancy, 4 mg/day, commencing before conception, be consumed; that high-risk groups (women with a positive family history, type 1 diabetes mellitus, seizure disorders treated with valproate or carbamazepine, or who themselves have a NTD) also consume 4 mg/day; that educa- tional programs be developed to promote folic acid consump- tion; and that fortification should attempt to provide all women capable of becoming pregnant with a daily intake of 0.4 mg/day

188. A 28 year old woman who is a primigravida of 10 weeks gestation presents with

sudden, severe lower abdominal pain. The abdomen is rigid and the uterus

tender. he most likely diagnosis is (Kerala PGMEE 2015)

(A) Appendicitis

(B) Urinary tract infection

(C) Miscarriage

(D) Ectopic pregnancy

The Correct Answer is:D

189. The disadvantage of midline episiotomy is (Kerala PGMEE 2015)

(A) Dyspareunia

(B) Post operative pain

(C) Faulty healing

(D) Third and fourth degree extensions

The Correct Answer is:D

190. The maternal mortality with Eisenmsnger’s syndrome is (Kerala PGMEE 2015)

(A) 10-15 %

(B) 15-20%

(C) 20-30%

(D) 30-50%

The Correct Answer is:D

191. The following are the predisposing factors for endometrial cancer EXCEPT (Kerala PGMEE 2015)

(A) Tamoxifen

(B) Early menopause

(C) Infertile women with PCOD

(D) Unopposed and unsupervised administration of HRT

The Correct Answer is: B

192 The following statements regarding Mirena coil are correct EXCEPT (Kerala PGMEE 2015)

(A) Controls menorrhagia

(B) Acts on the ovaries

(C) Acts as a contraceptive

(D) Needs to be changed every 5 years

The Correct Answer is:B

The levonorgestrel intrauterine system has several contraceptive effects:

  • Cervical mucus thickens
  • Sperm’s survival and ability to penetrate the egg is inhibited
  • Endometrium is suppressed
  • In some women, ovulation is inhibited

193. Late menopause is defined as a condition in which menstruation continues

beyond . (Kerala PGMEE 2015)

(A) 50 years

(B) 52 years

(C) 54 years

(D) 55 years

The Correct Answer is: d

Answer given by Kerala board was Ans b

194. Aetiology of post menopausal bleeding includes all EXCEPT (Kerala PGMEE 2015)

(A) Cervical polyp

(B) Senile vaginitis

(C) Carcinoma cervix

(D) Cyclical use of oestrogen with progesterone

The Correct Answer is:D

195. Which is the best method of emergency contraception in a nullip who had unprotected sexual contact 48 hours ago and her LMP being 16 days ago (Kerala PGMEE 2015)

(A) Combined oral contraceptive pill

(B) Mirena coil

(C) Depoprovera

(D) Levonorgestrel

The Correct Answer is:D

Levonorgestrel (or l-norgestrel or D-norgestrel) (Plan B, Next Choice, Postinor, “the morning after pill,” and others[1]) is a second generation progestin (synthetic progestogen) used as an active ingredient in some hormonal contraceptives, including combined oral contraceptive pills, progestogen only pills, emergency contraceptive pills, intrauterine systems, contraceptive implants, and hormone replacement therapy.

196. 20 year old unmarried girl is diagnosed as having PCOD with features of hirsutism. Treatment of choice is (Kerala PGMEE 2015)

(A) Clomiphene citrate

(B) Wedge resection of ovary

(C) Combinedo ral contraceptive pill

(D) Combined oral contraceptive pill with cyproterone acetate

The Correct Answer is:D

Cyproterone acetate  , also known as 1,2α-methylene-6-chloro-δ6-17α-acetoxyprogesterone is a synthetic, steroidal antiandrogen, progestin, and antigonadotropin

 It is primarily used in the treatment of androgen-related conditions by virtue of its ability to suppress androgenic activity in the body, an effect which it mediates by preventing endogenous androgens from interacting with the androgen receptor and by suppressing androgen biosynthesis

CPA has been approved for the treatment of prostate cancer, precocious puberty, androgen-related dermatological conditions (such as acne, seborrhea, hirsutism, and androgenic alopecia), and to reduce sex drive in sex offenders.

197.Cause of hirsutism include all EXCEPT (Kerala PGMEE 2015)

(A) PCOD

(B) Cushing’s syndrome

(C) Idiopathic

(D) Warfarin

The Correct Answer is:D

198.A 23 year old womanp resentsw ith fishy, foul smellingv aginalo dour.Clue cells

are found in the smear.Most likely causative organism is (Kerala PGMEE 2015)

(A) Trichomonas vaginalis

(B) Neisseria gonorrhoeae

(C) Candida albicans

(D) Gardnerella

The Correct Answer is:D

199.Candidal vaginitis is associated with the following EXCEPT (Kerala PGMEE 2015)

(A) Pruritus

(B) Characteristic Frothy yellow green discharge

(C) Glycosuria

(D) Immune suppression

The Correct Answer is:B

200. The life span of copper T 380 A is (Kerala PGMEE 2015)

(A) 3 years

(B) 5 years

(C) 8 years

(D) 10 years

The Correct Answer is:D