WB PGMAT 2014 MCQs recall discussion


WB PGMAT 2014 MCQs recall discussion

Also Download pdf of this discussion explanatory answers from Download section

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WB PGMAT 2014 conducted on January 18 2014 .

The MCQs are very good mixture of 30 % new and challenging MCQs and 70 % repeats. 

Dr Murali Bharadwaz Sir discussed the WB PGMAT 2014  Paper as a historical discussion based on the MCQs recalled by the students from Kolkata and Burdwan . These MCQs are going to have lot of repeats in various State PG Medical entrance exams in future and also help WB PGMAT 2015 , AIPGMEE,PGI,JIPMER,DNB CET Aspirants

# Surgery

@ 111. Most common age of clinical presentation of pediatric rectal prolapse is ?

a. 1-3 years

b. 3-5 years

c. 5-8 years

d. 8-12 years

Ans A (WB PGMAT 2014)

Rectal prolapse usually affects children between 1-3 years of age, a time during which rectal mucosa is loosely attached to the underlying muscularis and flattening of sacrum, which predispose to prolapse.


Although all ages can be affected, peak incidences are observed in the fourth and seventh decades of life. Pediatric patients usually are affected when younger than 3 years, with the peak incidence in the first year of life. Mucosal prolapse is more common than complete prolapse (possibly because of poor fixation of the submucosa to the mucosa in pediatric patients). The incidence of prolapsed rectum in children with cystic fibrosis approaches 20%.



# Radiology

@ 113. Golf hole ureter seen in

A. Ureteric calculus

B. Tuberculosis of ureter

C. Retroperitoneal fibrosis

D. Uretertal polyp


Ans B (WB PGMAT 2014)


@ 112. Tram track calcification in brain seen in:

a. Toxoplasmosis

b. CMV

c. Sturge weber syndrome

d. Craniopharyngioma

Ans C (WB PGMAT 2014)

The tramtrack sign is produced by cortical calcifications that result from leptomeningeal vascular malformations found in patients with Sturge-Weber syndrome



# Pediatrics

@ 114. All are true about measles except?

a. measles virus survives outside body for 5 days

b. measles sar less than rubella

c. Koplik’s spots are pathognomonic for measles

  1. Clinical diagnosis of measles requires a history of fever of at least three days

Ans A (WB PGMAT 2014)


Measles rash rarely causes scarring

Agent may survive less than 2 hours on surfaces or objects Footnote. Respiratory droplets can remain infective for at least 1 hour in a close space

The classic signs and symptoms of measles include four-day fevers [ the 4 D’s ] and the three Cs—cough, coryza (head cold), and conjunctivitis (red eyes)—along with fever and rashes. The fever may reach up to 40 °C (104 °F). Koplik’s spots seen inside the mouth are pathognomonic (diagnostic) for measles, but are not often seen, even in confirmed cases of measles, because they are transient and may disappear within a day of arising

Clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the three C’s (cough, coryza, conjunctivitis).



@ 115. In Treacher Collins syndrome , all are seen except?

a. coloboma of lower eyelid

b. micrognathia

c. down-slanting palpebral fissures

d. sensorinueral hearing loss

Ans D (WB PGMAT 2014)


Treacher Collins syndrome (TCS), also known as Treacher Collins–Franceschetti syndrome,or mandibulofacial dysostosis, is a rare autosomal dominant congenital disorder characterized by craniofacial deformities, such as absent cheekbones Treacher Collins syndrome is found in about 1 in 50,000 births. The typical physical features include downward-slanting eyes, micrognathia (a small lower jaw), conductive hearing loss, underdeveloped zygoma, drooping part of the lateral lower eyelids, and malformed or absent ears.

Patients are mostly characterized by these abnormalities:


▪      Hypoplasia of the facial bones: Most described is an underdeveloped mandibular and zygomatic bone. This leads to a small and malformed jaw. Mandible hypoplasia can result in a malocclusion.

▪      Ear anomalies: The external ear anomalies consist of small, rotated, or even absent auricles. Also symmetric, bilateral stenosis or atresia of the external auditory canals is described. In most cases, the ossicles and the middle ear cavity were dysmorphic. Inner ear malformations are rarely described. As a result of these abnormalities, a majority of the individuals with TCS have conductive hearing loss.

▪      Most patients experience eye problems, varying from colobomata of the lower eyelids and aplasia of lid lashes to short, down-slanting palpebral fissures and missing eyelashes. Vision loss can occur and is associated with strabismus, refractive errors, and anisometropia.

▪      Cleft palate

▪      Airway problems, which are often a result of mandibular hypoplasia



# medicine

@ 118. PCWP is increased in all except?

a. MS

b. AS

c. PS

d. left ventricular failure

Ans C (WB PGMAT 2014)


For example, it is considered the gold standard for determining the cause of acute pulmonary edema; this is likely to be present at a PCWP of >20mmHg. It has also been used to diagnose severity of left ventricular failure and mitral stenosis, given that elevated pulmonary capillary wedge pressure strongly suggests failure of left ventricular output.

The central venous pressure (CVP) measures the filling pressure of the right ventricular (RV); it gives an estimate of the intravascular volume status and is an interplay of the (1) circulating blood volume (2) venous tone and (3) right ventricular function.

Since there are no valves between the pulmonary capillaries and the left atrium, PCWP is a reflection of the LAP. During diastole, when mitral valve is open, the PCWP reflects LVEDP. LVEDP is an index of left ventricular end-diastolic volume


@ 116. Complications of amebiasis include all except

a. Bleeding

b. Perforation

c. Malignancy

d. pericaecal abscess

Ans C (WB PGMAT 2014)

  • In the majority of cases, amoebas remain in the gastrointestinal tract of the hosts. Severe ulceration of the gastrointestinal mucosal surfaces occurs in less than 16% of cases. In fewer cases, the parasite invades the soft tissues, most commonly the liver. Only rarely are masses formed (amoebomas) that lead to intestinal obstruction.(Mistaken for Ca caecum and appendicular mass) Other local complications include bloody diarrhea, pericolic and pericaecal abscess.
  • Complications of hepatic amoebiasis includes subdiaphragmatic abscess, perforation of diaphragm to pericardium and pleural cavity, perforation to abdominal cavital (amoebic peritonitis) and perforation of skin (amoebic cutis).


  • Pulmonary amoebiasis can occur from hepatic lesion by haemotagenous spread and also by perforation of pleural cavity and lung. It can cause lung abscess, pulmono pleural fistula, empyema lung and broncho pleural fistula. It can also reach brain through blood vessel and cause amoebic brain abscess and amoebic meningoencephalitis. Cutaneous amoebiasis can also occur in skin around sites of colostomy wound, perianal region, region overlying visceral lesion and at the site of drainage of liver abscess.
  • Urogenital tract amoebiasis derived from intestinal lesion can cause amoebic vulvovaginitis (May’s disease), rectovesicle fistula and rectovaginal fistula.


  • Entamoeba histolytica infection is associated with malnutrition and stunting of growth.



# Microbiology

@ 119. Enterotoxin is produced by all except ?

a. Staphylococcus aureus

b. Clostridium tetani

c. Salmonella

d. Vibrio cholerae

Ans B (WB PGMAT 2014)

Enterotoxin is produced by

▪      Clostridium difficile

▪      Clostridium perfringens (Clostridium perfringens enterotoxin)

▪      Vibrio cholerae (Cholera toxin)

▪      Staphylococcus aureus (Staphylococcal Enterotoxin B)

▪      Yersinia enterocolitica

▪      Shigella dysenteriae (Shiga toxin)


Salmonella strains may produce a thermolabile enterotoxin that bears a limited relatedness to cholera toxin both structurally and antigenically

S. aureus can produce an enterotoxin that is the causative agent of S. aureus gastroenteritis



# Surgery

@ 120. Dentate line is approximately ——- cm from anal verge?

a. 0.5

b. 1.5

c. 2.0

d. 2.5

Ans C (WB PGMAT 2014)

The pectinate line (dentate line) is a line which divides the upper two thirds and lower third of the anal canal. Developmentally, this line represents the hindgut-proctodeum junction.

Anal Canal is approximately 4 cm in length; Dentate line is approximately 2 cm from anal verge

# Micro

@122. Miller Fisher syndrome shows association with?

a)  HLA B 27

b)  HLA B 45

c)  HLA DQB1

d)  HLA A3

Ans C (WB PGMAT 2014)

HLA-DQB1*03 and preceding C. jejuni infection in GBS or Miller-Fisher syndrome.


@ 123. MC cause of watery diarrhoea in children

a. Rotavirus

b. E coli

c. Shigella dysentriae

d. Salmonella

Ans A (WB PGMAT 2014)

Rotavirus is the most common cause of severe diarrhea among infants and children throughout the world

# Radiology

@ 124. investigation of choice in bronchiectasis

a)  Bronchoscopy

b)  HRCT

c)  MRI

d)  PET Scan

Ans B (WB PGMAT 2014)

# Medcine

@ 126. CML blast crisis is associated with

a. 5q-

b. 7q-

c. trisomy 8

D. isochromosome 15

Ans C (WB PGMAT 2014)

Additional chromosomal abnormalities, such as an additional or double Ph1-positive chromosome or trisomy 8, 9, 19, or 21; isochromosome 17; or deletion of the Y chromosome, have been described as the patient enters a transitional form or accelerated phase of the blast crisis as the Ph chromosome persists


The most frequently observed genetic aberrations are a second Philadelphia chromosome, trisomy 8, isochromosome 17, trisomy 19, alone or in various combinations, and complex aberrations. Up to 80% of BC patients show some forms of chromosomal changes.


@ 125. Thalasemia mutation has high prevalence in?

a. Sindhis

b. Kashmiri pandits

c. Konkan

d. Tamil mudaliars

Ans A (WB PGMAT 2014)

High frequency of the IVS-I-1 (G–>T) mutation was also found in Sindhis (25.5%), Punjabi Hindus (34.7%), and Lohanas (31.2%)


@126. CML blast crisis is associated with

a. 5q-

b. 7q-

c. trisomy 8

D. isochromosome 15

Ans C (WB PGMAT 2014)


The most frequently observed genetic aberrations are a second Philadelphia chromosome, trisomy 8, isochromosome 17, trisomy 19, alone or in various combinations, and complex aberrations. Up to 80% of BC patients show some forms of chromosomal changes.




# gob

@ 128. obstetric conjugate measures:

a. 10.5 cm

b. 10 cm

c. 11 cm

d. 11.5 cm

Ans B (WB PGMAT 2014)

Its normal measurement is 10 cm or more. The obstetric conjugate is the shortest of the three.
# Physiology
@88. Most potent stimulus for ADH secretion:
a. Volume depletion
b. hypokalemia
c. Increased tonicity
d. decreased tonicity
Ans A (WB PGMAT 2014)

▪ Hypovolaemia is a more potent stimulus for ADH release BUT LESS SENSITIVE than is hyperosmolality.
▪ Hyperosmolality is most sensitive stimulus
1. Hypothalamic osmoreceptors (major influence)
a. specialized afferent cells in the hypothalamus that generate action potentials in proportion to interstitial fluid (and blood plasma) osmotic activity (and are silent when osmotic activity is low)
b. make excitatory synapses with ADH neurosecretory cells
c. result: Plasma Osmolality Ý Þ ADH Ý
d. located outside the blood-brain barrier
e. very sensitive; small increase in osmolality is sufficient to significantly increase ADH secretion rate

2. Blood volume
a. mediated by stretch-sensitive atrial cells (low pressure baroreceptors or vascular volume receptors)
b. blood volume decrease increase ADH
c. less sensitive (high threshold): 5-10% decrease in blood volume required for significant ADH increase
d. potent: once threshold is passed (e.g. serious dehydration), can cause large increase in ADH

3. Systemic arterial blood pressure
a. mediated by baroreceptors in the carotid sinus and aortic arch (same baroreceptors involved in blood pressure regulation)
b. blood pressure decrease increase ADH
c. less sensitive (high threshold): 10% decrease in blood pressure required for significant ADH increase
d. very potent: once threshold is passed (e.g. major hemorrhage), can cause large increase in ADH (emergency response)

The most important variable regulating antidiuretic hormone secretion is plasma osmolarity, or the concentration of solutes in blood. Osmolarity is sensed in the hypothalamus by neurons known as an osmoreceptors, and those neurons, in turn, stimulate secretion from the neurons that produce antidiuretic hormone.
Secretion of antidiuretic hormone is also stimulated by decreases in blood pressure and volume, conditions sensed by stretch receptors in the heart and large arteries. Changes in blood pressure and volume are not nearly as sensitive a stimulator as increased osmolarity, but are nonetheless potent in severe conditions

@71. Penile erection is due to?
a. sympathetic activation
b. Arteriolar dilation
c. venular dilation
d. ischiocavernosus relaxation
Ans B (WB PGMAT 2014)

Physiologically, erection is triggered by the parasympathetic division of the autonomic nervous system (ANS), causing nitric oxide (a vasodilator) levels to rise in the trabecular arteries and smooth muscle of the penis. The arteries dilate causing the corpora cavernosa of the penis (and to a lesser extent the corpora spongiosum) to fill with blood; simultaneously the ischiocavernosus and bulbospongiosus muscles compress the veins of the corpora cavernosa restricting the egress and circulation of this blood. Erection subsides when parasympathetic activity reduces to baseline.
@ 75. Banting and Macleod won Nobel prize in 1923 for discovery of ?
a. Insulin
b. Ion channel
c. Growth hormone
d. Prions
Ans A (WB PGMAT 2014)

# Surgery
@ 105. Mismatch among the following surgeries :
a) Achalasia – Heller myotomy
b) Congenital pyloric stenosis – Ramstedt operation
c) Duhamel procedure – Hirschsprung’s disease
d) Bishop Koop procedure – Intusussception
Ans D (WB PGMAT 2014)
Bishop Koop procedure in terms of duration of hospital stay, postoperative complications and survival rate for jejunoileal atresias (JIA) in neonates i
Heller myotomy is a surgical procedure in which the muscles of the cardia (lower esophageal sphincter or LES) are cut, allowing food and liquids to pass to the stomach. It is used to treat achalasia, a disorder in which the lower esophageal sphincter fails to relax properly, making it difficult for food and liquids to reach the stomach.
Duhamel procedure
This operation for Hirschsprung’s disease entails pulling down ganglionic bowel behind the lower aganglionic segment but within the sling of the puborectalis muscle. The rectum is divided near the peritoneal reflection, and the retrorectal space is opened to below the pelvic floor. An incision in the posterior half of the anal canal at the level of the dentate line allows the proximal ganglionic bowel to be pulled thorough and sutured to the posterior half of the anal canal opening. A common lumen is thus created to connect the anus and ganglionic bowel.

@ 94. Villous adenoma causes all except ?
a. dysentry
b. watery diarrhea
c. hypokalemia
d. metabolic acidosis
Ans A (WB PGMAT 2014)
Secretory villous adenomas of the colon have been known to cause a depleting syndrome characterized by dehydration, prerenal azotemia, hyponatremia, hypokalemia, metabolic acidosis, obtundation, and, in severe cases, death

@ 84. Most common breast Carcinoma
a) infiltrative lobular carcinoma
b) infiltrative ductal carcinoma
c) Inflammatory breast cancer
d) Angiosarcoma of breast
Ans B (WB PGMAT 2014)

It is also sometimes called infiltrative ductal carcinoma. IDC is the most common type of breast cancer, making up nearly 70- 80% of all breast cancer diagnose

@ 83. Which of the following is tumor marker of medullary carcinoma of thyroid
a) Parathormone
b) Calcitonin
c) Vitamin D
d) Alpha feto protein

Ans B (WB PGMAT 2014)

@74. Most common surgically treatable cause of infertility is :
a. Varicocele
b. cryptorchidism
c. Ejaculatory duct obstruction
d. Hypospadias
Ans A (WB PGMAT 2014)

Varicocele can be diagnosed in up to 35% of infertile men.1 It is currently recommended that treatment should be offered to couples with documented infertility whose male partner has a clinically palpable varicocele associated with an abnormal semen analysis.
Ejaculatory duct obstruction is a treatable cause of male infertility

@73. All are true about Hypospadias except ?
a. No treatment is required in glandular hypospadias
b. Associated with hooded prepuce
c. Associated with chordee
d. Associated with cryptorchidism
Ans A (WB PGMAT 2014)

Glandular hypospadias – commonest variety
• Treatment is required
◦ To improve urinary stream
◦ To allow sexual intercourse
• Usually performed between 2 and 4 years of age
• Glandular hypospadias requires a glandular meatotomy
• Coronal hypospadias requires a meatal advancement and glanduloplasty (MAGPI operation)
• Proximal hypospadias without a chordee can be treated by a skin flap advancement
If chordee present it should be excised and an island flap urethroplasty performed
Hypospadias may also include the following: A hooded appearance of the foreskin. This is because the foreskin does not develop on the underside of the penis
First degree hypospadias are primarily a cosmetic defect and have little effect on function except for direction of the urinary stream. If uncorrected, a second or third degree hypospadias can make urination messy, necessitate that it be performed sitting, impair delivery of semen into the vagina (possibly creating problems with fertility), or interfere with erections. In developed countries, most hypospadias are surgically repaired in infancy. Surgical repair of first and second degree hypospadias is nearly always successful in one procedure, usually performed in the first year of life by a pediatric urologist or a plastic surgeon.

When the hypospadias is third degree, or there are associated birth defects such as chordee or cryptorchidism, the best management can be a more complicated decision. A karyotype and endocrine evaluation should be performed to detect intersex conditions or hormone deficiencies. If the penis is small, testosterone or human chorionic gonadotropin (hCG) injections may be given to enlarge it before surgery.

Surgical repair of severe hypospadias may require multiple procedures and mucosal grafting. Preputial skin is often used for grafting and circumcision should be avoided before repair. In a minority of patients with severe hypospadias surgery produces unsatisfactory results, such as scarring, curvature, or formation of urethral fistulas, diverticula, or strictures. A fistula is an unwanted opening through the skin along the course of the urethra, and can result in urinary leakage or an abnormal stream. A diverticulum is an “outpocketing” of the lining of the urethra which interferes with urinary flow and may result in post-urination leakage. A stricture is a narrowing of the urethra severe enough to obstruct flow. Reduced complication rates even for third degree repair (e.g., fistula rates below 5%) have been reported in recent years from centers with the most experience, and surgical repair is now performed for the vast majority of infants with hypospadias

@72 Peyronie’s disease is seen in ?
a) palm
b) palate
c) penis
d) upper lip
Ans C (WB PGMAT 2014)
Peyronie’s disease or Peyronie disease, also known as induratio penis plastica (IPP or chronic inflammation of the tunica albuginea (CITA), is a connective tissue disorder involving the growth of fibrous plaques[2] in the soft tissue of the penis affecting 5% of men.Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening

@76. Treatment of CTEV in 2 months old?
a. Manipulation alone by mother
b. Manipulation and plaster casts
c. Dwyer’s osteotomy
d. Posteriomedial soft tissue release (PMSTR )
Ans B (WB PGMAT 2014)
Most orthopedic surgeons prefer to operate when the child is 6 months old, though some prefer to wait until 9 to 12 months of age

@ 104. Time between infection and maximum infectivity is known as? a) Incubation period
b) Serial interval
c) Generation Time
d) Communicable period
Ans C (WB PGMAT 2014)

@ Composition of WHO ORS include all except :
a) Sodium 75 mmol/litre
b) Anhydrous glucose 75 mmol/litre
c) Potassium 40 mmol/litre
d) Total osmolarity 245 mmol/litre
Ans C (WB PGMAT 2014)

@ 92. Neonatal mortality rate (NMR)
is calculated per
a) 100 live births
b) 1000 live birth
c) Mid year population
d) 1000 under 5 population
Ans B (WB PGMAT 2014)

Neonatal mortality rate (NMR)
The number of neonatal deaths per 1000 live births
A neonatal death is defined as a death during the first 28 days of life (0-27 days).

@ 78. In the staffing pattern of Primary Health centre ,number of Medical offices present in a PHC is /are
a. 3, with at least 1 female
b. 1
c. 2 , with at least 1 female
d. 4
Ans B (WB PGMAT 2014)

Staffing Primary Health Centre
S. No. Staff for New Primary Health Centre Existing IPHS proposed
1. Medical Officer 1 2
2. Pharmacist 1 1
3. Nurse Mid-wife (Staff Nurse) 1 3
4. Health Worker (Female)/ANM 1 1
5. Health Educator 1 1
6. Health Assistant (Male) 1 1
7. Health Assistant Female)/ LHV 1 1
8. Upper Division Clerk 1 1
9. Lower Division Clerk 1 1
10. Laboratory Technician 1 1
11. Driver (Subject to availability of Vehicle) 1 *
12. Class IV 4 4
Total 15 17/18

Box – 3 : Staffing Sub centre
S. No Staff For Sub-Centre Existing IPHS proposed
1. Health Worker(Female)/ANM 1 2
2. Health Worker (Male) 1 1
3. Voluntary Worker (optional on honorarium) 1 1
Total 2/3 3/4

• One subcentre caters to the healthcare needs of 5000 population in general and 3000 population in hilly, tribal and backward areas (MCQ)

@ 77. actual target of active surveillance is
a. Prevent disease
b. Health planning
c. Eradicate disease
d. confirmation of epidemic
Ans B (WB PGMAT 2014)

• Active surveillance: a system employing staff members to regularly contact heath care providers or the population to seek information about health conditions. Active surveillance provides the most accurate and timely information, but it is also expensive.
Passive surveillance: a system by which a health jurisdiction receives reports submitted from hospitals, clinics, public health units, or other sources. Passive surveillance is a relatively inexpensive strategy to cover large areas, and it provides critical information for monitoring a community’s health. However, because passive surveillance depends on people in different institutions to provide data, data quality and timeliness are difficult to control.

@ 79. Pre beta lipoprotein is :
a. LDL
c. HDL
d. Chylomicron
Ans B (WB PGMAT 2014)
α, pre-β and β lipoproteins correspond to HDL, VLDL and LDL, respectively
@ 80. False statement among the following regarding lipoproteins:
a. HDL is associated with LCAT
b. high intracellular cholesterol increase synthesis of LDL receptor
c. Chylomicrons transport dietary fats from intestines to tissues
d. VLDL is converted to LDL by removal of all proteins except apo B-100
Ans B (WB PGMAT 2014)
high intracellular cholesterol suppresses synthesis of LDL receptor

Lecithin—cholesterol acyltransferase (LCAT, also called phosphatidylcholine-sterol O-acyltransferase) is an enzyme that converts free cholesterol into cholesteryl ester (a more hydrophobic form of cholesterol), which is then sequestered into the core of a lipoprotein particle, eventually making the newly synthesized HDL spherical and forcing the reaction to become unidirectional since the particles are removed from the surface. The enzyme is bound to high-density lipoproteins (HDLs) and low-density lipoproteins in the blood plasma.
• 1. Chylomicrons -transport dietary fats and cholesterol from intestines to tissues.
• 2. Very Low Density Lipoproteins (VLDL) – transport endogenous fats and cholesterol from liver to tissues
• 3. Intermediate Density Lipoproteins (IDL) – transport endogenous fats and cholesterol from liver to tissues
• 4. Low Density Lipoproteins (LDL) transport endogenous fats and cholesterol from liver to tissues
5. High Density Lipoproteins (HDL) transport endogenous cholesterol from tissues to liver.

# Medcine
@107. Mitochondrial DNA mutations is 10 times more common than Nuclear DNA because ?
a. mitochondrial genome lacks repairing mechanism
b. mitochondrial genome is Circular DNA
c . mitochondrial genome has a much higher percentage of coding DNA
d. All of above
Ans C (WB PGMAT 2014)

The mitochondrial genome is a hotspot for pathogenic mutations
Because of the very large size of the human nuclear genome, most mutations occur in nuclear DNA sequences. By comparison, the mitochondrial genome is a small target for mutation (about 1/200 000 of the size of the nuclear genome). Unlike nuclear genes, mitochondrial genes are present in numerous copies (there are thousands of copies of the mtDNA molecule in each human somatic cell; some cells, such as brain and muscle cells, have particularly high oxidative phosphorylation requirements and so more mitochondria). The mtDNA is inherited from the maternal oocyte, which is an exceptional cell with many more mtDNA molecules than somatic cells. Given that a mutation in mitochondrial DNA must arise on a single mtDNA molecule, one might intuitively expect that the chances of a single mtDNA mutation becoming fixed would be very low and the mutation rate correspondingly low. On these grounds, one could anticipate that the proportion of clinical disease due to pathogenic mutation in the mitochondrial genome should be extremely low. Instead, the frequency of ‘mitochondrial disorders’ is rather high and the mitochondrial genome can be considered to be a mutation hotspot.
Different factors can explain this apparent paradox:

▪ Differential target size for pathogenic mutation. Pathogenesis is associated with mutations in coding DNA and the mitochondrial genome has a much higher percentage of coding DNA (93%) than found in the nuclear genome (3%). When this is taken into consideration, however, there is still a large imbalance: about 100 Mb of coding DNA in the nuclear genome but only 15.4 kb of coding sequence in the mitochondrial genome, giving a target ratio of 6000:1 in favor of the nuclear genome.
▪ High mutation rate in mtDNA. The mitochondrial genome is much more prone to nucleotide change than the nuclear genome. Even although about 100 000 copies of the mitochondrial genome are maternally inherited in the fertilized oocyte there are mechanisms which permit rapid fixation of mutations in mitochondrial DNA .The combination of mtDNA instability and a high fixation rate means that the mutation rate in mitochondrial DNA is very high. Mutations have been reported to be fixed in the mitochondrial genomes of animal cells at a rate which is about 10 times greater than occurring in equivalent sequences in the nuclear genome . This means that the small recombination-deficient animal mtDNA molecules appear to be evolving remarkably rapidly, corresponding to about 2–4% sequence divergence per million years. In contrast, plant mtDNA molecules are comparatively large (150 kb-2.5 Mb), have introns, engage in recombination and are evolving comparatively slowly.
▪ The high instability of mtDNA has been postulated to result from several factors. The high rate of production of reactive oxygen intermediates by the respiratory chain is thought to cause substantial oxidative damage to mtDNA which, unlike nuclear DNA, is not protected by histones. The mtDNA also has to undergo many more rounds of replication than chromosomal DNA. Although several well-characterized mtDNA repair systems are now known, some frequent mutations cannot be repaired, including thymidine dimers

@ 106. All are true about chromosome matching with the condition except :
a. Down’s syndrome : Trisomy 22
b. 45 XO Turner
c. 47 XXY Klinefelter
d. Patau’s syndrome : Trisomy 13
Ans A (WB PGMAT 2014)

@ 103. dependent thoracostomy tube drainage is done for ?
a. pleural effusion
b. pneumothorax
c. empyema
d. Bronchiectasis
Ans C (WB PGMAT 2014)
to resolve the empyema, dependent thoracostomy tube drainage was used

@102. Treatment of Empyema Thoracis is
a. Rib resection with drainage
b. Repeated aspirations
c. Intrapleural thrombolytic agents
D. Pnuemonectomy
Ans A (WB PGMAT 2014)

Parapneumonic pleural effusions are classified into 3 broad groups based on fluid characteristics, which, in turn, provides a reflection on both the severity and natural history of the pleural effusion.
• Uncomplicated parapneumonic effusions: These are exudative, predominantly neutrophilic effusions reflecting increasing passage of interstitial fluid as a result of inflammation associated with pneumonia. The fluid may be slightly cloudy or even clear, without any organisms noted on Gram stain or culture. They resolve with appropriate antibiotic treatment of the pneumonia.
• Complicated parapneumonic effusions: These occur as a result of bacterial invasion into the pleural space that leads to an increased number of neutrophils, decreased glucose levels, pleural fluid acidosis, and an elevated lactic dehydrogenase (LDH) concentration. These effusions often are sterile because bacteria are usually cleared rapidly from the pleural space. The fluid is typically cloudy and is classified as complicated because it requires drainage for resolution.
Empyema thoracis: This develops as frank pus accumulates in the pleural space. Laboratory studies indicate that preexisting pleural fluid is required for the development of an empyema because empyema is not seen after direct inoculation into a “dry” pleural space. The pus is seen after thoracentesis or any drainage procedure of the pleural space and is generally characterized as thick, viscous, and opaque
Insert chest tubes immediately after a complicated parapneumonic pleural effusion or empyema thoracis is diagnosed. The key to resolution involves prompt drainage of pleural fluid because delay leads to the formation of loculated pleural fluid
Continue closed-tube drainage as long as clinical and radiologic improvement are observed. The chest tube can be removed once the volume of the pleural drainage is less than 100 mL/24 h, with clearance of the pleural fluid turbidity seen in complicated pleural effusions.
Thoracoscopy is an alternate therapy for multiloculated empyema thoracis. In patients with multiloculated parapneumonic pleural effusions, the loculations in the pleural space can be disrupted with a thoracoscope, and the pleural space can be drained completely. If extensive adhesions are present or thick pleural peel entraps the lung, the procedure may be converted to open thoracostomy and decortication.
Open drainage of the pleural space may be used when closed-tube drainage of the pleural infection is inadequate and the patient does not respond to intrapleural thrombolytic agents. This procedure is recommended only when the patient is too ill to tolerate decortication. The resection of one to three ribs overlying the lower part of the empyema thoracis cavity is performed, a large-bore chest tube is inserted into the empyema thoracis cavity, and the tube is drained into a colostomy bag.

@ 91. Which among the following is leukotrine receptor antagonist
a. zafirlukast
b. nedocromil
c. latanoprost
d. Zileuton
Ans A (WB PGMAT 2014)

▪ Drugs such as zileuton block 5-lipoxygenase, inhibiting the synthetic pathway of leukotriene metabolism, whereas drugs such as MK-886 block the 5-lipoxygenase activating protein (FLAP) and may help in treating atherosclerosis.

▪ Antagonism of cysteinyl-leukotriene type 1 receptors[edit]
▪ Agents such as montelukast and zafirlukast block the actions of cysteinyl leukotrienes at the CysLT1 receptor on target cells such as bronchial smooth muscle.

▪ These modifiers have been shown to improve asthma symptoms, reduce asthma exacerbations and limit markers of inflammation such as eosinophil counts in the peripheral blood and bronchoalveolar lavage fluid. This demonstrates that they have anti-inflammatory properties.

@ 87. SIADH is caused by all except
a. Vincristine
b. Clofibrate
c. amitriptyline
d . Lithium
Ans D (WB PGMAT 2014)

Diabetes insipidus : Lithium was the most common cause followed by foscarnet and clozapine
Drugs that stimulate AVP release are as follows:
• Acetylcholine
• Antineoplastic agents – Adenine arabinoside, cyclophosphamide, ifosfamide, vincristine, vinblastine
• Barbiturates
• Bromocriptine
• Carbachol
• Chlorpropamide
• Clofibrate
• Cyclopropane
• Dibenzazepines (eg, carbamazepine, oxcarbazepine
• Halothane
• Haloperidol
• Histamine
• Isoproterenol
• Lorcainide
• Opiates e.g. Morphine
• Nicotine (inhaled tobacco)
• Nitrous oxide
• Phenothiazines (eg, thioridazine)
• Thiopental
• MAOIs (eg, tranylcypromine)
• Tricyclic antidepressants (eg, amitriptyline, desipramine)
Drugs that potentiate the effects of AVP action (primarily facilitates peripheral action of ADH) are as follows:
▪ Clofibrate
▪ Griseofulvin
▪ Hypoglycemic agents – Metformin, phenformin, tolbutamide
▪ Oxytocin (large doses)
▪ Prostaglandin synthetase inhibitors (inhibit renal PGE2 synthesis) – Indomethacin, aspirin, nonsteroidal anti-inflammatory drugs
▪ Theophylline
▪ Triiodothyronine
▪ Vasopressin analogs (eg, AVP, DDAVP)
Drugs with an uncertain mechanism are as follows:
▪ Antineoplastic agents – Cisplatin, melphalan, methotrexate, imatinib
▪ Ciprofloxacin
▪ Clomipramine
▪ Ecstasy
▪ Phenoxybenzamine
▪ Na+ valproate
▪ SSRIs (eg, sertraline, fluoxetine, paroxetine)

@81. True regarding Pulmonary embolism :
a. high PaO2, high PaCO2, high pH
b. high PaO2, low PaCO2, high pH
c. thrombolysis is not beneficial
d. causes Type 1 respiratory failure
Ans D (WB PGMAT 2014)

Type 1 respiratory failure
▪ Type 1 respiratory failure is defined as hypoxemia without hypercapnia, and indeed the PaCO2 may be normal or low.
▪ It is typically caused by a ventilation/perfusion (V/Q) mismatch; the volume of air flowing in and out of the lungs is not matched with the flow of blood to the lungs.
▪ The basic defect in type 1 respiratory failure is failure of oxygenation characterized by:
▪ PaO2 decreased (< 60 mmHg (8.0 kPa))
▪ PaCO2 -normal or decreased ( ▪ PA-aO2 -increased
This type of respiratory failure is caused by conditions that affect oxygenation such as:
▪ Low ambient oxygen (e.g. at high altitude)
▪ Ventilation-perfusion mismatch (parts of the lung receive oxygen but not enough blood to absorb it, e.g. pulmonary embolism)
▪ Alveolar hypoventilation (decreased minute volume due to reduced respiratory muscle activity, e.g. in acute neuromuscular disease); this form can also cause type 2 respiratory failure if severe
▪ Diffusion problem (oxygen cannot enter the capillaries due to parenchymal disease, e.g. in pneumonia or ARDS)
▪ Shunt (oxygenated blood mixes with non-oxygenated blood from the venous system, e.g. right-to-left shunt)
▪ Type 2
Hypoxemia (PaO2 <8kPa) with hypercapnia (PaCO2 >6.0kPa).
The basic defect in type 2 respiratory failure is characterized by:

▪ PaO2 -decreased (< 60 mmHg (8.0 kPa)) ▪ PaCO2 -increased (> 50 mmHg (6.7 kPa))
▪ PA-aO2 -normal
▪ pH -decreased
Type 2 respiratory failure is caused by inadequate alveolar ventilation; both oxygen and carbon dioxide are affected. Defined as the build up of carbon dioxide levels (PaCO2) that has been generated by the body but cannot be eliminated. The underlying causes include:
▪ Increased airways resistance (chronic obstructive pulmonary disease, asthma, suffocation)
▪ Reduced breathing effort (drug effects, brain stem lesion, extreme obesity)
▪ A decrease in the area of the lung available for gas exchange (such as in chronic bronchitis)
▪ Neuromuscular problems (Guillain-Barré syndrome, myasthenia gravis, motor neurone disease)
▪ Deformed (kyphoscoliosis), rigid (ankylosing spondylitis), or flail chest

@ 82. Crohn’s disease is associated strongly with:
a. Perinuclear Anti-Neutrophil Cytoplasmic Antibodies (pANCA)
b Cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA)
c. Anti-Saccharomyces cerevisiae antibodies (ASCA )
d. None
Ans C (WB PGMAT 2014)

Anti-Saccharomyces cerevisiae antibodies (ASCA), along with perinuclear antineutrophil cytoplasmic antibodies (pANCA), are among the two most useful and often discriminating markers for colitis.[1] ASCA tends to recognize Crohn’s disease more frequently, whereas pANCA tend to recognize ulcerative colitis

@ 85. cigar shaped macroconidia are typical of
a) trichophyton
b) microsporum
c) epidermophyton
d) trichosporon
Ans A (WB PGMAT 2014)
Typical cigar shaped macroconidia of T. rubrum granular type.

# pathology
@ 86. inheritance pattern of Fragile X syndrome is :
a. Autosomal dominant
b. Autosomal recessive
c. X linked recessive
d. . X linked dominant
Ans D (WB PGMAT 2014)

Fragile X syndrome has traditionally been considered an X-linked dominant condition with variable expressivity and possibly reduced penetrance.[4] However, due to genetic anticipation and X-inactivation in females, the inheritance of Fragile X syndrome does not follow the usual pattern of X-linked dominant inheritance and some scholars have suggested discontinuing labeling X-linked disorders as dominant or recessive

# Anatomy
@89. Anatomical structure found at mid inguinal point is ?
a. femoral vein
b. femoral artery
c. great saphenous vein
d.femoral nerve
Ans B (WB PGMAT 2014)
The mid-inguinal point is defined as the point halfway along a line between the anterior superior iliac spine and the top of the pubic symphysis, the latter by definition is in the midline.

It is the landmark of the femoral artery when traced to below the inguinal ligament, and is about one centimetre medial to the internal ring.

# Pharmacology
@90. Site of action of Amphotericin B?
a. cell membrane
b. motochondria
c. cytosol
d. endoplasmic reticulum
Ans A (WB PGMAT 2014)
As with other polyene antifungals, amphotericin B binds with ergosterol, a component of fungal cell membranes, forming a transmembrane channel that leads to monovalent ion (K+, Na+, H+ and Cl−) leakage, which is the primary effect leading to fungal cell death

@ 96. In PCOD, treatment of hirsutism is
a. hMG
b. hCG
c. Spironolactone
d. GnRH
Ans C (WB PGMAT 2014)
Spironolactone: Spironolactone, in daily doses of 50-200 mg, blocks androgen receptors. Spironolactone also decreases testosterone production, making it additionally effective for hirsutism. Spironolactone is especially useful in a patient with hypertension or edema because the drug is a mild diuretic.
@ 97. Treatment of endometriosis include all except:
a. Danazol
b. Tamoxifen
c. Combination oral contraceptive pills
d. Goserelin
Ans B (WB PGMAT 2014)

COCPs act by ovarian suppression and continuous progestin administration. Initially, a trial of continuous or cyclic COCPs should be administered for 3 months. With pain relief, this treatment is continued for 6-12 months. Pregnancy rates following discontinuation of the pill are 40-50%. This applies to a population unselected for stage and fertility status of the disease. Although few choices are available among individual formulations, note that the long-term efficacy of multiphasic preparations remains unproven.
Progestational agents
▪ All progestational agents act by decidualization and atrophy of the endometrium.

▪ Medroxyprogesterone acetate has proven efficacy in pain suppression in both the oral and injectable depot preparations.[66, 67] Oral doses of 10-20 mg/d can be administered continuously. The time to resumption of ovulation is longer and variable with depot preparations. Adverse effects include weight gain, fluid retention, depression, and breakthrough bleeding.

▪ Megestrol acetate has been used in doses of 40 mg with similarly good results.

▪ The levonorgestrel intrauterine system (LNG-IUS) has been shown to reduce endometriosis-associated pain. When inserted at the time of laparoscopic surgery, it has been found to reduce the recurrence of dysmenorrhea by 35%

▪ GnRH analogues produce a hypogonadotrophic-hypogonadic state by downregulation of the pituitary gland. Goserelin and leuprolide acetate are the commonly used agonists. Efficacy is limited to pain suppression, and fertility rates may show no improvement

▪ Danazol acts by inhibiting the midcycle follicle-stimulating hormone (FSH) and luteinizing hormone (LH) surges and preventing steroidogenesis in the corpus luteum. It is the most extensively studied agent for endometriosis

@ 98. In vaginal secretions , sperm is motile for ?
a. 2 hours
b 6 hours
c. 12 hours
d. 18 hours
Ans A (WB PGMAT 2014)

▪ The optimal pH for sperm viability is between 7.0 and and a reduction in sperm motility is seen at a pH less than 6.0. Normal vaginal pH is only 3.5 to 4.0, and the acidic environment of the vagina is thus toxic to sperm. However, both seminal fluid and cervical mucus present within the posterior vagina are alkaline and act as buffers. Fox and coworkers have shown that vaginal pH rises to 7.0 within just seconds after ejaculation, and this decrease in acidity can be maintained for up to two hours after ejaculation.

▪ Within about 1 minute after coitus, the ejaculate undergoes coagulation. This coagulum temporarily restricts movement of sperm out of the seminal clot, thus preventing their passage into the cervical mucus and ascension up the female reproductive tract. Over the next 20 to 30 minutes, however, a seminal-fluid proteolytic enzyme produced by the prostate gland gradually liquefies the clot.

▪ At this time, motile sperm may then enter the cervical mucus, leaving behind the seminal plasma. Although there are reports of motile sperm persisting within the vagina for up to 12 hours after ejaculation,11 motility of most vaginal sperm is diminished within about 30 minutes, and after 2 hours almost all sperm motility in the vagina has been lost.
@ 99. Capacitation means:
a. Development of hyperactivated motility of sperm
b. Zona pellucida penetration by sperm
c. happening of second meiotic division in sperm
d.nuetralisation of vaginal pH
Ans A (WB PGMAT 2014)

Capacitation is now commonly regarded as the reversible, prefertilization activation process of sperm which results in the spermatozoa gaining the ability to:
• Develop hyperactivated motility, with vigorous nonlinear flagellar motion
• Bind to the zona pellucida
• Undergo the acrosome reaction
Proceed eventually to fusion with the oolemma and egg fertilization

@ 95. Triple test include all except?
a. unconjugated estriol (UE3)
b. inhibin A
c. human chorionic gonadotropin (hCG)
d. alpha-fetoprotein (AFP)

Ans B (WB PGMAT 2014)

▪ The triple test, also called triple screen, the Kettering test or the Bart’s test, is an investigation performed during pregnancy in the second trimester to classify a patient as either high-risk or low-risk for chromosomal abnormalities (and neural tube defects).
▪ The triple test measures the following three levels in the maternal serum:
▪ alpha-fetoprotein (AFP)
▪ human chorionic gonadotropin (hCG)
▪ unconjugated estriol (UE3)

▪ AFP – low UE3 –low hCG -high
o Down Syndrome
▪ AFP – low UE3 –low hCG –low
o trisomy 18 (Edward’s syndrome)
▪ AFP High
o neural tube defects (like spina bifida that may have associated increased levels of acetylcholinesterase in the amnionic fluid), omphalocele, gastroschisis, multiple gestation (like twins or triplets), or an underestimation of gestational age.
Quadruple test
▪ A test of levels of dimeric inhibin A (DIA) is sometimes added to the other three tests, under the name “quadruple test.” Other names used include “quad test”, “quad screen”, or “tetra screen.” Inhibin A (DIA) will be found high in cases of Trisomy 21 and low in cases of Trisomy 1

Inhibin A
▪ High – Trisomy 21 (Down Syndrome)
▪ Low – Trisomy 18 (Edward’s syndrome)
▪ Variable – Trisomy 13 (Patau syndrome)
# Radiology
@ 100. Maximum tolerated radioactivity by liver is :
a. 15 Gy
b. 30 Gy
c. 50 Gy
d. 80 Gy
Ans B (WB PGMAT 2014)

Another 2002 article suggested that when the effective liver volume is 1.0 (i.e., whole liver irradiation), the dose with 5% RILD incidence is 24Gy, and dose with 50% RILD incidence is 43Gy. However if the effective liver volume irradiated is 0.5 (ie., half the liver), the 5% RILD incidence occurs at 32Gy.

# Forensic
108. Ponds fracture common in which age group?
a. infants
b. Young adult
c. Middle age
d. Old age
Ans A (WB PGMAT 2014)
Pond – this is a shallow depressed fracture, more common in infants

# Ophthalmology
@110. Interphotoreceptor matrix contains all except :
a. Glycoprotein
b. Proteoglycan
c. Glycolipids
d. Metalloproteinase
Ans D (WB PGMAT 2014)
Glycoconjugates, including glycolipids, glycoproteins, and proteoglycans, are present in the plasma membrane of photoreceptor cells and in the interphotoreceptor matrix surrounding photoreceptor cell ellipsoids and outer segments

The interphotoreceptor matrix is a unique extracellular complex occupying the interface between photoreceptors and the retinal pigment epithelium in the fundus of the eye. Because of the putative supportive role in photoreceptor maintenance, it is likely that constituent molecules play key roles in photoreceptor function and may be targets for inherited retinal disease

@64. Contraindication of stapedectomy is ?
a) Good cochlear reserve
b) Only hearing ear
c) Air bone gap of 40 dB.
d) Presence of Carhart’s notch in the audiogram
Ans B (WB PGMAT2014)
Indications of stapedectomy:
• Conductive hearing loss (due to fixation of stapes).
• Air bone gap of at least 30 dB.
• Presence of Carhart’s notch in the audiogram of a patient with conductive hearing loss (relative)
• Good cochlear reserve as assessed by the presence of good speech discrimination.
Contraindications for stapedectomy:
• Poor general condition of the patient.
• Only hearing ear.
• Poor cochlear reserve as shown by poor speech discrimination scores
• Patient with tinnitus and vertigo
• Presence of active otosclerotic foci (otospongiosis) as evidenced by a positive flemmingo sign.
• Conductive deafness due to Ehlers-Danlos Syndrome (EDS)

@ Anatomical landmark indicating position of mastoid antrum? WBPGMAT 2014 news4medico
a. Suprameatal triangle
b. Tip of mastoid process
c. Spine of henle
d. None
Ans A (WB PGMAT 2014)

@ Most common cause of tinnitus is
b. Meniere’s
c. Presbycusis
d. Acoustic neuroma
Ans C (WB PGMAT 2014)
News4medico dot com
The most common cause of tinnitus is hearing loss that occurs with aging (presbycusis), but it can also be caused by living or working around loud noises (acoustic trauma). Tinnitus can occur with all types of hearing loss and may be a symptom of almost any ear disorder
@10. A CSOM patient presents with with ‘Picket fence’ pattern fever associated with rigors ,headache . He appears ematiated and anaemic . Papilloedema is found on examination . Diagnosis is
a. Meningitis
b. Brain Abscess
c. Cerbral malaria
d. Lateral sinus thrombosis
Ans D (WB PGMAT 2014)

•  The patients manifest with severe fever, wasting illness in association with middle ear infection. The fever is high and swinging in nature, when charted it gives an appearance of ‘Picket fence’. It is always associated with rigors. The temperature rose rapidly from 39 – 40 degree Centigrade.
• Headache is a common phenomenon, associated with neck pain.
• The patient appear ematiated and anaemic. When the clot extended down the internal jugular vein, it will be accompanied by perivenous inflammation, with tenderness along the course of the vein. This tenderness descended down the neck along with the clot, and would be accompanied by perivenous oedema or even suppuration of the jugular lymph nodes. Perivenous inflammation around jugular foramen can cause paralysis of the lower three cranial nerves. Raised intracranial pressure produce papilloedema and visual loss. Hydrocephalus could be an added complication if the larger or the only lateral sinus is occluded by the thrombus, or if the clot reaches the superior sagittal sinus. Extension to the cavernous sinus can occur via the superior petrosal sinus, and may cause chemosis and proptosis of one eye. If circular sinus is involved it could spread to the other eye. The propagation of the infected emboli may cause infiltrates in the lung fields, and may also spread to joints and other subcutaneous tissues.. These distant effects usually developed very late in the disease, these could be the presenting features if the disease is insiduous in onset. Masking by antibiotics could be one of the causes. Patients always feel ill, and persisting fever is usual. The patients may have ear ache, in association with mastoid tenderness, and stiffness along the sternomastoid muscle. The presence of anaemia is rare now a days. Papilloedema is still a common finding. Other coexisting intracranial complications must be expected in more than 50 percent of patients.
• Extension of infected clot along the internal jugular vein is always accompanied by tenderness and oedema along the course of the vein in the neck, and localised oedema over the thrombosed internal jugular vein may still be seen. One rare finding is the presence of pitting oedema over the occipital region, well behind the mastoid process, caused by clotting within a large mastoid emissary vein, this sign is known as the Griesinger’s sign. Infact there is no single pathognomonic sign for lateral sinus thrombosis and a high index of suspicion is a must in diagnosing this condition.

@ Most common site of Anterior epistaxis is ?
a. anterior end of middle turbinate
b. anterior end of inferior turbinate
c. anterioinferior end of nasal septum
d. posterior septum overlying the vomer bone
Ans C (WB PGMAT 2014)
Most nasal bleeding is anterior, originating from a plexus of vessels in the anteroinferior septum (Kiesselbach’s area).
Less common but more serious are posterior nosebleeds, which originate in the posterior septum overlying the vomer bone, or laterally on the inferior or middle turbinate. Posterior nosebleeds tend to occur in patients who have preexisting atherosclerotic vessels or bleeding disorders and have undergone nasal or sinus surgery
# Anatomy
@37. Recurrent laryngeal nerve is nerve of which of the following branchial arches?
a. 2nd
b. 3rd
c. 4th
d. 6th
Ans D (WB PGMAT 2014)

@ Corneal endothelium is derived embryologically from?
a. Ectoderm
b. Neural crest
c. Mesoderm
d. Endoderm
Ans B (WB PGMAT2014)
The corneal endothelium is embryologically derived from the neural crest

@11. Which among the following is axial sulcus?
a. Calcarine sulcus
b. Lunate sulcus
c. Post-central sulcus
d. Central sulcus
Ans A (WB PGMAT 2014)

@ 2. In development of cerebellum ,which of the following fissure is first to appear on the cerebellar surface ?
a. fissura prima
b. fissura secunda
c. posterolateral fissure
d. prepyramidal fissure
Ans C (WB PGMAT 2014)

The cerebellum is developed in the roof of the anterior part of the hind-brain .The alar laminæ of this region become thickened to form two lateral plates which soon fuse in the middle line and produce a thick lamina which roofs in the upper part of the cavity of the hind-brain vesicle; this constitutes the rudiment of the cerebellum, the outer surface of which is originally smooth and convex. The fissures of the cerebellum appear first in the vermis and floccular region, and traces of them are found during the third month; the fissures on the cerebellar hemispheres do not appear until the fifth month. The primitive fissures are not developed in the order of their relative size in the adult—thus the horizontal sulcus in the fifth month is merely a shallow groove. The best marked of the early fissures are: (a) the fissura prima between the developing culmen and declive, and (b) the fissura secunda between the future pyramid and uvula. The flocculus and nodule are developed from the rhombic lip, and are therefore recognizable as separate portions before any of the other cerebellar lobules. The groove produced by the bending over of the rhombic lip is here known as the floccular fissure; when the two lateral walls fuse, the right and left floccular fissures join in the middle line and their central part becomes the post-nodular fissure
@ 3. Which of the following is not associated with a defect in neural migration?
A. Lissencephaly
B. Schizencephaly
C. Polymicrogyria
D. Focal cortical brain maldevelopment
Ans D (WB PGMAT 2014)
The structural abnormalities found in Neuronal Migration Disorderss (NMD) include schizencephaly, porencephaly, lissencephaly, agyria, macrogyria, polymicrogyria, pachygyria, microgyria, micropolygyria, neuronal heterotopias (including band heterotopia), agenesis of the corpus callosum, and agenesis of the cranial nerves.
# Biochemistry
@34. NMR spectrometry is to detect and quantify biologically important motions in a near cellular environment of complexes
a. < 30 kDa b. > 30 kDa
c. 60 kDa
Ans A (WB PGMAT 2014)
Nuclear Magnetic Resonance (NMR) spectroscopy is the method of choice to detect and quantify biologically important motions in a near cellular environment.
Traditionally, the application of NMR spectroscopy has been limited to complexes below 25 kDa in molecular weight. Recent advances have, however extended this molecular weight regime into the hundreds of kDa and in favorable cases over 1 MDa. This makes the large complexes involved in mRNA decay amenable to detailed studies of molecular dynamics. On the campus of the Max Planck Institute for Developmental Biology in Tübingen we now have 2 brand new NMR spectrometers installed (600 MHz and 800 MHz).

@ Hunter’s disease is due to deficiency of :
a. alpha-L iduronidase
b. iduronate sulfatase
c. Heparan sulfamidase
d. Galactose-6-sulfate sulfatase

Ans B (WB PGMAT2014)
• Hunter syndrome
o Hunter syndrome, or mucopolysaccharidosis II (MPS II), is a lysosomal storage disease caused by a deficient (or absent) enzyme, iduronate-2-sulfatase (I2S)
o The accumulated substrates in Hunter syndrome are heparan sulfate and dermatan sulfate
o The syndrome has X-linked recessive inheritance
• Hurler syndrome,
o also known as mucopolysaccharidosis type I (MPS I),
o Hurler’s disease, also gargoylism, is a genetic disorder that results in the buildup of glycosaminoglycans (formerly known as mucopolysaccharides) due to a deficiency of alpha-L iduronidase, an enzyme responsible for the degradation of mucopolysaccharides in lysosomes.
o Without this enzyme, a buildup of heparan sulfate and dermatan sulfate occurs in the body. Symptoms appear during childhood and early death can occur due to organ damage.

@ Number of Carbons present in progesterone are
a) 18
b) 21
c) 27
d) 28
Ans B (WB PGMAT2014)
Cholesterol contains 27 C. 
Progesterone, aldosterone and cortisol all contain each 21 C.


@ 68. Which of the following shows association with fibroid
a) endometrial hyperplasia
b) theca lutien cysts
c) endometriosis
d) Pagets disease of vulva
Ans A (WB PGMAT 2014)
frequent association of fibroids with endometrial hyperplasia suggests that they, like the latter, should be looked upon as an end-result of hormonal cell stimulation, another type of cellular metaplasia caused by underlying glandular dysfunction
@63. Which of the following is correct physiologic change seen in pregnancy ?
a. oxygen dissociation curve shifts to the right
b. low HCO3
c.decrease in plasma sodium
d.metabolic acidosis
Ans B (WB PGMAT2014)
Cardiac output increases by about 50%,

The hyperventilation that occurs during pregnancy is probably due in part to progesterone stimulating the respiratory center. Lung volume changes and altered compliance may also contribute. The effect is a chronic respiratory alkalosis which is compensated by renal excretion of bicarbonate. Typical blood gases results in the third trimester are
Typical ABGs in the Third Trimester
• pH 7.43
• pCO2 33mmHg
• [HCO3] 21mmHg
• pO2 104 mmHg.
The reduction in bicarbonate results in a slightly reduced ability to buffer a metabolic acid load. The lower pCO2 would shift the oxygen dissociation curve to the left, but the minimal change in pH and the increased 2,3 DPG levels during pregnancy mean the ODC is little altered in position.
A pregnant woman may experience an increase in kidney and ureter size. The glomerular filtration rate (GFR) commonly increases by 50%, returning to normal around 20 weeks postpartum.Plasma sodium does not change because this is offset by the increase in GFR. There is decreased blood urea nitrogen (BUN) and creatinine and glucosuria (due to saturated tubular reabsorption) may be seen. Persistent glucosuria may suggest gestational diabetes. The renin-angiotensin system is upregulated, causing increased aldosterone levels

Cardiac output increases by about 50%, mostly during the first trimester.

@ Commonest fetal infection in first trimester of pregnancy?
a. HBV
b. Rubella
c. Toxoplasma
d. Cytomegalovirus
Ans D (WB PGMAT 2014)
Cytomegalovirus, is the most common congenital infection

@ All the following cause Oligohydramnios except
a. Renal agenesis
b. Post dated
c. Anencephaly
Ans C (WB PGMAT 2014)
Oligohydramnios is often associated with:
• fetal chromosomal anomolies
• intra uterine infections
• Drugs; PG inhibitors, ACE inhibitors
• renal agenesis or obstruction of the urinary tract (posterior urethral valve in male fetus)of the fetus preventing micturation
• IUGR associated with placental insufficiency
• amnion nodosum; failure of secretion by the cells of the amnion covering the placenta
• postmaturity (dysmaturity)

@20. Germ cells originate from:
a. Yolk sac
b. Amnion
c. Chorion
D. Allantois
Ans A (WB PGMAT 2014)
Human primordial germ cells (PGCs) can be recognized in the yolk sac wall, from 3-4 weeks post conception

@ What is the fate of coiled arteries of secretory endometrium in pregnancy?
a. Form the artery of placenta
b. converted for uteroplacental bood flow during pregnancy
c. Atrophy
d. Become more coiled
Ans B (WB PGMAT2014)
• Spiral arteries are small arteries which temporarily supply blood to endometrium of the uterus during the luteal phase of the menstrual cycle.
• The spiral arteries are converted for uteroplacental bood flow during pregnancy, involving:
o Loss of smooth muscle & elastic lamina from the vessel wall.
o 5-10 fold dilation at the mouth of the vessel.
• Failure of the physiological conversion of the spiral arteries can cause a number of complications, including intrauterine growth restriction and pre-eclampsia.
• Spiral arteries, so called because of their coiled appearance, supply blood to the endometrial layer and, in the pregnant uterus, span the inner myometrium and the decidua. During pregnancy the placental bed spiral arteries are transformed from high-resistance, low-flow vessels into large dilated vessels with an increased blood flow at a much reduced pressure .These alterations occur as a result of loss of smooth muscle cell and elastic lamina from the vessel wall. The endothelium is temporarily replaced with a trophoblast layer, although it is restored later in pregnancy. The lumen of the remodelled vessel is dilated and there is trophoblast deposition of a fibrinoid matrix
• Maternal placental circulation
• In preparation for implantation of the blastocyst, the uterine endometrium undergoes “decidualisation”. Spiral arteries in decidua are remodeled so that they become less convoluted and their diameter is increased. The increased diameter and straighter flow path both act to increase maternal blood flow to the placenta. The relatively high pressure as the maternal blood fills intervillous space through these spiral arteries bathes the fetal villi in blood, allowing an exchange of gases to take place. In humAns A (WB PGMAT 2014)nd other hemochorial placentals, the maternal blood comes into direct contact with the fetal chorion, though no fluid is exchanged. As the pressure decreases between pulses, the deoxygenated blood flows back through the endometrial veins.
Maternal blood flow is approximately 600–700 ml/min at term.
• Fetoplacental circulation
• Deoxygenated fetal blood passes through umbilical arteries to the placenta. At the junction of umbilical cord and placenta, the umbilical arteries branch radially to form chorionic arteries. Chorionic arteries, in turn, branch into cotyledon arteries. In the villi, these vessels eventually branch to form an extensive arterio-capillary-venous system, bringing the fetal blood extremely close to the maternal blood; but no intermingling of fetal and maternal blood occurs (“placental barrier”

@ Vaginal glycogen is under influence of?
a. LH
b. FSH
c. Progesterone
d. Estrogen
Ans D (WB PGMAT 2014)
Vaginal epithelium accumulates glycogen under influence of estrogens
Estrogen also causes increased acidity (lower pH) in the vagina.
The mechanism for lower pH is attributed to a general increase in metabolic activity under the influence of estrogen. The glycogen in the vaginal epithelium breaks down and results in increased lactic acid. The lower pH (3.5-6) is thought to ward off infection to some degree and alter the growth of pathogenic bacteria in the vagina

# Physiology
@65. Glucose absorption in Proximal convoluted tubule is?
a. Active
b. Passive
c. Facilitated
d. secondary active
Ans D (WB PGMAT 2014)
Firstly, the glucose in the proximal tubule is co-transported with sodium ions into the proximal convoluted tubule walls. Some (typically smaller) amino acids are also transported in this way. Once in the tubule wall, the glucose and amino acids diffuse directly into the blood capillaries along a concentration gradient. This blood is flowing, so the gradient is maintained. Lastly, sodium/potassium ion active transport pumps remove sodium from the tubule wall and the sodium is put back into the blood. This maintains a sodium concentration gradient in the proximal tubule lining, so the first step continues to happen.
Firstly, the Na+/K+ ATPase pump on the basolateral membrane of the proximal tubule cell uses ATP to move 3 sodium ions outward into the blood, while bringing in 2 potassium ions. This creates a downhill sodium ion gradient inside the proximal tubule cell in comparison to both the blood and the tubule. The SGLT proteins use the energy from this downhill sodium ion gradient created by the ATPase pump to transport glucose across the apical membrane against an uphill glucose gradient. Therefore, these co-transporters are an example of secondary active transport. (The GLUT uniporters then transport the glucose across the basolateral membrane, into the peritubular capillaries.) Both SGLT1 and SGLT2 are known as symporters, since both sodium ions and glucose are transported in the same direction across the membrane.

@Phantom limb sensations are best described by ?

a. weber Fechner law
b. power law
c. bell magendie law
d. law of projection
Ans D (WB PGMAT 2014)

@61. The most commonly used fiberoptic arthroscope for knee and shoulder surgery is a —— mm scope that has a ——— angle
a) 3 , 30o
b) 4, 30 o
c) 3, 60 o
d) 4, 60 o

Ans B (WB PGMAT2014)
The most commonly used fiberoptic arthroscope for knee and shoulder surgery is a 4.0 mm scope that has a 30° angle at the end which allows the scope to be rotated to provide a much wider viewing area.

@ Which of the following is epiphysis lesion:
a) Ewing sarcoma
b) Lymphoma
c) Fibrous dysplasia
d) chondroblastoma
Ans D (WB PGMAT 2014)

Epiphyseal Lesions
• Chondroblastoma (age 10-25)
• Giant cell tumor (age 20-40)
• Clear cell chondrosarcoma (rare)

@ 45 year old patient with expansile lesion in center of femoral metaphysis showing endosteal scalloping and punctate calcifications
a. Osteosarcoma
b. Chondrosarcoma
c. osteoid osteoma
d. Giant cell tumor
Ans B (WB PGMAT2014)

@ 53. PTB cast is used in fracture of:
a. Tibia
b. Femur
c. Patella
d. Calcaneum
Ans A (WB PGMAT 2014)
The patella tendon bearing (PTB) cast is usually applied as the last stage of treatment for tibial fractures. The pressure applied to the fracture site as the patient walks stimulates bone growth. The PTB may also be used for rehabilitation of the knee for a patient whose leg has been immobilized by a long leg cast. In this presentation the application of the PTB will be demonstrated.

@ All are true about Phantom limb except?
a. Always painful
b. Seen in 80% of all acquired amputees
c. Phantom limb pain is usually intermittent
d. can also occur after the removal of body parts other than the limbs
Ans A (WB PGMAT 2014)
A phantom limb is the sensation that an amputated or missing limb (even an organ, like the appendix) is still attached to the body and is moving appropriately with other body parts.
Approximately 60 to 80% of individuals with an amputation experience phantom sensations in their amputated limb, and the majority of the sensations are painful
Phantom sensations may also occur after the removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye (phantom eye syndrome). The missing limb often feels shorter and may feel as if it is in a distorted and painful position. Occasionally, the pain can be made worse by stress, anxiety, and weather changes. Phantom limb pain is usually intermittent. The frequency and intensity of attacks usually declines with time.
Although not all phantom limbs are painful, patients will sometimes feel as if they are gesturing, feel itches, twitch, or even try to pick things up.
For example, Ramachandran and Blakeslee describe that some people’s representations of their limbs do not actually match what they should be, for example, one patient reported that her phantom arm was about “6 inches too short
# Surgery
@25. Most common organ injured in perforating injury abdomen is :
a. Liver
b. Duodenum
c. Small intestine
d. Large intestine
Ans C (WB PGMAT 2014)
Liver – most commonly injured in all abdominal trauma
(blunt and penetrating)
Spleen – most commonly injured organ in blunt trauma
In children, the liver is the most commonly injured abdominal organ
The small intestines are especially vulnerable to penetrating wounds as they cover the abdominal surface.
@26. Most common etiology of Multiple organ dysfunction syndrome (MODS) ?
a. Sepsis
b. Hypotension
c. Trauma
D. hypermetabolism
Ans A (WB PGMAT 2014)
The condition usually results from infection, injury (accident, surgery), hypoperfusion and hypermetabolism. The primary cause triggers an uncontrolled inflammatory response. Sepsis is the most common cause in operative and non-operative patients. Sepsis may result in septic shock. In the absence of infection, a sepsis-like disorder is termed systemic inflammatory response syndrome (SIRS). Both SIRS and sepsis could ultimately progress to multiple organ dysfunction syndrome. However, in one-third of the patients no primary focus can be found.[1] Multiple organ dysfunction syndrome is well established as the final stage of a continuum: SIRS + infection U+2192.svg sepsis U+2192.svg severe sepsis U+2192.svg Multiple organ dysfunction syndrome. Currently, investigators are looking into genetic targets for possible gene therapy to prevent the progression to Multiple organ dysfunction syndrome. Some authors have conjectured that the inactivation of the transcription factors NF-κB and AP-1 would be appropriate targets in preventing sepsis and SIRS.[2] These two genes are pro-inflammatory. However, they are essential components of a normal healthy immune response, so there is risk of increasing vulnerability to infection, which can also cause clinical deterioration.

@ In Nyhus classification ,femoral hernia is classified as ?
b. II
d. IV
Ans C (WB PGMAT 2014)
Classification of inguinal hernias (Nyhus)
• Type 1
o Indirect hernia with normal internal ring
• Type 2
o Indirect hernia with dilated internal ring. Posterior wall intact
• Type 3
o Posterior wall defect
o Type 3 A -Direct inguinal hernia
o Type 3 B -Indirect inguinal hernia. Internal ring dilated. Posterior wall defective
o Type 3 C – Femoral hernia
• Type 4 -Recurrent hernia

@ What is initial investigation of choice for post cholecystectomy CBD stricture ?
a. CT
b. MRI
c. Ultrasound
Ans C (WB PGMAT 2014)
• Laparoscopic cholecystectomy has emerged as a gold standard therapeutic option for the management of symptomatic cholelithiasis. However, adaptation of LC is associated with increased risk of complications, particularly bile duct injury ranging from 0.3 to 0.6%. Occurrence of BDI results in difficult reconstruction, prolonged hospitalization, and high risk of long-term complications
• Abnormal liver function test suggestive of BDI should be investigated further. A wide array of imaging techniques is used to identify the nature and extent of injury and the associated complications
• Abdominal ultrasonography as the initial investigation of choice may demonstrate fluid collection within the right subhepatic space in addition to revealing a proximal dilated biliary system in patients with complete division of the CBD .Further investigation is then warranted in the evaluation of the cause of this collection or suspected obstruction.
• In many cases, abdominal CT is unhelpful merely confirming the ultrasound appearance Endoscopic retrograde cholangiography (ERCP) and magnetic resonance cholangiography (MRC) examination are likely to demonstrate the presence of biliary leak and often provide the level of duct laceration or transaction). ERCP in addition provides a therapeutic option in this scenario when sphincterotomy and endobiliary stenting may be considered ,other therapeutic intervention commonly used includes percutaneous transhepatic cholangiography, transhepatic biliary drainage, and percutaneous drainage of intra-abdominal collection .Due to its excretion into the biliary tree h-imino-diacetic acid (HIDA), scintigraphy may be of value in investigation of patients with suspected biliary leak. It may also demonstrate continuity between the biliary tree and the subhepatic collection
@9. Most common anterior mediastinal tumor in adults is
a. Thymoma
b. Neurogenic cyst
c. Lymphoma
d. Ectopic thyroid
Ans A (WB PGMAT 2014)
Most common primary anterior mediastinal tumor (20%) in adults but rarely seen in children is thymoma
# Radiology
@69. The earliest radiographic changes seen on X Ray in Cystic fibrosis (CF) include ?
a) bronchial wall thickening
b) overinflation
c) Fibrotic changes
d) cysts
Ans B (WB PGMAT2014)
The earliest radiographic changes indicating lung disease in cystic fibrosis are overinflation or atelectasis,probably related to mucus plugging.Withprogression from a bron- chiolitis to bronchitis,bronchial wall thickening occurs giving radiographic circular lesion sort tramlines depending on the orientation of the bronchi to the x ray beam. Progressive bronchiectasis is associated with the ap- pearance of cysts and rounded opacities, depending on their content of mucopus, which may coalesce into large lesions. Fibrotic changes may cause a generalised increase in background shadowing on the radiograph.
Although the lung manifestations of CF can be highly variable most patients with CF demonstrate some of the classic chest radiographic findings that reflect chronic bronchiectasis: hyperinflation, bronchial thickening and dilatation, peribronchial cuffing, mucoid impaction, cystic radiolucencies, an increase in interstitial markings, and scattered nodular densities. Complications of advanced CF include atelectasis, mucoid impaction, pneumothorax, pneumomediastinum, pulmonary hemorrhage, cardiomegaly, and enlargement of the pulmonary artery with cor pulmonale. Scoring systems have been developed to grade the chest radiograph in CF and to more accurately quantitate the severity of disease. Currently, the Brasfield system is in widest use.

@ Squared patella and notched femoral condyles is a radiologic feature seen in ?
a. Hemophilia
b. Thalassemia
c. TB Kee
d.Osgood schattler disease
Hemophilic arthropathy
◦ widened intercondylar notch
◦ squared inferior margin of the patella
◦ bulbous femoral condyles
◦ flattened condylar surfaces
# spm
@ Grass root workers are all except
a. Health assistants (HA)
b. Traditional Birth attendants (TBA)
c. Anganwadi workers (AWW)
d. Village health guides (VHG)
Ans A (WB PGMAT 2014)

@ Fraction of TT leprosy in India and Africa?
a. 30 %
b. 50 %
c. 70 %
d. 90 %
Ans D (WB PGMAT 2014)
In India and Africa, 90% of cases are tuberculoid; in Southeast Asia, 50% are tuberculoid and 50% lepromatous; and in Mexico, 90% are lepromatous

@ High risk group for HIV are all except?
a. Homosexuals
b. Hemophilia
c. Health workers
d. Heroin addicts
Ans C (WB PGMAT 2014)
But by 1982, the CDC named four groups as “risk factors” for HIV infection: homosexuals, heroin addicts , hemophiliacs and Haitians.

# Anesthesia
@ Dissociative anesthesia is seen with
a) Halothane
b) Isoflurane
c) enflurane
d) ketamine
Ans D (WB PGMAT 2014)

@ True regarding inhalational anesthesia ?
a. Blood Gas partition coefficient of sevoflurane is 0.42
b. Desflurane is used for induction
c. Sevoflurane produces compound A
d. Desflurane can be used with halothane vaporizer
Ans C (WB PGMAT 2014)
The inhaled anaesthetic sevoflurane is metabolised into two products that have the potential to produce renal injury. Fluoride ions are produced by oxidative defluorination of sevoflurane by the cytochrome P450 system in the liver.
Compound A (fluoromethyl-2,2-difluoro-1-[trifluoromethyl] vinyl ether) is a breakdown product of sevoflurane produced by its interaction with carbon dioxide absorbents in the anaesthesia machine
Some drawbacks of desflurane are its low potency, its pungency and its high cost. It may cause tachycardia and airway irritability when administered at concentrations greater than 10 vol%. Due to this airway irritability, desflurane is infrequently used to induce anesthesia via inhalation techniques.
There are generally two types of vaporizers: plenum and drawover. Both have distinct advantages and disadvantages.
A third type of vaporizer is exclusively used for the agent desflurane.

@30. Longest acting Local Anesthetic ?
a. Ropivacaine
b. Bupivacaine
c. Prilocaine
d. Lignocaine

Ans B (WB PGMAT2014)
Drug Onset Maximum Dose

(with Epinephrine)


(with Epinephrine)

Lidocaine Rapid 4.5 mg/kg (7 mg/kg) 120 min (240 min)
Mepivacaine Rapid 5 mg/kg (7 mg/kg) 180 min (360 min)






2.5 mg/kg (3 mg/kg)

2-3 mg/kg

2.0 mg/kg or 400mg in 24 hrs

4 hours (8 h)

3 hours (6 h)

4-6 hours (8-12 h)

Procaine Slow 8 mg/kg (10 mg/kg) 45 min (90 min)
Chloroprocaine Rapid 10 mg/kg (15 mg/kg) 30 min (90 min)
Etidocaine Rapid 2.5 mg/kg (4 mg/kg) 4 hours (8 h)
Prilocaine Medium 5 mg/kg (7.5 mg/kg) 90 min (360 min)
Tetracaine Slow 1.5 mg/kg (2.5 mg/kg) 3 hours (10 h)

@ Absolute contraindication to elective use of the Laryngeal Mask Airway include all except
a) hiatus hernia
b) Oropharyngeal pathology
c) Prone position
d) Glottic surgery

Ans C (WB PGMAT 2014)
Absolute Contraindications
• Full stomach / significant aspiration risk (including hiatus hernia)
• Extremely morbidly obese patients (non-rescue situations)
• Untrained in LMA use
• Oropharyngeal pathology very likely to result in a poor mask fit (e.g., radiotherapy for hypopharynx/larynx)
• Glottic surgery (some forms)
Relative Contraindications
• PPV with AWP > 20 cm H2O (stiff lungs, Trendelenburg position, laparoscopy)
• Very long cases
• Prone position
# Pediatrics
@ Most common suprasellar lesion in pediatric age group is
a. Glioma
b. Medulloblastoma
c. Craniopharyngioma
d. Cerebral lymphoma
Ans C (WB PGMAT 2014)

In contrary to the adult age the most common suprasellar tumors in children are with decreasing frequency craniopharyngiomas, chiasmatic/hypothalamic low-grade gliomas, germinomas and lesions attributable to a LangerhAns C (WB PGMAT 2014)ell histiocytosis. For differential diagnostic purposes also the rare hypothalamic hamartoma and meningeal metastases in the infundibular recess of the third ventricle are included

@Signs of severe dehydration by WHO are all except
a. Not able to drink
b. Sunken eyes
c. Irritability
d. Skin pinch recoil
Ans C (WB PGMAT 2014)

Assessment of dehydration
According to the World Health Organization (WHO), a patient exhibiting 2 of the following signs can be considered to have some amount of dehydration:
• Restless, irritable
• Sunken eyes
• Thirsty, drinks eagerly
• Skin pinch goes back slowly
According to the WHO, a patient exhibiting 2 of the following signs can be considered to have severe dehydration:
• Lethargic or unconscious
• Sunken eyes
• Not able to drink or drinking poorly
• Skin pinch goes back very slowly

separate studies looking at individual signs and symptoms of dehydration found only abnormal capillary refill (>2 sec), decreased skin turgor, and abnormal respiratory pattern (hyperpnea) had statistically and clinically significant positive and negative likelihood ratios for detecting dehydration in children

@ A child can copy triangle at age of ?
a. 3 yrs
b. 4 yrs
c. 5 yrs
d. 6 yrs
Ans C (WB PGMAT 2014)

All the following are seen in ostium secundum ASD except
a) right atrial enlargement
b) left atrial enlargement
c) right ventricular dilation
d) increased pulmonary arterial vascularity
Ans B (WB PGMAT2014)
Routine chest radiography is not essential in the evaluation of a child with a suspected secundum atrial septal defect. They demonstrate increased pulmonary arterial vascularity with a prominent pulmonic trunk, right atrial enlargement, no evidence of left atrial enlargement, and right ventricular dilation.
Echocardiography is essential in the evaluation of a child with a suspected atrial septal defect. The right atrium and right ventricle are dilated; paradoxical motion of the ventricular septum is usually present.
Two-dimensional imaging from the subcostal position best reveals the defect in the atrial septum. The diameter of the defect can be measured, multiple defects can be identified, and associated anomalies can be evaluated. Some investigators use 3-dimensional echocardiography to provide an accurate assessment of the exact shape of the defect because this can be important in device closure of atrial septal defects.
Color Doppler studies provide direct, simulated visualization of flow from the left atrium to the right atrium. This flow is not turbulent when the defect is large enough to be clinically apparent because its size eliminates the pressure difference between the atria.
Complete echocardiographic examination must also identify normality of the coronary sinus, normal entrance of the pulmonary veins, an intact primum portion of the atrial septum, and normal mitral valve function. Left ventricular contractility may appear abnormal due to the dilated right ventricle. This corrects rapidly after atrial septal defect closure.
Transesophageal echocardiography may be necessary in some patients because of large body size or other impediments to adequate transthoracic visualization. Transesophageal echocardiography is also used during interventional catheterization to close a secundum atrial septal defect by guiding device placement

# Pathology
@43. Medulloblastoma are classified by WHO as grade ?
a. I
b. II
c. III
d. IV
Ans D (WB PGMAT 2014)
All medulloblastomas are considered to be malignant and invasive tumors and are thus classified as grade IV by the WHO. These are highly cellular neoplasms that are composed of cells with small- to medium-sized, hyperchromatic nuclei and little apparent cytoplasm,

@Idiopathic thrombocytopenic purpura is caused by which of the following types of hypersensitivity
a) type 1
b) type 2
c) type 3
d) type 4
Ans B (WB PGMAT2014)
@ Call Exner bodies are hallmark of
a) Serous cysadenoma
b) Mucous cystadenoma
c) Granulosa cell tumor
d) Teratoma
Ans C (WB PGMAT 2014)
Call–Exner bodies are small eosinophilic fluid-filled spaces between granulosa cells.

@ Post streptococcal glomerulonephritis (PSGN) is characterized by all except
a) low C3 beyond 6-8 weeks
b) high ASO
c) microscopic hematuria
d) anti-DNAase B
Ans A (WB PGMAT 2014)
Theoretically, the complement (or C3) levels should be decreased in all such patients; however, the duration of low values may be quite brief and, therefore, missed, even when examined serially. When the serum level is low in individuals with APSGN, a depressed level for longer than 6-8 weeks is unusual. Thus, if the value remains low after this period of time, thinking of some other nephritic process, such as membranoproliferative glomerulonephritis (MPGN), is wise
A urinalysis is helpful as microscopic hematuria is typically present in children with APSGN.
Recent poststreptococcal infection is most commonly demonstrated by serological markers for elevated antibodies to extracellular streptococcal antigens. The streptozyme test, which measures 5 different streptococcal antibodies, is positive in more than 95% of patients with APSGN due to pharyngitis. However, sensitivity drops to 80% if APSGN follows pyoderma
Apart from antistreptokinase (ASKase), all other streptococcal antibodies are commonly elevated after a pharyngitis, whereas only anti-DNAase B and AHase titers are typically increased after pyoderma. Thus, if only an ASO titer is used to screen for APSGN after skin infections, it may be falsely low or negative, and if the patient has received prior antibiotic treatment for a pharyngitis, this may blunt the rise in ASO titer.
Indications for kidney biopsy include the following:
◦ Failure to document a recent streptococcal infection by a rise in ASO or streptozyme titer
◦ Normocomplementemia
◦ Renal insufficiency, especially if the glomerular filtration rate remains less than 30 mL/min/1.73 m2 for more than 1 week
◦ Persistently low complement (C3) levels beyond 6-8 weeks, without resolution of features of acute glomerulonephritis.
Recurrent episodes of hematuria, especially frank hematuria

@ Predominant glomerular lesion in HIV associated nephropathy (HIVAN) is histologically characterized as
a) MPGN Type 1
b) MPGN Type 2
c) Membranous glomerulonephrits
Ans D (WB PGMAT 2014)
FSGS is the predominant glomerular lesion in HIVAN

# MedIcine
@70. Typical organism responsible for lung injury in cystic fibrosis?
a. Pseudomonas aeruginosa
b. Burkholderia cepacia
c. Hemophilus influenzae
d. Streptococcus pnuemoniae
Ans A (WB PGMAT 2014)
Some common bacteria in cystic fibrosis are listed below.
• Staphylococcus aureus: This is commonly carried on the skin and nose.
• Pseudomonas aeruginosa: This is the main most common bacteria responsible for lung injury in CF patients and can be difficult to treat.
• Burkholderia cepacia: This is a particularly aggressive bacteria that can cause a rapid decline in lung function. It and is often difficult to treat.
• Aspergillus fumigatus: This is a fungus or mold that is common in the environment. It may or may not cause symptoms if it is present in the lungs. Some patients develop an allergy to the Aspergillus fumigatus. This allergy is called allergic bronchopulmonary aspergillosis or ABPA. Treatment of this organism depends on your symptoms.

@ 67. Which of the following lung lesion is not related to smoking?
a. Pulmonary LangerhAns C (WB PGMAT 2014)ell histiocytosis (PLCH)
b. Bronchiolitis obliterans organizing pneumonia (BOOP)
c. Desquamative interstitial Pneumonia (DIP)
d. acute eosinophilic pneumonia (AEP)
Ans B (WB PGMAT2014)
Bronchiolitis obliterans organizing pneumonia (BOOP) is a non-infectious pneumonia; specifically, an inflammation of the bronchioles (bronchiolitis) and surrounding tissue in the lungs. It is often a complication of an existing chronic inflammatory disease such as rheumatoid arthritis, or it can be a side effect of certain medications such as amiodarone.
BOOP occurs equally among men and women, and is not related to smoking.
Respiratory bronchiolitis (RB) and desquamative interstitial pneumonia (DIP) are closely associated histological patterns of interstitial pneumonia, although there are no studies on the extent of individual histological parameters. Furthermore, the term smoking related-interstitial lung disease (SR-ILD) has been proposed as a term to encompass patients with both these histological patterns who give a history of smoking, though it is not well defined how this term relates to historical cases of DIP.
• Smoking related lung diseases are the respiratory manifestations of disease that is related to smoking.
• Smoking effects the lungs in numerous ways, and can be classified under the following headings:
• smoking related interstitial lung diseases (SR-ILD)
• respiratory bronchiolitis
• respiratory bronchiolitis ILD (RB-ILD)
• desquamative interstitial pneumonitis (DIP)
• pulmonary LangerhAns C (WB PGMAT 2014)ell histiocytosis (PLCH)
• acute eosinophilic pneumonia (AEP)
• combined pulmonary fibrosis and emphysema
• neoplasms
• lung cancer
• tracheal tumours
• obstructive pulmonary disease
• emphysema
• constrictive bronchiolitis

@66. All are true about Pulmonary langerhAns C (WB PGMAT 2014)ell histiocytosis (PLCH) except ?
a. 20-40 male
b. associated with smoking
c. Pneumothorax in 10%
d.increased diffusing capacity for carbon monoxide (DLco)
Ans D (WB PGMAT 2014)

Unlike systemic LangerhAns C (WB PGMAT 2014)ell histiocytosis or that confined to bone (eosinophilic granuloma) which is seen in paediatric population, pulmonary LCH is usually identified in young adults (20-40 years of age). A history of current or previous cigarette smoking is identified in up to 95% of cases
About two-thirds of patients are symptomatic at presentation. Dyspnea and unproductive cough are the most common symptoms at diagnosis. Constitutional manifestations, including fever, sweats, and weight loss occur in 15-20% of patients. Chest pain usually indicates pneumothorax which occurs in about 15% of patients. Hemoptysis is uncommon. Pulmonary function is frequently abnormal at presentation but up to 20% of patients have normal pulmonary function tests at diagnosis. The course of PLCH in adults is variable and unpredictable. PLCH may occur as part of multisystemic LangerhAns C (WB PGMAT 2014)ell Histiocytosis syndromes
Pulmonary Langerhans’ cell histiocytosis (PLCH) is an unusual cystic lung disease that is also characterized by extrapulmonary manifestations.
PLCH was once considered to be more common in men), but more recently has been reported at least as frequently in women as in men .The latter finding is believed to have resulted from changes in the epidemiology of smoking over the past few decades . Indeed, smoking is strongly associated with PLCH; at least 90% of PLCH patients are current smokers
Pulmonary function tests in patients with PLCH are variable, with the most common abnormality being a reduced diffusing capacity for carbon monoxide (DLco) – observed in at least 70% of patients

@52. Aura with seizures is a feature of ?
a. Primary Generalised tonic clonic seizeres
b. Petit mal seizures
c simple partial seizures
d Myoclonic seizures
Ans C (WB PGMAT 2014)
Auras occur in approximately 80% of temporal lobe seizures. They are a common feature of simple partial seizures

@Manifestation of Grave’s disease that worsen with radiation therapy ?
a. Pretibial myxedema
b. Thyroid acropathy
c. Thyroid ophthalmopathy
d. Tremors
Ans C (WB PGMAT 2014)
reatment of the overactive thyroid gland with radiation therapy is more likely to worsen the eye disease
@45. HIV defining lesion include all except
a) Esophageal candidiasis
b) Pulmonary tuberculosis
c) Cytomegalovirus retinitis
d) Kaposi’s sarcoma
Ans B (WB PGMAT2014)
• 1987 definition
o Candidiasis of bronchi, trachea, or lungs
o Candidiasis esophageal
o Coccidioidomycosis, disseminated or extrapulmonary
o Cryptococcosis, extrapulmonary
o Cryptosporidiosis, chronic intestinal for longer than 1 month
o Cytomegalovirus disease (other than liver, spleen or lymph nodes)
o Cytomegalovirus retinitis (with loss of vision)
o Encephalopathy (HIV-related)
o Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis
o Histoplasmosis, disseminated or extrapulmonary
o Isosporiasis, chronic intestinal (for more than 1 month)
o Kaposi’s sarcoma
o Lymphoma, Burkitt’s
o Lymphoma, immunoblastic (or equivalent term)
o Lymphoma, primary, of brain
o Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary
o Mycobacterium, other species, disseminated or extrapulmonary
o Mycobacterium tuberculosis, any site (extrapulmonary)
o Pneumocystis jirovecii pneumonia (formerly Pneumocystis carinii)
o Progressive multifocal leukoencephalopathy
o Salmonella septicemia (recurrent)
o Toxoplasmosis of the brain
o Tuberculosis, disseminated
o Wasting syndrome due to HIV
• Added in 1993
o Cervical cancer (invasive)
o Mycobacterium tuberculosis, any site (pulmonary)
o Pneumonia (recurrent)
• Children < 13 years
o Additional conditions are included for children less than 13
o Bacterial infections, multiple or recurrent
o Lymphoid interstitial pneumonia or pulmonary lymphoid hyperplasia complex
• Dominant cause
o Cryptococcosis causing fungi C. gattii and C. neoformAns A (WB PGMAT 2014)re found in California trees (and soil), among other parts of the globe, and is said to be responsible for 60-70% of all AIDS defining illness

@ Post streptococcal reactive arthritis (PSRA) differ from acute rheumatic fever (ARF) by all except
a) PSRA is poorly responsive to salicylates
b) PSRA generally has a shorter latency to onset after streptococcal infection than ARF
c) PSRA resolves in 2 weeks
d) PSRA arthritis is additive, symmetric
Ans C (WB PGMAT 2014)
The presentation of arthritis following streptococcal pharyngitis is often considered to be a manifestation of acute rheumatic fever (ARF). Poststreptococcal reactive arthritis (PSRA) is a clinically distinct entity from ARF and can often manifest with arthritis alone. Much like ARF, development of PSRA is less common in the context of a properly treated streptococcal infection.
Given that the distinction in diagnoses may have important ramifications in treatment and surveillance of these diseases, it is important to understand the following clinical question: What is post-streptococcal reactive arthritis and how does it differ from acute rheumatic fever?
Alternatively, the proposed diagnostic criteria for PSRA includes the following clinical features:
1) an acute arthritis which is poorly responsive to salicylates or NSAIDs,
2) evidence of antecedant group A streptococcal infection and 3) a failure to fulfill the Jones Criteria for ARF. There has been concern, however, that these suggested guidelines may lead to the over diagnosis of ARF and under diagnosis of PSRA as there are a large number of patients who meet the Jones Criteria with 1 major criterion and 2 minor criteria (e.g. arthritis, elevated ESR/CRP and fever) who may be better classified as having PSRA
ARF is generally a disease of children, most commonly manifesting between 4-9 years of age, while PSRA follows a bimodal age distribution between the first and second decades and the third and fourth decades, respectively. This distinction also separates PSRA from reactive arthritis which has a single peak of distribution between 27-34 years of age. PSRA generally has a shorter latency to onset after streptococcal infection than ARF (within 2 weeks versus 2-3 weeks). The character of the arthritis in ARF is usually migratory and resolves within two weeks while in PSRA it is additive, symmetric, and averages at least two months in duration with reported cases of arthritis lasting as long as eight months. The involved joints, in order of frequency, include the knees, ankles, hips, wrists, shoulders and elbows Finally, the response of ARF to aspirin and NSAIDs is rapid and impressive while in PSRA the benefit of NSAIDs is characteristically minimal

Poststreptococcal reactive arthritis (PSRA)
• It refers to a poststreptococcal arthritic condition that does not fulfill the Jones Criteria for diagnosis of acute rheumatic fever. Clinical features include additive rather than migratory arthritis that responds relatively poorly to salicylates and nonsteroidals; persistence for mean of 2 months; elevated acute phase reactants; and laboratory (usually serologic) evidence of recent group A streptococcal infection.
• PSRA is not associated with HLA-B27 but rather with HLA-DRB1*01. Because up to 6% of PSRA patients develop mitral valve disease, it is recommended that antistreptococcal prophylaxis be administered for 1 year and then discontinued if there is no evidence of cardiac involvement.
• A more recent addition to the reactive arthropathies, and differing from the arthritis of acute rheumatic fever, is the entity known as poststreptococcal reactive arthritis (PSRA)

# Ophthalmology
@54. Shaffer’s sign , clumping of pigment cells within the anterior vitreous on ophthalmoscopy is seen in
a) Tractional retinal detatchment
b) Rhegmatogenous retinal detatchment
c) Exudative retinal detatchment
d) Eales disease
Ans B (WB PGMAT2014)
Ophthalmoscopy in cases of RRD usually reveals a clumping of pigment cells within the anterior vitreous (Shaffer’s sign)
There may be an area of white or grayish elevated retina adjacent to the instigating retinal break. If a significant area of the retina is involved, you may note a milky, lackluster appearance with undulating retinal folds.

@ First clinical manifestation of Siderosis bulbi ?
a. Lens staining
b. Retina degeneration
c. Iris pigmentation
d. Conjunctival congestion
Ans A (WB PGMAT 2014)
Iron intraocular foreign bodies can result in siderosis bulbi, a condition characterized by deposition of iron molecules in the trabecular meshwork, lens epithelium, iris, and retina . The epithelium and cortical fibers of the affected lens at first show a yellowish tinge, followed later by a rusty brown discoloration. Lens involvement occurs more rapidly if the retained foreign body is embedded close to the lens. Later manifestations of siderosis bulbi are complete cortical cataract formation and retinal dysfunction
@28. Mechanism of action of Pilocarpine in treatment of glaucoma ?
a. Increased aqueous humor outflow
b. Decreased aqueous humor secretion
c. Ciliary muscle relaxation
d. All of above
Ans A (WB PGMAT 2014)

It has also been used in the treatment of chronic open-angle glaucoma and acute angle-closure glaucoma for over 100 years . It acts on a subtype of muscarinic receptor (M3) found on the iris sphincter muscle, causing the muscle to contract -resulting in pupil contraction (miosis). Pilocarpine also acts on the ciliary muscle and causes it to contract. When the ciliary muscle contracts, it opens the trabecular meshwork through increased tension on the scleral spur. This action facilitates the rate that aqueous humor leaves the eye to decrease intraocular pressure.
# Dermatology
@ 59. HLA B*1502 mutation causes a skin reaction with which drug?
a. Phenytoin
b. Valproate
c. Carbamazepine
d. lamotrigine
Ans C (WB PGMAT 2014)
Recently, the USA FDA has made a labeling change to the drug information contained in carbamazepine. Owing to recent data implicating the HLA allele B*1502 as a marker for carbamazepine-induced Stevens–Johnson syndrome and toxic epidermal necrolysis in Han Chinese, the FDA recommends genotyping all Asians for the allele. This allele is seen in high frequency in many Asian populations other than Han Chinese, but there are few data on whether the allele is a marker for this severe outcome in anyone other than Han Chinese.

@49. Yellow kit NACO contains all the following drugs except
a) cefixime
b) metronidazole
c) doxycycline
d) azithromycin
Ans D (WB PGMAT 2014)

@ 41. Erythema nodosum leprosum (ENL) occurs in which form of leprosy?
a) LL
b) BL
c) BT
d) TT
Ans A (WB PGMAT 2014)
Attending to the clinical and histopathological manifestations, leprosy reactions may be separated in 2 or 3 different variants: reverse reaction (type I), erythema nodosum leprosum (type II), erythema polymorphous (type II) and Lucio’s phenomenon, mainly considered a type II reaction, but sometimes designated type III. Type I leprosy reaction, also named “upgrading reaction,” occurs in borderline leprosy states and is associated with a shift toward the tuberculoid pole. Type II reaction usually occurs in lepromatous leprosy, and there are 3 different clinical variants, including erythema nudosum leprosum, erythema polymorphous-like reaction, and Lucio’s phenomenon.
@42. Most common site for Fixed drug reaction (FDR) is :
a. Genitalia
b. Trunk
c. Limb
d. Face
Ans A (WB PGMAT 2014)

@ Topically used drug in treatment of molluscum contagiosum is ?
a. Cidofovir
b. Lamivudine
c. Abacavir
d. Nelfinavir
Ans A (WB PGMAT 2014)
Cidofovir is a selective inhibitor of viral DNA production in cytomegalovirus and other herpes viruses. One case report showed improvement in 3 out of 3 patients with HIV and extensive co-infection with molluscum contagiosum virus.
Ritonavir is an antiretroviral protease inhibitor. In one case report, a patient with HIV and intractable molluscum contagiosum had resolution of lesions after treatment
Astringent chemicals applied to the surface of molluscum lesions to destroy successive layers of the skin include potassium hydrochloride, and cantharidin

For mild cases, over-the-counter wart medicines, such as salicylic acid may or may not shorten infection duration. Daily topical application of tretinoin cream may also trigger resolution. These treatments require several months for the infection to clear, and are often associated with intense inflammation and possibly discomfort.

Imiquimod, a form of immunotherapy, had been proposed as a treatment for molluscum, based on promising results in small case series and clinical trials

# Pharmacology
@Which of the following antiepileptic reduces calcium currents via T-type calcium channels
a) tiagabine
b) ethosuximide
c) lamotrigine
d) Zonisamide
Ans B (WB PGMAT2014)
Gamma-aminobutyric acid (GABA), one of the main inhibitory neurotransmitters in the brain, interacts with three types of receptors for GABA–GABA(A), GABA(B) and GABA(C). GABA(A) receptors, associated with binding sites for benzodiazepines and barbiturates in the form of a receptor complex, control opening of the chloride channel. When GABA binds to the receptor complex, the channel is opened and chloride anions enter the neuron, which is finally hyperpolarized. GABA(B) receptors are metabotropic, linked to a cascade of second messengers whilst the physiological meaning of ionotropic GABA(C) receptors, mainly located in the retina, is generally unknown. Novel antiepileptic drugs acting selectively through the GABA-ergic system are tiagabine and vigabatrin. The former inhibits neuronal and glial uptake of GABA whilst the latter increases the synaptic concentration of GABA by inhibition of GABA-aminotransferase. Gabapentin, designed as a precursor of GABA easily entering the brain, was shown to increase brain synaptic GABA. This antiepileptic drug also decreases influx of calcium ions into neurons via a specific subunit of voltage-dependent calcium channels. Conventional antiepileptics generally inhibit sodium currents (carbamazepine, phenobarbital, phenytoin, valproate) or enhance GABA-ergic inhibition (benzodiazepines, phenobarbital, valproate). Ethosuximide, mainly controlling absences, reduces calcium currents via T-type calcium channels. Novel antiepileptic drugs, mainly associated with an inhibition of voltage-dependent sodium channels are lamotrigine and oxcarbazepine. Since glutamate-mediated excitation is involved in the generation of seizure activity, some antiepileptics are targeting glutamatergic receptors–for instance, felbamate, phenobarbital, and topiramate. Besides, they also inhibit sodium currents. Zonisamide, apparently sharing this common mechanism, also reduces the concentration of free radicals

# Psychiatry
@ 48. All are true about delusion except
a) delusion is a belief that would be seen by most members of a society as a misrepresentation of reality
b) shared with many in groups
c) delusion is a disorder of thought content
d) delusions are maintained despite obvious, incontrovertible proof to the contrary
Ans B (WB PGMAT2014)

• A delusion is a belief that would be seen by most members of a society as a misrepresentation of reality.
• It is a disorder of thought content, not process
• Delusions are fixed, blatantly false convictions deduced from incorrect ideas about reality.
• They are maintained despite obvious, incontrovertible proof to the contrary.
• They are not widely believed in the person’s culture or subculture.
• A false belief that involves an extreme value judgment is a delusion only when it defies credibility.
• Systematized delusions have a common theme or event and make up a network of beliefs.
• Delusions occur in individuals, not groups.
• Exception in DSM: shared psychotic disorder (folie a deux): two people share a delusional belief. It can also occur “among a larger number of individuals” such as a family, in which children adopt the parents’ delusional beliefs.
• Shared Delusions
• Folie a deux: 90% of cases are within families
• Eg. Randy & Evi Quaid
• Occurs in delusional parasitosis
• Occurs in some twins
• Folie a trois, etc.
• Cults (eg., “we are God’s chosen ones”)
• Munchausen by proxy syndrome
• The parent and child believe the child is sick.
• Shared psychotic disorder
• Two or more people share a delusion
• Mass psychogenic illness
• Several people share physical symptoms (eg, blindness, paralysis, tics).
• Previously called “mass hysteria.”
• A form of conversion disorder (somatic symptoms due to psychological mechanisms).
• These people do not have a delusion

@33. Biploar with predominant depression is treated with:
a. Lithium carbonate
b. Lamotrigine
c. Amitryptiline
d. Fluoxetine
Ans B (WB PGMAT2014)
Lamotrigine and lithium were superior to placebo for the prevention of mood episodes in bipolar I patients, with lamotrigine predominantly effective against depression and lithium predominantly effective against mania

# Microbiology
@Which of the following is not a habitat of vagina?
a. Doderlein bacilli
b. Chlamydia
c. Candida
d. Streptococcus
Ans B (WB PGMAT2014)
Lactobacillus, also called Döderlein’s bacillus
The primary colonizing bacteria of a healthy individual are of the genus lactobacillus, such as L. crispatus, and the lactic acid they produce (some species produce hydrogen peroxide or antibiotic), in combination with fluids secreted during sexual arousal, are greatly responsible for the characteristic scent associated with the vaginal area.
The primary colonizing bacteria of a healthy individual are of the genus lactobacillus.[1] Since the first description of lactobacilli by Döderlein, lactobacilli have been’generally considered as the gatekeepers of the vaginal ecosystem. Lactobacilli have been shown to inhibit in vitro growth of pathogenic microorganisms, e.g. Bacteroides fragilis, Escherichia coli, Gardnerella vaginalis, Mobiluncus spp., Neisseria gonorrhoeae, Peptostreptococcus anaerobius, P. bivia and Staphylococcus aureus. It is generally accepted that this is achieved through the action of lactic acid primarily.
Several anaerobic bacterial species are frequently found in the vagina, such as the Gram positive cocci: Atopobium vaginae, Peptostreptococcus spp., Staphylococcus spp., Streptococcus spp., and Bacteroides spp., Fusobacterium spp., Gardnerella vaginalis, Mobiluncus, Prevotella spp., and Gram-negative enteric organisms, such as Escherichia coli.Also Candida albicans, Mycoplasma and Ureaplasma are frequently found in the vagina

@ 60. Sclerotic bodies are seen in:
a. Chromoblastomycosis
b. Rhinosporidiosis
c. Sporotrichosis
d. Rhinoscleroma
Ans A (WB PGMAT 2014)

Nowadays, the term chromoblastomycosis is restricted to the cases in which sclerotic cells are present in tissue. Sclerotic cells, also known as Medlar bodies, are globe-shaped, cigar-colored, thick-walled structures that are 4-12 µm in diameter
# gob
@ 154. Pain in fibroid during pregnancy is most commonly due to :
a. Red degeneration
b. Hyaline degeneration
c. Calcerous degeneration
d. Torsion
Ans A

Red degeneration in pregnancy is believed to occur when a fibroid outstrips its blood supply, leading to progressive degeneration and necrosis.
2. These patients often present with an acute abdomen, with non-specific symptoms.
3. Ultrasound allows rapid and easy detection of fibroids. However, ultrasound is not sensitive for determining the presence of red degeneration.
4. As red degeneration is self-limiting, the management is usually conservative.
@ 155. Oxidative burst and phagocytosis are mediated by ?
a. IL 2
b. IL 4
c. IL 5
d. G-CSF
Ans D
prolonged in vitro or in vivo exposure to IL-8 and/or G-CSF enhances the subsequent oxidative burst and phagocytic responses of bovine neutrophil
# Microbiology
@156. Endemic typhus is caused by?
a. R. prowazekii
b. R. tsutsugamushi
c. Bartonella quintana
d. R. typhi
Ans D

• Endemic typhus fever is a disease caused by bacteria called Rickettsia typhi or bacteria called Rickettsia felis
• Typhus is caused by one of two types of bacteria: Rickettsia typhi or Rickettsia prowazekii.
• Rickettsia typhi causes murine or endemic typhus.
• Endemic typhus. It is usually seen in areas where hygiene is poor and the temperature is cold. Endemic typhus is sometimes called “jail fever.” The bacteria that causes this type is usually spread by rats to fleas to humans.
• Murine typhus.. It is often seen during the summer and fall. It is rarely deadly. You are more likely to get this type of typhus if you are around rats feces or fleas, and other animals such as cats, opossums, raccoons, and skunks.
Rickettsia prowazekii causes epidemic typhus. It is spread by lice.
Brill-Zinsser disease is a mild form of epidemic typhus. It occurs when the bacteria re-activates in a person who was previously infected. It is more common in the elderly.
The causative agent of scrub typhus formerly known as R. tsutsugamushi has been reclassified into the genus Orientia.
@158. Which of the following Ulcerative colitis (UC) involved?
a. mucosa
b. submucosa
c. muscularis
d. All of the above
Ans A
# Medcine
@ 159. Metabolic acidosis is associated with:
a. hyperventilation
b. hypokalemia
c. hypoaldosteronism
d. hypochloremia
Ans C

@ 160. Non anion gap acidosis is seen in?
a. ARF due to PSGN
b Diabetic ketoacidosis
c.Distal Renal tubular acidosis
d. Aspirin intoxication
Ans C

High anion gap.
• Lactic acidosis
• Ketoacidosis
• Diabetic ketoacidosis
• Alcohol abuse
• Toxins:
o Methanol
o Ethylene glycol
o Propylene glycol
• Lactic acid
• Uremia
• Aspirin
• Phenformin
• Iron
• Isoniazid
Cyanide, coupled with elevated venous oxygenation
Renal failure, causes high anion gap acidosis by decreased acid excretion and decreased HCO3− reabsorption.
Accumulation of sulfates, phosphates, urate, and hippurate accounts for the high anion gap.

# Pathology
@ B Lymphocyte marker is ?
a. CD 3
b. CD 19
c. CD 8
d. CD 16
Ans b

• CD16 should be a good NK marker in the mouse
• Bcell CD19
• CD3 good pan T cell marker.
• Defects in CD19 cause immunodeficiency common variable type 3 characterized by antibody deficiency, hypogammaglobulinemia, recurrent bacterial infections and an inability to mount an antibody response to antigen
CD Markers
• stem cells CD34+, CD31-, CD117
• all leukocyte groups CD45+
• Granulocyte CD45+, CD11b, CD15+, CD24+, CD114+, CD182+
• Monocyte – CD45+, CD14+, CD114+, CD11a, CD11b, CD91+, CD16+
• T lymphocyte CD45+, CD3+
• T helper cell CD45+, CD3+, CD4+
• T regulatory cell CD4, CD25, and Foxp3
• Cytotoxic T cell CD45+, CD3+, CD8+
• B lymphocyte CD45+, CD19+ or CD45+, CD20+, CD24+, CD38, CD22
• Thrombocyte CD45+, CD61+
• Natural killer cell CD16+, CD56+, CD3-, CD31, CD30, CD38

# Anatomy
@ 153. Middle meningeal artery passes through?
a. Foramen ovale
b. Foramen spinosum
c. Foramen rotundum
d. Foramen lacerum
Ans B
The middle meningeal artery is typically the third branch of the first part (retromandibular part) of the maxillary artery, one of the two terminal branches of the external carotid artery. After branching off the maxillary artery in the infratemporal fossa, it runs through the foramen spinosum to supply the dura mater (the outermost meninges) and the calvaria. The middle meningeal artery is the largest of the three (paired) arteries that supply the meninges, the others being the anterior meningeal artery and the posterior meningeal artery.

# Biochemistry
@ 150. Which of the following is typical example of an allosteric enzyme?
a. Aspartate transcarbamoylase
b. xanthine oxidase
c. Uricase
d. All of above
Ans A
The enzyme aspartate transcarbamoylase (ATCase) is an allosteric enzyme

# Dermatology
@ 151. Melanocytes are found in which layer of skin ?
a. Stratum corneum
b. Stratum granulosum
c. Stratum basale
d. Dermis
Ans C
The epidermis is avascular, nourished almost exclusively by diffused oxygen from the surrounding air. It is 95% keratinocytes but also containing melanocytes, Langerhans cells, Merkel cells, and inflammatory cells. Rete ridges (“rete tips”) are epidermal thickenings that extend downward between dermal papillae.
Blood capillaries are found beneath the epidermis, and are linked to an arteriole and a venule.

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

• cornified layer (stratum corneum)
o Composed of 10 to 30 layers of polyhedral, anucleated corneocytes (final step of keratinocyte differentiation), with the palms and soles having the most layers. Corneocytes are surrounded by a protein envelope (cornified envelope proteins), filled with water-retaining keratin proteins, attached together through corneodesmosomes and surrounded in the extracellular space by stacked layers of lipids. Most of the barrier functions of the epidermis localize to this layer.
o clear/translucent layer (stratum lucidum, only in palms and soles)
o The skin found in the palms and soles is known as “thick skin” because it has 5 epidermal layers instead of 4.
• granular layer (stratum granulosum)
o Keratinocytes lose their nuclei and their cytoplasm appears granular. Lipids, contained into those keratinocytes within lamellar bodies, are released into the extracellular space through exocytosis to form a lipid barrier.
o Those polar lipids are then converted into non-polar lipids and arranged parallel to the cell surface. For example glycosphingolipids become ceramides and phospholipids become free fatty acids.
• spinous layer (stratum spinosum)
o Keratinocytes become connected through desmosomes and start produce lamellar bodies, from within the Golgi, enriched in polar lipids, glycosphingolipids, free sterols, phospholipids and catabolic enzymes.
o Langerhans cells, immunologically active cells, are located in the middle of this layer.
• basal/germinal layer (stratum basale/germinativum).
o Composed mainly of proliferating and non-proliferating keratinocytes, attached to the basement membrane by hemidesmosomes.
o Melanocytes are present, connected to numerous keratinocytes in this and other strata through dendrites. Merkel cells are also found in the stratum basale with large numbers in touch-sensitive sites such as the fingertips and lips. They are closely associated with cutaneous nerves and seem to be involved in light touch sensation
# Surgery
@ 152. Laugier’s hernia develops through ?
a. Lacunar ligament
b. Conjoint tendon
c. pectineal fascia
d. lateral to femoral vessels
Ans a

a femoral hernia may arise in different locations developing through the lacunar ligament (Laugier’s hernia), through the pectineal fascia (Cloquet’s hernia), or in relation to the femoral vessels – lateral (Hesselbach’s hernia), prevascular (Velpeau’s hernia) or retrovascular (Serafini’s hernia).1

# Forensic
@ 148. Aseptic autolysis is seen in?
a. Mumification
b. Adipocere
c. Putrefaction
d. Maceration
Ans D
• Still birth
o It is the child (born after 28 weeks)which did not breathe or show any sign of life at any time after being expelled from the mother.
o Common causes are prematurity, anoxia, birth trauma especially intracranial hemorrhage due to excess moulding, placental abnormality.
• Dead birth:
o Is a child which has died in the utero and shows one of the following signs after complete birth:
o Rigor mortis at delivery
o Maceration (aseptic autolysis after 3-4 days in uterus filled with amniotic fluid and no air). The earliest sign of maceration is skin slippage, which can be seen in 12 hours after death in utero. The body of the macerated fetus is soft, flaccid, and flattens out when placed on a level surface. It has a sweetish disagreeable odor. Spalding’s sign is the loss of alignment and overriding of the bones of the cranial vault.
o Mummification: is the condition in which the fetus dries up, shriveled in the uterus. It occurs when fetus dies from deficient supply of blood, when the liqor amni is scanty and when no air enters the uterus.
@ 149. Which of the following is not seen in dead born fetus ?
a. Maceration
b. Adipocere
c. Rigor mortis
d. Mummification
Ans B

# gob
@ 147. All are causes of primary amenorhea except?
a. Mayer-Rokitansky-Küster-Hauser syndrome
b. Sheehan syndrome
c. Turner syndrome
d. Kallman syndrome
Ans B

# gob
@ 146. Precocius puberty in girls is defined by onset of puberty before?
a. 8
b. 9
c. 10
d. 12
Ans A
Precocious puberty is the onset of puberty at an abnormally early age; usually before the age of 8 in girls and 9 in boys

# Biochemistry
@ 145. Allosteric activator of enzyme glutamate dehydrogenase
a. ADP
b. GTP
c. cAMP
d. cGMP
Ans A
Glutamate dehydrogenase (GLDH) is an enzyme, present in most microbes and the mitochondria of eukaryotes, as are some of the other enzymes required for urea synthesis, that converts glutamate to α-ketoglutarate, and vice versa. In animals, the produced ammonia is usually used as a substrate in the urea cycle. Typically, the α-ketoglutarate to glutamate reaction does not occur in mammals, as glutamate dehydrogenase equilibrium favours the production of ammonia and α-ketoglutarate. Glutamate dehydrogenase also has a very low affinity for ammonia (high Michaelis constant K_m of about 1 mM), and therefore toxic levels of ammonia would have to be present in the body for the reverse reaction to proceed (that is, α-ketoglutarate and ammonia to glutamate and NAD(P)+). In bacteria, the ammonia is assimilated to amino acids via glutamate and aminotransferases. In plants, the enzyme can work in either direction depending on environment and stress.
Allosteric regulation:
• Allosteric inhibitors:
o Adenosine triphosphate (ATP)
o Guanosine triphosphate (GTP)
o Palmitoyl-CoA
o Zn2+
• Activators:
o Adenosine diphosphate (ADP)
o Guanosine diphosphate (GDP)
o Leucine
# Biochemistry
@ 141. Which of the following is not a nitrogenous waste product. ?
a. Bilirubin
b. Uric acid
c. urea
d. creatinine
Ans A

bile pigments are not a nitrogenous waste product.
Bilirubin, Formula C33H36N4O6

• Uric acid is a heterocyclic compound of carbon, nitrogen, oxygen, and hydrogen with the formula C₅H₄N₄O₃.
• Creatinine (C4H7N3O ) is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body
• Urea – CH4N2O
# Physiology

@ 142. Second messenger of G protein–coupled receptors (GPCRs)
a. cAMP
b. cGMP
c. adenylate cyclase
d. guanylate cyclase
Ans A
G protein–coupled receptors (GPCRs), also known as seven-transmembrane domain receptors, 7TM receptors, heptahelical receptors, serpentine receptor, and G protein–linked receptors (GPLR), constitute a large protein family of receptors that sense molecules outside the cell and activate inside signal transduction pathways and, ultimately, cellular responses. They are called seven-transmembrane receptors because they pass through the cell membrane seven times.
There are two principal signal transduction pathways involving the G protein–coupled receptors:
• the cAMP signal pathway and
• the phosphatidylinositol signal pathway.
# Physiology
@ 143. Intracellular receptor among the following :
a) calcitriol
b) Calcitonin
c) Platelet derived growth factor
d) Insulin
Ans A

Classification of hormones according to the mechanism of action.
• Group I Hormones that bind to intracellular
o Androgens Oestorgens Progestins
o Retinoic acid
o Glucocorticoids Mineralocorticoids
o Thyroid hormones
o Calcitriol
• Group II Hormones that bind to cell surface receptors
o Cyclic AMP as second messenger
• α2 adrenergic catecholamines
• β2 adrenergic catecholamines
• Calcitonin
• Somatostatin Glucagon
o Cyclic GMP as second messenger
• Atrio peptides
• Nitric oxide
o Calcium or phosphatidylinositides (or both) as second messenger
• Platelet derived growth factor
• Angiotensin II
• GnRH
o Kinase/phosphatase cascade as second messenger
• Insulin
• Growth hormone
• Epidermal growth factor
• Insulin like growth factors I and II Fibroblast growth factor
• Oxytocin
• Prolactin
• Nerve growth factor
• Epidermal growth factor
• Erythropoietin

Intracellular receptors are receptors located inside the cell rather than on its cell membrane.
• Classic hormones that use intracellular receptors include thyroid and steroid hormones.
• Examples are the class of nuclear receptors located in the cell nucleus and cytoplasm and the IP3 receptor located on the endoplasmic reticulum. The ligands that bind to them are usually intracellular second messengers like inositol trisphosphate (IP3) and extracellular lipophilic hormones like steroid hormones.
• Some intracrine peptide hormones also have intracellular receptors.
Cell surface receptors (membrane receptors, transmembrane receptors) are specialized integral membrane proteins that take part in communication between the cell and the outside world.
Extracellular signaling molecules (usually hormones, neurotransmitters, cytokines, growth factors or cell recognition molecules) attach to the receptor, triggering changes in the function of the cell. This process is called signal transduction:
The binding initiates a chemical change on the intracellular side of the membrane. In this way the receptors play a unique and important role in cellular communications and signal transduction.

# Micro
@129. Dengue fever is caused by:
a. Culex mosquito bite
b. Arbo virus
c. Adeno virus
d.Coxscakie B
Ans B

Dengue fever virus (DENV) is an RNA virus of the family Flaviviridae; genus Flavivirus. Other members of the same genus include yellow fever virus, West Nile virus, St. Louis encephalitis virus, Japanese encephalitis virus, tick-borne encephalitis virus, Kyasanur forest disease virus, and Omsk hemorrhagic fever virus. Most are transmitted by arthropods (mosquitoes or ticks), and are therefore also referred to as arboviruses (arthropod-borne viruses)
Dengue fever also known as breakbone fever, is a mosquito-borne tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs.

Dengue is transmitted by several species of mosquito within the genus Aedes, principally A. aegypti. The virus has five different types; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. As there is no commercially available vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites.

# Ortho
@132. A 10 yr old child presented with thigh pain with painfully restricted hip and knee movement, raised local temperature and 1000F fever . On clinical examination, the child is holding the hip slightly bent, turned outwards and away from the middle line X- ray normal.He has history of upper respiratory tract infection a week ago . Treatment is ?
a. Incision and drainage
b. observation
c. Aspiration
d. Blood culture and empirical antibiotic therapy .
Ans B
Transient synovitis usually affects children between three and ten years old (but it has been reported in a 3-month-old infant and in adult). It is the most common cause of sudden hip pain and limp in young children. Boys are affected two to four times as often as girls.The exact cause is unknown. A recent viral infection (most commonly an upper respiratory tract infection) or a trauma have been postulated as precipitating events, although these are reported only in 30% and 5% of cases, respectively.
Transient synovitis causes pain in the hip, thigh, groin or knee on the affected side. There may be a limp (or abnormal crawling in infants) with or without pain. In small infants, the presenting complaint can be unexplained crying (for example, when changing a nappy). The condition is nearly always limited to one side. The pain and limp can range from mild to severe.
Some children may have a slightly raised temperature; high fever and general malaise point to other, more serious conditions. On clinical examination, the child typically holds the hip slightly bent, turned outwards and away from the middle line (flexion, external rotation and abduction).Active and passive movements may be limited because of pain, especially abduction and internal rotation. The hip can be tender to palpation. The log roll test involves gently rotating the entire lower limb inwards and outwards with the patient on his back, to check when muscle guarding occurs. The unaffected hip and the knees, ankles, feet and spine are found to be normal.

@ 134. Karyotype of Oogonium ?
a. 22x
b. 22y
c. 46 XY
d. 23
Ans C

@133. Branch of 1st part of Axillary artery?
a. Superior thoracic artery
b. lateral thoracic artery
c. Acromio thoracic artery
d. Thoraco dorsal artery
Ans A
The axillary artery is often referred to as having three parts, with these divisions based on its location relative to the Pectoralis minor muscle, which is superficial to the artery.
• First part – the part of the artery medial to pectoralis minor
• Second part – the part of the artery that lies posteriorly to pectoralis minor
• Third part – the part of the artery lateral to pectoralis minor

She Tastes Like Sweet Apple Pie (Mnemonic)
Branches of Axillary artery
• First part (1 branch)
o Superior thoracic artery (Supreme thoracic artery)
• Second part (2 branches)
o Thoraco-acromial artery
o Lateral thoracic artery.
• Third part (3 branches)
o Subscapular artery
o Anterior humeral circumflex artery
o Posterior humeral circumflex artery

Continues as the brachial artery past the inferior border of the teres major.

@ 135. Muscle power of Grade 3 means :
a. Full range of motion without gravity
b. Full range of motion with gravity
c. Full range of motion , some resistance
d. Full range of motion, full resistance
Ans B
• 0 – No contraction
• 1 – Slight contraction, no movement
2 – Full range of motion without gravity
• 3 – Full range of motion with gravity
• 4 – Full range of motion , some resistance
• 5 – Full range of motion, full resistance
# gob
@ 136. Karyotype of patient with Testicular feminization is
a. XX
b. XY
c. XXY
d. XYY
Ans B

# Surgery
@ 137. Slipping rib syndrome involves all of the following ribs except ?
a. 5th rib
b. 8 th rib
c. 9th rib
d. 10 th rib
Ans A
Slipping rib syndrome is a condition that is often misdiagnosed or undiagnosed and can subsequently lead to months or years of unresolved abdominal and/or thoracic pain. Surgical findings suggest the condition arises from hypermobility of the anterior ends of the false rib costal cartilages, which often leads to slipping of the affected rib under the superior adjacent rib. This slippage or movement can lead to an irritation of the intercostal nerve,strain of the intercostal muscles,sprain of the lower costal cartilage,or general inflammation in the affected area.

The medical literature primarily refers to this condition as slipping rib syndrome. However, it has also been referred to as clicking rib, displaced ribs,interchondral subluxation, nerve nipping, painful rib syndrome, rib tip syndrome, slipping rib cartilage syndrome, traumatic intercostal neuritis, and 12th rib syndrome
Ribs 8 through 10 (false ribs), which are not connected to the sternum but are connected to each other via a cartilaginous cap or fibrous band, tend to be the most mobile and susceptible to trauma. Because of this, slipping rib syndrome is usually caused by hypermobility of rib 8, 9, or 10.

# Pharma
@138. Alpha glucosidase inhibitor among the following drugs
a. Miglitol
b. Metformin
c. Glimipiride
d. Rapaglinide
Ans A
• Examples of alpha-glucosidase inhibitors include:
o Acarbose
o Miglitol
o Voglibose
# Biochemistry
@ Number of ATP consumed to make 1 glucose molecule from 2 pyruvate molecules in gluconeogenesis ?
a. 1
b. 2
c. 3
d. 6
Ans D

• Glycolysis:
glucose + 2 NAD+ + 2 ADP + 2 Pi = 2 pyruvate + 2 NADH + 2 ATP
• Gluconeogenesis:
2 pyruvate + 2 NADH + 4 ATP + 2 GTP = glucose + 2 NAD+ + 4 ADP + 2 GDP + 6 Pi
• Glycolysis yields 2 ~P bonds of ATP.
• Gluconeogenesis expends 6 ~P bonds of ATP and GTP.
# Anatomy
@ 140. Juxtaglomerular apparatus include all except:
a. Podocytes
b. Mesangial cells
c. Macula densa
d. juxtaglomerular cells
Ans A

• The juxtaglomerular apparatus is a microscopic structure in the kidney that regulates the function of each nephron. The juxtaglomerular apparatus is named for its proximity to the glomerulus: It is found between the vascular pole of the renal corpuscle and the returning distal convoluted tubule of the same nephron. This location is critical to its function in regulating renal blood flow and glomerular filtration rate. The three cellular components of the apparatus are the macula densa of the distal convoluted tubule, smooth muscle cells of the afferent arteriole known as juxtaglomerular cells, and extraglomerular mesangial cells.

@ 161. Eosinophilic effusion is seen in all except:
a. Pneumothorax
b. pulmonary embolism
c. benign asbestos pleural effusions
d . Tuberculosis
Ans D

Eosinophilic pleural effusion occurs most commonly during conditions associated with the presence of blood or air in the pleural space, infections, and malignancy. Drug-induced pleural effusions, pleural effusions accompanying pulmonary embolism, and benign asbestos pleural effusions are also among the common causes of eosinophilic pleural effusion
The time course of the development of pleural fluid and serum eosinophilia in response to air or blood in the pleural space suggests that the specific mechanisms that trigger eosinophil accumulation may vary [6]. PFE develops within hours after a spontaneous pneumothorax compared to 10 to 14 days after the onset of a traumatic or hemorrhagic pleural effusion . In addition, pleural trauma and hemothorax, but not pneumothorax, are often associated with peripheral blood eosinophilia that develops days after PFE.
– Innate type 2 immunity is associated with eosinophilic pleural effusion in primary spontaneous pneumothorax
@ 163. Most often Monosaccharide separation is done by ?
a. Chromatography
b. Electrophoresis
c. X Ray crystallography
d. SDS PAGE technique
Ans A

Most often monosaccharide separations are done by chromatographic method
# gob
@ 164. pH in vagina in pre pubertal girl is ?
a. <4
b. 4-5
c. 6-7
d. >7
Ans D
Due to the low oestrogen levels, the vaginal pH in prepubertal girls is alkaline
@165. Most common site of genital tuberculosis is ?
a. uterus
b. Fallopian tube
c. ovary
d. cervix
Ans b
fallopian tube is the most common site in many studies

# Path
@166. Large abnormal mitochondria seen in?
a. Thyroid Oncocytoma
b . Medullary carcinoma of thyroid
c . papillary carcinoma of thyroid
d. Follicaular carcinoma of thyroid
Ans A
Thyroid oncocytoma is characterized by the presence of oncocytes containing abnormally large numbers of mitochondria.
# Micro
@ 167. False about L-form bacteria ?
a. Generated in presence of penicillin
b. these organisms may infect immunosuppressed patients having undergone bone marrow transplants

c. L means Lister institute, London
d. Mycoplasma are considered L-forms
Ans D

• L-form bacteria, also known as L-phase bacteria, L-phase variants, and cell wall-deficient (CWD) bacteria, are strains of bacteria that lack cell walls.
• They were first isolated in 1935 by Emmy Klieneberger-Nobel, who named them “L-forms” after the Lister Institute in London where she was working.
• Two types of L-forms are distinguished: unstable L-forms, spheroplasts that are capable of dividing, but can revert to the original morphology, and stable L-forms, L-forms that are unable to revert to the original bacteria.
• Some parasitic species of bacteria, such as mycoplasma, also lack a cell wall,but these are not considered L-forms since they are not derived from bacteria that normally have cell wall
• L-forms can be generated in the laboratory from many bacterial species that usually have cell walls, such as Bacillus subtilis or Escherichia coli. This is done by inhibiting peptidoglycan synthesis with antibiotics or treating the cells with lysozyme, an enzyme that digests cell walls. The L-forms are generated in a culture medium that is the same osmolarity as the bacterial cytosol (an isotonic solution), which prevents cell lysis by osmotic shock.[2] L-form strains can be unstable, tending to revert to the normal form of the bacteria by regrowing a cell wall, but this can be prevented by long-term culture of the cells under the same conditions that were used to produce them
• Recent study suggested that these organisms may infect immunosuppressed patients having undergone bone marrow transplants.he formation of strains of bacteria lacking cell walls has also been proposed to be important in the acquisition of bacterial antibiotic resistance.
# Pharma
@ 170. INR is monitored for therapy with ?
a. Warfarin
b. Heparin
c. Lepirudin
d. Enoxaparin
Ans A

@171 Which of the following is a part of primordial follicle?
a. 1st polar body
b. 2nd polar body
c. oocyte
d. corona radiata
Ans C
• An oocyte surrounded by one layer of squamous follicle-like cells is most likely a primordial follicle
• An antrum is characteristic of Secondary and Graafian follicles
• Ovarian stromal cells surround the developing primary oocyte to form a single layer of flattened follicular cells. The primary oocyte and its follicular cells constitute the primordial follicle
o The follicular cell layer becomes cuboidal and then columnar as the primary oocyte enlarges at puberty and a primary follicle is formed
• A primary follicle with more than one layer of cuboidal follicular cells is called a growing follicle
• Primary oocytes begin the first meiotic division before birth but do not complete prophase until after puberty (arrested in the dictyotene stage until before ovulation)
• Long duration of the meiotic division may account for the high frequency of meiotic errors such as nondisjunction
• The secondary oocyte released at ovulation is surrounded by the zona pellucida and a follicular cell layer, the corona radiata. It is a large cell

# Pharma
@ 173. All are mood stabilizers except?
a. Carbamazepine
b. Phenytoin
d. Valproate
Ans C

• Drugs commonly classed as mood stabilizers include
o Lithium
o Valproate
o Lamotrigine
o Carbamazepine
o Oxcarbazepine
Some atypical antipsychotics (risperidone, olanzapine, quetiapine, paliperidone, ziprasidone, and lurasidone) also have mood stabilizing effects and are thus commonly prescribed even when psychotic symptoms are absent
Clonazepam has both anti-anxiety and anticonvulsant properties, and thus can be used both as a tranquilizer and as a mood stabilizer
@ Most important support of uterus for preventing prolapse is:
A.Pelvic floor
B.Round ligament of uterus
C.Broad ligament
D.Transverse cervical ligament

Correct D
transverse cervical ligament/mackenrodt ligament which is also known as cardinal ligament is the most cardinal support of uterus.By three tier system mackenrodt,uterosacral and pubocervical ligament form middle tier which constitute strongest support of uterus.Pelvic floor muscles are included in inferior tier which gives indirect support to uterus.Round ligament keeps the fundus pulled forwards and maintains the angle of anteversion against the backward pull of the uterosacral ligaments.Broad ligament is a peritoneal ligament and provide very weak support or of doubtful value

@ 176. ESI extended sickness benefit is payable for a duration of ?
a. 91 days
b. 124 days
c. 3 years
d. 2 years
Ans C

In addition to 91 days of sickness benefit, insured persons suffering from certain long-term diseases are entitled to extended sickness benefit for 34 diseases
ESB period shall consist of a period of 3 years from the date of commencement of the spell of certified incapacity for which an IP is entitled to ESB in case of Tuberculosis and from the date of diagnosis in case of any other disease.
The ESB period of 124 days and where it is further extended to 309 days may not be consecutive and shall exclude the days on which the IP is entitled to Sickness Benefit Rate prescribed for the wage group.

Daily rate of benefit will be 140% of the Standard Benefit rate (equivalent to 70% of average daily wage).

# Surgery
@ 178. In Scalp , dangerous layer is :
a. second
b. third
c. fourth
d. Fifth
Ans C

The scalp is usually described as having five layers, which can conveniently be remembered as a mnemonic:
• S: The skin on the head from which head hair grows. It contains numerous sebaeceous glands and hair follicles.
• C: Connective tissue. A dense subcutaneous layer of fat and fibrous tissue that lies beneath the skin, containing the nerves and vessels of the scalp.
• A: The aponeurosis called epicranial aponeurosis (or galea aponeurotica) is the next layer. It is a tough layer of dense fibrous tissue which runs from the frontalis muscle anteriorly to the occipitalis posteriorly.
• L: The loose areolar connective tissue layer provides an easy plane of separation between the upper three layers and the pericranium. In scalping the scalp is torn off through this layer. It also provides a plane of access in craniofacial surgery and neurosurgery. This layer is sometimes referred to as the “danger zone” because of the ease by which infectious agents can spread through it to emissary veins which then drain into the cranium. The loose areolar tissue in this layer is made up of random collagen I bundles, collagen III. It will also be rich in glycosaminoglycans (GAGs) and will be constituted of more matrix than fibers. This layer allows the more superficial layers of the scalp to shift about in relation to the pericranium.
• P: The pericranium is the periosteum of the skull bones and provides nutrition to the bone and the capacity for repair. It may be lifted from the bone to allow removal of bone windows (craniotomy).

# Radiology
@ 179. Discovery of radioactivity is done by
a. Curie
b. Becquerel
c. Roentgen
d. Hounsfeild
Ans b
Antoine-Henri Becquerel (1852-1908) is known for his discovery of radioactivity, for which he received the Nobel Prize for Physics jointly with Marie Curie (1897-1934) and Pierre Curie (1859-1906) in 1903 and the contributions he made to that field.

@180. Osteitis and osteomyelitis associated with which vaccine?
a. OPV
b. BCG
c. Measles
d. Hepatitis B
Ans b

Risk of osteomyelitis due to BCG in immunodeficient patients is much higher and is associated with fatal disseminated infection
@ 183. total length of small bowel is ?
a. 100-150 cm
b. 200-220 cm
c. 250-280 cm
d .690 -710 cm
Ans D
average length of the small intestine in an adult human male is 6.9 m (22 ft 8 in), and in an adult female 7.1 m (23 ft 4 in)

# Surgery
@ 187. Reactionary hemorrhage is produced within :
a. 24 hrs
b. 48 hrs
c. 6 days
d. 8 days
Ans B

hen you have closed an operation wound it may start bleeding: (1) During the first 48 hours (reactionary haemorrhage) because a clot in a vessel has been displaced, or a ligature has slipped. Or, (2) 8 to 14 days later (secondary haemorrhage) when the wound has become infected and eroded a vessel, usually quite a small one, sometimes a larger one.

# Ophthalmology
@ 189. Cataract is not seen in:
a. Wilson’s disease
b. Dystrophia myotonica
c. Atopic dermatitis
d. Hemochromatosis
AnS d

• Wilson’s disease is also associated with sunflower cataracts exhibited by brown or green pigmentation
• Myotonic dystrophy (dystrophia myotonica, myotonia atrophica) is a chronic, slowly progressing, highly variable, inherited multisystemic disease.

• It is characterized by wasting of the muscles (muscular dystrophy), cataracts, heart conduction defects, endocrine changes, and myotonia
• Ocular complications of atopic dermatitis (AD) include herpes simplex, conjunctivitis, keratoconus, retinal detachment, and subcapsular cataracts (SCs). Both posterior and anterior SCs have been described in AD patients, but the related risk factors and pathogenesis of their formation are largely unknown
@ 190. minimum level of hCG at which gestational sac is visible in Transvaginal ultrasound ?
a. 1000
b. 1500
c. 2000
d. 3000
Ans A

Gestational age B-HCG (mIU/ml) TVUS findings
4.5-5 weeks <1,000 Gestational sac
5 weeks 1,000-2,000 Gestational sac + DDS*
5-6 weeks >2,000 Yolk sac** (+/- fetal pole)
6 weeks 10,000-20,000 Embryo with cardiac activity
7 weeks >20,000 Embryonic torso/head

• B-HCG of 1,500 is considered the discriminatory zone, i.e. minimum quantitative level of HCG at which intrauterine pregnancy should be seen by ultrasound.
• Abnormal gestation or embryonic demise if:
◦ Gestational sac > 10 mm without a yolk sac
◦ Gestational sac > 18 mm without a fetal pole
◦ Fetal pole > 5 mm without cardiac activity
• If the B-HCG is > 1500 and no GS is seen
◦ Ectopic pregnancy
◦ Completed abortion
• If the B-HCG is < 1500 and the uterus is empty
◦ Early normal pregnancy
◦ Ectopic pregnancy
◦ Completed abortion
• Serial B-HCG value in 48 hours
◦ Live IUP: doubles
◦ Completed abortion: decreases
Ectopic pregnancy: stable or small rise

@191. Ca2+ bind to which part of skeletal muscle muscle–
a. Troponin-C
b. Troponin-I
c. Troponin-T
d. Tropomyosin
Ans C

Individual subunits serve different functions:

• Troponin C binds to calcium ions to produce a conformational change in TnI
• Troponin T binds to tropomyosin, interlocking them to form a troponin-tropomyosin complex
• Troponin I binds to actin in thin myofilaments to hold the troponin-tropomyosin complex in place

@ 191.Hygiene hypothesis is proposed in causation of which of the following diseases
a. Bronchopneumonia
b. Asthma
c. Malaria
d. Rheumatic fever
the hygiene hypothesis is a hypothesis that states that a lack of early childhood exposure to infectious agents, symbiotic microorganisms (e.g. gut flora or probiotics), and parasites increases susceptibility to allergic diseases by suppressing the natural development of the immune system
The original formulation of the hygiene hypothesis dates from 1989 when Strachan proposed that lower incidence of infection in early childhood could be an explanation for the rapid 20th century rise in allergic diseases such as asthma and hay fever

@Which one of the following is the most common location of hypertensive bleed in the brain?
A. Putamen
B. Pons
C. Ventricles
D. Lobar white matter
Ans A
Correct answer : A. Putamen/external capsule

@ 193. Defense mechanism used in alcoholic who says : “I am not an alcoholic. I don’t know what you are talking about.” Is
a. Denial
b. Sublimation
c. Projection
d. Rationalization
Ans A
Normal defense mechanisms of particular importance in the maintenance of addictive disease include denial, paranoid projection, avoidance, isolation of affect, rationalization and intellectualization. In the psychodynamic hierarchy of mental defense mechanisms denial and paranoid projection are regarded as psychotic defenses because their fundamental character involves a severe disruption of reality testing that causes the afflicted individual to lose touch with consensual reality and to dwell increasingly in a world and reality of his own. Individuals relying heavily upon primitive psychotic mental defense mechanisms such as denial and paranoid projection are relatively or even wholly inaccessible to corrective influences such as logic, data, or the opinions of others. One therefore cannot reason them out of their beliefs or persuade them to change their minds, regardless of how compelling the contrary data and reasons might seem to anyone but the individual ‘in denial.’
Denial in this psychodynamic defensive sense must be distinguished from lying, dishonesty and other forms of conscious and deliberate falsification. Though there is obviously a gray zone and sort of ‘No man’s land’ between wholly unconscious defensive psychodynamic denial and half-conscious deliberate distortion and evasion of the truth, the foundations of true denial rest solidly upon a profoundly misconceived and yet firmly and unshakably believed private version of reality that is relatively or absolutely immune to outside influence. In conscious and deliberate deception the individual remains aware of the difference between his own truth claims and what he realizes is the actual truth of the matter; in psychodynamic denial he believes his own deceptions and distortions and therefore regards the contrary opinions of others as false and their efforts to convince him otherwise as misguided at best and malevolent at worst.
Denying – There is not problem. The problem lies outside the person’s conscious awareness.
General: “I don’t have a problem.”
Alcoholic: “I am not an alcoholic. I don’t know what you are talking about.”
Sexaholic: “I don’t have a problem with this.” [they have not added all the times they acted out in a sexually addictive way.]
RX addict: “I don’t take narcotics.” [when they are on the fentanil patch]

# gob
@196. Morula is how many celled stage?
a. 4
b. 8
c. 16
d. 32
Ans C
The morula is produced by a series of cleavage divisions of the early embryo, starting with the single-celled zygote. Once the embryo has divided into 16 cells, it begins to resemble a mulberry, hence the name morula (Latin, morus: mulberry).Within a few days after fertilization, cells on the outer part of the morula become bound tightly together with the formation of desmosomes and gap junctions, becoming nearly indistinguishable. This process is known as compaction.A cavity forms inside the morula, by the active transport of sodium ions from trophoblast cells and osmosis of water. This results in a hollow ball of cells known as the blastocyst. The blastocyst’s outer cells will become the first embryonic epithelium (the trophectoderm). Some cells, however, will remain trapped in the interior and will become the inner cell mass (ICM), and are pluripotent. In mammals (except monotremes), the ICM will ultimately form the “embryo proper”, while the trophectoderm will form the placenta and other extra-embryonic tissues. However, reptiles have a different ICM. The stages are longer and divided in 4 parts

# Pharma
@ Drug acting on “motilin recepor” :

a) erythromycin
b) chloramphenicol
c) norfloxacin
d) Gatifloxacin

Erythromycin and related antibiotics act as non-peptide motilin agonist
# spm
@ Which of the following statements about ‘Late Expanding Phase of Demographic Cycle’ is true
[A]. Birth Rate is lower than Death Rate
[B]. Death Rate begins to decline while Birth Rate remains unchanged
[C]. Death Rate declines more than Birth rate
[D]. High Death Rate and High Birth Rate
Ans C
WBPGMAT 2014 Paper MCQs.
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