PGI May 2013 PG Medical Entrance MCQs

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PGI May 2013 PG Medical Entrance MCQs

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ANATOMY

  1. During a thyroid operation, a nerve coursing along

with the superior thyroid artery is injured. What can

be the possible consequence(s):(PGI MAY -2013)

A,   Loss of sensation above vocal cord

B.   Loss of sensation below vocal cord

C. Paaralysis of lateral cricoarytenoid muscle

D. Paralysis of cricothyroid muscle

E .Loss of sensation in pyriform fossa

Ans:D

  • External laryngeal nerve   accompanies the superior thyroid artery   .
  • The external laryngeal nerve is the smaller, external branch (ramus externus) of the superior laryngeal nerve.
  • It descends on the larynx, beneath the sternothyroid muscle, to supply the cricothyroid muscle.
  • It functions to tense the vocal cords by activating the cricothyroid muscle, increasing pitch.
  • Above the vocal folds the sensory innervation of the larynx is via the internal laryngeal nerve.
  • Below the vocal folds it is by way of branches of the recurrent laryngeal nerve. The vocal fold itself receives dual innervation from both nerves.
  • It gives branches to the pharyngeal plexus and the superior portion of the inferior pharyngeal constrictor, and communicates with the superior cardiac nerve behind the common carotid artery.
  • The external branch is susceptible to damage during thyroidectomy or cricothyrotomy, as it lies immediately deep to the superior thyroid artery. The ability to produce pitched sounds is then impaired along with easy voice fatigability, (usually mono-toned voice). Damage to the superior laryngeal nerve leaves the vocal cord abducted and poses an aspiration risk.
  • The internal laryngeal nerve is the internal branch (ramus internus) of the superior laryngeal nerve. It descends to the thyrohyoid membrane, piercing it in company with the superior laryngeal artery, and is distributed to the mucous membrane of the larynx.
  • Of these (sensory) branches, some are distributed to the epiglottis, the base of the tongue, and the epiglottic glands; others pass posteriorly, in the aryepiglottic fold, to supply the mucous membrane surrounding the entrance of the larynx, and the muscous lining of the larynx as inferior as the vocal folds.
  • A filament descends beneath the mucous membrane on the inner surface of the thyroid cartilage and joins the recurrent nerve.

 

  1. Nerve of Wrisberg contain(s): (PGI MAY -2013)

 

  1. Motor fibers
  2. Sensory fibers
  3. Secretory fibers
  4. Parasympathetic fibers
  5. Sympathetic fibers

2.   Ans:B ,D

 

The nerve of Wrisberg (named for Heinrich August Wrisberg) can refer to:

  • Medial cutaneous nerve of arm
  • A branch of the facial nerve, also called Nervus intermedius

The nervus intermedius, or intermediate nerve, or “nerve of Wrisberg”,

  • It is the part of the facial nerve (cranial nerve VII) located between the motor component of the facial nerve and the vestibulocochlear nerve (cranial nerve VIII).
  • It contains the sensory and parasympathetic fibers of the facial nerve. Upon reaching the facial canal, it joins with the motor root of the facial nerve at the geniculate ganglion.

 

  1. Causes of facial palsy include(s): (PGI MAY -2013)

 

A.   Lacunar infarct

B.     Parotid tumour surgery

C.   Bell’s palsy

D.   GBS

E.   Melkersson syndrome

3.   Ans: b ,c, d, e

 

Melkersson–Rosenthal syndrome

  • a rare neurological disorder characterized by recurring facial paralysis, swelling of the face and lips (usually the upper lip), and the development of folds and furrows in the tongue

 

  1. Roof of Inguinal canal is/are formed by: (PGI MAY -2013)

 

  1. Internal oblique muscle

B.   Fascia transversalis

  1. Transversus abdominis muscles

D. oblique muscle

  1. Conjoint tendon

4.   Ans:A , C

  • anterior wall:

o   aponeurosis of external oblique

o   fleshy part of internal oblique (lateral third of canal only)

o   superficial inguinal ring (medial third of canal only

  • superior wall (roof):

o   Medial crus of aponeurosis of external oblique

o   Musculoaponeurotic arches of internal oblique and transverse abdominal

o   Transversalis fascia

  • posterior wall:

o   transversalis fascia

o   conjoint tendon (Inguinal falx,reflected part of inguinal ligament, medial third of canal only)

o   deep inguinal ring (lateral third of canal only)

  • inferior wall (floor):

o   inguinal ligament

o   lacunar ligament (medial third of canal only)

o   iliopubic tract (lateral third of canal only

 

The structures which pass through the canal differ between males and females:

 

in males : the spermatic cord and its coverings + the ilioinguinal nerve.

in females : the round ligament of the uterus + the ilioinguinal nerve.

The classic description of the contents of spermatic cord in the male are:

  • 3 arteries: artery to vas deferens (or ductus deferens), testicular artery, cremasteric artery;
  • 3 fascial layers: external spermatic, cremasteric, and internal spermatic fascia;
  • 3 other structures: pampiniform plexus, vas deferens (ductus deferens), testicular lymphatics;
  • 3 nerves: genital branch of the genitofemoral nerve (L1/2), sympathetic and visceral afferent fibres, ilioinguinal nerve (N.B. outside spermatic cord but travels next to it)

Note that the ilioinguinal nerve passes through the superficial ring to descend into the scrotum, but does not formally run through the canal

 

  1. After surgery on right side of neck, a person could not

raise his arm above head and also could not shrug

the shoulder. What is the possible cause/causes: (PGI MAY -2013)

A.   Damage to spinal accessory nerve

  1. Paralysis of trapezius muscle
  2. Injury to axillary nerve
  3. Paralysis of latissimus dorsi
  4. Injury to dorsal scapular nerve

5. Ans: a,b, e

  • Levator scapula, rhomboids & upper trapezius all work to elevate the scapula as in shrugging the shoulders
  • The rhomboid major, like the rhomboid minor, is innervated by the ventral primary ramus via the dorsal scapular nerve (C5)

Axillary Nerve injury Clinical features

  • Losing feeling (numbness) in the upper outer arm, near the deltoid muscle.
  • Shoulder and arm weakness.
  • Arm fatigue.
  • Loss of proper functioning of the shoulder (bringing the arm above shoulder level).
  • Sometimes, there is burning or tingling in the upper arm or shoulder.
  • Shrinking (atrophy) of the deltoid muscle

 

 

  1. An person is unable to dorsiflex the foot and there

is loss of sensations on dorsal foot. Possible nerve

injury is: (PGI MAY -2013)

 

  1. Damage to common peroneal nerve at neck of fibula
  2. Damage to common peroneal at medial malleolus
  3. Compression of anterior tibial nerve at ankle
  4. Damage to superficial peroneal nerve
  5. Damage of deep peroneal nerve

6.   Ans:A

Why is the answer , damage to common peroneal nerve at neck of fibula

  • unable to dorsiflex the foot – deep peroneal nerve
  • loss of sensations on dorsal foot – superficial peroneal nerve

 

 

  • The common fibular nerve (common peroneal nerve; external popliteal nerve; peroneal nerve; lateral popliteal nerve), is derived from the dorsal branches of the fourth and fifth lumbar and the first and second sacral nerves.
  • Previous to its division it gives off articular and lateral sural cutaneous nerves.
  • The motor branches:

o   As the common fibular nerve exits the popliteal fossa, it courses around the lateral aspect of the leg just below the head of the fibula. Here it is apposed with fibula and gives off two branches, the superficial fibular (peroneal) branch and deep fibular (peroneal) branch.

o   Superficial peroneal nerve

  • supplies the muscles of the lateral compartment of the leg namely: peroneus longus and peroneus brevis.
  • These two muscle help in eversion and plantar flexion of the foot.
  • The superficial fibular nerve innervates the skin over the antero-lateral aspect of the leg along with the greater part of the dorsum of the foot (with the exception of the first web space, which is innervated by the deep peroneal nerve).
  • Injury to the nerve can result in an inability to evert the foot and loss of sensation over the dorsum of the foot (with the exception of the first web space between the great toe and the second toe, where the inferior fibular nerve innervates)

o   Deep peroneal nerve

  • innervates the muscles of the anterior compartment of the leg which are: tibialis anterior, extensor hallucis longus, extensor digitorum longus, and the fibularis (peroneus) tertius.
  • Together these muscles are responsible for dorsiflexion of the foot and extension of the toes.
  • The deep peroneal nerve also innervates intrinsic muscles of the foot including the extensor digitorum brevis and the extensor hallucis brevis

7. A person having difficulty in opening in mouth but not in closing the mouth. Which of the following statement is correct about concerned muscle: (PGI MAY -2013)

 

  1. Origin from lateral pterygoid
  2. Origin from medial pterygoid plate
  3. Insertion to anterior margin of articular disc
  4. Supplied by mandibular nerve
  5. Depress mandible while opening it

 

7.   Ans:   A,C ,D ,E

 

The internal pterygoid (IP) – closes the jaw

 

 

 

Masseter (MASS) – closes the jaw.

 

 

3. Temporalis (TEM) – closes the jaw pulls mandible back

 

Anterior belly of the digastric (AD) – opens the jaw – pulls tongue body forward and up
– if the hyoid bone isn’t stabalized

Geniohyoid (GH) – opens the jaw (if the hyoid is stabalized).
– pulls tongue body forward and up (if the hyoid isn’t stabalized

 

Geniohyoid (GH) – opens the jaw (if the hyoid is stabalized).
– pulls tongue body forward and up (if the hyoid isn’t stabalized)

Mylohyoid (MH) – same action as Geniohyoid

Muscles that move the body of the tongue (extrinsic tongue muscles): 1. Styloglossus – pulls body of tongue up and back

 

 

Genioglossus – pulls body of tongue forward

 

 

3. Hyoglossus – pulls body of tongue down

 

 

  • Elevation of mandible is brought about by the contraction of the temporalis, the masseter & the medial pterygoids
  • Depression of mandible is brought about by contraction of the digastrics, the geniohyoids & the mylohyoids; the lateral pterygoids play an important role by pulling the mandible forward

Lateral pterygoid muscle :

  • The upper/superior head originates on the infratemporal surface and infratemporal crest of the greater wing of the sphenoid bone, and the lower/inferior head on the lateral surface of the lateral pterygoid plate.
  • Inferior head inserts onto the neck of condyloid process of the mandible; upper/superior head inserts onto the articular disc and fibrous capsule of the temporomandibular joint.
  • The mandibular branch of the fifth cranial nerve, the trigeminal nerve, specifically the lateral pterygoid nerve, innervates the lateral pterygoid muscle.

 

  1. Cranial nerve passing through internal auditory

meatus: (PGI MAY -2013)

  1. 7th cranial nerve
  2. 9th cranial nerve
  3. 10th cranial nerve
  4. 11th cranial nerve
  5. 12th cranial nerve

8.   Ans:A (7th cranial…) [Ref: BDC4th/Voi.in 139 ; Snells’ Anatomy 8th/764]

INTERNAL AUDITORY iMEATUS: STRUCTURES

PASSING

” I am 78 Inches Lady ”

” 7th cranial nerve

8th cranial nerve

Nervus intermedius

Labrynthine vessels

INTERNAL AUDITORY MEATUS   OR

«. It is a canal in the petrous part of the temporal bone

of the srkull that carries nerves from inside the skull towards the middle and inner ear, namely cranial nerve VII and cranial nerve VII!. There are two internal auditory meatus in most individuals, one on the left side of the skull and one on the right. The internal acoustic meatus transmits the facial and

vestibulocochlear nerves and the labyrinthine artery (an internal auditory branch of the basiiar artery). The facial nerve travels through the facial canal, eventually exiting the skull at the stylomastoid foramen. © The opening of the meatus is called the porus acusticus intemus, or its English translation, the internal acoustic opening.

 

  1. A person can not able to adduct his thumb. The nerve

involved is characterized by: (PGI MAY -2013)

  1. Having C7 8 T1 root value
  2. Arise from medial cord of brachial plexus
  3. Arise from lateral cord of brachial plexus
  4. Arise from posterior cord of brachial plexus
  5. Supplies 1st two lumbricals   v

9.   Ans:A (Having …) & B (Arise…)

 

 

  1. True about anatomy of lateral wall of nose:   (PGI MAY -2013)

A.   Superior turbinate is a separate bone

B. Ethmoid bone forms an important part of the lateral wall

  1. Middle turbinate is formed by medial process of the ethmoidal labyrinth
  2. Opening of inferior meatus is present

Ans:B ,C , D

  • Lateral wall of the nasal cavity is mainly made up by the maxilla, however there is a deficiency that is compensated by: the perpendicular plate of the palatine bone, the medial pterygoid plate, the labyrinth of the ethmoid and the inferior concha.
  • Nasal turbinates:

o   The turbinates are the most prominent feature of the lateral nasal wall.

o   They are usually three or sometimes four in number.

o   These turbinates appear as scrolls of bone, delicate, covered by ciliated columnar epithelium.

o   These turbinates sometimes may contain an air cell, in which case it is termed as a concha.

o    Among these turbinates the superior and the middle turbinates are components of the ethmodial complex where as the inferior turbinate is a separate bone.

o    Commonly a prominence may be seen at the anterior attachment of the middle turbinate. This prominence is known as the agger nasi cell. These agger nasi cells overlie the lacrimal sac, separated from it just by a thin layer of bon

o   Superior & middle concha are formed by medial process of the ethmoidal labyrinth, inferior concha is a independent bone

Physiology

11.   Not found in seminal fluid: (PGI MAY -2013)

  1. Fructose
  2. Prostaglandins
  3. Spermine

D. Citric Acid

E. lnositol

 

Ans:E

 

  1. Which of the following sugar is/are found in amniotic

fluid : (PGI MAY -2013)

A.   Mannose

B.     Sucrose

C.   Glucose

D.   Fructose

E.   Galactose

 

12. Ans:C

o   At first, amniotic fluid is mainly water with electrolytes, but by about the 12-14th week the liquid also contains proteins, carbohydrates, lipids and phospholipids, and urea, all of which aid in the growth of the fetus

o   Amniotic fluid has 20 mg% of glucose

 

 

  1. True about Shear stress on vessel: (PGI MAY -2013)
  2. Parallel to the long axis of blood vessel
  3. Perpendicular to long axis of blood vessel
  4. Increases with increase in axial velocity of fluid
  5. Poiseuille-Hagen equation correlate flow   with viscosity      .
  6. Depend upon viscosity

 

13.     Ans:A ,C ,D, E

 

Poiseuille-Hagen Formula

            The following formula describes the rate of streamlined flow in a tube:

 

P is pressure (dynes/cm2), h the viscosity (poise), r the radius (cm) and l (cm) is the length. If the indicated units are used, the rate of flow will be in cm3/sec (i.e., ml/sec). Some of the terms in this equation are common sense, others are quite surprising.

o   PA-PB is the driving pressure between point A and point B in the tube (also indicated as DP). The greater the driving pressure, the greater the rate of flow.

o   p/8 is a geometrical term related to the circular cross section of the tube.

o   1/h indicates the inverse proportionality to the fluid viscosity. A more viscous fluid, such as molasses, will flow slower than water given the same driving pressure.

o   r4/l – illustrates, first, that flow rate is decreased in long tubes, that is, resistance to flow increases with tube length. If you have ever tried to run water through several connected garden hoses, you have seen this principle at work. The relationship to r4 is a surprising and profound part of this formula

o   By definition, a fluid cannot permanently resist a shearing force, that is, a force that causes layers within the fluid to slide over one another. If we use a stack of papers to represent a fluid, a shearing force would cause the papers to slide over one another and scatter across a table. Viscosity is a measure of a fluid’s ability to temporarily resist a shearing force.

o   Flowing blood creates a force on the endothelium that is parallel to the long axis of the vessel.

o   This shear stress (y) is proportionate to viscosity (n) times the shear rate (dy/dr), which is the rate at which the axial velocity increases from the vessel wall toward the lumen. ‘

 

 

14. Carbon monoxide transfer factor   is/are increased

in:        : (PGI MAY -2013)

  1. Polycythemia
  2. Anaemia
  3. L—>R shunt
  4. R—>L shunt
  5. Pulmonary embolism

14.   Ans:A , C

DLCO or TLCO (diffusing capacity or transfer factor of the lung for carbon monoxide (CO) is the extent to which oxygen passes from the air sacs of the lungs into the blood.

Decrease

DLCO is decreased in any condition which affects the effective alveolar surface area:

o   Hindrance in the alveolar wall. e.g. fibrosis, alveolitis, vasculitis

o   Decrease of total lung area, e.g. Restrictive lung disease

o   Chronic obstructive pulmonary disease (COPD), due to large residual air stuck in the lungs

o   Uneven spread of air in lungs, e.g. emphysema

o   Pulmonary embolism

o   Cardiac insufficiency

o   Pulmonary hypertension

o   Bleomycin (upon administration of more than 200 units)

o   Chronic heart failure

o   Anemia-due to decrease in blood volume

o   Amiodarone high cumulative dose; more than 400 milligrams per day

Increase

o   Factors that can increase the DLCO include polycythaemia, asthma (can also have normal DLCO) and increased pulmonary blood volume as occurs in exercise. Other factors are left to right intracardiac shunting, and alveolar hemorrhage

 

15.   Which hormone regulate(s) serum caicium level: (PGI MAY -2013)

  1. PTH
  2. Calcitonin
  3. Adrenaline
  4. 1,25-Dihydroxy-cholecalciferol
  5. Procalcitonin

15.     Ans:A ,B ,D

  1. True statement regarding arterial BP : (PGI MAY -2013)
  2. Diurnal variation present
  3. Low when taken with small cuff
  4. Standing increases both SBP & DBP
  5. Should be measured in both arms
  6. Exercise increases both SBP & DBP

16. Ans: A , D , E

 

o   Studies have shown that using too small of a blood pressure cuff can cause a patient’s systolic blood pressure measurement to increase 10 to 40 mmHg.

o   Upon standing – (Option C)

o   perinheral pooling of blood in dependent parts causes decreased venous return that decrease Cardiac output and decrease SBP

o   Decrease in SBP decrease baroreceptor discharge and increase DBP

  1. Features of ECF as compared to !CF : (PGI MAY -2013)
  2. High K
  3. High Na
  4. High proteins
  5. High Cl
  6. Nearly equal osmolarity in both fluid

17.   Ans:B ,D &E

 

  1. Calcium sensing receptors is/are present at: (PGI MAY -2013)
  2. PCT
  3. DCT
  4. Loop of Henle
  5. Apical brush-border membrane of the intestinal enterocyte
  6. Epithelium of intestine

 

18.     Ans:AH(A,B,C,D&E)

Biochemistry

  1. Which of the following is/are not sphingolipidosis: (PGI MAY -2013)
  2. Tay Sach’s disease
  3. Sandhoff’s disease
  4. Krabbe’s disease
  5. Fabry’s disease
  6. Wolman disease

19.     Ans:B & E

Sandhoff disease, also known as Sandhoff-Jatzkewitz disease, variant 0 of GM2-Gangliosidosis or Hexosaminidase A and B deficiency, is a lysosomal genetic, lipid storage disorder caused by the inherited deficiency to create functional beta-hexosaminidases A and B These catabolic enzymes are needed to degrade the neuronal membrane components, ganglioside GM2, its derivative GA2, the glycolipid globoside in visceral tissues, and some oligosaccharides. Accumulation of these metabolites leads to a progressive destruction of the central nervous system and eventually to death

Enzyme defects in various Sphingolipidoses:

o   GaUChers Disease: beta GlUCosidase

o   Fabry’s : ALpha gALactosidase

o   Nieman Pick : Sphingomyelinase

o   Tay-Sachs : Hexosaminidose (Remember TSH)

FABRY’S

o   Foam cells found in glomeruli and tubules

o   Angiokeratomas/ Alfa galactosidase A deficiency

o   Burning pain in extremeties/ BUN elevated

o   Renal failure

o   YX (males, x linked recessive)

o   Sphingolipidosis

 

 

  1. Disease of branched chain amino acid includes: (PGI MAY -2013)
  2. Phenylketonuria
  3. Maple syrup disease
  4. Taysach’s disease
  5. Isovaleric acidemia
  6. Niemann-Pick disease

20.     Ans:B,D

Isovaleric acidemia, also called isovaleric aciduria or isovaleric acid CoA dehydrogenase deficiency, is a rare autosomal recessive metabolic disorder which disrupts or prevents normal metabolism of the branched-chain amino acid leucine. It is a classical type of organic acidemia.

 

  1. True about gluconeogenesis: (PGI MAY -2013)
  2. Prevent hypoglycemia during prolonged fasting
  3. Occur in both muscle and liver
  4. Fructose 2,6-biphosphate stimulate it
  5. Excess of acetyl CoA cause stimulation
  6. Carbon skeleton of amino acid is involved in

 

21. Ans:A ,D ,E

1. F2,6BP activates PFK1 (glycolysis) and inhibits F1,6BPase (gluconeogenesis)

2. PFK2 makes F2,6BP from F6P

3. F2,6BPase breaks down F2,6BP to F6P

4. PFK2 is converted to F2,6BPase by cAMP-dependent protein kinase by phosphorylation (requires cAMP – stimulated by glucagon or epinephrine)

5. F2,6BPase is converted back to PFK2 in absence of cAMP

o   So, when epinephrine or glucagon stimulates cells -> cAMP is produced ->cAMP-dependent protein kinase is activated -> PFK2 is converted to F2,6BPase ->F2,6BP is broken down -> Fructose 1,6-bisphophatase (gluconeogenesis) is activated and PFK1 (glycolysis) is inhibited

o   In the absence of epinephrine/glucagon stimulation (or with insulin stimulation), cAMP is broken down -> cAMP-dependent protein kinase is inactivated -> F2,6BPase is converted to PFK2 -> F2,6BP is made -> PFK1 (glycolysis) is stimulated and fructose-1,6-bisphsophatase (gluconeogenesis) is inhibited.

o   The most potent allosteric regulator of the glycolysis and gluconeogenesis pathways is fructose-2,6-bisphosphate (F2,6BP). As shown in Figure 16.6, F2,6BP activates phosphofructokinase (also called PFK1) – the enzyme in glycolysis that converts fructose-6-phosphate to fructose-1,6-bisphosphate. F2,6BP also inhibits fructose-1,6-bisphosphatase (F1,6BPase) – the enzyme in gluconeogenesis that accomplishes the opposite reaction. In fact, F1,6BP is ten times more sensitive to F2,6BP than AMP, another reciprocal regulator.

o   A single polypeptide contains both of the activities necessary to synthesize and degrade F2,6BP. The synthetic activity is called phosphofructokinase-2 (PFK2). To distinguish PFK2 from phosphofructokinase (the glycolysis enzyme), the latter enzyme is sometimes called PFK1. The catalytic activity that breaks down F2,6BP is referred to as fructose-2,6-bisphosphatase (F2,6BPase). Interconversion of PFK2 and F2,6BPase is accomplished by a cAMP-stimulated phosphorylation of PFK2 (by cAMP-dependent protein kinase) to form F2,6BPase.

o   Thus, in the presence of cAMP (which is produced in response to glucagon or epinephrine action), destruction of F2,6BP is favored. Because PFK1 is stimulated by F2,6BP, but F1,6BPase (the corresponding gluconeogenesis enzyme) is inhibited by F2,6BP, cAMP produced by glucagon or epinephrine will turn off glycolysis and turn on gluconeogenesis. Thus, due to hormonal control of F2,6BP, glycolysis and gluconeogenesis respond rapidly to hormonal regulation.

22.   Essential fatty acid is/are: (PGI MAY -2013)

A.   Palmitic acid

B.   Linoleic acid

C.   Linolenic acid

D.   Oleic acid            *

E.    Free fatty acid

22.     Ans:B & C

 

23.. Which substrate is/are used to provide energy for body: (PGI MAY -2013)

  1. Ketone bodies
  2. Glucose
  3. Free fatty acids
  4. Creatine phosphate
  5. Collagen

Ans:A ,B , C & D

 

24.   Correct combination of Urine odour in various metabolic disorders: (PGI MAY -2013)

  1. Phenylketonuria -Mousy odour
  2. Tyrosinemia-Rotten cabbage
  3. Hawkinsinuria- Potato smell
  4. Maple syrup disease-Rotten tomato
  5. Alkaptonuria-Rotten egg

 

24.     Ans: A, B

Hawkinsinuria, also called 4-Alpha-hydroxyphenylpyruvate hydroxylase deficiency, is an autosomal dominant metabolic disorder affecting the metabolism of tyrosine.[1] Normally, the breakdown of the amino acid tyrosine involves the conversion of 4-hydroxyphenylpyruvate to homogentisate by 4-Hydroxyphenylpyruvate dioxygenase. Complete deficiency of this enzyme would lead to tyrosinemia III.

o   Patients present with metabolic acidosis during the first year of life, which should be treated by a phenylalanine- and tyrosine-restricted diet. The tolerance toward these amino acids normalizes as the patients get older. Then only a chlorine-like smell of the urine indicates the presence of the condition, patients have a normal life and do not require treatment or a special diet.

o   Maple syrup disease-characteristic Maple syrup odour to urine

o   Isovaleric academia: The affected individual exhibit a cheesy odour in the breath & body fluids

 

25.   Which group of amino acid is responsibie for peptide bond: (PGI MAY -2013)

  1. Amino group
  2. Carboxyl group
  3. Side chain
  4. Aldehyde group
  5. Amide group

25.     Ans:A ,B

When two amino acids form a dipeptide through a peptide bond it is called condensation. In condensation, two amino acids approach each other, with the acidmoiety of one coming near the amino moiety of the other. One loses a hydrogen and oxygen from its carboxyl group (COOH) and the other loses a hydrogen from its amino group (NH2). This reaction produces a molecule of water (H2O) and two amino acids joined by a peptide bond (-CO-NH-). The two joined amino acids are called a dipeptide.

The peptide bond is synthesized when the carboxyl group of one amino acid molecule reacts with the amino group of the other amino acid molecule, causing the release of a molecule of water (H2O), hence the process is a dehydration synthesis reaction (also known as a condensation reaction).

 

 

 

# Immunology

 

  1. In a sample of DNA, if Adenine is 23%. What will the

amount of guanine present: (PGI MAY -2013)

A.   23%

B.     25%

C.   46%

D.     27%

E.   54%

26.     Ans:   c

Chargaff princple – A=T   &G=C

o   Adenine & Guanine are purine whereas cytosine, thymine & uracil are pyrimidine-

o   Given adenine(A)- 23% so Thymine(T) also =23%

o   If A+ T = 46% , then G+C = 54%

o   So Guanine(G) & Cytosine(C) both combined will constitute 54%(as total 100%).

o   As both are equal in DNA so each will be 54%/2= 27%

 

  1. True about DNA polymerase used in PCR: (PGI MAY -2013)
  2. Obtained from virus
  3. Obtained from bacteria
  4. Used for joining the two strands
  5. It is heat stable

E.   Add nucleotide

27,     Ans:B ,D ,E

o   Almost all PCR applications employ a heat-stable DNA polymerase, such as Taq polymerase (an enzyme originally isolated from the bacterium Thermus aquaticus).

o   This DNA polymerase enzymatically assembles a new DNA strand from DNA building-blocks, the nucleotides, by using single-stranded DNA as a template and DNA oligonucleotides (also called DNA primers), which are required for initiation of DNA synthesis.

o   The vast majority of PCR methods use thermal cycling, i.e., alternately heating and cooling the PCR sample through a defined series of temperature steps.

o   In the first step, the two strands of the DNA double helix are physically separated at a high temperature in a process called DNA melting. In the second step, the temperature is lowered and the two DNA strands become templates for DNA polymerase to selectively amplify the target DNA.

o   The selectivity of PCR results from the use of primers that are complementary to the DNA region targeted for amplification under specific thermal cycling conditions.

 

  1. Post transcriptional modification includes: (PGI MAY -2013)
  2. All RNA undergo post transcriptional modification
  3. Capping of the pre-mRNA involves the addition of 7-methylguanosine to the 5′ end
  4. Poly A tailing occur at 3’end
  5. Intron excision by spliceosome
  6. Primarily occur in cytoplasm

28.     Ans:A,B ,C, d

 

o   Co-transcriptional modification is a process in eukaryotic cells, primary transcript RNA is converted into mature RNA.

o   A notable example is the conversion of precursor messenger RNA into mature messenger RNA (mRNA), which includes splicing and occurs prior to protein synthesis. This process is vital for the correct translation of the genomes of eukaryotes because the human primary RNA transcript that is produced, as a result of transcription, contains both exons, which are coding sections of the primary RNA transcript and introns, which are the non-coding sections of the primary RNA transcript

o   The pre-mRNA molecule undergoes three main modifications.

o   These modifications are 5′ capping, 3′ polyadenylation, and RNA splicing, which occur in the cell nucleus before the RNA is translated

o   The primary transcript are extensively modified in the nucleus after transcription

 

  1. True about prokaryotic DNA replication: (PGI MAY -2013)
  2. Conservative
  3. Semi conservative
  4. Unidirectional

D.   Bidirectional

E.   Semidiscontinuous

Ans:B ,D ,E

o   Replication is semi-conservative since half of the original DNA is conserved in the daughter DNA

o   DNA synthesis is semidiscontinuous & bidirectional

o   DNA molecules are double-stranded and the two strands are antiparallel, ie, running in opposite directions.

 

  1. immunoflorescent probes are used in : (PGI MAY -2013)
  2. FRET
  3. Microarray

C.   RIA

  1. Recombinant DNA
  2. ELISA

 

30. Ans:A ,C, E

o   High-throughput immunofluorescence microscopy using yeast spheroplast cell-based microarrays.

o   Förster resonance energy transfer (FRET), fluorescence resonance energy transfer (FRET), resonance energy transfer (RET) or electronic energy transfer (EET) is a mechanism describing energy transfer between two light-sensitive molecules (chromophores).

o   A donor chromophore, initially in its electronic excited state, may transfer energy to an acceptor chromophore through nonradiative dipole–dipole coupling.[2] The efficiency of this energy transfer is inversely proportional to the sixth power of the distance between donor and acceptor, making FRET extremely sensitive to small changes in distance

 

 

31, Which of the following gene combination is/are found in sarcoma : (PGI MAY -2013)

A.     EWS-ETV1

B.     EWS-ERG

C.   EWS-CHN

D.     EWS-ATF1

E.     EWS-WT1          :

Ans a,b,c,d,e

Ewing’s sarcoma/ Peripheral primitive neuroectodermal tumor

t(11;22)(q24;q12)t(21;22)(q22;q12)t(7;22)(p22;q12)

t(17;22)(q12;q12)

t(2;22)(q33;q12)

t(16;21)(p11;q22)

EWS-FLI1EWS-ERGEWS-ETV1

EWS-FEV

EWS-E1AF

FUS-ERG

 

o    EWS/CHN and RBP56/CHN fusion genes are found in extraskeletal myxoid chondrosarcoma

o   In addition, the N-termina! part of EWS is fused with the DNA-binding domain ofATFI, a member of the bZIP family, in clear cell sarcomas of tendons and aponeuroses with t(12;22)(q13;q12), with the DNA-binding domain of WT1 in the intra-abdominal desmoplastic small round ceil tumourwith t(11;22)(p13;q12), and with the CHOP gene in myxoid liposarcomas with translocations between 12q13

32.   Which of the following statement(s) is/are true about pilocytic astrocytoma: (PGI MAY -2013)

A.   Slow growing

B.Increase in vascularity

C.Most commonly involve cerebellum

D.Mostly cystic in nature

E.Mostly malignant

Ans: A ,B,C ,D

o   Pilocytic astrocytoma or juvenile pilocytic astrocytoma or cystic cerebellar astrocytoma (and its variant juvenile pilomyxoid astrocytoma) is a neoplasm of the brain that occurs more often in children and young adults (in the first 20 years of life). They usually arise in the cerebellum, near the brainstem, hypothalamic region, or the optic chiasm, but they may occur in any area where astrocytes are present, including the cerebral hemispheres and the spinal cord.

o   These tumors are usually slow growing. The neoplasms are associated with the formation of a single (or multiple) cyst(s), and can become very large.

o   The pilocytic astrocytoma is, in general, considered a benign tumor.

o   It is often cystic, and, if solid, it tends to be well-circumscribed. It is characteristically a contrast-enhancing tumor by current imaging investigations (e.g., CT scan, MRI)

o   Juvenile pilocytic astrocytoma is associated with neurofibromatosis type 1 (NF1), and optic gliomas are among the most frequently encountered tumors in patients with this disorder.

o   It is classified as Grade 1 Astrocytoma

o   The World Health Organization (WHO) classifies astrocytomas into four prognostic grades based on histologic features: grade I (pilocytic astrocytoma, subependymal giant cell astrocytoma); grade II (diffuse astrocytoma); grade III (anapiastic astrocytoma); and grade IV (glioblastoma).

o   Grades I and II are considered low-grade, and grades III and IV high-grade, astrocytomas.

 

  1. Human PapillomaVirus does not cause: (PGI MAY -2013)
  2. Oropharyngeal carcinoma
  3. Cervical carcinoma
  4. Oesophageal carcinoma
  5. Cutaneous carcinoma
  6. Burkitt’s lymphoma

33. Ans: E

“Burkitt’s lymphoma: More than 90% of African tumors carry the Epstein-Barr virus genome.

 

  1. True about cholelithiasis : (PGI MAY -2013)
  2. Cholesterol stones are most common
  3. 90% of gallstone are radio-opaque
  4. Mirrizi syndrome is due to impaction   of stone in hartmann’s pouch
  5. Hemolytic anaemia cause black colored stone
  6. Carcinoma is not a risk associated with gallstone

 

Ans A,C,D

o   Most notable complication is the increased risk for carcinoma of the gallbladder

o   Stones composed largely of cholesterol are radiolucent; sufficient calcium carbonate is found in 10% to 20% of cholesterol stones to render them radio-opaque

 

  1. All are true about ascending choiangitis except: (PGI MAY -2013)
  2. Most commonly caused by gram positive organisms
  3. In severe cases collapse can occur
  4. Urgent removal of stone by ERCP can be done
  5. Cholecystectomy is also done
  6. Commonly caused by obstruction of bile duct by

stone

.     Ans: A

Cholangitis : The bacteria are usually enteric Gram-negative aerobes such as E. coli, Klebsiella, Ciostridium, Bacteroides, or Enterobacter and Group D streptococci. Cholangitis usually presents with fever, chills, abdominal pain, and jaundice, accompanied by acute inflammation of the wall of the bile ducts with entry of neutrophils into the luminal space

 

 

  1. Not true about von Willebrand disease; (PGI MAY -2013)
  2. aPTT is normal
  3. Bleeding time is normal
  4. Most common pattern of inheritance is autosomal

recessive

  1. Bleeding from mucosa in oral cavity may present
  2. Normal platelet count

36.     Ans: A,B , C

In most cases, it is transmitted as an autosomal dominant disorder, but several rare autosomal recessive variants have been identified

 

37.True about Peutz-jeghers syndrome: (PGI MAY -2013)

  1. Pigmentary changes in skin and mucous membrane around mouth
  2. Adenomatous polyp in intestine
  3. Most common of pattern inheritance is autosomal recessive
  4. 20-30% premalignant
  5. May presents as anemia in children

 

37.     Ans: A, E

 

Peutz-Jeghers syndrome is an autosomal dominant condition characterized by hamartomatous polyps throughout the gastrointestinal tract (most notably in the small intestine) as well as mucocutaneous pigmented macules on the lips, buccal mucosa, and skin.

 

  1. All are true about Mantle cell lymphoma except: (PGI MAY -2013)
  2. Associated with an (11; 14) translocation
  3. Overexpression of the BCL protein   3
  4. CD 5 positive
  5. CD 23 positive
  6. Centroblasts frequently seen

38.     Ans: D,E

Mantle cell lymphoma – 6 points for PG Medical entrance

o   It is usually CD5 positive and CD23 negative, which can help to distinguish it from chronic lymphocytic leukemia/ small lymphocytic lymphoma.

o   Large cells resembling centroblasts are usually absent, as are proliferation centers, helping to distinguish mantle cell lymphoma from follicular lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma, respectively”

o   Mantle cell lymphoma expresses CD19, CD20,

o   It is also characteristically positive for cyclin D1 protein.

o   these lymphomas have a characteristic chromosomal translocation, t(11;14), between the immunoglobulin heavy chain gene on chromosome 14 and the bcl-1 gene on chromosome 11

o   they regularly overexpress the BCL-1 protein,

 

 

  1. Which of the following statement is true about Congenitai nephrotic syndrome caused by Nephrin protein mutation :     (PGI MAY -2013)
  2. Cause steroid resistant nephrotic syndrome
  3. Nephrin is a key component of the slit diaphragm
  4. Coded by NPHS1 gene
  5. Symptom occur only after 1 st month of age
  6. Autosomal dominant pattern

 

Ans: a,b,c

o   Congenital nephrotic syndrome is a very rare form of nephrotic syndrome. It occurs predominantly in families of Finnish origin and manifests shortly after birth. It is an inherited disorder.

o   The condition is caused by a defect in the protein nephrin, which is found in the kidney

o   Congenital nephrotic syndrome of the Finnish type (NPHS1) is an autosomal-recessive disorder, characterized by massive proteinuria in utero and nephrosis at birth.

o   The NPHS1 gene product, termed nephrin, have a crucial role in the development or function of the kidney filtration barrier

 

40.   Reed Sternberg like cell are seen in: (PGI MAY -2013)

A.   Adult T cell lymphoma

B.   Extranodal NK/T-Cell Lymphoma

  1. Marginal zone lymphoma
  2. Diffuse large B cell lymphoma

E Infectious mononucleosis

40.   a,d,e

 

o   Reed–Sternberg cells are large and are either multinucleated or have a bilobed nucleus (thus resembling an “owl’s eye” appearance) with prominent eosinophilic inclusion-like nucleoli.

o   Reed–Sternberg cells are CD30 and CD15 positive, usually negative for CD20 and CD45. The presence of these cells is necessary in the diagnosis of Hodgkin’s lymphoma – the absence of Reed–Sternberg cells has very high negative predictive value.

o   They can also be found in reactive lymphadenopathy (such as infectious mononucleosis, carbamazepine associated lymphadenopathy) and very rarely in other types of non-Hodgkin lymphomas.

 

 

 

41.   If a patient has bilirubin 20 mg/dl, AST==313, ALT=103 & GGT=44 iU/L Most probable diagnosis is: (PGI MAY -2013)

A,    Viral hepatitis

B.   Alcoholic hepatitis

C.   Billiary atresia

D.   Drugs

E.   Autoimmune hepatitis

Ans: B

o   An AST.ALT ratio >2:1 is suggestive, while a ratio >3:1 is highly suggestive of alcoholic liver disease.

o   The AST in alcoholic liver disease is rarely >300 U/L, and the ALT is often normal. A low level of ALT in the serum is due to an alcohol-induced deficiency of pyridoxal phosphate.

o   Here AST > ALT(>3 times)- so most probable diagnosis is alcoholic hepatitis

 

42.   Not raised in liver disorder;(PGI MAY -2013)

A.   Lipase

B.   Urease

C.   ALP

D.   AST

E.   ALT

42.     Ans: a,b

 

  1. Presentation of   antiphospholipid syndrome

includes: (PGI MAY -2013)

A.   Recurrent abortion

  1. Fetal death
  2. Both arterial and venous thrombosis
  3. Prolonged aPTT
  4. Prolonged PT

43. Ans: a,b,c,d

 

 

 

  1. Feature of Goodpasture syndrome is/are: (PGI MAY -2013)
  2. Antibody to a chain of Type IV collagen (COL-4A)
  3. Basement membrane involvement
  4. Pulmonary haemorrhage
  5. Crescent formation
  6. Subendotheiial deposits

 

.   Ans a,b,c,d

 

Siniliar MCQ

: In acute PSGN immune deposit occur at

a)Subepithelial

b)sub endothelial

C)intramembranous

D) all

Ans A

o   Subendothelial deposits found in lupus nephritis and MPGN.

o   Mesangial deposits in IgA nephropathy

o   Basement membrane deposita in goodpasteur syndrome

o   Epimembranous deposits are seen in membranous nephropathy.

 

  1. Which of the following disease is caused by point mutation; (PGI MAY -2013)
  2. Colon cancer
  3. Diabetes mellitus type II
  4. Cystic fibrosis
  5. Sickle cell
  6. Gauchers disease

45.     Ans: C,D

o   Point mutations, or single-base substitutions, are the most common form of mutations

o    Many disease-causing point mutations are known at the “CpG island.”

o   A single gene disorder is the result of a single mutated gene.

o   Sickle-cell anemia is also considered a recessive condition, but heterozygous carriers have increased resistance to malaria in early childhood, which could be described as a related dominant condition.

 

  1. True about protooncogene: (PGI MAY -2013)
  2. Regulate cell growth and expression
  3. Found in normal cells
  4. Induced by virus

D.   inactivated by virus

E.   May convert to oncogene

 

46. Ans A,B,C,E

o   Proto-oncogene is a normal gene that can become an oncogene due to mutations or increased expression. The resultant protein may be termed as oncoprotein.[11] Proto-oncogenes code for proteins that help to regulate cell growth and differentiation. Proto-oncogenes are often involved in signal transduction and execution of mitogenic signals, usually through their protein products.

o   Upon activation, a proto-oncogene (or its product) becomes a tumor-inducing agent, an oncogene.

o   Examples of proto-oncogenes include RAS, WNT, MYC, ERK, and TRK.

o   The MYC gene is implicated in Burkitt’s Lymphoma, which starts when a chromosomal translocation moves an enhancer sequence within the vicinity of the MYC gene. The MYC gene codes for widely used transcription factors.

o   When the enhancer sequence is wrongly placed, these transcription factors are produced at much higher rates. Another example of an oncogene is the Bcr-Abl gene found on the Philadelphia Chromosome, a piece of genetic material seen in Chronic Myelogenous Leukemia caused by the translocation of pieces from chromosomes 9 and 22. Bcr-Abl codes for a receptor tyrosine kinase, which is constitutively active, leading to uncontrolled cell proliferation

  1. True about beta thalassemia : (PGI MAY -2013)
  2. Common in india
  3. Change in globin gene
  4. Microcytosis

D.       decreased HbF

  1. Secondary hemochromatosis may occur

 

Ans: A,B,C,E

 

Similar MCQ

The presence of HbF in blood of children and adults is characteristic of

a) alpha thalasemia

b) beta thalasemia

c) megaloblastic anemia

d) sickle cell anemia

e) spherocytic anemia

Ans B

o   Thalassemia is a hemoglobinopathic anemia in children of Italian and Greek heritage due to partial or complete failure of formation of globin chain in their erythrocytes.

o   In alpha thalassemia there is a gene deletion on chromose 16, and in beta thalassemia there is defect on chromosome 11. Children in whom the trait is homozygous develop a severe anemia (thalassemia major).

o   Those who are heterozygous have mild anemia (thalassemia minor).

o   In beta thalassemia, beta chain formation is defective. HbA production is decreased, and there is increased formation of HbF (fetal Hb) and HbA2, which do not contain beta chains.

o   The Hb in erythrocytes contains an excess of alpha chains, which may be responsible for hemolysis in beta thalassemia

 

  1. Mitochondrial inheritance: (PGI MAY -2013)
  2. Mothers transmit their mtDNAto both their sons and daughters
  3. Both parents can transmit their mtDNA to both their children         .
  4. Mitochondrial DNA codes for 37 genes
  5. Mitochondrial disease commonly affect neuromuscular system
  6. Mutation cause Leber hereditary optic neuropathy

48.     Ans: A,C,D, E

 

 

Mothers transmit their mtDNA to both their sons and daughters, only the daughters are able to transmit    the inherited mtDNA to future generations

 

 

  1. True about serum AFP level: (PGI MAY -2013)
  2. Raised in testicular tumor
  3. Raised in 70% cases of HCC
  4. Correlation between tumor recurrence after surgery in HCC
  5. Correlation with HCC size
  6. Upper limit of normal in the serum is 200 ng/mL

 

Ans: A,B,C,D

o   The lower limit of AFP concentration in normal serum is less than 1 IU/mL; the upper limit is about 10 IU/mL

o   values above 200 ng/mL are suggestive of hepatoma, while levels above 400 ng/mL in a cirrhotic patients with a hypervascular liver mass > 2 cm in diameter are diagnostic

 

 

 

  1. Maternal serum AFP raised in: (PGI MAY -2013)

A.   Gestational Trophoblastic disease

  1. Down syndrome
  2. Omphaiocoele
  3. Sacrococcygeal tetatoma
  4. Neural tube defect

 

.     Ans:   C,D,E

 

AFP is measured in pregnant women through the analysis of maternal blood or amniotic fluid, as a screening test for a subset of developmental abnormalities.

Some of the diseases in which AFP will be elevated in a person are listed below:

 

o   Omphalocele

o   Hepatocellular carcinoma/hepatoma: ↑ α-fetoprotein

o   Neural tube defects: ↑ α-fetoprotein in amniotic fluid and maternal serum

o   Nonseminomatous germ cell tumors

o   Yolk sac tumor

o   Ataxia telangiectasia: Elevation of AFP is used as one factor in the diagnosis of ataxia telangiectasia

o   Tumors: AFP can also be used as a biomarker to detect a subset of tumors in non-pregnant women, men, and children. A level above 500 nanograms/milliliter of AFP in adults can be indicative of hepatocellular carcinoma, germ cell tumors, and metastatic cancers of the liver.

 

  1. True about Carcinoembryonic antigen (CEA): (PGI MAY -2013)
  2. Used for monitoring of recurrence of colon cancer
  3. Specific for colon cancer
  4. Increased in smokers
  5. Increased in colon cancer

51.   Ans: a,c,d

o   Serum from individuals with colorectal carcinoma often has higher levels of CEA than healthy individuals (above approximately 2.5 µg/L).

o   CEA measurement is mainly used as a tumor marker to monitor colorectal carcinoma treatment, to identify recurrences after surgical resection, for staging or to localize cancer spread through measurement of biological fluids.

o   CEA levels may also be raised in gastric carcinoma, pancreatic carcinoma, lung carcinoma, breast carcinoma, and medullary thyroid carcinoma, as well as some non-neoplastic conditions like ulcerative colitis, pancreatitis, cirrhosis, COPD, Crohn’s disease, hypothyroidism [9] as well as in smokers.

o   The CEA blood test is not reliable for diagnosing cancer or as a screening test for early detection of cancer.

o   Most types of cancer do not result in a high CEA level. Elevated CEA levels should return to normal after successful surgical resection or treatment

 

52   True about CA125: (PGI MAY -2013)

A.   Glycoprotein

B.   It is a specific marker

  1. Increased in colon carcinoma
  2. Normal range in pre menopausal females is 200 U/ ml
  3. May elevated in Pelvic inflammatory disease

 

52.   a,c,e

About 1 % of normal females have serum CA-125 levels >35 U/mL. However, in postmenopausal women with an asymptomatic pelvic mass and CA-125 levels >65

U/mL, the test has a sensitivity of 97% and a specificity of 78%

 

 

PHARMACOLOGY

 

53. Which of the following drugs is/are contraindicated in sulphonamide allergy: (PGI MAY -2013)

A.   Brinzolamide

B.     Levobunolol

C.   Bumetanide

D.   Nitrate

E.   Acetazolamide

Ans: a,c,e

 

 

  1. Isoniazid is metabolised in body by: (PGI MAY -2013)
  2. Acetylation
  3. Sulfation
  4. Hydroxylation
  5. Methylation

E.   First metabolized in liver and   then excreted in urine

Ans: a, e

  • Isoniazid reaches therapeutic concentrations in serum, cerebrospinal fluid, and within caseous granulomas. It is metabolized in the liver via acetylation.
  • Two forms of the enzyme are responsible for acetylation, so some patients metabolize the drug more quickly than others. Hence, the half-life is bimodal, with peaks at one and three hours in the population. The metabolites are excreted in the urine. Doses do not usually have to be adjusted in case of renal failure

 

  1. ATT drug which is not bacteriostatic: (PGI MAY -2013)

A.   INH

B.     Rifampicin

C.   Pyrazinamide

D.   PAS

E.   Ethambutol

Ans :a , b,c

  • Bactericidal drugs are: Rifampicin(R), Isoniazid (INH), Streptomycin (S) & Pyrazinamide
  • “Bacteriosiatic drugs are: Ethambutoi(E)   & Thioacetazone(Tzn)
  • “Para-amino salicylic acid(PAS) is tuberculostatic

 

  1. Regarding drug transport which of the following is/ are true except: (PGI MAY -2013)
  2. Active transport: it is energy dependent
  3. Passive diffusion:Most common method of drug transport
  4. Faciliated diffusion: not need energy
  5. Faciliated diffusion: carrier mediated diffusion
  6. Pinocytosis: transport by diffusion

Ans: E

Pinocytosis involves invagination of part of the cell membrane and the trapping within the cell of a small vesicle containing extracellular constituents. The vesicle contents can then be released within the cell, or extruded from its other side

 

  1. Beta blocker with no alpha1 antagonistic property: (PGI MAY -2013)

A.   Labetalol

B.   Carvedilol

C.   Atenolol

D.   Nebivolol

E.   Betaxolol

Ans: c,d,e

Third generation Beta blockers with additional alpha biocking effect –Labetalol & Carvedilol

 

  1. True statement about essential medicines: (PGI MAY -2013)
  2. Emergency medicine
  3. Costly but necessary
  4. Drug listed in pharmacopoeia
  5. Need for society
  6. Should be available at all times

Ans: B,D,E,

Essential medicines, as defined by the World Health Organization (WHO) are “those drugs that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in appropriate dosage forms, at a price the community can afford

 

  1. Adrenergic receptor effects includes: (PGI MAY -2013)
  2. Piloerection
  3. Urine retention
  4. Diarrhoea
  5. Pupillary dilation
  6. Bronchodilation

Ans:A,B,D,E

GIT. Smooth muscles in the intestinal wall are relaxed by adrenergic stimulation

 

  1. Antibiotics acting through cell wall inhibition: (PGI MAY -2013)
  2. Cephalosporin
  3. Vancomycin
  4. Penicillin
  5. Aminoglycosides
  6. Sulfonamides

Ans:a,b,c

 

  1. Antagonistic drug combination(s) is/are: (PGI MAY -2013)
  2. Penicillin + Aminoglycosides
  3. Penicillin + Tetracycline
  4. Vancomycin + Ceftriaxone
  5. Ceftriaxone+ Tazobactam
  6. Amphotericin B + Flucytosine

Ans:B

  • Additive/Synergistic effect

o   Penicillin/Ampicillin   +   Streptomycin/ Gentamycin(Aminogiycosides):

  • Antagonism

o   Penicillin + Tetracycline/Chloramphenicoi/Etythromycin

 

62.   KD constant of drug-receptor interactions is: (PGI MAY -2013)

  1. Concentration of drug at which half the receptors are bound
  2. Concentration of drug at which maximal response is seen
  3. Concentration at which antagonist is able to bind to half of the receptors
  4. Concentration of drug at which half of the maximal response is seen

Ans:d

KD is dissociation constant of the drug-receptor complex, which is equal to the dose of the drug at which half maximal response is produced

 

MICROBIOLOGY

 

  1. Antibodies present in person with O blood group: (PGI MAY -2013)
  2. Anti-A antibody only
  3. Anti-B antibody only
  4. Both Anti-A & Anti-B antibody
  5. No antibody
  6. Anti-0 antibody

. Ans: C

 

  1. According to drug and cosmetic act which is not mandatory for screening of donated blood : (PGI MAY -2013)
  2. HIV
  3. Hepatitis B
  4. Hepatitis C
  5. West Nile virus
  6. CMV

Ans : d, e

 

  1. All the following vaccines developed from embryonated eggs except: (PGI MAY -2013)

A.   Influenza

B.     Hepatitis A

C.   Yellow fever

D.   Rabies

E.   CMV

Ans :b,e

  • Hepatitis A virus is grown in human dipioid cell culture
  • For CMV no vaccine is available

66.   True about gas gangrene: (PGI MAY -2013)

  1. Underlying skin and muscle are normal
  2. Caused by tetanospasmin toxin
  3. Muscle rigidity & spasm are characteristic
  4. Most common organism implicated is Cl. Perfringes
  5. Passive immunization does not help

Ans : D

 

 

67.   Urine dipstick is/are useful for detection of: (PGI MAY -2013)

  1. Microalbunemia
  2. RBC detection
  3. WBC detection
  4. Bence-Jones protein

Ans : a,b,c

68,   Disorders of phagocytosis are all except: (PGI MAY -2013)

  1. Job’s syndrome
  2. Chediak-Hegashi syndrome
  3. Myeloperoxidase deficiency
  4. Wiskott-Aldrich Syndrome
  5. Tuftsin deficiency

Ans : D

Disorder, of phagocytosis

  • Chronic granulomatous disease
  • Chediak-Higashi syndrome
  • Leukocyte G6PD deficiency
  • Lazy leukocyte syndrome
  • Hyper-lgE syndrome
  • Shwachman-Diamond syndrome
  • Myeloperoxidase deficiency
  • Job’s syndrome
  • Tuftsin deficiency
  • Actin binding protein deficiency

 

69.   Which of the following are used for sterilization of surgical instrument: (PGI MAY -2013)

A.   Ethylene oxide

B.   Gamma radiation

C.   Autoclaving

D.   Glutaraldehyde

E.   Hot air oven

Ans : A,D,E

 

 

 

 

70. True about H.influenzae :(PGI MAY -2013)

  1. Also called as Pfeiffer’s bacilli
  2. In acute infections capsulated strains are often isolated
  3. Gram negative motile bacilli
  4. Easily stainable
  5. VP Test positive

Ans : a,b

H influenzae is gram negative, nonmotile, nonsporing bacillus, exhibiting considerable pleomorphism.Stains isolated from acute infections are often .capsulated. The bacilli are relatively difficult to stain

 

Voges-proskauer (VP) test

  • VP positive organisms include Enterobacter, Klebsiella, Serratia marcescens, Hafnia alvei, Vibrio damsela, and Vibrio alginolyticus
  • VP negative organisms include Citrobacter freundii, Shigella,   Yersinia, Edwardsiella,   Salmonella, Citrobacter,   Vibrio furnissii,   Vibrio fluvialis, Vibrio vulnificus, and Vibrio parahaemolyticus

 

 

  1. Which is used in digestion and decontamination of sputum in smear preparation: (PGI MAY -2013)

A.   NaOH

B.     KOH

C.   NaCI

D.   KCI

E.   N-acetyl-L-cysteine

Ans : a,e

Sputum decontamination with N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH) is expected to improve detection of Mycobacterium tuberculosis (M. tb) by culture better than that with modified Petroff s; which is widely used in laboratories

 

  1. Heterophile agglutination   is/are used in all tests except; (PGI MAY -2013)

A.   Widal test

  1. Weil-Felix reaction
  2. Paul -Bunnel test
  3. ELISA
  4. Cold agglutination test

Ans : a, d

  • The mononuclear spot test or monospot test, a form of the heterophile antibody test, is a rapid test for infectious mononucleosis due to Epstein–Barr virus (EBV). It is an improvement on the Paul-Bunnell test.
  • The test is sensitive for heterophile antibodies produced by the human immune system in response to EBV infection.

 

73.   Active immunity can be induced by: (PGI MAY -2013)

  1. Toxoids
  2. Subclinical infection
  3. Antitoxin
  4. Immunoglobulins
  5. Antigen exposure

Ans : a,b,e

 

  1. True about passive immunity: (PGI MAY -2013)
  2. Can not be given with active immunity
  3. Last for 4-5 days only
  4. It can be given before disease occurence
  5. Can be transferred   by antibodies from another host
  6. Takes long time to develop

Ans : c,d

 

  1. Anaphylaxis is mediated by: (PGI MAY -2013)
  2. 5-hydroxytryptamine
  3. . Heparin
  4. Prostaglandin
  5. Anaphylotoxins from complement activation
  6. Platelet activating factor

Ans : a,b,c,d,e

 

  1. True statement about Enteroviruses: (PGI MAY -2013)
  2. Composed of segmented RNA genome
  3. Stable at pH 4
  4. Cause pleurodynia
  5. Cause encephalitis
  6. Cause meningitis

Ans : b,c,d,e

  • Enteroviruses are a genus of positive-sense single-stranded RNA viruses associated with several human and mammalian diseases. Serologic studies have distinguished 71 human enterovirus serotypes on the basis of antibody neutralization tests.
  • On the basis of their pathogenesis in humans and animals, the enteroviruses were originally classified into four groups, polioviruses, Coxsackie A viruses (CA), Coxsackie B viruses (CB), and echoviruses, but it was quickly realized that there were significant overlaps in the biological properties of viruses in the different groups
  • There are 64 non-polio enteroviruses that can cause disease in humans: 23 Coxsackie A viruses, 6 Coxsackie B viruses, 28 echoviruses, and 5 other enteroviruses
  • Poliovirus, as well as coxsackie and echovirus are spread through the fecal-oral route. Infection can result in a wide variety of symptoms ranging from mild respiratory illness (common cold), hand, foot and mouth disease, acute hemorrhagic conjunctivitis, aseptic meningitis, myocarditis, severe neonatal sepsis-like disease, and acute flaccid paralysis

 

  1. True about dengue fever: (PGI MAY -2013)
  2. Caused by 4 serotypes
  3. Effective vaccine is available
  4. Presents with fever and joint pain
  5. Virus belongs to flavivirus genus
  6. Contain segmented RNA

Ans : a,c,d

Segmented RNA Viruses

  • Bora
  • Bunya
  • Orthomyxovirus
  • Reovirus
  • Arena virus

 

  1. A stool examination was carried out which showed organism with darting motility. Which of the following organism may be in stool: (PGI MAY -2013)

A.   V.cholerae

B.   Shigella

C.   Salmonella

D.   Camplyobacter jejuni

E.   E.coli

Ans : a,d

Walking style of microbes – High yield facts for PG Medical entrance

  • Tumbling motility – Listeria
  • Stately – Clostridia, Bacillus
  • Cork screw -T. pallidum
  • Lashing– Borrelia
  • Gliding– Mycoplasma
  • Swarming— Proteus mirabilis , P. vuigaris, Ci. Tetani , Bacillus cereus
  • Darting – V. Cholerae, Campylobacter

 

  1. True about Vibrio alginolyticus: (PGI MAY -2013)
  2. Non-halophilic
  3. Voges Proskauer (VP) positive
  4. Swarming
  5. Cause sea borne auricular infections
  6. Does not grow in 10% NaCI

Ans : b,c,d

  • Vibrio alginolyticus is a Gram-negative marine bacterium.
  • It is medically important since it causes otitis and wound infection.
  • It is also present in the bodies of animals such as pufferfish, where it is responsible for the production of the potent neurotoxin, tetrodotoxin.

 

  1. Not a cause of epidemic encephalitis : (PGI MAY -2013)

A.   Herpes simplex virus

B.   Rabies

C.   West Nile virus

D.   Nipah virus

E.   Japanese encephalitis virus

Ans: a,b

  • Herpes simplex virus encephalitis is the most common sporadic acute viral encephalitis
  • The most commonly identified viruses causing sporadic cases of acute encephalitis in immunocompetent adults am herpesviruses (HSV, VZV, EBV)
  • Epidemics of encephalitis are caused by arboviruses, which belong to several different viral taxonomic groups including Alphaviruses (e.g., EEE virus, western , equine encephalitis virus), Flaviviruses (e.g., WNV, St. Louis encephalitis virus, Japanese encephalitis virus, Powassan virus), and Bunyaviruses (e.g., California encephalitis virus serogroup, LaCrosse virus).

 

  1. True about Visceral leishmaniasis: (PGI MAY -2013)
  2. Neutropenia
  3. Eosinophilia
  4. Hypergammaglobulinemia
  5. Lymphadenopathy
  6. Skin hyperpigmentation

Ans : a,d,e

  • When people develop visceral leishmaniasis, the most typical symptoms are fever and the enlargement of the spleen, with enlargement of the liver sometimes being seen as well.
  • The blackening of the skin that gave the disease its common name in India does not appear in most strains of the disease, and the other symptoms are very easy to mistake for those of malaria. Misdiagnosis is dangerous, as without proper treatment the mortality rate for kala-azar is close to 100%.L. donovani itself is not usually the direct cause of death in kala-azar sufferers, however. Pneumonia, tuberculosis, and dysentery are omnipresent in the depressed regions where leishmaniasis thrives, and, as with AIDS, it is these opportunistic infections that are more likely to kill, flaring up in a host whose immune system has been weakened by the L. donovani infection. Progress of the disease is extremely variable, taking anywhere from one to twenty weeks, but a typical duration for the Sudanese strain of the disease is narrower, between twelve and sixteen weeks
  • A reduction in the number of red and white blood cells and platelets (pancytopenia) was found to be highly specific (98%) for VL in suspected clinical patients in Nepal but the sensitivity was low (16%) .
  • Marked polyclonal hypergammaglobulinemia (the production of high titres of non-specific antibody), a common finding in VL, can be detected by a formol gel test (FGT; also called the aldehyde test), which is still used in East Africa and Asia because of its simplicity and low cost. However, as the sensitivity of this test is poor (as low as 34%59), some experts have recommended its use be discontinued

 

 

  1. True about antibody: (PGI MAY -2013)
  2. IgM is produced in primary response
  3. IgD protects mucosa
  4. IgE is main antibody in secondary response
  5. IgG is main antibody in secondary response
  6. IgA protects body surface

Ans : a,d,e

  • IgG protects the body fluids
  • IgA protects the body surface,
  • IgM protects the bloodstream,
  • IgE mediates reaginic hypersensitivity
  • IgD is a recognition molecule on the surface of B lymphocyte
  • The primary immune response is the formation of IgM immunoglobulin. This is followed by secondary immune response in formation of IgG immunogiobulin

 

83. True about Yaws: (PGI MAY -2013)

  1. Sexually transmitted disease
  2. Transmitted by fomites
  3. Mother-child transmission
  4. Periostitis occurs
  5. Caused by T. pailidum subspecies endemicum

Ans: B,D

  • Yaws (also known as frambesia tropica, thymosis, polypapilloma tropicum, parangi, bouba, frambösie, and pian) is a tropical infection of the skin, bones and joints caused by the spirochete bacterium Treponema pallidum pertenue.
  • The disease begins with a round, hard swelling of the skin, 2 to 5 centimeters in diameter. The center may break open and form an ulcer. This initial skin lesion typically heals after three to six months. After weeks to years, joints and bones may become painful, fatigue may develop, and new skin lesions may appear. The skin of the palms of the hands and the soles of the feet may become thick and break open.
  • The bones (especially those of the nose) may become misshapen. After five years or more large areas of skin death with subsequent scarring may occur.
  • Other related treponemal diseases are bejel (Treponema pallidum endemicum), pinta (Treponema pallidum carateum), and syphilis (Treponema pallidum pallidum).
  • Yaws is spread by direct contact with the fluid from a lesion of an infected person. The contact is usually of a non-sexual nature
  • The disease is most common among children, who spread it by playing together. Yaws is often diagnosed by the appearance of the lesions. Blood antibody tests may be useful but cannot separate previous from current infections.Polymerase chain reaction (PCR) is the most accurate method of diagnosis

84. True about mechanism of bacteria! toxins: (PGI MAY -2013)

  1. Cholera toxin acts by inhibition of guanyl cyclase
  2. Botulinum toxin inhibits Ach release
  3. Shiga toxin of Shigella dysenteriae act by inhibiting protein synthesis
  4. Diphtheria toxin act by inhibiting protein synthesis

Ans : B,C,D

Toxins and MOA

  • Boiulinum toxin act by blocking the production or release of acetylcholine at synapses & neuromuscuiar junction
  • ‘Diphtheria toxin act by inhibiting protein synthesis
  • Diphtheria toxin & shigs toxin inhibit protein synthesis
  • Cholera toxin activate cellular adenylate cyclase & causes accumulation of cAMP

Toxins inhibiting protein synthesis (High yield fact for PG Medical entrance )

  • Shigella dysenteriae (Shiga toxin)
  • Diphtheria
  • Pseudomonas
  • Verotoxin =Shiga like toxin of E.coli

 

Forensic medicine

 

  1. True statement about Adipocere: (PGI MAY -2013)
  2. Offensive smell
  3. Seen if body is buried in moist soil
  4. Also called saponification
  5. In widespread adipocere body become dry
  6. Formation of wax-like substance

Ans: a,b,c,d,e

 

  1. Various names of post mortem colour change in dependent parts of the body are : (PGI MAY -2013)
  2. Post mortem lividity
  3. Livor mortis
  4. Cadaveric lividity
  5. Suggilations
  6. Vibices

Ans:a,b,c,d,e

Postmortem lividity

  • This is the bluish-purple or purplish-red discoloration which appears under the skin in the most superficial layers of the dermis (rete mucosum of the dependent part of the body after death, due to capillo-venous distention.
  • When coagulation in capillaries takes place, the stains become permanent and this is known as fixation of post-mortem staining.

 

87.   Abrasion collar is seen in: (PGI MAY -2013)

  1. Firearm entry wound
  2. Firearm exit wound
  3. Rail track accident
  4. Lathi injury
  5. Incised wound

Ans:A

  • Abrasion collar (Marginal abrasion) and dirt collar
  • Abrasion collar surrounds the dirt collar.
  • The abraded collar is reddish at first, but becomes reddish brown as it dries.
  • These two features are proof of an entrance firearm wound

 

 

88.   Confirmatory test for blood stain is(PGI MAY -2013)

  1. Benzidine test
  2. Spectroscopic test
  3. Ortho-tolidine test
  4. Microscopic test
  5. Precipitin test

Ans:B

 

  • The spectroscopic test is one of the confirmatory tests for blood.
  • Its sensitivity is about 1:5000.
  • This is therefore considered one of the best tests for identification of blood in stains

 

SPM

89   Quadrivalent vaccine for HPV contains all except : (PGI MAY -2013)

A.   Type 7

B.   Type 11

C.   Type 16

D.   Type 26

E.   Type 18

Ans: a,d

 

Two vaccines have market approval in many countries as of 2014 (called Gardasil and Cervarix in the US).

  • Both vaccines protect against the two HPV types (HPV-16 and HPV-18) that cause 70% of cervical cancers, 80% of anal cancers, 60% of vaginal cancers, and 40% of vulvar cancers. These HPV types also cause most HPV induced oral cancers, and some other rare genital cancers.
  • Gardasil also protects against the two HPV types (HPV-6 and HPV-11) that cause 90% of genital warts.
  • Both vaccines have been shown to prevent precancerous lesions of the cervix. Gardasil has been shown to prevent precursors to anal,vulvar, vaginal,and penile cancers. HPV vaccines are expected to protect against HPV induced cancers of these areas as well as HPV induced oral cancers

 

  1. Which of the following is Millenium development Goals in India for 2015: (PGI MAY -2013)
  2. Have halted by 2015 and begun to reverse the spread of HIV/AIDS
  3. Have halted by 2015 and begun to reverse the incidence of malaria
  4. Reduce the maternal mortality ratio by two-third
  5. Reduce the under-five mortality rate by half
  6. Half the extreme poverty & hunger

Ans; a,b,e

Target No. Target Description
Halve, between 1990 and 2015, proportion of population below national poverty line
Halve, between 1990 and 2015, proportion of people who suffer from hunger
Ensure that by 2015 children everywhere, boys and girls alike, will be able to complete a full course of primary education
Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015
Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources
Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation
By 2020, to have achieved, a significant improvement in the lives of at least 100 million slum dwellers
In cooperation with the private sector, make available the benefits of new technologies, especially information and communication

 

  1. Outbreak of avian influenza epidemic in china in 2013 is caused due to stain: (PGI MAY -2013)

A. H1N1

B. H3N2

C. H5N1

D. H7N7

E. H7N9

Ans:   E

 

  1. Feature of case control study is/are: (PGI MAY -2013)
  2. Can be used for rare disease
  3. Error is high
  4. Study multiple potential causes of disease
  5. Association seen in terms of relative risk

E.   Large sample required

Ans-.a,b,c

 

  1. Xpert MTB/RIF test is/are used for: (PGI MAY -2013)
  2. For assessing resistance to isoniazid
  3. For assessing multi drug resistant TB
  4. For assessing rifampicin resistance
  5. Monitoring drug response in MDR TB
  6. Diagnosis of TB

Ans:   c,e

 

  • The Xpert MTB/RIF is a cartridge-based, automated diagnostic test that can identify Mycobacterium tuberculosis (MTB)DNA and resistance to rifampicin (RIF)by nucleic acid amplification technique(NAAT).
  • It was co-developed by the laboratory of Professor David Alland at the University of Medicine and Dentistry of New Jersey (UMDNJ)., Cepheid Inc. and Foundation for Innovative New Diagnostics, with additional financial support from the US National Institutes of Health (NIH).
  • In December 2010, the World Health Organization (WHO) endorsed the Xpert MTB/RIF for use in TB endemic countries and declared it a major milestone for global TB diagnosis.
  • This followed 18 months of rigorous assessment of its field effectiveness in TB, MDR-TB and TB/HIV co-infection. This test, and others that are likely to follow, have the potential to revolutionize the diagnosis of TB

 

  1. Which of the following statement is true about Women empowerment: (PGI MAY -2013)
  2. Power over resources
  3. Involvement in Political decision making
  4. Involvement in economic decision making
  5. Improved standard of living
  6. Increased life expectancy

Ans: a,b,c,d

 

Women’s empowerment has five components:

  • women’s sense of self-worth;
  • their right to have and to determine choices;
  • their right to have access to opportunities and resources;
  • their right to have the power to control their own lives, both within and outside the home;
  • and their ability to influence the direction of social change to create a more just social and economic order, nationally and internationally.
  1. Criteria for drinking water quality recommended by WHO includes; (PGI MAY -2013)
  2. Colour >15TCU
  3. pH 6.5-8.5
  4. Chloride 200-600 mg/l
  5. Turbidity < 5 NTU
  6. chloride level of 200 mg/l.

Ans: b,c,d,e

WHO water standards

  • Chloride:

o   The standard prescribed for chloride is 200 mg/l.

o   The maximum permissible level is 600 mg/dl

  • An acceptable pH of drinking water is between 6.5 & 8.5
  • Water with turbidity of less than 5 nephelometric turbidity units(NTU) is usually acceptable to consumers
  • Colour: The guideline value is upto 15 true colour unit(TCU)

 

 

  1. Criteria for diagnosing muitibaciiiary leprosy include(s): (PGI MAY -2013)

A.   ≥ 6 Skin lesion

B.     Skin smear 1 +

C.   Skin smear 2+

D.   Deformity ±

E.   Eye lesion +

Ans: a,b,c

  • According to the WHO Global Strategy for further reducing the leprosy burden and sustaining leprosy control activities (2006 – 2010), patients with 6 or more patches are classified as MB, whereas those with up to 5 patches as PB.
  • When skin smears are available and are dependable, any patient with a positive skin smear, irrespective of the clinical picture, must be classified as multibacillary leprosy and must be treated with the multidrug therapy regimen for multibacillary leprosy.

 

 

  1. One has following data regarding village: population on July 1 is 3000, total birth through out year= 40, total deaths – 20, emmigration=15 & immigration= 20 Calculate crude birth rate of the village: (PGI MAY -2013)

A. 13.33 per thousand

B. 42 per thousand

C. 44 per thousand

D. 38 per thousand

E.   49 per thousand

Ans: A

  • The crude birth rate (CBR) is equal to the number of live births (b) in a year divided by the total midyear population (P)
  • This number is then usually multiplied by 1,000 to arrive at the actual crude birth rate.
  • Formula for crude birth rate is: CBR = (b/p) x 1000
  • CBR= 40/3000 X 1000= 13.33 per thousand

 

 

 

98. A city have a population of 10000 with 500 diabetic patients, A new diagnostic test gives true positive result in 350 patients and false positive result in 1900 patients. Which of the following is true regarding the test: (PGI MAY -2013)

  1. Prevalence is 5%
  2. Sensitivity is 70%
  3. Specificity is 80%
  4. Sensitivity is 80%
  5. Specificity is 70%

Ans: a,b,c

 

  • Sensitivity: A/(A+C) × 100
  • Specificity: D/(D+B) × 100
  • Positive Predictive Value: A/(A+B) × 100
  • Negative Predictive Value: D/(D+C) × 100
  • A+B+C+D= 10000
  • All diseased = (True positives + False negatives) = A+C= 500
  • A (True positives) =350
  • B (False positives) = 1900
  • False negatives = C= 150
  • All nor diseased = ( False positives + True Negatives) = (B+D) =( 1900+D) =(Total population – All diseased) = (10000- 500) = 9500
  • 1900+D =9500 hence D= 7600
  • Sensitivity = 350/500 X 100= 70%
  • Specificity = 7600/9500 X100= 80%
  • Prevalence = No. of all cases/Total population X 100= 500/10000   X 100= 5%

 

99.   True about tuberculin test: (PGI MAY -2013)

  1. Patients with sarcoidosis show anergy
  2. TB pericarditis patient may have positive test
  3. MilliaryTB may comes out as negative test
  4. Tuberculin test is the only way to diagnose pulmonary TB if sputum smear and microscopy is negative
  5. Used for measuring the prevalence of tuberculosis infection in a community

 

Ans: A,B,C,E

 

OPHTHALMOLOGY

 

  1. Ectopia ientis Is/ars seen in : (PGI MAY -2013)
  2. Maple syrup disease
  3. Homocystinuria
  4. Ehler Danlos syndrome
  5. Myotonic dystrophy
  6. Sulfite oxidase deficiency

100. Ans: B,C,E

Ectopia Lentis ( A hot topic for PG Medical entrance )

  • Marfan’s syndrome (displaced upwards and temporally) (Mnemonic Marfan is tall guy hence lens looks upwards)
  • Homocystinuria (subluxated downwards and nasally)
  • Weil-Marchesani syndrome (forward subluxation) (Mnemonic : Walk forward and fall in Well)
  • Ehler ‘   Danlos syndrome (subluxation of lens and blue sclera)
  • Hyperlysinaemia
  • Stickler syndrome
  • Sulphite oxidase deficiency
  • Hypermature cataract
  • Buphthalmos
  • High myopia
  • Staphyloma
  • Intra-ocular tumors
  • Uveitis .
  1. True statement about accommodation: (PGI MAY -2013)

A.     Mainly occur due to change in curvature of posterior surface of lens

B.     Helps to improve steriopsis

C.   It is abolished by sympathomimetic drugs

D.   Produced due to an increase in curvature of the anterior surface of the lens ‘

E.   Elasticity of capsule has bearing on accomodation

101. d,e

  • At rest the radius of curvature of the anterior surface of the lens is 10 mm and that of posterior surface is 6 mm . In accommodation, the curvature of the posterior surface remains almost the same, but the anterior surface changes, so thai in strong accommodation its radius of curvature becomes 6 mm
  • The young human eye can change focus from distance (infinity) to 7 cm from the eye in 350 milliseconds. This dramatic change in focal power of the eye of approximately 13 dioptres (the reciprocal of focal length in metres) occurs as a consequence of a reduction in zonular tension induced by ciliary muscle contraction.
  • The amplitude of accommodation declines with age. By the fifth decade of life the accommodative amplitude has declined so that the near point of the eye is more remote than the reading distance. When this occurs the patient is presbyopic. Once presbyopia occurs, those who are emmetropic (do not require optical correction for distance vision) will need an optical aid for near vision; those who are myopic (nearsighted and require an optical correction for distance vision), will find that they see better at near without their distance correction; and those who are hyperopic (farsighted) will find that they may need a correction for both distance and near vision. The age-related decline in accommodation occurs almost universally to less than 2 dioptres by the time a person reaches 45 to 50 years, by which time most of the population will have noticed a decrease in their ability to focus on close objects and hence require glasses for reading or bifocal lenses.

 

  1. True about ciliary body: (PGI MAY -2013)
  2. Located 10 mm from corneoscleral junction
  3. Consists of pars plana and pars plicata
  4. Contraction   of   ciliary   body   helps   on accommodation
  5. Secretes aqueous humuor
  6. Derives its blood supply from the short posterior ciliary arteries

102. B,C,D

  • The blood supply to the ciliary body derives from two long posterior ciliary arteries and seven anterior ciliary arteries, two from each rectus muscle except for the lateral rectus, which provides only one
  • The.anterior margin of the ciliary body is at the scierai spur, and thus 1.5 mm posterior to the corneal iimbus in the horizontal meridian and 2 mm posterior in the vertical meridian.
  • It terminates posteriorly at the ora serrata, which is approximately 7.5 to 8 mm posterior to the cornea! limbus temporally, 6.5 to 7 mm nasally, and 7 mm inferiorly and superiorly.
  1. Which of the foliowing is/are caused by bacterial infection: (PGI MAY -2013):
  2. Phlyctenularconjunctivitis
  3. Marginal keratitis
  4. Mooren ulcer
  5. Vogt-Koyanagi -Harada syndrome

E.   Hypopyon ulcer

103. Ans:   E

“Hypopyon corneal ulcer: Many pyogenic organisms (staphylococci, streptococci, gonococci, Moraxella) may produce hypopyon, but by far the most dangerous are pseudomonas poyocyanea and pneumococcus

Mooren’s ulcer is a rapidly progressive, painful, ulcerative keratitis which initially affects the peripheral cornea and may spread circumferentially and then centrally.

  • Mooren’s ulcer can only be diagnosed in the absence of an infectious or systemic cause and must be differentiated from other corneal abnormalities, such as Terrien’s degeneration.
  • Although the etiology remains unknown, recent research has proposed an underlying immune process and a possible association with the hepatitis C virus. The response to medical and surgical intervention is typically poor, and the visual outcome can be devastating

 

  1. Which of following is the feature of pailledema(PGI MAY -2013)
  2. Normal blind spot
  3. Normal visual acuity even at last stage
  4. Loss of venous pulsation at disc
  5. Sluggish papillary reaction from early stage
  6. Normal colour vision

104. C,E

  • Papilledema may be asymptomatic or present with headache in the early stages. However it may progress to enlargement of the blind spot, blurring of vision, visual obscurations (inability to see in a particular part of the visual field for a period of time) and ultimately total loss of vision may occur.
  • The signs of papilledema that are seen using an ophthalmoscope include:

o   venous engorgement (usually the first signs)

o   loss of venous pulsation

o   hemorrhages over and / or adjacent to the optic disc

o   blurring of optic margins

o   elevation of optic disc

o   Paton’s lines = radial retinal lines cascading from the optic disc

  • On visual field examination, the physician may elicit an enlarged blind spot; the visual acuity may remain relatively intact until papilledema is severe or prolonged.
  • Colour vision is not impaired in papilioederna

 

  1. Anterior uveitis is/are caused by; (PGI MAY -2013)
  2. Sarcoidosis
  3. Juvenile idiopathic arthritis
  4. Juvenile chronic arthritis
  5. Juvenile xanthogranuloma
  6. TB       –

105.   Ans: A,B,C,E

Anterior uveitis

o   Redness of the eye

o   Blurred vision

o   Photophobia or sensitivity to light

o   Irregular pupil

o   Eye pain

o   Floaters, which are dark spots that float in the visual field

o   Headaches

o   Signs of anterior uveitis include dilated ciliary vessels, presence of cells and flare in the anterior chamber, and keratic precipitates (“KP”) on the posterior surface of the cornea. In severe inflammation there may be evidence of a hypopyon. Old episodes of uveitis are identified by pigment deposits on lens, KPs, and festooned pupil on dilation of pupil.

o   Busacca nodules, inflammatory nodules located on the surface of the iris in granulomatous forms of anterior uveitis such as Fuchs heterochromic iridocyclitis (FHI).[4]

o   Synechia

Intermediate uveitis

o   Most common:

o   Floaters

o   Blurred vision

o   Intermediate uveitis normally only affects one eye. Less common is the presence of pain and photophobia

Posterior uveitis

Inflammation in the back of the eye is commonly characterized by:

o   Floaters

o   Blurred vision

o   Photopsia or seeing flashing lights

  1. Most common site of congenital nasofacrimal duct obstruction is: (PGI MAY -2013)
  2. Upper canaliculus
  3. Lower canalicus          !
  4. Common canaliculus
  5. Valve of Hassner
  6. Middle turbinate near canthus

106.   d

As many as 30 percent of newborn infants are believed to have closure of nasolacrimal duct at birth; mostly due to ‘membranous occlusion1 at its lower end, near the valve of Hasner.

 

  1. Least affected cranial nerve in retro-orbital block : (PGI MAY -2013)

A.     1 CN

B.     2 CN

C.   3 CN

D.     4 CN

E.   6 CN

107.   A

o   A retrobulbar block is a regional anesthetic nerve block into the retrobulbar space, the area located behind the globe of the eye. Injection of local anesthetic into this space constitutes the retrobulbar block. This injection provides akinesia of the extraocular muscles by blocking cranial nerves II, III, and VI, thereby preventing movement of the globe.

o   Cranial nerve IV lies outside the muscle cone, but is blocked by diffusion of the local anesthetic. It also provides sensory anesthesia of the conjunctiva, cornea and uvea by blocking the ciliary nerves. This block is most commonly employed for cataract surgery, but also provides anesthesia for other intraocular surgeries

 

  1. Select the correct match: (PGI MAY -2013)
  2. Wilson disease-sunflower cataract
  3. Alport syndrome-posterior lenticonus
  4. Amiodarone-anterior subcapsular cataract
  5. Myotonic dystrophy-Christmas tree
  6. Down syndrome:Cortical cataract

108. A,B,C,D

Myotonic dystrophy

o  typically the cataract first appears in the outer layers at the back of the lens as very fine dust-like particles that can have a brightly coloured appearance

o   At this early stage, it is often called a Christmas tree cataract because of its resemblance to the coloured lights on a Christmas tre

Down syndrome causes   Anterior & posterior subcapsular cataract

 

ENT

109. Method of speech communications after laryngectomy include : (PGI MAY -2013)

  1. Electrolarynx
  2. Oesophageal speech
  3. Tracheo-oesophageal puncture
  4. Trachea! speech
  5. Transoral pneumatic device

109. A,B,,D,E

There are three methods of alaryngeal speech. They are:

1. Oesophageal speech

2. Electrolarynx

3. Tracheo oesophageal puncture

Oesophageal speech:

o   Patients after total laryngectomy acquire a certain degree of oesophageal speech.  In fact all the other alaryngeal speech modalities are compared with that of oesophageal speech.  It is the gold standard for post laryngectomy speech rehabiltation methods.  
     In this method air is swallowed into the cervical oesophagus.  This swallowed air is immediately expelled out causing vibrations of pharyngeal mucosa.  These mucosal vibrations along with tongue in the oral cavity cause articulations.  This method is very difficult to learn and only 20 % of patients succeed in this endeavour.

o    Patient’s with oesophageal speech speak in short bursts, as the bellow effect of the lungs are not utilised in speech generation.  The vibrations of muscles and mucosa of cervical oesophagus and hypopharynx are responsible for speech production.  Oral cavity plays an important role in generation of oesophageal speech.  Air from the oral cavity is swallowed into the cervical oesophagus before speech is generated.

Electrolarynx:

o  These are vibrating devices.  A vibrating electrical larynx is held in the submandibular region.  Muscular contraction and facial tension can be modified to generate rudiments of speech.  The initial training phase to use this machine must begin even before the surgical removal of larynx.  This helps the patient in easy acclamitiation after surgery.

o    There are three types of electro larynges available.  They are:

1. Pneumatic – Dutch speech aid, Tokyo artificial speech aid etc.

2. Neck

3. Intra oral type

 

  1. Most common site of laryngeai papiiiams in adult: (PGI MAY -2013)

A.   Anterior commissure

B.   Posterior commissure

  1. Anterior half of vocal cord
  2. Middle of vocal cord
  3. False vocal cords .

110. Ans:a,c

Juvenile papiHomas: They are mostly seen on the true & false cords & the epiglottis, but they may involve other sites in the larynx & trachea

 

  1. Most common site of vocal nodule of larynx: (PGI MAY -2013)
  2. Anterior part of epiglottis
  3. False vocal folds
  4. Anterior commisure
  5. Posterior commisure
  6. On true vocal cord at junction of Anterior 1/3 with Posterior 2/3

111.   Ans:E

 

 

112. True about benign paroxymal positional vertigo: (PGI MAY -2013)

  1. Hearing loss is often present
  2. Most commonly seen in 2nd decade
  3. Hallpike manoevuvre is not helpful in diagnosis
  4. Epley maneuver is used for treatment
  5. Disorder of posterior semicircular canal

112.   Ans:d,e

o   Benign paroxysmal positional vertigo (BPPV) is a disorder arising in the inner ear. Its symptoms are repeated episodes of positional vertigo, that is, of a spinning sensation caused by changes in the position of the head.

o   BPPV is the most common cause of the symptoms of vertigo

The nystagmus associated with BPPV has several important characteristics which differentiate it from other types of nystagmus.

o   Positional: the nystagmus occurs only in certain positions

o   Latency of onset: there is a 5-10 second delay prior to onset of nystagmus

o   Nystagmus lasts for 5–120 seconds

o   Visual fixation suppresses nystagmus due to BPPV

o   Rotatory/Torsional component is present or (in the case of lateral canal involvement) the nystagmus beats in either a geotropic (towards the ground) or ageotropic (away from the ground) fashion

o   Repeated stimulation, including via Dix-Hallpike maneuvers, cause the nystagmus to fatigue or disappear temporarily.

Two treatments have been found effective for relieving symptoms of posterior canal BPPV, the canalith repositioning procedure (CRP) or Epley maneuver, and the liberatory or Semont maneuver

o   The CRP employs gravity to move the calcium build-up that causes the condition. The particle repositioning maneuver can be performed during a clinic visit by health professionals or taught to patients to practice at home.

o   In the Semont maneuver, patients themselves are able to achieve canalith repositioning. Both treatments, when performed by a health professional, appear to be equally effective.

o   When practiced at home, the CRP is more effective than the Semont maneuver. The most effective repositioning treatment for posterior canal BPPV is the therapist-performed CRP combined with home practiced CRP.

o   The Epley maneuver (particle repositioning) does not address the actual presence of the particles (otoconia), rather it changes their location. The maneuver aims to move these particles from some locations in the inner ear which cause symptoms such as vertigo, and reposition them to where they do not cause these problems.

 

o   The Brandt-Daroff exercises may be prescribed by the clinician as a home treatment method usually in conjunction with particle repositioning maneuvers or in lieu of the particle repositioning maneuver. The exercise is a form of habituation exercise, designed to allow the patient to become accustomed to the position which causes the vertigo symptoms. The Brandt-Daroff exercises are performed in a similar fashion to the Semont maneuver; however, as the patient rolls onto the unaffected side, the head is rotated toward the affected side.

o   The exercise is typically performed 3 times a day with 5-10 repetitions each time, until symptoms of vertigo have resolved for at least 2 days

Dix-Hallpike test

o   The condition is diagnosed by the patient’s history, and by performing the Dix-Hallpike maneuver and/or the roll test.

o   The Dix-Hallpike test is a common test performed by examiners to determine whether the posterior semicircular canal is involved.

o   It involves a reorientation of the head to align the posterior semicircular canal (at its entrance to the ampulla) with the direction of gravity. This test will reproduce vertigo and nystagmus characteristic of posterior canal BPPV

  1. Most common cause of B/L Recurrent iaryngeaL paralysis: (PGI MAY -2013)
  2. Thyroid surgery
  3. Cancer cervical oesophagus
  4. Blow from nasal cavity
  5. Thyroid cancer
  6. Bronchogenic carcinoma         .

113.   Ans: A

‘ Neuritis or surgical trauma (Thyroideciorny) are the most important cause of bilateral abductor paralysis (recurrent iaryngeal nerve paralysis)

 

  1. True about otosclerosis : (PGI MAY -2013)
  2. Most common site is footplate of stapes
  3. More common in female
  4. Schwartz sign indicate active focus
  5. Autosomal recessive
  6. Carhart notch become -ive after successful stapedectomy

114. AnsB,C,E

o   Fossula ante-fenestram is the most common site for otosclerosis.

o   About 50% of otoscelerosis have positive family history. Genetic studies reveal that otosclerosis is an autosomai dominant trait with incomplete penetrance & a variable expressivity

o   Otosclerosis is more common in female than males

 

  1. Most common location of nasal hemangioma: (PGI MAY -2013)
  2. Nasal Septum
  3. Inferior turbinate
  4. Vestibule
  5. Uncinate process
  6. Nasopharynx

115.   Ans:A

Capillary hemangioma (Bleeding polypus of the septum): arise from anterior part of nasal septum

 

116. Veins not involved in spreading infection to cavernous sinus from danger area of face: (PGI MAY -2013)

A.   Lingual vein

B.     Pterygoid plexus

C.   Facial vein

D.   Opthalmic vein

E.   Cephalic vein

116.   a, e

This is possible because of venous communication (via the ophthalmic veins) between the facial vein and the cavernous sinus. The cavernous sinus lies within the cranial cavity, between layers of the meninges and is a major conduit of venous drainage from the brain

 

MEDICI NE

 

  1. All are true about Berger disease except: (PGI MAY -2013)
  2. Mesangial proliferation
  3. Incresed polyclonal IgA
  4. IgA, C3 & IgG deposits in the mesangium
  5. Hematuria may be gross or microscopic
  6. Absence of proteinuria is pathognomonic .

117. Ans: E

The two most common presentations of IgAnephropathy are recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection often accompanied by proteinuria or persistent asymptomatic microscopic hematuria. Nephrotic syndrome, however, is uncommon

 

  1. True about acute pancreatitis : (PGI MAY -2013)
  2. Amylase has prognostic value
  3. CT is the best imaging study for initial evaluation
  4. Nasojejunal feeding is better than total parenteral nutrition
  5. ERCP is better than CT
  6. Ultrasound confirms the diagnosis in most cases

118. Ans b, c

Amylase is not part of Ranson prognostic riteria

o   CT is the best imaging study for initial evaluation of a suspected pancreatic disorder and for the complications of acute and chronic pancreatitis. It is especially useful in the detection of pancreatic and peripancreatic acute fluid collections, fluid-containing lesions such as pseudocysts, walled-off necrosis, calcium deposits

o   Parenteral nutrition (including lipids) should be considered in patients who have severe pancreatitis and ileus and will be without oral nutrition for at least 7-10 days. Enteral nutrition via a nasojejunal or possibly nasogastric feeding tube is preferable but may not be tolerated in some patients with an ileus

  1. True about Enteric nutrition: (PGI MAY -2013)
  2. Given early in Post-op period to prevent mucosal atrophy
  3. More chance of spread of infection than total parenteral nutrition
  4. It must be given in all post-operative patients
  5. Enterocutaneous fistula is indication of parenteral nutrition
  6. Stimulates the production of immunoglobulins in the

119. Ans: a,d,e

 

  1. True about esophagea! adenocarcinoma : (PGI MAY -2013)
  2. Majority of cases arise in Barret’s oesophagus
  3. Common in upper part esophagus
  4. Commonly arise in the distal esophagus
  5. Tobacco exposure and obesity are risk factors
  6. Incidence is increasing

120. Ans: a,c,d,e

 

  1. Ail are true about systemic sclerosis except: (PGI MAY -2013)
  2. Skin involvement occur
  3. Generalized blood vessel involvement
  4. Pulmonary arterial hypertension
  5. Bleomycin may cause systemic sclerosis like illness
  6. Raynaud’s phenomenon precedes skin involvement diffuse cutaneous form

121.   Ans:   E

Drugs implicated in SSc-like illnesses include bleomycin, pentazocine and cocaine, and appetite suppressants linked with pulmonary hypertension

 

  1. All are true   about Acute Intermittent Porphyria except: (PGI MAY -2013)
  2. Occur due to HMB-synthase enxyme deficiency
  3. Increased amount of porphobilinogen in the urine during an acute attack
  4. Neurovisceral symptoms occurs
  5. Cutaneous photosensitivity is always present
  6. Intermittent abdominal pain may occur

122.   Ans: D

In contrast to other forms of porphyria, cutaneousphotosensitivity is absent in Acute Intermittent Porphyria

 

  1. Drug used to relieve facial flushing associated with niacin toxicity: (PGI MAY -2013)

A.   Fometidine

B.   Foxafenadine

C.   Ranitidine

D,   Laropiprant

123. Ans: D

o   Laropiprant (INN) is a drug used in combination with niacin to reduce blood cholesterol (LDL and VLDL)

o   Laropiprant itself has no cholesterol lowering effect, but it reduces facial flushes induced by niacin.

o   Niacin in cholesterol lowering doses (500–2000 mg per day) causes facial flushes by stimulating biosynthesis of prostaglandin D2 (PGD2), especially in the skin. PGD2 dilates the blood vessels via activation of prostaglandin D2 receptors (DP1), increasing blood flow and thus leading to flushes.Laropiprant acts as a DP1 antagonist, reducing the vasodilation.

  1. True about Wernicke encephalopathy; (PGI MAY -2013)
  2. Cerebellar involvement occur
  3. Occur due to Vit B1 deficiency
  4. Bilateral frontal lobe atrophy
  5. Persistent seizure
  6. Ophthalmoplegia

124, Ans: a,b,e

Wernicke encephalopathy

o   The clinical presentation features a malnourished patient (frequently but not necessarily alcoholic) with confusion, ataxia, and diplopia resulting from inflammation and necrosis of periventricular midline structures, including dorsomedial thalamus, mammillary bodies, midline cerebellum, periaqueductal gray matter, and trochlear and abducens nuclei.

o   Damage to the dorsomedial thalamus correlates most closely with the memory loss

 

  1. True about subarachnoid hemorrhage: (PGI MAY -2013)
  2. CT scan has 95% sensitivity if done within 72 hours
  3. Lumbar puncture shows xanthochromia
  4. 10% of SAH are caused by ruptured AV malformation
  5. 20% risk of rebleeding within first 2 week
  6. Rupture of sacular aneurysm   is most common cause

125. Ans: a,b,d

 

Delayed neurological deficit – major causes in SAH

o   Rerupture

o   The incidence of rerupture of an untreated aneurysm in the first month following SAH is around 30%, with the peak in first 7 days

o   Hydrocephalus

o   Vasospasm

o   Hyponatremia

Triple H therapy in subarachnoid hemorrhage consists of hypervolumeia, hypertension and haemodilution to treat the cerebral vasospasm.

 

  1. Pulmonary-renal syndrome is/are seen In : (PGI MAY -2013)
  2. G. B Syndrome
  3. HSP
  4. Good pasture syndrome
  5. Hanta virus infection
  6. Microscopic polyangitis

126. Ans: C,D,E

 

Pulmonary-renal syndromes are not a single entity, but are caused by a wide variety of f diseases, including various forms of primary systemic ‘ vasculitis (especially Wegener’s granulomatosis and microscopic poiyangiitis), Goodpasture’s syndrome and systemic lupus erythematosus.

Causes of pulmonary-renal syndrome

o   Pulmonary edema secondary to hypovolerhia in ARF as etiology

o   Severe cardiac failure with pulmonary edema

o   Severe pneumonia e.g. Legionella pneumonia with ATN

o   Infection with pulmonary syndrome and interstitial nephritis e.g. Hanta virus, Leptospira, Legionella

o   Good pasture syndrome

o   Systemic vasculitis: Wegener’s granulomatosis. microscopic poiyangitis, Behcet’s syndrome, cryoglobulinemia

o   Thrombosis of renal/IVC with pulmonary emboli

o   Antiphospholipid syndrome

o   Thrombotic microangiopathy (HUS) with lung syndrome    ;

o   Fibrillary GN, Amyloidosis

o   Systemic sclerosis, SLE,-RA,.. Polyrnyositis or dermatomyositis

o   Drugs e.g. penicillamine

o   Paraquat poisoning

  1. All drugs are used in management of psoariatic arthritis except: (PGI MAY -2013)
  2. Methotrexate
  3. Leflunomide
  4. Chloroquine
  5. Alefacept
  6. Infliximab

.   Ans: C

Certain medications are associated with triggering psoriasis, including:

o   Lithium

o   Antimalarials:

o   Plaquenil, Quinacrine, chloroquine and hydroxychloroquine may cause a flare of psoriasis, usually 2 to 3 weeks after the drug is taken. Hydroxychloroquine has the lowest incidence of side effects.

o   Propranolol

o   Quinidine:

o   Indomethacin:

128. Orally used direct thrombin inhibitor(s) is /are(PGI MAY -2013)

A.   Argatroban

B,   Bivalirudin

C.   Lepirudin

D.   Dabigatran etexilate

E.   Rivaroxaban

128. Ans: D

Dabigatran is an oral anticoagulant from the class of the direct thrombin inhibitors. It is being studied for various clinical indications and in some cases it offers an alternative to warfarin as the preferred orally administered anticoagulant since it does not require blood tests for international normalized ratio (INR) monitoring while offering similar results in terms of efficacy

 

Bivalent DTIs include

o   Hirudin

o   Bivalirudin (transient inhibition – is cleaved by thrombin)

o   Lepirudin

o   Desirudin

Univalent DTIs include:

o   Argatroban

o   Melagatran (and its prodrug ximelagatran)

o   Dabigatran

Allosteric Inhibitors

o   Thrombin demonstrates a high level of allosteric regulation.

o   Allosterism in thrombin is regulated by the exosites 1 and 2 and the sodium binding site. A recent patent review has shown that the general consensus among researchers is that allosteric inhibitors may provide a more regulatable anticoagulant.

o   Some of the allosteric inhibitors discovered include DNA aptamers, benzofuran dimers,[4] benzofuran trimers,as well as polymeric lignins.

o   A new sulfated β-O4 lignin (SbO4L) has been discovered which has shown a dual mechanism of action for anti-thrombosis. This SbO4L shows allosteric inhibition of thrombin for fibrinogen, while providing a competitive inhibition of thrombin interaction with platelet glycoprotein Ibα (GPIbα), thereby preventing thrombin mediated platelet aggregation.

 

129. Causes of reversed spitting of the Second Heart Sound; (PGI MAY -2013)

  1. ASD
  2. WPW syndrome
  3. Pulmonary hypertension
  4. Pulmonary stenosis

E. Wolff-Parkinson White syndrome

129. Ans: b.e

Reverse splitting of the Second Heart Sound

o   Delayed aortic closure

o   LBBB (left bundle Branch block (delayed electrical activation of left ventricle or prolonged left ventricular mechanical systole)

o   Hypertensive cardiovascular disease (prolonged left ventricular mechanical systole)

o   Atherosclerotic heart disease (prolonged left ventricular mechanical systole)

o   Early pulmonic closure

o   Wolff-Parkinson White (early activation of right ventricle)

  1. Cause of diarrhea include fs}:(PGI MAY -2013)
  2. Hyperparathyroidism
  3. Hypothyroidism
  4. Hyperthyroidism
  5. Carcinoid syndrome
  6. Diabetes melliitus

130. Ans: c,d,e

  1. Which finding favours diagnosis of MR rather than MS: (PGI MAY -2013)
  2. Loud SI
  3. Third heart sound
  4. Tapping apex
  5. Displaced apex beat
  6. Left ventricular dilatation

131. Ans: B,D,E

 

  1. Ail are features of psuedohypoparathyriosim except; (PGI MAY -2013)
  2. Hypocaicemia

B.       Hypercalcemia

  1. Resistance to parathyroid hormone
  2. Raised levels of PTH
  3. Defect in PTH receptor

132. Ans; B

o   Pseudohypoparathyroidism is a condition associated primarily with resistance to the parathyroid hormone

o   Patients have a low serum calcium and high phosphate, but the parathyroid hormone level (PTH) is actually appropriately high (due to the hypocalcemia). Its pathogenesis has been linked to dysfunctional G Proteins (in particular, Gs alpha subunit).

133- Features of Duchenne muscuiar dystrophy includes: (PGI MAY -2013)

  1. Defective gene is dystoophin
  2. Ragged red fibres
  3. Autosomal recessive mode of inheritance
  4. Anticentromere antibody present
  5. Serum CK levels are raised

133. Ans: a, e

DMD is X-linked recessive disorder

 

  1. True about ankylosing spondylitis: (PGI MAY -2013)
  2. Presents with backache and joint stiffness
  3. Associated with HLA B27
  4. Inflammation of ligament and tendon at attachment to bones
  5. Foot joint involvement
  6. Spine involvement

.   Ans: a,b,c,d,e

ANKYLOSING SPOMDYLITIS

 

  1. Eosinophilia is/are seen in: (PGI MAY -2013)
  2. Visceral leishmania
  3. Churg-Strauss syndrome
  4. Visceral larva migrans
  5. Drug reaction
  6. Parasitic infestations

135. Ans: b,d, e

o   Leishmaniasis causes leucopenia with marked neutropenia with thrombocytopenia but not eosinophilia

o   Visceral larva migrans:marked leucocytosis occurs with high eosinophilia

Churg-Strauss syndrome

o   also known as eosinophilic granulomatosis with polyangiitis [EGPA] or allergic granulomatosis)

o   is an autoimmune medium and small vessel vasculitis in persons with a history of airway atopy.

o   It usually (but not always) manifests in three stages.

o   The prodromal stage is marked by airway inflammation: almost all patients experience asthma and/or allergic rhinitis

o   the second stage is characterized by hypereosinophilia: abnormally high numbers of eosinophils, which causes tissue damage — most commonly to the lungs and the digestive tract.

o   The third and final stage consists of vasculitis, which can eventually lead to necrosisand is potentially life-threatening

136, Clubbing Is/are seen in: (PGI MAY -2013)

  1. Lung carcinoma
  2. Idiopathic pulmonary fibrosis
  3. COPD
  4. Tuberculosis
  5. Lung abscess

136. A,B,E

Clubbing is associated with:

o   Lung disease:

o   Lung cancer, mainly non-small-cell (54% of all cases), not seen frequently in small-cell lung cancer (< 5% of cases)

o   Interstitial lung disease

o   Complicated tuberculosis

o   Suppurative lung disease: lung abscess, empyema, bronchiectasis, cystic fibrosis

o   Mesothelioma of the pleura

o   Arteriovenous fistula or malformation

o   Heart disease:

o   Any disease featuring chronic hypoxia

o   Congenital cyanotic heart disease (most common cardiac cause)

o   Subacute bacterial endocarditis

o   Atrial myxoma (benign tumor)

o   Tetralogy of Fallot

o   Gastrointestinal and hepatobiliary:

o   Malabsorption

o   Crohn’s disease and ulcerative colitis

o   Cirrhosis, especially in primary biliary cirrhosis[8]

o   Hepatopulmonary syndrome, a complication of cirrhosis

o   Others:

o   Graves’ disease (autoimmune hyperthyroidism) – in this case it is known as thyroid acropachy

o   Familial and racial clubbing and “pseudoclubbing” (people of African descent often have what appears to be clubbing)

o   Vascular anomalies of the affected arm such as an axillary artery aneurysm (in unilateral clubbing)

Nail clubbing is not associated with chronic obstructive pulmonary disease (COPD). Therefore, in patients with COPD with significant degrees of clubbing, a search for signs of bronchogenic carcinoma (or other causes of clubbing) might be indicated

 

SURGERY

 

137, Which Is seen after total gastrectomy ; (PGI MAY -2013)

  1. Anaemia due to iron deficiency
  2. Anaemia due to folate deficiency
  3. Diarrhoea
  4. Collapse after taking meals
  5. Post-prandial hypoglycemia

137.   Ans: A,B,C,D,E

The most obvious effect of the removal of the stomach is the loss of a storage place for food while it is being digested. Since only a small amount of food can be allowed into the small intestine at a time, the patient will have to eat small amounts of food regularly in order to prevent gastric dumping syndrome.

 

Another major effect is the loss of the intrinsic-factor-secreting parietal cells in the stomach lining. Intrinsic factor is essential for the uptake of vitamin B12 in the terminal ileum and without it the patient will suffer from a vitamin B12 deficiency. This can lead to a type of anemia known as megaloblastic anaemia (can also be caused by folate deficiency, or autoimmune disease where it is specifically known as pernicious anaemia) which severely reduces red-blood cell synthesis (known as erythropoiesis, as well as other haemotological cell lineages if severe enough but the red cell is the first to be affected). This can be treated by giving the patient direct injections of vitamin B12

 

  1. True about cryptorchidism: (PGI MAY -2013)

A.   Occur in 10% of newboms

  1. It has malignant potential
  2. Sterility can occur
  3. Laproscopy has a role in diagnosis & treatment
  4. Orchidopexy done at 5 yr of age to prevent cancer

138. Ans: B,C,D

o   Orchidopexy is usually performed after the age of 1 year to avoid the risks of operating on a tiny patient. Testes should be brought down into the scrotum before the boy starts school

o   About 4% of boys are born with one or both testes

139,     Which of the following dyads is/are correct for(PGI MAY -2013)

  1. E2: Eye opening to pain
  2. V2: Incomeprehensible sounds
  3. M3: Withdrawl to pain
  4. V3 :Confused in Verbal Response
  5. M2 : Abnormal extension

139. Ans:   a,b,e

Glasgow Coma scale

Eye response (E)

There are four grades starting with the most severe:

  1. No eye opening
  2. Eye opening in response to pain stimulus. (a peripheral pain stimulus, such as squeezing the lunula area of the patient’s fingernail is more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect)
  3. Eye opening to speech. (Not to be confused with the awakening of a sleeping person; such patients receive a score of 4, not 3.)
  4. Eyes opening spontaneously

Verbal response (V)

There are five grades starting with the most severe:

  1. No verbal response
  2. Incomprehensible sounds. (Moaning but no words.)
  3. Inappropriate words. (Random or exclamatory articulated speech, but no conversational exchange. Speaks words but no sentences.)
  4. Confused. (The patient responds to questions coherently but there is some disorientation and confusion.)
  5. Oriented. (Patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month, etc.)

Motor response (M)

There are six grades:

  1. No motor response
  2. Decerebrate posturing accentuated by pain (extensor response: adduction of arm, internal rotation of shoulder, pronation of forearm and extension at elbow, flexion of wrist and fingers, leg extension, plantarflexion of foot)
  3. Decorticate posturing accentuated by pain (flexor response: internal rotation of shoulder, flexion of forearm and wrist with clenched fist, leg extension, plantarflexion of foot)
  4. Withdrawal from pain (Absence of abnormal posturing; unable to lift hand past chin with supra-orbital pain but does pull away when nailbed is pinched)
  5. Localizes to pain (Purposeful movements towards painful stimuli; e.g., brings hand up beyond chin when supra-orbital pressure applied.)
  6. Obeys commands (The patient does simple things as asked.)

 

  1. True about epigastric hernia ; (PGI MAY -2013)
  2. Caused by defect in linea alba
  3. Caused by defective healing of surgical wound
  4. Multiple in 20% of cases
  5. More common in males
  6. Incidence increases in pregnancy

140. Ans: a, c,d

Epigastric hernias.

o   They are more common in men than in women

o   most common between the ages of 20 and 50.

o   About 20% of epigastric hernias are multiple, and about 80% occur just off the midline

o   Like umbilical hernias, epigastric hernias are more common in individuals with a single

  1. True about varieoceie: (PGI MAY -2013)
  2. More commen in right side
  3. May lead to infertility
  4. Aneurysmal dilatation of testicular artery
  5. May be associated   with left sided renal cell carcinoma
  6. Surgery always required
  7. Ans: B, D

o   Varicocele is on the left side in 98% of cases, presumably because of venous drainage of the left testes to the left renal vein, causing increased retrograde venous pressure. The varicocele is bilateral in up to 50% of cases.

o   Mild varicoceles are commonly asymptomatic, but a dragging scrotal sensation may be noted. Varicocele may lead to infertility in some men

o   Asymptomatic varicocele Is best untreated unless it is a suspected factor in male infertility

 

  1. Bladder cancer not associated with: (PGI MAY -2013)
  2. Occupation exposure in industralised countries
  3. Schistosomiasis
  4. Smoking
  5. Alcohol
  6. Bladder catheterisation

142. D, E

o   Tobacco smoking is the main known contributor to urinary bladder cancer; in most populations, smoking is associated with over half of bladder cancer cases in men and one-third of cases among women.

o   There is a linear relationship between smoking and risk, and quitting smoking reduces the risk.

o   Passive smoking has not been proven to be involved.

 

o   Thirty percent of bladder tumors probably result from occupational exposure in the workplace to carcinogens such as benzidine. 2-Naphthylamine, which is found in cigarette smoke, has also been shown to increase bladder cancer risk. Occupations at risk are bus drivers, rubber workers, motor mechanics, leather (including shoe) workers, blacksmiths, machine setters, and mechanics.

o   Hairdressers are thought to be at risk as well because of their frequent exposure to permanent hair dyes.

o   It has been suggested that mutations at HRAS, KRAS2, RB1, and FGFR3 may be associated in some cases

  1. Absorbabie suture(s) is/are: (PGI MAY -2013)

A.   Polyglyconate

B.   Polydioxanone

C.   Polyamide

D.   Polyester

E.   Polylactin

143. Ans:   a,b,e

All sutures are classified as either absorbable or non-absorbable depending on whether the body will naturally degrade and absorb the suture material over time.

o   Absorbable suture materials include the original catgut as well as the newer synthetics polyglycolic acid, polylactic acid, polydioxanone, and caprolactone. They are broken down by various processes including hydrolysis (polyglycolic acid) and proteolytic enzymatic degradation. Depending on the material, the process can be from ten days to eight weeks. They are used in patients who cannot return for suture removal, or in internal body tissues. In both cases, they will hold the body tissues together long enough to allow healing, but will disintegrate so that they do not leave foreign material or require further procedures. Occasionally, absorbable sutures can cause inflammation and be rejected by the body rather than absorbed.

o   Non-absorbable sutures are made of special silk or the synthetics polypropylene, polyester or nylon. Stainless steel wires are commonly used in orthopedic surgery and for sternal closure in cardiac surgery. These may or may not have coatings to enhance their performance characteristics. Non-absorbable sutures are used either on skin wound closure, where the sutures can be removed after a few weeks, or in stressful internal environments where absorbable sutures will not suffice. Examples include the heart (with its constant pressure and movement) or the bladder (with adverse chemical conditions).

o   Non-absorbable sutures often cause less scarring because they provoke less immune response, and thus are used where cosmetic outcome is important. They must be removed after a certain time, or left permanently

.

 

  1. Risk factors of breast carcinoma include(s): (PGI MAY -2013)

A.   Alcohol

B.   Late menarche

C.   Late pregnancy

D.   Late menopause

E.   Early menopause   .

144. a,c,d

o   Risk factors for developing breast cancer include obesity, lack of physical exercise, drinking alcohol, hormone replacement therapy during menopause, ionizing radiation, early age at first menstruation, and having children late or not at all.

o   About 5–10% of cases are due to genes inherited from a person’s parents, including BRCA1 and BRCA2 among others.

 

145. Complication of craniofacial surgery: (PGI MAY -2013)

  1. Sudden death
  2. Convulsion
  3. Encephalitis
  4. CSF Ieak
  5. Meningitis

 

145. Ans: a,b,d,e

 

146. Anterior triangle neck mass is/are: (PGI MAY -2013)

  1. Thyroglossal cyst
  2. Carotid body tumor
  3. Supraclavicular nodes
  4. Branchial cyst
  5. Submandibular gland

146. B,D,E

 

  1. True about arterial ulcer: (PGI MAY -2013)
  2. Punched out margin
  3. Painless
  4. Usually at the tip of toe
  5. Almost all arterial ulcers have surrounding lipodermatosclerosis
  6. Characteristically develops in the skin of the gaiter region

147= Ans: A, C

Arterial ulcers

o   most commonly involves the toes

o   are usually very painful

o   accompanied by rest pain in the foot.

o   margin of the ulcer is sharply demarcated or punched-out

o   the base is devoid of healthy granulation tissue.

o   The surrounding skin is pale and mottled,

o   signs of chronic ischemia are invariably present.

Venous ulcers

o   responsible for between 60% and 70% of all ulcers in the lower leg.

o   Almost ail venous ulcers have surrounding lipodermatosclerosis.

o   This is thickening, pigmentation, inflammation and induration of the calf skin.

o   The pigmentation comes from haemosiderin and melanin and the haemosiderin itself may be an important factor in the ulcer development

o   It characteristically develops in the skin of the gaiter region, the area between the muscles of the calf and the ankle. This is the region where many of the Cockett perforators join the posterior tibial vein to the surface vein, known as the posterior arch vein.

o   The majority of ulcers develop on the medial side of the calf but ulcers associated with lesser saphenous incompetence often develop on the lateral side of the leg.

 

  1. True about Kasabach-Merritt syndrome: (PGI MAY -2013)
  2. Thrombocytopenia
  3. Large haemangioma
  4. HypoflbrInogenemia
  5. Massive splenomegaly always present
  6. Microangiopathic hemolytic anemia

148. A,B,C, E

Kasabach-Merritt phenomenon is characterized by profound thrombocytopenia , microangiopathic hemolytic anemia, a consumptive coagulopathy, and an enlarging vascular lesion

 

  1. Common presentation of carcinoma of right colon ; (PGI MAY -2013)
  2. Presents as mass in RIF
  3. Bleed per rectum
  4. Change in bowel habits
  5. Obstruction
  6. Anaemia

149, Ans: a, e

o   Right-sided tumours: iron deficiency anaemia, abdominal mass

o   Left-sided tumours: rectal bleeding, alteration in bowie habit, tenesmus, obstruction

  1. Medullary thyroid carcinoma has: (PGI MAY -2013)
  2. Arise from parafollicular cell or C cell
  3. Amyloid deposit
  4. Orphan-Annie nuclei
  5. Secrete calcitonin
  6. Psammoma body

150. Ans: a,b,d

Psammoma bodies are present in about 60% cases of papillary carcinoma

 

  1. True about acute appendicitis; (PGI MAY -2013)
  2. Pain migrates from RIF to umbilical area
  3. Pain occur only after vomiting
  4. USG is useful for making diagnosis
  5. Faecolith can cause this
  6. Treatment is appendectomy

151. Ans: C,D,E

o   The pain is described as being located in the periumbilical region initially and then migrating to the right lower quadrant.

o   Anorexia is very common; a hungry patient almost invariably does not have acute appendicitis.

o   Nausea and vomiting occur in 50-60% of cases, but vomiting is usually self-limited

 

  1. True about abscess : (PGI MAY -2013)
  2. Infective endocarditis can cause microabscess in other part of body
  3. Hematogenous spread is common
  4. Type of drainage depends on size of abscess & location
  5. Needle aspiration and antibiotics can be given for breast abscess

152. Ans a,b,c,d

 

  1. Angiodysplasia mainly affects: (PGI MAY -2013)

A.   Duodenum

B.   Jejunum

C.   Caecum

D.   Ascending colon

E.   Rectum

153. Ans: c,d

“Most lesions are located in the cecum and proximal ascending colon, but in younger persons they are occasionally found in the small bowel, principally the jejunum. Multiple lesions occur in 25% of cases”-

 

  1. True about Hirshsprung: (PGI MAY -2013)
  2. Absence of ganglion in auerbach plexus
  3. Increased acetylcholinesterase in affected tissue
  4. Dilation of aganglionic segment
  5. In 10% of cases rectum & sigmoid region is involved
  6. May presents with delayed passage of meconium in the neonatal period

154. Ans: a,b.e

Absent ganglia, hypertrophied nerve trunks, and robust immunostaining for acetylcholinesterase are the pathologic criteria to make the diagnosis

Hirschsprung’s disease is associated with a contracted aganglionic segment

 

155. True about Haemorrhoid: (PGI MAY -2013)

  1. Internal haemorrhoid is dilation of superior rectal artery
  2. Internal haemorrhoid lined by – Squamous & transitional epithelium
  3. External   haemorrhoid lined by – Squamous & transitional epithelium
  4. Internal haemorrhoid   is classified on basis of prolapse
  5. Seen in portal hypertension

 

155. Ans: D

Internal hemorrhoids are further classified into the following grades:

o   Grade I — Hemorrhoids bleed and may protrude into, but do not prolapse out of, the anal canal.

o   Grade II — Hemorrhoids prolapse on defecation but reduce spontaneously.

o   Grade III — Hemorrhoids require manual reduction.

o    Grade IV — Hemorrhoids cannot be reduced. They are permanently prolapsed

Portal hypertension was long thought to increase the risk of hemorrhoidal bleeding because of the anastomoses between the portal venous system (middle and upper hemorrhoidal plexuses) and the systemic venous system (inferior rectal plexuses). It is now understood that hemorrhoidal disease is no more common in patients with portal hypertension than in the normal population.

  1. True about Fibrocystic disease of breast: (PGI MAY -2013)
  2. Most common age group of presentation is 35-45 year
  3. Common in post-menopausai period
  4. Predispose to carcinoma
  5. Pain occur after menstruation

Ans A

o   atypical proliferations of ductal epithelial cells confer increased risk for breast cancer. However, FCC is not itself a risk factor for the development of breast malignancy

o   It is common in women 30-50 years of age but rare in postmenopausal women who are not taking hormonal replacement medications.

o   . In many cases, discomfort occurs or is increased during the premenstrual phase of the cycle, at which time the cysts tend to enlarge

 

157,     True about post-spienectomy complication: (PGI MAY -2013)

  1. Pneumococcal vaccination indicated
  2. Penicillin prophylaxis   is to be given for three weeks
  3. Malaria protection   is given when travelling to endemic area
  4. Heinz bodies are seen in RBC

157. Ans: a,c,d

It is thought that children who have undergone splenec-tomy before the age of 5 years should be treated with a daily dose of penicillin until the age of 10 years. Prophylaxis in older children should be continued at least until the age of 16 years, but its use is less well defined in adults

 

158, True about acute peritonitis : (PGI MAY -2013)

  1. Colicky pain
  2. Pain initially located over area of inflammation
  3. Patient prefers to lie still
  4. Patient tosses in bed
  5. USG diagnostic

158. Ans: b,c,e

 

OBSTETRICS & GYNAECOLOGY

  1. Al! are features of Turner’s syndrome except: (PGI MAY -2013)
  2. Karyotype is 46 XO
  3. Normal breast
  4. Underdeveloped uterus
  5. Normal secondary sexual characters
  6. Primary amenorrhoea

159.   Ans:b,d

o   The genitalia remain infantile.

o   The vagina & Uterus, if present are underdeveloped.

o   Ovaries are reduced to atrophic fibrous strands, devoid of ova & follicles (streak ovaries)

  1. Indications for termination of pregnancy includes: (PGI MAY -2013)
  2. Aortic stenosis
  3. Eisenmengers syndrome
  4. Tricuspid stenosis
  5. Severe mitral stenosis + NYHA grade II
  6. NYHA grade 4 heart disease with history of decompensation in the previous pregnancy

160. Ans:B,E

 

  1. All statement(s) is/are about use of magnesium sulphate except: (PGI MAY -2013)
  2. Therapeutic level is 4-7 mEq/L
  3. Used in spinal anesthesia
  4. Used in seizure prophylaxis
  5. Decrease neuromuscular blockage
  6. Used in Pre-emptive analgesia

161. Ans: d

The use of magnesium sulfate can induce prolong neuromuscular block

 

  1. HIV transmission from mother to child can be prevented by: (PGI MAY -2013)
  2. Elective LSCS
  3. Breast feeding
  4. Vaginal delivery
  5. Antiretroviral therapy
  6. Formula feed

Breast feeding is thought to increase the rate of transmission by 10-20%

 

163. Abnormal uterine bleeding is/are: (PGI MAY -2013)

  1. Blood loss of more than 80ml.
  2. Cycle duration is more than 35 days or less than 21 days
  3. Bleeding period lasting 7 days or more
  4. Irregular bleeding during a regular cycle

163.   Ans:A,B,C,D

o   Polymenorrhea: uterine bleeding at intervals of fewer than 21 days.

o   Oligomenorrhea: uterine bleeding at intervals of more than 35 days.

o   Menorrhagia: excessive bleeding at regular intervals; typical definition is >80 mL

o   Metrorrhagia: bleeding at irregular intervals (between menstrual periods).

o   Menometrorrhagia: heavy, irregular bleeding.

o   Intermenstrual bleeding; bleeding between regular menses.

164. Minimum criteria to diagnose PID Include(s): (PGI MAY -2013)

  1. Lower abdominal pain
  2. Fever
  3. Cervical motion tenderness
  4. Adnexal tenderness
  5. Leucocytosis

164. Ans: A,C,D

o   One or more of the following minimum criteria must be present on pelvic examination to diagnose PID:

o   Cervical motion tenderness

o   Uterine tenderness

o   Adnexal tenderness

o   The following criteria can improve the specificity of the diagnosis:

o   Oral temperature > 101°F (> 38.3°C)

o   Abnormal cervical or vaginal mucopurulent discharge

o   Presence of abundant numbers of white blood cells on saline microscopy of vaginal fluid

o   Elevated erythrocyte sedimentation rate

o   Elevated C-reactive protein level

o   Laboratory documentation of cervical infection with gonorrhea or chlamydia

o   The following test results are the most specific criteria for diagnosing PID:

o   Endometrial biopsy with histopathologic evidence of endometritis

o   Transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex, or Doppler studies suggesting pelvic infection (e.g., tubal hyperemia)

o   Laparoscopic abnormalities consistent with PID

  1. Most important investigation for ectopic pregnancy: (PGI MAY -2013)
  2. TVS
  3. Serial phCG levels

C. Doppler USG

D.   Progesterone

E.   Culdocentesis

165. Ans: A

o   Transvnginal sonography(TVS) detects uterine gestation sac 1 wk earlier than transabdominal probe(TAS) & gives a clearer image because of its proximity to the pelvic organs.

o   The pregnancy can be detected by TVS approximately 14 days after pregnancy detection by serum hCG at 1000 IU/L(5th week of gestation).

o   Pulse Doppler USG can add further information regarding the vascularity of the peritrophoblastic structure & reduce the false-positive findings.

o   The TAS detects uterine pregnancy at –hCG of 1800 IU/L

  1. True statement about symmetrical IUGR with respect to asymmetrical IUGR: (PGI MAY -2013)
  2. Worse prognosis
  3. Neurological defects
  4. Head larger than abdomen
  5. Less common
  6. Total number of cell is normal

166. Anss A,D

Asymmetrical IUGR

o   It is more common (70%).

o   In asymmetrical IUGR, there is restriction of weight followed by length. The head continues to grow at normal or near-normal rates (head sparing).

o   A lack of subcutaneous fat leads to a thin and small body out of proportion with the head. This is a protective mechanism that may have evolved to promote brain development. In these cases, the embryo/fetus has grown normally for the first two trimesters but encounters difficulties in the third, sometimes secondary to complications such as pre-eclampsia.

o   Other symptoms than the disproportion include dry, peeling skin and an overly-thin umbilical cord. The baby is at increased risk of hypoxia and hypoglycaemia.

o   This type of IUGR is most commonly caused by extrinsic factors that affect the fetus at later gestational ages.

o   Specific causes include:

o   Chronic high blood pressure

o   Severe malnutrition

o   Genetic mutations, Ehlers–Danlos syndrome

Symmetrical IUGR

o   It is less common (20-25%).

o   It is commonly known as global growth restriction, and indicates that the fetus has developed slowly throughout the duration of the pregnancy and was thus affected from a very early stage.

o   The head circumference of such a newborn is in proportion to the rest of the body.

o   Since most neurons are developed by the 18th week of gestation, the fetus with symmetrical IUGR is more likely to have permanent neurological sequela.

o   Common causes include:

o   Early intrauterine infections, such as cytomegalovirus, rubella or toxoplasmosis

o   Chromosomal abnormalities

o   Anemia

o   Maternal substance abuse (prenatal alcohol use can result in Fetal alcohol syndrome)

 

  1. True about timing of LH surge : (PGI MAY -2013)
  2. Occur 12 hr before ovulation
  3. Occur 24 hr before ovulation
  4. Occur 12 hr after ovulation
  5. Occur 24 hr after ovulation
  6. Occur at time of ovulation

167. Ans:a,b

“The mininum peak of estrogen secretion is seen about 48 hours before ovulation, whereas the LH peak occurs about 24-38 hours before ovuiation

 

 

  1. Regarding androgen insensitivity syndrome, which statement is/are true: (PGI MAY -2013)
  2. Genotype is 46 XX
  3. Scanty pubic hair

G.   Well developed female external genitalia

  1. Uterus absent
  2. Breast development is adequate

168. Ans:b,d,e

 

  1. Which of following are used   for prevention & treatment of post-partum haemorrhage: (PGI MAY -2013)

A,   Misoprostol

B.   Oxytocin

C.   Ergometrine

D.   Carbiprost

E.   Mifepristone

169. Ans:a,b,c,d

o   Carboprost is a synthetic prostaglandin analogue of PGF2α (specifically, it is 15-methyl-PGF2α) with oxytocic properties.

o   Carboprost induces contractions and can trigger abortion in early pregnancy. It also reduces postpartum bleeding.

o   Mifepristone is a progesterone receptor antagonist used as an abortifacient in the first months of pregnancy, and in smaller doses as an emergency contraceptive. It is also a powerful glucocorticoid receptor antagonist, and has occasionally been used in refractory Cushing’s syndrome (due to ectopic/neoplastic ACTH/cortisol secretion).

  1. Complications of diabetes in pregnancy includes all except: (PGI MAY -2013)
  2. Macrosomia
  3. Shoulder dystocia
  4. Hyperglycemia in newborn
  5. IUGR
  6. Caudal regression

170. Ans:C

Neonatal complications of Maternal diabetes

o   Hypoglycaemia

o   Hypocalcemia

o   Hypomagnesemia

o   Polycythaemia

o   Hyperbilirubinaemia

o   Respiratory distress syndrome

o   Cardiomyopathy

 

171,     Site of placement of tension free vaginal tapes in stress urinary incontinence: (PGI MAY -2013)

  1. At ureterovaginal junction
  2. At urethrovaginal junction
  3. At upper part of urethera
  4. At middle part of urethera
  5. At lower part of urethera

171. Ans:D

Tension-free vaginal tape (TVT) has been designed from non-tissue reactive synthetic material (prolene). After exposing the region of the bladder neck on vaginal dissection, the hammock of the tape is placed underneath it to provide support, at the midurethral level, the lateral extensions are brought out paraurethrally onto the skin at the level of the pubic symphysis and the vagina! incision is closed.

 

172. 2nd trimester USG is/are done for detection of : (PGI MAY -2013)

  1. Sex determination
  2. No. of fetus
  3. Amniocentesis
  4. Gestational age estimation
  5. Congenital defect

172. Ans a,b,,c,d,e

The early pregnancy scan (or fetal viability scan) is usually done between 5 and 12 weeks. A trans-vaginal probe is used for this examination. The scan will provide the following information:

o   Detection of fetal heart movement/rate. Seeing the heart beating is reassuring and confirms that the baby is okay.

o   Number of fetuses. Determination of chorionicity in twin pregnancy (identical twins) for example can be made early and extra surveillance of these high risk pregnancies can be organized to optimize the outcome.

o   Ensure an intra-uterine pregnancy. It confirms that the fetus is well placed in the womb and therefore excludes an out-of-place (or ectopic) pregnancy.

o   Detection of structural abnormalities. Gross fetal abnormalities such as anencephaly (fetus without a brain) can be detected early in pregnancy.

o   Determines the gestational age of the fetus. This can be made accurately by measuring the crown-rump length (CRL). It will help in determining the expected date of delivery (EDD).

The fetal viability scan is important for women who experience bleeding in pregnancy, previous miscarriages or fetal abnormalities in pregnancy. It is often used to reassure women that their pregnancy is off to a good start

 

PAEDIATRICS

 

  1. indication of kidney biopsy in Post-streptococcal Glomerulonephritis in a child is/are: (PGI MAY -2013)
  2. Presence of nephrotic syndrome
  3. Presence of microscopic hematuria
  4. Low complement level in first week
  5. Acute renal failure
  6. Absence of evidence of streptococcal infection

173. Ans: A,D,E

Renal Biopsy indications n PSGN

o   when renal function is severely impaired beyond 7-10 days

o   serum C3 remains depressed beyond 6-8 weeks

o   Patient with unresolving acute GN(persistentoliguria or azotemia past 7-10 days,

o   hypertension or gross haematuria past 2-3 weeks

o   those with features of a systemic illness(systemic lupus)

 

  1. Feature of scurvy in children include(s): (PGI MAY -2013)
  2. Bleeding from gums
  3. Tibial edema
  4. Costochondral junction become angular
  5. Windswept hip deformity
  6. Splaying & cupping of metaphysis

174. Ans: A,B

o   Splaying & cupping of metaphysis occurs in rickets

o   Windswept hip deformity occurs in Cerebral palsy

175. Use of IV magnesium in children includes; (PGI MAY -2013)

A.        Carpopedal spasm in calcium deficiency

B.        Vit. D resistant rickets

C.        Torsaded de pointes

  1. AV heart block
  2. Severe hypomagnesemia

175. Ans: A,C,E

o   Magnesium is effective for treating eclampsia and preeclampsia.

o   Intravenous magnesium is effective for treating torsade de pointes and managing rapid atrial fibrillation.

o   In severe acute asthma, parenteral magnesium supplementation improves peak expiratory flow rate and forced expiratory volume in one second, and reduces hospital admissions.

o   Oral and parenteral magnesium is possibly effective in improving symptoms of migraine.

o   Magnesium is a widely accepted and effective approach to treat dyspepsia.

o   Magnesium is accepted as a standard treatment for constipation, but there are few rigorous studies to prove its effectiveness.

Because magnesium is cleared renally, patients with renal insufficiency (creatinine clearance of less than 30 mL per minute [0.50 mL per second]) may be at increased risk of heart block or hypermagnesemia; therefore, magnesium levels should be monitored

X-linked hvpophosphatemia (XLH). also called X-iinked dominant hypophosphatemic rickets.

Treatment options include

o   Calcitriol

o   GH

o   Phosphates

o   anticalciurics to promote healthy bone growth and diminish mineral loss

Nephrocalcinosis, the long-term result of overaggressive therapy, may be more damaging

 

 

176. True statement regarding children: (PGI MAY -2013)

  1. BMI more than 95 percentile for age as obesity
  2. BMI more than 85 percentile for age as overweight
  3. Weight more than 95 percentile for age as obesity
  4. Weight more than 85 percentile for age as overweight
  5. BMI is calculated by dividing the weight in kilograms by the height in meters square (kg/m2).

Ans:A,B,E

BMI (kg/m2) Classification[17]
< 18.50 underweight
18.50–24.99 normal weight
25.00–29.99 overweight
30.00–34.99 class I obesity
35.00–39.99 class II obesity
≥ 40.00   class III obesity

 

Children with BMI more than 85 percentiie for age are consideted at risk for obesity while those more than 95 percentiie for age are obese

 

  1. True about autism: (PGI MAY -2013)
  2. More common in girls
  3. Concordance in monozygotic twins is 60-90%
  4. MMR vaccine increases the risk
  5. Child may have mental retardation

177. Ans:B,D

o   There is a 60-90% concordance rate for monozygotic twins and a 0% concordance rate for dizygotic twins. There is a 92% concordance rate for monozygotic twins and a 30% concordance rate for dizygotic twins for the broader spectrum of social and communication difficulties

o   Auiism develops before 36 month of age

o   typically diagnosable at 18 month of age

 

  1. Poor prognostic factor in bacteria! meningitis   in children includes(s): (PGI MAY -2013)
  2. Age less than 6 months
  3. Seizures occurring more than 4 days into therapy
  4. Neck rigidity
  5. Focal neurological deficits
  6. High concentrations of bacteria in CSF

Ans: a,b,d,e

Focal seizures have a worse prognosis

Factors that can affect outcome from bacterial meningitis are age; etiology; CSF findings at the time of diagnosis, including concentration of bacteria or bacterial products, WBC count, and glucose concentration; and the time to ster- ilization of CSF after start of therapy. Decreased level of consciousness and seizures occurring during hospitalization have been associated with increased mortality and neurologic sequelae in several studies

Seizures that are focal or are difficult to control imply an underlying vascular disturbance, such as venous thrombosis or infarction, and are associated with epilepsy and other neurologic sequelae

 

 

  1. Hypercalcemia in children is/are seen in all of the following combinations except: (PGI MAY -2013)
  2. Wolfram syndrome and MEN II syndrome
  3. William syndrome and thiazide diuretics
  4. MEN I and hypervitaminosis D
  5. Thyrotoxicosis and Hypervitaminosis A
  6. Hypervitaminosis C

179. Ans: A,E

o   “Wolfram syndrome, also called DIDMOAD (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, and Deafness), is a rare genetic disorder, causing diabetes mellitus, optic atrophy, and deafness

o   High ceiling diuretics cause hypocalcemia, whereas thiazides cause hypercalcemia

o   Hyperparathyroidism is the commonest cause of chronic hypercalcemia in children. William syndrome may cause hypercalcemia

  1. Constipation in child is/are caused by: (PGI MAY -2013)
  2. Stool consistency matters, not frequency
  3. Milk of magnesia
  4. Defect in auerbach plexus as occur in Hirschsprung disease
  5. In majority of infant organic cause is present
  6. Hypothyroidism

180.   Ans: C, E

o   Milk of magnesia (Magnesium hydroxide) cause diarrhea

o   Stool frequency of less than 3 times per week at any age is abnormaL

o   Only minority of children have an organic cause for constipation. In about 95% of children no obvious abnormality seen

  1. True regarding classical Tetralogy of Fallot: (PGI MAY -2013)
  2. Right to left shunt
  3. Left to right shunt
  4. Severe pulmonary valvular stenosis
  5. Subvalvular pulmonary stenosis may be severe
  6. VSD is small

181, Ans: a,c,d

o   VSD in the majority of cases is single and large.

o   Pulmonary stenosis can occur at the pulmonary valve (valvular stenosis) or just below thepulmonary valve (infundibular Stenosis

 

  1. Most common cause of acute tracheitis in children is: (PGI MAY -2013)
  2. Staphylococcus aureus
  3. H.influenzae
  4. Streptococcus pyogenes
  5. Moraxella catarrhalis
  6. Mycoplasma

182. Ans: A

 

  1. All of the following are the causes of neonatal cholestasis except: (PGI MAY -2013)
  2. Extrahepatic Biliary atresia
  3. Alagille syndrome
  4. Gilbert syndrome
  5. Rotor syndrome
  6. Gaucher’s disease

183.   Ans.C

Alagille syndrome (arteriohepatic dysplasia) is the most common syndrome with intrahepatic bile duct paucity.

 

  1. Causes of unconjugated bilirubinemia : (PGI MAY -2013)
  2. Dubin Johnson syndrome
  3. Gilbert syndrome
  4. Neonatal hepatitis
  5. Rotor syndrome
  6. Crigler-Najjar’s syndrome

184. Ans B,E

 

  1. Which of the fo!lowing match is correct   regarding miiestones that are normal (PGI MAY -2013)
  2. 4 month: recognize mother
  3. 2 yr: Can make tower of blocks 15-20 cubes
  4. 6 Month: Coos
  5. 1 yr: Standing without support
  6. 2 yr- sentence of 2-3 words

185. Ans: a ,c,e

Tower building by blocks

o   Tower of 3 blocks – 18 months

o   Tower of 6 blocks – 2 years

o   Tower of 3 blocks: 15 month; Tower of 4 blocks: 18 month

o   Tower of 6 blocks:21 months

o   Tower of 7 blocks: 24 months