AIIMS - May 2014

Q1. Which of the following is not derived from ectoderm?

1. Hair follicles

2. Arrector pili ✅
3. Sebaceous glands

4. Mammary glands

Answer: (2) — Arrector pili

Explanation: 1. All are derived from ectoderm except Arrector pili is a smooth muscle in the dermis, derived from lateral plate [Link] skin
has two layers which develop from different parts of the embryo. The epidermis develops from the surface ectoderm and the dermis from the
underlying mesenchyme. Hair follicles are formed from solid epidermal proliferations that penetrate the dermis, which is surrounded by
mesenchyme to form the dermal root sheath. Reference: Gray's Anatomy The Anatomical Basis Of Clinical Practice Edition 42 nd Page no 204

Q2. Which of the following muscles is not a mesoderm derivative?

1. Skeletal muscles

2. Smooth muscles

3. Cardiac myocyte

4. Dilators of pupil ✅
Answer: (4) — Dilators of pupil

Explanation: The muscular system is made up of skeletal, smooth, and cardiac muscle, with the exception of a few types of smooth muscle tissue
which are derived from the ectoderm. Certain types of smooth muscle - pupillary, mammary gland, and sweat gland muscles - derive from ectoderm
(i.e., sphincter and dilator pupillae, myoepithelial cells). Skeletal muscle originates from the paraxial mesoderm which forms somites from the
occipital to the sacral regions and somitomeres in the head. As precursor cells, known as myoblasts, fuse and form long, multinucleated muscle
fibers, myofibrils soon appear in the cytoplasm, and by the end of the third month, cross striations can be observed. Tendons which attach muscles to
bones stem from the sclerotome components of these somites. Smooth muscle arises from the splanchnic layer of the lateral plate mesoderm
surrounding the gut, while cardiac muscle is formed from the splanchnic layer of lateral plate mesoderm surrounding the heart tube Reference:
Langman' Medical Embryology Edition 14 th page no 163,164

Q3. What is the source of the buccopharyngeal membrane?

1. Ectoderm + Mesoderm

2. Ectoderm + Endoderm ✅
3. Mesoderm + Endoderm

4. Ectoderm + Mesoderm + Endoderm

Answer: (2) — Ectoderm + Endoderm

Explanation: The buccopharyngeal and cloacal membranes are regions of specitication for the gut tube, where the ectoderm and endoderm are
apposed without intervening mesoblast. The buccopharyngeal membrane creates the opening of the oral cavity, while the cloacal membrane creates
the opening for the anus. Reference: Langman' Medical Embryology Edition 14 th page no 191

Q4. Which of the following DOES NOT include epithelioid cells?

1. Islet cells of pancreas

2. Theca lutein cells

3. Cells of Brunner's gland ✅

4. Interstitial cells of Leydig

Answer: (3) — Cells of Brunner's gland

Explanation: Epithelioid cells are cells with abundant cytoplasm, elongated nuclei, and indistinct cell margins, They are found in our body at 1.
Interstitial cells of Leydig 2. Lutein Cells 3. Islets of Langerhans 4. Adrenal gland parenchyma 5. Anterior lobe of pituitary. 6. Sebacoeus glands
They are not present in Brunner's gland - its an exocrine gland and has epithelial cells. Reference :
[Link]

Q5. Where does the esophageal venous drainage go?

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 1. Azygous and inferior thyroid veins

2. Azygous, inferior thyroid and left gastric veins ✅

3. Azygous, inferior thyroid and right gastric veins

4. Superior thyroid, inferior thyroid veins, azygous and hemi-azygous veins

Answer: (2) — Azygous, inferior thyroid and left gastric veins

Explanation: Venous drainage of esophagus - • Cervical part- into inferior thyroid vein • Thoracic part- into azygous and hemi azygous vein •
Abdominal part- partly drains into left gastric vein of the portal venous system and partly into the inferior hemiazygous vein of the systemic vein.
Reference: Gray's Anatomy The Anatomical Basis Of Clinical Practice Edition 42 nd Page no 1160,1059

Q6. What is the most frequent variation in the colon's blood supply?

1. Absent right colic artery ✅

2. Absent middle colic artery

3. Absent left colic artery

4. Absent superior rectal artery

Answer: (1) — Absent right colic artery

Explanation: The position of right colic artery is highly variable, with its most common origin being a common trunk along with the middle colic
artery. It can similarly originate separately from the right side of the superior mesenteric artery, or it may even come from the ileocolic artery in
which case it is known as an accessory right colic artery. In some cases, it may even be absent. Variation in position of other arteries are rare.
Reference: Gray's Anatomy The Anatomical Basis Of Clinical Practice Edition 42 nd Page no 1464.e77

Q7. Which of the following are not the contents of the mesorectal fascia?

1. Superior rectal vein

2. Inferior rectal vein ✅

3. Para rectal nodes

4. Inferior mesenteric plexus

Answer: (2) — Inferior rectal vein

Explanation: Mesorectum contains superior rectal artery with its branches, superior rectal vein and its tributaries, lymphatic vessels and nodes that
lie along the superior rectal artery, branches from the inferior mesenteric plexus which descend to innervate the rectum and loose adipose connective
tissue. Inferior rectal vein is not a content of mesorectum. Reference-: [Link]

Q8. Which of the following statements is incorrect about the blood-testis barrier?

1. It is formed by Sertoli cells

2. It is formed before primary spermatogenesis ✅

3. Any rupture of can cause immune response to germ cells

4. Germ cells are not necessary for formation of the barrier

Answer: (2) — It is formed before primary spermatogenesis

Explanation: The blood-testis barrier, formed by Sertoli cells, develops during puberty and is essential for protecting germ cells from the immune
system. It is not fully established before primary spermatogenesis begins. The adjacent Sertoli cells are bound together by a unique Sertoli cell- to-
Sertoli cell junctional complex at the basolateral part of the cell, forming a blood-testis barrier. This complex is composed of a tight junction in the
adjacent membranes, a flattened cisterna of sER lying parallel to the plasma membrane in the region of the junction in each cell and actin filament
bundles that are hexagonally packed and interposed between the sER cisternae and the plasma [Link] cells are not necessary for blood
testis barrier. Reference: Ganong's Review of Medical Physiology Edition 26 th Page no 411,412

Q9. Which of the following statements about Dura Mater is incorrect?

1. It is the outermost layer of the cranial meninges

2. It has periosteal and meningeal layer

3. Dural venous sinuses lie below the meningeal layer ✅

4. It is supplied by a branch of the V cranial nerve

Answer: (3) — Dural venous sinuses lie below the meningeal layer

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 Explanation: Dural venous sinuses lie between outer endosteal and inner meningeal layers hence outer to the meningeal layer and not inner. Thus it
is a false statement. Rest all are true. The outermost layer of the meninges is known as the duramater, or pachymeninx. It is continuous with the
spinal duramater through the foramen magnum, and is separated into two distinct layers: an external endosteal layer and an internal meningeal layer.
The latter two layers meet, but separate at points around the venous sinuses that transfer blood away from the brain and the bones within the
cranium. The endosteal layer is connected with the cranial sutures and foramina, as well as the orbital periosteum via the superior orbital fissure.
Reference-: [Link]

Q10. Which of the following structures is seen in the centre of the cavernous sinus?

1. Maxillary division of V nerve

2. Mandibular division of V nerve

3. Internal carotid artery ✅

4. Trochlear nerve

Answer: (3) — Internal carotid artery

Explanation: Internal carotid artery with its surrounding sympathetic plexus and abducens nerve, are the contents of cavernous sinus. Maxillary
division of V nerve, Mandibular division of V nerve, Internal carotid artery and Trochlear nerve are seen in the cavernous sinus, but ICA lies inside
(in the centre of the sinus, while the other three lie in the lateral wall of the sinus Reference: Gray's Anatomy The Anatomical Basis Of Clinical
Practice Edition 42 nd Page no 403,402

Q11. Which of the following arteries does not supply blood to the medulla?

1. Anterior spinal artery

2. Posterior inferior cerebellar artery

3. Vertebral artery

4. Superior cerebellar artery ✅

Answer: (4) — Superior cerebellar artery

Explanation: Vertebral Artery and its branches give rise to Medullary Arteries, which are distributed over a large area in the brain stem, the
Medulla Oblongata. Anterior spinal artery supplies the median area of Medulla and PICA supplies the lateral part of medulla. The Superior
Cerebellar Artery, however, is not a branch of the Vertebral Artery. The Superior cerebellar artery arises close to the terminal bifurcation of the
basilar artery and supplies the cerebellum's cortex, white matter, and central nuclei. Reference: [Link]

Q12. Which of the following is supplied by the contralateral nerve nucleus?

1. Superior rectus ✅
2. Inferior rectus

3. Medial rectus

4. Inferior oblique

Answer: (1) — Superior rectus

Explanation: Only superior rectus is supplied by contralateral 3rd nerve nuclei due to cross over of fibres. So one sided nucleus lesion of 3rd nerve
leads to bilateral superior rectus muscle palsy. Reference: Gray's Anatomy The Anatomical Basis Of Clinical Practice Edition 42 nd Page no
774,1464.e12

Q13. Which one of the following muscles is not supplied by the trigeminal nerve?

1. Stylohyoid ✅
2. Medial pterygoid

3. Lateral pterygoid

4. Tensor veli palatini

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 Answer: (1) — Stylohyoid

Explanation: The stylohyoid originates on the back side of the styloid process in close proximity to its base. It extends to the body of the hyoid
bone at the point where it intersects the greater cornu. It is supplied by the stylohyoid branch of the facial nerve, which often appears in tandem with
the digastric branch then entering into the midsection of the [Link] is innervated by the stylohyoid branch of the facial nerve. Reference: Gray's
Anatomy The Anatomical Basis Of Clinical Practice Edition 42 nd Page no 748,677,678

Q14. Which of the following does not get secretomotor fibres from the facial nerve?

1. Lacrimal gland

2. Parotid gland ✅
3. Submandibular gland

4. Nasal glands

Answer: (2) — Parotid gland

Explanation: The parotid gland is supplied by secretomotor parasympathetic fibres from the inferior salivatory nucleus in the brainstem which
travel through the tympanic branch of the glossopharyngeal nerve, tympanic plexus, lesser petrosal nerve, otic ganglion and auriculotemporal nerve.
Submandibular and sublingual glands are supplied by the submandibular ganglion, with preganglionic fibres arising from the superior salivatory
nucleus and passing through the facial nerve. Lacrimal and nasal glands are supplied by the pterygopalatine ganglion, with preganglionic fibres
arising from the lacrimal nucleus of the brainstem and again passing through the facial nerve. Reference: Gray's Anatomy The Anatomical Basis Of
Clinical Practice Edition 42 nd Page no 1464.e17-1464.e19

Q15. Where are the transections performed in an encephale-isole preparation?

1. First cervical spinal segment ✅

2. Level of the medulla

3. Midpontine level

4. Mid collicular level

Answer: (1) — First cervical spinal segment

Explanation: Encephale isole : the transection is done at first cervical spinal [Link] neck muscles were dissected away from the occipital
region of skull, the occipital joint exposed and the dura incised between the foramen magnum and the first cervical vertebra. The spinal cord was
then transected through this aperture by means of a blunt leucotome, whilst full anaesthesia was maintained." Cerveau isole: mid-collicular level
transection Reference:[Link]

Q16. The wave patterns of EEF, EOG, and EMG are depicted below. Where does the pattern marked belong?

1. NREM sleep ✅
2. REM sleep

3. Wakefulness

4. Quiet wakefulness

Answer: (1) — NREM sleep

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 Explanation: The EMG graph is flat in REM( atonia) and NREM: muscles maintain their tone. Reference- Ganong’s Review of Medical
Physiology Edition 26 th Page no 272

Q17. When an excitable tissue, such as a nerve or muscle, is exposed to supramaximal stimulation and a response is produced, in what state is the
tissue?

1. Absolute refractory period

2. Relative refractory period ✅

3. Latent period

4. After - depolarization

Answer: (2) — Relative refractory period

Explanation: The absolute refractory period begins once the firing level is reached and continues until repolarization is around one-third complete.
Following this is the relative refractory period, in which stronger than usual stimuli can still elicit a response while weaker stimuli will not. During
the absolute refractory period, no matter how powerful a stimulus is, the nerve cannot be excited. Reference- Ganong’s Review of Medical
Physiology Edition 26 th Page no 91

Q18. What are nuclear bag fibres related to?

1. Force

2. Length

3. Tone

4. Length and velocity ✅

Answer: (4) — Length and velocity

Explanation: When a muscle is stretched and has its nerve intact, the response it produces is known as the stretch reflex. The muscle spindle, a
small enclosed fusiform structure within the muscle, is the sensory organ that detects the stretch stimuli. It consists of two subtypes of Nuclear bag
fibres which are responsible for detecting both the velocity of the stretch (dynamic) and the steady-state length of the muscle (static). Reference-
Ganong’s Review of Medical Physiology Edition 26 th Page no 225,226

Q19. Which of the following is true about the Golgi tendon organ?

1. Sense the dynamic length of the muscle

2. Are involved in reciprocal innervations

3. Are stimulated by alpha motor neuron

4. Sense muscle tension ✅

Answer: (4) — Sense muscle tension

Explanation: Golgi tendon organ is a type of proprioreceptor which senses change in muscle tension. It is present at the myotendinous junction
and forms the sensory component of golgi tendon reflex. Reference- Ganong’s Review of Medical Physiology Edition 26 th Page no 158

Q20. What is the function of mechano stretch receptors in joints and ligaments?

1. Fast adapting

2. Slow adapting ✅
3. Non adapting

4. Adapt differentially for different stresses

Answer: (2) — Slow adapting

Explanation: Proprioceptors are slowly adapting stretch receptors, which can be found in the muscles, ligaments, tendons, and joint capsule in
order to inform change in muscle length and tension which is in conjunction with a difference in joint angle. This gives the body information
regarding its position, or proprioception. Reference:[Link]

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 Q21. The loss of ligaments and joint receptors during hip replacement surgery will result in?

1. No loss of sensation

2. Loss of all sensations

3. Joint sensation lost in stable position

4. Decrease in movements and loss of sensation ✅

Answer: (4) — Decrease in movements and loss of sensation

Explanation: he correct answer is 4. Decrease in movements and loss of sensation . Explanation: During hip replacement surgery, the removal of
certain ligaments and joint receptors (like those involved in proprioception) can lead to a decrease in the ability to sense the position and movement
of the hip joint. This loss of joint receptors can impair proprioception, which is the body's sense of the position and movement of the joint. Though
the joint may still function mechanically after the surgery, the person might experience a decrease in certain movements and a reduction in sensory
feedback from the joint. While the prosthetic joint itself may not have the same sensory feedback as the natural joint, sensory abilities and joint
movement can improve with rehabilitation. Reference: Ganong's Review Of Medical physiology 26th Edition Page no 165

Q22. When are fast fatigue fibres recruited during walking?

1. In the beginning

2. In the end ✅
3. Throughout the walking process

4. When small neurons are excited

Answer: (2) — In the end

Explanation: The motor units are classified according to the type of muscle fibres they innervate, and this categorization is based on the duration of
the muscle twitches they produce. Additionally, the recruitment of motor units during muscle contraction follows a general process known as the
Size Principle, where certain types of motor units are recruited to produce specific responses. Slow S motor units are recruited to initiate a muscle
action, followed by faster FR motor units for more powerful responses over shorter time periods, and finally the most fatigable FF motor units for
the most demanding tasks. Reference- Ganong’s Review of Medical Physiology Edition 26 th Page no 110

Q23. Which of the following can be increased and result in a leftward shift in the oxygen-hemoglobin dissociation curve? 2

1. pH ✅
2. Temperature

3. 2,3-BPG

4. pCO

Answer: (1) — pH

Explanation: Physiological factors have an effect on the oxygen haemoglobin dissociation curve, resulting in a shift either to the left or the right. A
leftward shift implies that a decrease in temperature, fall in blood PCO2, decrease in 2,3-DPG and rise in pH, would increase the affinity of
haemoglobin to oxygen, i.e. less oxygen is released in the tissues. On the other hand, a rightward shift implies that an increase in temperature, rise in
PCO2, decrease in 2,3-DPG and a fall in pH, would decrease the affinity of haemoglobin to oxygen, i.e. more oxygen would be released in the
tissues. The alkalosis causes increae in H+ ions resulting in loading of oxygen and unloading of CO2 which leads to left shift of the curve.
Reference- Ganong's Review of Medical Physiology Edition 26 th Page no 631

Q24. The inward flow pressure in the provided circuit is 100 mm Hg, while the outward flow pressure is 10 mm Hg. The resistance in each parallel
circuit is 5 mm Hg/mL/min. How much current will flow via the circuit?

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 1. 45 mL

2. 90 mL ✅
3. 3.6 mL

4. 135 mL

Answer: (2) — 90 mL

Explanation: In fluid mechanics, The hydraulic resistance, R is defined as the ratio of pressure drop, Pi- Po, to flow, Q. Pi is the pressure at inflow
Po is the pressure at outflow Thus, R = (Pi -Po)/Q Given each circuit has resistance = 5 mm Hg/mL/min. Also for resistance in parallel 1/net
resistance = 1/r1 + 1/r2 ………1/rn Thus net resistance in the given question = 1 mm hg/ml min Hence, by calculation for flow using ohms law, we
get Flow, Q = (100-90)/1 = 90 ml/min. Reference: [Link]

Q25. Which of the following defines vascular system pressure in the absence of blood flow?

1. Pulse pressure

2. Critical closing pressure

3. Mean circulatory filling pressure ✅

4. Perfusion pressure

Answer: (3) — Mean circulatory filling pressure

Explanation: Equilibrium pressure in the absence of flow pressure is called Mean circulatory filling pressure and is exerted by the blood volume on
the whole cardiovascular circuit. When the heart is stopped, either through electrical shock or any other method, circulation ceases almost
immediately and the pressures across the body become equal. This pressure is known as the mean circulatory filling pressure. Reference:
[Link]

Q26. Which of the following defines vascular system pressure in the absence of blood flow?

1. Pulse pressure

2. Critical closing pressure

3. Mean circulatory filling pressure ✅

4. Perfusion pressure

Answer: (3) — Mean circulatory filling pressure

Explanation: Equilibrium pressure in the absence of flow pressure is called Mean circulatory filling pressure and is exerted by the blood volume
on the whole cardiovascular circuit. When the heart is stopped, either through electrical shock or any other method, circulation ceases almost
immediately and the pressures across the body become equal. This pressure is known as the mean circulatory filling pressure.
Reference-: [Link]

Q27. Which of the following statements about blood pressure measurement is correct?

1. Bladder in the blood pressure cuff should cover more than 80% of the arm area ✅
2. The person should be comfortably sitting and blood pressure cuff should be at a higher level than the heart

3. Caffeine intake induces decrease in blood pressure

4. Blood pressure increases during sleep

Answer: (1) — Bladder in the blood pressure cuff should cover more than 80% of the arm area

Explanation: Following are the initial steps of BP measurement outlining the question. a. Have the patient rest for at least 5 minutes and for 30 or
more minutes after drinking coffee or smoking. b. It is best to take readings for both arms, as the higher of the two is normally closest to the aortic
pressure and is thus used to decide on treatment. c. While the patient is either standing or seated comfortably, make sure to have the arm be placed at
a heart level position with no tight clothing on the upper arm. It is also fine to measure by leaving thin clothing on. d. The usual Riva-Rocci cuff

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 should be 12.5 cm wide and 30-35 cm long. Make sure to have the center of the cuff fit around at least 80% of the circumference of the arm. Place
the cuff over the brachial artery. Option 4 is also false as blood pressure decreases during sleep. Reference-: [Link]
tests/measuring-blood-pressure/

Q28. Why is the left atrium's "v" wave larger than the right atrium's "a" wave?

1. Left side is high-pressure system ✅

2. Left atrium is more compliant

3. Left atrium is compressed posteriorly by pulmonary veins

4. Right atrial pressure is transmitted into the pulmonary circulation

Answer: (1) — Left side is high-pressure system

Explanation: The v wave represents atrial filling which occurs at the end of ventricular systole, Its height is determined by the volume of blood
returning to the right atrium, either antegrade from the vena cavae and/or retrograde through an incompetent TV.V wave in left atrium is higher than
in right atrium because left side is high pressure system. In left sided system, muscle mass is more. So, the pressures in left sided chambers are
higher than right ones.” Reference- Ganong's Review of Medical Physiology Edition 26 th Page no 530

Q29. Which cells of the human body are most sensitive to ischemia?

1. Neurons ✅
2. Nephrons

3. Cardiac myocyte

4. Hepatocytes

Answer: (1) — Neurons

Explanation: Neurons are the cells of the human body that are most sensitive to ischemia, which refers to a lack of oxygen and nutrients due to
decreased blood flow to a particular tissue or organ. Neurons require a constant supply of oxygen and glucose to function properly, and even a brief
interruption of blood flow can cause irreversible damage. Other cells, such as nephrons in the kidneys, cardiac myocytes in the heart, and
hepatocytes in the liver, are also sensitive to ischemia, but neurons are the most vulnerable Reference-: Robbins and Cotran Pathologic Basis of
Disease Edition 10 th Page no 134

Q30. What is the most important hormone that increases gallbladder contraction after a fatty meal?

1. Gastrin

2. Secretin

3. CCK ✅
4. GIP

Answer: (3) — CCK

Explanation: Cholecystokinin (CCK) is an endocrine hormone released by I cells in the upper small intestine. Its action includes stimulating
pancreatic enzyme secretion, contracting the gallbladder and relaxing the sphincter of Oddi allowing bile and pancreatic juice into the intestinal
lumen, augmenting the action of secretin, inhibiting gastric emptying, having a trophic effect on the pancreas and increasing enterokinase synthesis.
It also augments the contraction of the pyloric sphincter, preventing reflux of duodenal contents into the stomach. This hormone is the strongest
stimulus for gallbladder emptying, which occurs during the intestinal phase of digestion. Reference- Ganong's Review of Medical Physiology
Edition 26 th Page no 458

Q31. What is the most serious complication of prolonged sitting?

1. Venous thromboembolism ✅
2. Dysrhythmias

3. Hypotension

4. Nerve palsies

Answer: (1) — Venous thromboembolism

Explanation: Following are the Complications of Prolonged sitting posture- a. Deep vein thrombosis (DVT) b. Pressure sores of the c. Muscle
contractures d. Deconditioning of the cardiovascular system. To prevent the complication low- dose heparin or non-pharmacologic means like
graduated compression stockings should be used. Reference-: Robbins and Cotran Pathologic Basis of Disease Edition 10 th Page no 132

Q32. Which of the following is not an intermediate product of the citric acid cycle?

1. Acetyl Co-A ✅
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 2. Succinyl Co-A

3. Citrate

4. α-ketoglutarate

Answer: (1) — Acetyl Co-A

Explanation: Acetyl-CoA is the initial molecule of the citric acid cycle, while Succinyl-CoA, a-Ketoglutarate and Citrate are the intermediates
within the cycle. Thus, Acetyl-CoA is not part of the intermediates, but rather the beginning compound of the citric acid cycle. Reference: Harper's
Illustrated Biochemistry, 32nd Edition, Page no 157.

Q33. Which enzyme is common to both glycogenolysis and glycogenesis?

1. Glycogen phosphorylase

2. Glycogen synthase

3. Glucotransferase

4. Phosphoglucomutase ✅
Answer: (4) — Phosphoglucomutase

Explanation: Glucose-6-phosphatase is the common enzyme for both glycogenolysis and gluconeogenesis pathways, it is present in the liver and
kidney, absent in muscle and adipose tissue, that catalyses the breakdown of glucose-6-phosphate into glucose. This breakdown leads to an increase
in the concentration of glucose in the blood. Lack of this enzyme results in glycogen storage disease type I, which causes a build-up of glycogen in
the liver and renal cells, hypoglycemia, lactic acidemia, ketosis and hyperlipidemia. Reference: Harper's Illustrated Biochemistry, 32nd Edition,
Page no 173.

Q34. What percentage of the total human genome is made up of coding DNA?

1. 2% ✅
2. 10%

3. 0.1%

4. 4%

Answer: (1) — 2%

Explanation: Coding DNA makes 1-2% of the total DNA in human body. Reference : Lippincott' Illustrated Reviews, 5th edition, Page no 465.

Q35. What results from cytosine methylation?

1. Increased expression of gene

2. Decreased expression of gene ✅

3. No effect on gene expression

4. Mutation

Answer: (2) — Decreased expression of gene

Explanation: Epigenetic mechanisms involved in cancer include methylation of specific cytosine bases in genes, resulting in silencing of certain
genes. Post-translational modifications of histones, such as acetylation, methylation, phosphorylation and ubiquitination also affect gene expression.
remember acetylation - kind of activation and methylation is like deactivation. Reference : Lippincott' Illustrated Reviews, 5th edition, Page no 460.

Q36. 2,3-BPG binds to _________________ site of hemoglobin and __________________ the affinity for oxygen

1. alpha; decreases

2. beta; decreases ✅
3. alpha; increases

4. beta; increases

Answer: (2) — beta; decreases

Explanation: Physiological factors have an effect on the oxygen haemoglobin dissociation curve, resulting in a shift either to the left or the right. A
leftward shift implies that a decrease in temperature, fall in blood PCO2, decrease in 2,3-DPG and rise in pH, would increase the affinity of
haemoglobin to oxygen, i.e. less oxygen is released in the tissues. On the other hand, a rightward shift implies that an increase in temperature, rise in
PCO2, increase in 2,3-DPG and a fall in pH, would decrease the affinity of haemoglobin to oxygen, i.e. more oxygen would be released in the
tissues. 2,3- BPG binds to the central part of tetramer structure of Hemoglobin. Thus correct answer is option 2. Reference: Harper's Illustrated
Biochemistry, 31st Edition, Page no 53.

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 Q37. In an electron transport system, which part will be the last to get electrons? 2 2

1. Coenzyme-Q

2. FADH

3. O ✅
4. Cytochrome-C

Answer: (3) — O

Explanation: The electron transport chain necessitates oxygen, so this chain is also known as the respiratory chain since it is responsible for the
most significant use of oxygen in the body. In this chain, electrons come together with oxygen and protons to produce water. Reference: Harper's
Illustrated Biochemistry, 31st Edition, Page no 119.

Q38. A 50-year-old patient is admitted with episodes of weakness/difficulty breathing and bleeding. He had a platelet count of 50 x 109 cells/L and
a leukocyte count of 48 x 109 cells/L. A differential count revealed 76% neutrophils, 8% blast cells, 12% myelocytes and metamyelocytes, and 4%
other cells, indicating neutrophil dysplasia. 14% of blasts were found in the bone marrow analysis. Cytogenetics revealed that the patient has
t(8:21). Which diagnosis is more likely?

1. Acute myeloid leukemia ✅

2. Chronic myeloid leukemia

3. Chronic lymphoid leukemia

4. Myelodysplastic syndrome

Answer: (1) — Acute myeloid leukemia

Explanation: Correct Answer is (Option 1) Acute myeloid leukemia With the given features the diagnosis can be concluded to that of AML. Acute
leukemias are characterized by an abrupt onset and clinical signs and symptoms related to suppressed marrow function , such as fatigue, fever,
bleeding, bone pain, generalized lymphadenopathy, splenomegaly, and hepatomegaly. Central nervous system manifestations such as headache,
vomiting, and nerve palsies can also occur, particularly in children and in ALL. Remember in patients with AML with t (8;21), inv 16, and t (15:17)
- even if blasts are less than 20% in Bone Marrow- a diagnosis of AML can be made. Reference: Robbins and Cotran Pathological basis of disease,
10 th edition, Page No 617.

Q39. Which of the following is incorrect regarding cellular events in acute inflammation?

1. PECAM/CD31 is responsible for neutrophil activation ✅

2. Components of complement can assist in chemotaxis

3. Neutrophil rolling is assisted by selectins

4. ICAM-1/VCAM-1 is responsible for neutrophil adhesion

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 Answer: (1) — PECAM/CD31 is responsible for neutrophil activation

Explanation: Correct Answer is (Option 1) PECAM/CD31 is responsible for neutrophil activation PECAM-1 , platelet endothelial cell adhesion
molecule-1 also called CD31 , a cellular adhesion molecule expressed on leukocytes and endothelial cells, mediates the binding events needed for
leukocytes to traverse the endothelium(Diapedesis) . PECAM is involved in transmigration and not activation. Hence option 1 is incorrect. The
initial rolling interactions are mediated by selectins , of which there are three types: one expressed on leukocytes (L-selectin), one on endothelium
(E-selectin), and one in platelets and on endothelium (P-selectin) TNF and IL-1 induce endothelial expression of ligands for integrins, mainly
vascular cell adhesion molecule 1 (VCAM-1), the ligand for the β1 integrin VLA-4, and intercellular adhesion molecule-1 (ICAM-1) , the ligand for
the β2 integrins LFA-1 and MAC-1. Reference: Robbins and Cotran Pathological basis of disease, 10 th edition, Page No 79.

Q40. Which of the following factors is both morphogenic and mitogenic?

1. Fibroblast growth factor

2. Platelet derived growth factor

3. Bone morphogenetic protein ✅

4. Insulin-like growth factor

Answer: (3) — Bone morphogenetic protein

Explanation: Correct Answer is (Option 3) Bone morphogenetic protein Bone morphogenetic protein constitutes a group of pivot morphogenetic
signals involved in the development of heart, central nervous system, cartilage as well as post-natal bone development. B one morphogenic proteins
activate MAP kinase and help in mitosis. Recombinant human BMPs are used in orthopedic applications such as spinal fusions, non-unions and oral
surgery. Reference: Harrison's Principals of Internal Medicine, 21 st edition, Page No 2856.

Q41. What is the cause of ARDS?

1. Type 1 pneumocytes proliferation

2. Damage to Type 2 pneumocytes

3. Clara cells

4. Damage to Endothelial cells ✅

Answer: (4) — Damage to Endothelial cells

Explanation: Correct Answer Is Option (4) Damage to Endothelial cells > Option(2) - Answer confirmed by consulting with SRs/Assistant
Professor at AIIMS, Delhi. ARDS is a progressive condition that includes three stages: 1. Exudative 2. Proliferative 3. Fibrotic. The exudative stage
involves injury to the alveolar-capillary endothelial cells and type II pneumocytes (endothelial-epithelial barrier damage) While the initial insult
damages both endothelial cells and type II pneumocytes - the primary inciting event is the damage to endothelial cells which results in the secretion
of multiple inflammatory cytokines (TNF-alpha/IL-1/IL-8) that cause Neutrophil activation and migration - causing further endothelial-epithelial
damage - causes fluid accumulation leading to non-cardiogenic pulmonary edema which is characteristic of ARDS. The endothelial injury also leads
to microthrombi and results in ischemic injury too. The proliferative stage involves the proliferation of type II pneumocytes and the synthesis of

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 new pulmonary surfactant. (Hence, option 1 is incorrect - there is proliferation of type 2 pneumocytes) In the fibrotic phase , the alveolar edema and
inflammatory exudates are converted to extensive alveolar duct and interstitial fibrosis, necessitating long-term support with mechanical ventilation
and/or supplemental oxygen. Reference : Robbins and Cotran Pathological basis of disease, 10th edition, Page No 676.

Q42. Where can we find Verocay bodies?

1. Meningioma

2. Hemangioma

3. Glioma

4. Schwannoma ✅
Answer: (4) — Schwannoma

Explanation: Correct Answer is (Option 4) Schwannoma Schwannoma (neurilemoma) is typically a solitary tumor, most commonly located on the
flexor surfaces of the extremities, neck, mediastinum, retroperitoneum, posterior spinal roots, and cerebellopontine angle. Grossly, larger
schwannomas often contain cystic areas. Microscopically, there are two different patterns, designated as type A and type B. In type A, the cells are
spindle-shaped and arranged in a palisading or organoid formation aka Verocay bodies. In type B, the cells are separated by edematous fluid that can
form cystic spaces. Ancient schwannomas may contain isolated cells with bizarre hyperchromatic nuclei, though these are of no particular
significance. Reference: Robbins and Cotran Pathological basis of disease, 10 th edition, Page No 1237.

Q43. According to histopathology, rosettes are not present in?

1. Retinoblastoma

2. Neurocysticercosis ✅
3. PNET

4. Medulloblastoma

Answer: (2) — Neurocysticercosis

Explanation: Correct Answer is (Option 2) Neurocysticercosis Out of the given options, Neurocysticercosis do no show rosettes. a. Retinoblastoma
has Flexer-Wintersteiner rosettes. b. Ewing sarcoma has Homer-Wright rosettes. c. Ependymoma has round rosettes or elongated canals. d.
Medulloblastoma shows Homer Wright or neuroblastic rosette Reference: Harrison’s Principals of Internal Medicine, 21 st edition, Page No 1120.

Q44. What of the following does not become an active metabolite?

1. Lisinopril ✅
2. Fluoxetine

3. Cyclophosphamide

4. Enalapril

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 Answer: (1) — Lisinopril

Explanation: Correct Answer is (Option 1) Lisinopril Lisinopril is a lysine derivative of enalaprilat and requires no active hydrolysis. Enalapril is a
prodrug and its active metabolite is Enalprilat. Cyclophosphamide gets converted to its active metabolite 4-hydroxycyclophosphamide in liver while
Fluoxetine gets converted to the active metabolite norfluoxetine in liver (desmethylfluoxetine). Another ACE inhibitor that is not prodrug is
Captopril . Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition, Page No 532.

Q45. Methacholine is a type of?

1. M1 receptor agonist

2. M2 receptor agonist ✅
3. M3 receptor agonist

4. M4 receptor agonist

Answer: (2) — M2 receptor agonist

Explanation: Correct Answer is (Option 2) M2 receptor agonist Methacholine show maximum agonist action at M2. Acetyl-methylcholine, also
known as methacholine, is a synthetic ester of choline which is slightly different from acetylcholine, with an added methyl group which makes it
resistant to hydrolysis by cholinesterase, thus making it last longer in the body. Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th
edition, Page No 112.

Q46. Which of the following is not caused by Alpha 2 agonists?

1. Analgesia

2. Hyperalgesia ✅
3. Sedation

4. Anxiolysis

Answer: (2) — Hyperalgesia

Explanation: Correct Answer is (Option 2) Hyperalgesia Alpha 2 agonist do not cause hyperalgesia. They could be a beneficial option for certain
individuals undergoing anesthesia as it may reduce the need for anesthetics and make hemodynamic stability more attainable. Additionally,
clonidine can reduce preoperative anxiety, lessen mucus secretions, and provide conditioning to mitigate feelings of pain. *Important functions of
Alpha 2 receptors: Inhibition of transmitter release Vasoconstriction Decreased central sympathetic flow Decreased insulin release Platelet
aggregation Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition, Page No 140.

Q47. Which of the following contains both alpha and beta agonists?

1. Dobutamine

2. Fenoldopam

3. Epinephrine ✅
4. Phenylephrine

Answer: (3) — Epinephrine

Explanation: Correct Answer is (Option 3) Epinephrine Epinephrine or adrenaline has both alpha and beta receptor action, with a weak effect on
the gamma receptor. Option 1 Dobutamine primarily acts upon beta-1 receptors, and is a selective beta-1 agonist Option 4 Phenylephrine is a
selective alpha agonist with no effect on beta receptors Option 2 Fenoldopam is not an inducer of either alpha, beta, or gamma receptors, but rather
is a selective agonist on dopamine-1 receptors. Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition, Page No 142.

Q48. Which of the following anti-Parkinsonian medications causes peripheral vasospasm?

1. Ropinirole

2. Levodopa

3. Bromocriptine ✅
4. Entacapone

Answer: (3) — Bromocriptine

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 Explanation: Correct Answers is (Option 3) Bromocriptine Bromocriptine is a dopamine-receptor agonist derived from the vasoconstrictive
alkaloid ergotamine. It is typically administered in slowly increasing doses over a period of 2 to 3 months, but there are numerous potential side
effects, including hallucinations, confusion, delirium, nausea and orthostatic hypotension. It can also increase the risk of psychiatric illness, and
serious cardiac problems, such as myocardial infarction, may develop. Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition,
Page No 261.

Q49. Which of the following statements is incorrect about methadone? \(\mu -\) receptor agonist

1. It is a long-acting

2. It is rapidly absorbed from the gastrointestinal tract and is detected in plasma 30 minutes after oral administration

3. The primary use of methadone is relief of chronic pain

4. The onset of analgesia is 30-60 minutes after parenteral administration and 1-2 hours after oral administration ✅
Answer: (4) — The onset of analgesia is 30-60 minutes after parenteral administration and 1-2 hours after oral administration

Explanation: Correct Answer is (Option 4) The onset of analgesia is 30-60 minutes after parenteral administration and 1-2 hours after oral
administration Methadone is a mu full agonist. The onset of analgesia occurs 10-20 minutes after parenteral administration and 30-60 minutes after
oral medication. The average minimal effective analgesic concentration in blood is ~30 ng/mL. It is used in management of chronic pain and
antitussive. Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition, Page No 504.

Q50. What part of the body does the loop diuretic furosemide act on?

1. Thick ascending limb of loop of Henle ✅

2. Descending limb of loop of Henle

3. Proximal convoluted tubule

4. Distal convoluted tubule

Answer: (1) — Thick ascending limb of loop of Henle

Explanation: Correct Answer is (Option 1) Thick ascending limb of loop of Henle Furosemide acts on the thick ascending limb of the loop of
Henle and inhibits Na+K+Cl- symporters thus increasing the Renal blood flow. The major site of action is the thick ascending limb of loop of Henle
(TAL), therefore, called loop diuretics. Furosemide inhibits Na+- K+-2Cl¯ cotransport. A minor component of action on PT has also been
demonstrated. It is secreted in PT by organic anion transport and reaches TAL where it acts from luminal side of the membrane. The
corticomedullary osmotic gradient is abolished and positive as well as negative free water clearance is blocked. K+ excretion is increased mainly
due to high Na+ load reaching DT. Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition, Page No 606.

Q51. Which of the following pairs of drugs and their indications is mismatched?

1. Carbamazepine- status epilepticus ✅

2. Octreotide treatment of diarrhea associated with vasoactive intestinal peptide tumors

3. Desmopressin-treatment of diabetes insipidus

4. hCG - treatment of infertility in men and women

Answer: (1) — Carbamazepine- status epilepticus

Explanation: Correct Answer is (Option 1) Carbamazepine- status epilepticus Carbamazepine is the drug of choice for partial seizures and
trigeminal neuralgia. * Adverse effect profile- 1. SIADH- hyponatremia- seen more commonly with oxcarbazepine in elderly individuals. 2. MC-
drowsiness 3. SJS/TEN- Associated with HLA-B-1502 gene. 4. Aplastic anemia and agranulocytosis * Toxicity of the drug leads to- paradoxical
seizures, coma, hypotension, arrythmia * Antidote- Na Bicarbonate Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition, Page
No 442.

Q52. What causes delayed post-antibiotic effects and time-dependent killing?

1. Fluoroquinolones

2. Beta lactam antibiotics

3. Clindamycin ✅
4. Erythromycin

Answer: (3) — Clindamycin

Explanation: Correct Answer is (Option 3) Clindamycin Time dependent killing and post antibiotic effects are seen in clindamycin out of the
following options. Killing effect of these drugs depends on the length of time the concentration remains above MIC and also there is inhibitory
effect of antibiotics even when their concentration is below MIC. * Drugs having time-dependent killing and post antibiotic effect are : -
Clindamycin Clarithromycin Linezolid Streptogramins Tetracyclines Azoles Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th
edition, Page No 805.

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 Q53. Which of the following does not include non-nucleoside reverse transcriptase inhibitors (NN-RTIs)?

1. Nevirapine

2. Delavirdine

3. Etravirine

4. Lamivudine ✅
Answer: (4) — Lamivudine

Explanation: Correct Answer is (Option 4) Lamivudine Lamivudine is a Nucleoside Reverse Transcriptase Inhibitors (NRIT) and not Non -
Nucleoside Reverse Transcriptase Inhibitors (NNRIT) Trick to memorize NNRTI: - END RT E favirenz, Etravirine N evirapine D elaviridine
Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition, Page No 863.

Q54. Which among the following antitubercular medications is linked to hypothyroidism?

1. Rifampicin

2. Pyrazinamide

3. Ethionamide ✅
4. Streptomycin

Answer: (3) — Ethionamide

Explanation: Correct Answer is (Option 3) Ethionamide It has been observed that ethionamide, which belongs to the second line of anti-tubercular
drugs, may induce hypothyroidism, possibly because its structure is similar to methimazole, a known inhibitor of thyroid hormone synthesis. This
hypothyroidism caused by ethionamide is at least partly reversible upon cessation of the drug. Additionally, para-amino salicylate (PAS) has also
been shown to lead to hypothyroidism. Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition, Page No 821.

Q55. Nausea, with or without vomiting, is the most typical adverse effect of cancer chemotherapy. The likelihood of nausea and vomiting is
different among anti-cancer medications. Which of the following anti-cancer medications has the lowest risk of producing nausea and vomiting?

1. Chlorambucil ✅
2. Cisplatin

3. Doxorubicin

4. Daunorubicin

Answer: (1) — Chlorambucil

Explanation: Correct Answer is (Option 1) Chlorambucil Least emetogenic drug out of the following can be concluded as Chlorambucil based on
their classification based on risk. Chlorambucil can cause nausea and vomiting which is known as an emetogenic effect. This occurs due to the
destruction of rapidly dividing cells in the body, which is how chemotherapy works, but can also be found in the cells in the digestive system or
stomach that would normally help prevent the feeling of nausea. If these cells are destroyed, it can lead to nausea and other digestive symptoms.
Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition, Page No 918.

Q56. Which of the following drugs is necessary to lessen the toxicity of pemetrexed? 6 12 6 and Vitamin B 12

1. Folic acid and vitamin B

2. Folic acid and vitamin B ✅

3. Vitamin B

4. Folic acid and dexamethasone

Answer: (2) — Folic acid and vitamin B

Explanation: Correct Answer is (Option 2) Folic acid and vitamin B 12 Pemetrexed is a drug used alone or with other drugs to treat certain types of
non-small cell lung cancer and malignant pleural mesothelioma. Pemetrexed disodium stops cells from using folic acid to make DNA and may kill
cancer cells. It is a type of antimetabolite and a type of antifolate. Patients are administered intramuscular vitamin B12 (1 mg) and folic acid tablets
with the first dose of pemetrexed to correct possible B12, deficiency. These small doses of folate and B12, do not compromise the therapeutic effect.
Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition, Page No 921.

Q57. Which of the following is correct about staining?

1. Gram-positive bacteria stain black

2. Gram-negative bacteria stain pink ✅

3. Gomori's methenamine silver stains fungi green

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 4. Calcofluor white stains acanthamoeba red

Answer: (2) — Gram-negative bacteria stain pink

Explanation: Gram positive bacteria are stained purple/violet while negative are stained pink(due to safranin counterstain) Gomori's methenamine
silver stains fungi black and background green Calcofluor white stains acanthamoeba Apple-green, Reference : Ananthanarayan and Paniker's
Textbook of Microbiology, 10th edition, Page no 13.

Q58. Which of the following contains both DNA and RNA?

1. Bacteria ✅
2. Prions

3. Viroids

4. Plasmid

Answer: (1) — Bacteria

Explanation: Bacteria are prokaryotic organisms that reproduce asexually and contain both DNA and RNA; which are essential for replication,
translation, and transduction. In contrast, viruses can contain either DNA or RNA. Plasmids are made up of only circular DNA. Reference :
Ananthanarayan and Paniker's Textbook of Microbiology, 10th edition, Page no 18.

Q59. Which of the following statements about IgE antibodies is incorrect?

1. It mediates the release of histamine and other chemical mediators

2. It is the primary antibody involved in allergic reactions

3. It is involved in anti-parasitic immune responses

4. May cross the placenta and fix complement ✅

Answer: (4) — May cross the placenta and fix complement

Explanation: People who have been exposed to certain antigens in the past and have developed antibodies to it (IgE) may experience an immediate
allergic response if re-exposed, known as Immediate or Type I Hypersensitivity. This is a fast-acting immunologic reaction which can happen within
minutes following the combination of the antigen and the antibodies to it, bound to mast cells. IgE antibodies do NOT cross the placenta. IgG is the
only class of immunoglobulins which can cross the placenta Ig E has the following features: •Half-life 1 to 5 days. •Causes type 1 hypertensivity
reaction. •It is the only heat liable antibody. •Levels are raised in helminthic infections. Reference : Ananthanarayan and Paniker's Textbook of
Microbiology, 10th edition, Page no 101.

Q60. A 10-year-old boy who had a very bad sore throat and a greyish pseudomembrane covering his tonsils and pharynx presented. What is most
likely the organism causing this infection?

1. A gram positive bacillus ✅

2. A gram negative bacillus

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 3. A catalase-positive gram positive coccus that grows in clusters

4. A single-stranded positive sense RNA virus

Answer: (1) — A gram positive bacillus

Explanation: Pseudomembrane over tonsil and pharynx is caused by Gram +ve bacilli out of the following, as the two main infectious causes of
pseudomembrane over tonsil are membranous tonsillitis, caused by Gram positive catalase negative cocci, and diphtheria, caused by
Corynebacterium diphtheria, which are Gram+ bacilli. The membrane of diphtheria may spread beyond the tonsils onto the soft palate. Reference :
Ananthanarayan and Paniker's Textbook of Microbiology, 10th edition, Page no 240.

Q61. During the autopsy of an AIDS patient, a lung segment was stained with hematoxylin and eosin to reveal type 1 pneumocyte desquamation
with conspicuous intranuclear basophilic inclusion bodies encircled by a clear halo. Before it died, the CD4 count was less than 100 cells/mm3.
What is the diagnosis in this situation?

1. Acute respiratory distress syndrome

2. Pneumocystis jirovecii pneumonia

3. CMV pneumonia ✅
4. Mycobacterium avium-intracellulare pneumonia

Answer: (3) — CMV pneumonia

Explanation: Based on the given clinical scenario of an immunocompromised individual with intra-nuclear basophilic inclusion bodies, the most
likely diagnosis is CMV pneumonia. The major biological characteristic of CMV as with other herpes viruses is its ability to become latent in the
human host and therefore, the potential for reactivation. Drug of choice for CMV pneumonia is valganciclovir. Reference : Ananthanarayan and
Paniker's Textbook of Microbiology, 10th edition, Page no 480.

Q62. A patient with end-stage renal disease secondary to polycystic kidney disease underwent a living donor kidney transplant 4 months ago. The
patient is on immunosuppressive therapy (tacrolimus and mycophenolate mofetil).The patient presents to the outpatient clinic with complaints of
fever, fatigue, and a sore throat for the past week. She also mentions a decrease in appetite and unintentional weight loss of about 5 pounds. On
further examination , the patient's histopathological examination shows as given below. What is the most likely the root of this infection?

1. CMV ✅
2. Rubella

3. HIV

4. Epstein-Barr virus

Answer: (1) — CMV

Explanation: CMV is the most reasonable option out of the given choices considering that it is the most common type of infection in renal
transplant recipients. Prophylaxis against CMV infection is possible with ganciclovir, valganciclovir, or valacyclovir. Reference : Ananthanarayan
and Paniker's Textbook of Microbiology, 10th edition, Page no 480.

Q63. In which year was the causative organism for AIDS identified?

1. 1983 ✅
2. 1976

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 3. 1994

4. 1969

Answer: (1) — 1983

Explanation: HIV virus was discovered in 1983, it was isolated from a patient with lymphadenopathy, and by 1984 it was demonstrated clearly to
be the causative agent of AIDS. Reference : Ananthanarayan and Paniker's Textbook of Microbiology, 10th edition, Page no 574.

Q64. What does the term "malaria recrudescence" mean?

1. Same as relapse in P. vivax and P. ovale malaria

2. Resistance to antimalarial drugs

3. Recurrence of parasitaemia after completion of treatment ✅

4. Reinfection with the same species

Answer: (3) — Recurrence of parasitaemia after completion of treatment

Explanation: Malaria recrudescence is a situation in which a person has an episode of malaria reappearance of asexual phase of parasitaemia
despite having been treated for the infection previously. It is caused when the infected person does not complete the full course of antimalarial
treatment or when antimalarials used to treat the infection were not effective against the particular type of malaria parasite that infected that person.
It can also be caused by reinfection with the malaria parasite, as the immunity acquired from previous infection with the same strain of malaria is
usually short-lived. Recrudescence occurs in Plasmodium falciparum and malariae species. Reference : Paniker's Textbook of Medical Parasitology,
8th edition, Page no 69, 81.

Q65. Under which section of the IPC are the legal responsibilities of an intoxicated person given?

1. 82

2. 83

3. 84

4. 85 ✅
Answer: (4) — 85

Explanation: Sec 85 IPC - An act done by a person, who is incapable of knowing the nature of the act due to intoxication is not an offence, if the
thing which intoxicated him was administered to him without his knowledge or against his will. Sec 86 IPC is regarding criminal responsibility after
voluntarily drunkenness. Reference: THE ESSENTIALS OF FORENSIC MEDICINE AND TOXICOLOGY, Dr. K.S. NARAYAN REDDY, 33 rd
Edition, Page No 519.

Q66. Which of the following section of IPC defines perjury as a crime and which section outlines its punishment?

1. Section 190, section 191 of IPC respectively

2. Section 191, section 193 of IPC respectively ✅

3. Section 192, section 193 of IPC respectively

4. Section 193, section 190 of IPC respectively

Answer: (2) — Section 191, section 193 of IPC respectively

Explanation: Perjury is an offense defined in Section 191 of the Indian Penal Code, Section 192 of the Indian Penal Code and Section 344 of the
Criminal Procedure Code. Perjury refers to giving false evidence - It arises when a person's statements under oath contradict each other and cannot
be reconciled. The punishment for perjury is outlined in Section 193 of the Indian Penal Code, where imprisonment can be up to 7 years. It arises
when a person's statements under oath contradict each other and cannot be reconciled. Section 191- defines perjury(giving false evidence) Section
193- punishment of perjury(giving false evidence) - imprisonment up to 7 years and fine. Reference: THE ESSENTIALS OF FORENSIC
MEDICINE AND TOXICOLOGY, Dr. K.S. NARAYAN REDDY, 33 rd Edition, Page No 55.

Q67. According to Gustafson's method, what is the most significant indicator of age determination?

1. Root transparency ✅
2. Root attrition

3. Root resorption

4. Paradentosis

Answer: (1) — Root transparency

Explanation: Correct Option is 1. Root transparency Dentin becomes less visible with age, as mineral deposits fill the wide dentin tubules which
become smaller and less translucent. This process of gradual mineralization is the most dependable way of determining a person's age. After around

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 30 years of age, the dentin becomes transparent due to mineralization and osteoporosis. This makes Root transparency the single most important
indicator for Gustafson method of age analysis. Transparency of root occurs from below upwards in lower jaw and from above downwards in upper
jaw. It is the most reliable of all criteria . Reference: THE ESSENTIALS OF FORENSIC MEDICINE AND TOXICOLOGY, Dr. K.S. NARAYAN
REDDY, 34 th Edition, Page No 69.

Q68. What does a person with eonism find enjoyable?

1. Wearing clothes of the opposite sex ✅

2. Fondling female body parts

3. Rubbing genitalia against body of other person

4. Seeing the opposite partner nude

Answer: (1) — Wearing clothes of the opposite sex

Explanation: Transvestism or eonism is the practice of individuals identifying with and expressing themselves through the clothing, behaviour, and
attitude typically associated with the opposite gender. The term is derived from Chevalier d’Eon Beamont, a Frenchman who identified as a woman
and often dressed in traditionally feminine attire. Transvestism is particularly common in men who derive sexual pleasure from wearing female
clothing. Reference: THE ESSENTIALS OF FORENSIC MEDICINE AND TOXICOLOGY, Dr. K.S. NARAYAN REDDY, 33 rd Edition, Page No
432.

Q69. In India, cannabis is the most often used illegal substance. Which of the following is not a cannabis derivative?

1. Bhang

2. Charas

3. Ganja

4. Afeem ✅
Answer: (4) — Afeem

Explanation: afeem is not a form of marijuana it is a opium product derived from poppy flower juices. Products of cannabis include - • Ganja -
flowering tops of female plant - smoking • Bhang - large green leaves and flowering shoots- cooked and eaten • Hashish - concentrated resin •
Charas - resin from unfertilized flowers • Majoon - sweet prepared with bhang. Reference: THE ESSENTIALS OF FORENSIC MEDICINE AND
TOXICOLOGY, Dr. K.S. NARAYAN REDDY, 33 rd Edition, Page No 536.

Q70. Which toxin is responsible for the distinctive smell of burning rope?

1. Cannabis ✅
2. Tobacco

3. Strychnine

4. Chloral hydrate

Answer: (1) — Cannabis

Explanation: A distinct smell similar to burnt rope can be detected on the breath of a person who has just smoked. Cannabis , which is an Indian
hemp plant known as Cannabis sativa, is an aromatic, resilient annual herb found in a variety of climates. The chemical compound Delta-9
tetrahydrocannabinol (THC) is present in the highest concentration in bracts, flowers and leaves, with little or no THC present in stems, roots or
seeds. Reference: THE ESSENTIALS OF FORENSIC MEDICINE AND TOXICOLOGY, Dr. K.S. NARAYAN REDDY, 33 rd Edition, Page No
600.

Q71. What is the active principal of white oleander?

1. Nicotine

2. Nerin ✅
3. Abrine

4. Pilocarpine

Answer: (2) — Nerin

Explanation: In India, the White Oleander , also known as kaner, is a wild growing plant with strongly fragrant blooms that cluster at the end of
branches. Its every aspect - excluding the roots - are highly poisonous, containing a range of cardiac glycosides, chiefly Oleandrin and Nerin ,
producing effects comparable to Digitalis (Foxglove). Other active principles include folinerin and rosagenin. The nectar yields a poisonous honey.
Reference: THE ESSENTIALS OF FORENSIC MEDICINE AND TOXICOLOGY, Dr. K.S. NARAYAN REDDY, 33 rd Edition, Page No 616.

Q72. A patient with a viper snake bite is being treated by a doctor. He must keep in mind that viper venom is:

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 1. Histotoxic

2. Vasculotoxic ✅
3. Musculotoxic

4. Neurotoxic

Answer: (2) — Vasculotoxic

Explanation: Viper venom - haemotoxic and vasculotoxic Cobra and krait venom - neurotoxic sea snake venom - myotoxic Reference: THE
ESSENTIALS OF FORENSIC MEDICINE AND TOXICOLOGY, Dr. K.S. NARAYAN REDDY, 33 rd Edition, Page No 565.

Q73. The prospectively evaluated, double-blinded, randomized clinical trial represents the 'gold-standard' for providing evidence for therapeutic
decision marking. This was first proposed by the father of evidence based medicine:

1. Tolstoy

2. Sackett ✅
3. Hippocrates

4. da Vinci

Answer: (2) — Sackett

Explanation: Father of evidence based medicine is David Lawrence Sackett . David Lawrence Sackett OC FRSC (November 17, 1934 – May 13,
2015) was an American-Canadian physician and a pioneer in evidence-based medicine . He is known as one of the fathers of Evidence-Based
Medicine . He founded the first department of clinical epidemiology in Canada at McMaster University , and the Oxford Centre for Evidence-Based
Medicine . He is well known for his textbooks Clinical Epidemiology and Evidence-Based Medicine . Online reference :
[Link]

Q74. Which of the following statements is incorrect about the calculation of HDI?

1. The minimum value for combined gross enrolment ratio is fixed at 0% .

2. The minimum value for adult literacy rate is fixed at 0 .

3. The maximum value of life expectancy at birth is taken as 100 ✅

4. The maximum value for per capita income is fixed at 75,000

Answer: (3) — The maximum value of life expectancy at birth is taken as 100

Explanation: The Human Development Report of 1997 presented a Human Poverty Index (HPI) that amalgamated a variety of elements reflecting
the quality of life to accurately judge the magnitude of poverty experienced by a population. HPI-1's development in less economically developed
countries is based on three particular dimensions : a) life expectancy at birth and the risk of premature mortality, b) adult literacy rates, and c) access
to adequate sanitary facilities and an appropriate standard of living, as illustrated by the two indicators of the percentage of people not using
improved water sources and the percentage of children below their proper weight-for-age. HDI Components: 1) life expectancy - min of 20 to max
of 85 yrs, 2) Expected years of schooling - min is 0 to max of 18, 3) Mean years of schooling -min of zero to max of 15 yrs, 4) GNI per capita - min
of 100 and max of 75,000. Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 18.

Q75. Which of the following statements is correct regarding education in HDI? rd weightage is given to adult literacy rd weightage is given to gross
enrolment

1. In gross enrolment, only secondary education is considered, not primary education

2. 1/3

3. 2/3

4. Country's achievement is computed on the basis of adult literacy ✅

Answer: (4) — Country's achievement is computed on the basis of adult literacy

Explanation: Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 17.

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 Q76. Which of the following vaccines leads to an immune thrombocytopenic purpura (ITP) complication?

1. MMR ✅
2. Hib conjugate polysaccharide vaccine

3. Typhoid Vi polysaccharide vaccine

4. Influenza vaccine

Answer: (1) — MMR

Explanation: ITP stands for idiopathic thrombocytopenic purpura. It is an autoimmune disease that causes low platelet counts and can lead to
bleeding. It is believed to be caused by an immune reaction to certain vaccines, most commonly the measles, mumps, and rubella vaccine.
Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 125.

Q77. Chemoprophylaxis is suggested for all of the following except?

1. Cholera

2. Measles ✅
3. Meningococcal meningitis

4. Conjunctivitis

Answer: (2) — Measles

Explanation: Chemoprophylaxis refers to the use of medication to prevent disease, particularly infections. Chemoprophylaxis is is suggested for all
of the above options except measles. Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 139.

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 Q78. Which of the following statements is incorrect about INH chemoprophylaxis?

1. It is cheap

2. It is not feasible to apply on a large scale

3. It has risk of drug-induced hepatitis

4. It is not highly clinically effective ✅

Answer: (4) — It is not highly clinically effective

Explanation: The incorrect statement about INH (Isoniazid) chemoprophylaxis is: It is not highly clinically effective. INH chemoprophylaxis is
actually considered to be highly effective in preventing the development of active tuberculosis, especially in individuals at high risk. The other
statements are generally accurate. Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 232.

Q79. Positive predictive value is a function of sensitivity, specificity, and

1. Absolute risk

2. Relative risk

3. Incidence

4. Prevalence ✅
Answer: (4) — Prevalence

Explanation: PPV =Sensitivity x Prevalence/[ Sensitivity × Prevalence + 1( - Specificity) × (I - Prevalence)], thus PPV , is a function of sensitivity,
specificity and prevalence. While the sensitivity and specificity of a test depend only on the characteristics of the test itself, predictive values vary
according to the prevalence (or underlying probability) of the disease . Thus, predictive values cannot be determined without knowing the
prevalence of the disease—they are not qualities of the test per se, but are a function of the test’s characteristics and of the setting in which it is
being used. The higher the prevalence of a disease in the population, the higher the PPV and the lower the NPV of a test for it. Reference : High
Yield Biostatistics, Epidemiology and Public Health, 4th edition, Page no 76.

Q80. Which of the following statements is incorrect about the period of isolation in the following diseases?

1. Chicken pox: 6 days after the onset of rash

2. Measles: 3 days after the onset of rash

3. German measles: 7 days after the onset of rash ✅

4. Herpes zoster: 6 days after the onset of rash

Answer: (3) — German measles: 7 days after the onset of rash

Explanation: The incorrect statement about the period of isolation in the mentioned diseases is: German measles: 7 days after the onset of rash. For
German measles (rubella) , the recommended isolation period is typically 4 days after the onset of the rash, not 7 days. The other statements
regarding chicken pox, measles, and herpes zoster are correct. Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page
no 169.

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 Q81. Which of the following is incorrect about the oral polio vaccine (OPV)?

1. Useful in epidemics

2. Excretion of virus in stools may cause disease to the unimmunized ✅

3. Rapid antibody response

4. Protective even in the presence of maternal anti-bodies

Answer: (2) — Excretion of virus in stools may cause disease to the unimmunized

Explanation: Regarding oral polio vaccine (OPV) , excretion of virus in stools may cause disease to the unimmunized is not correct statement. Oral
Polio Vaccine (OPV) : The OPV progeny excreted in the feces and secondary spread occurs to household contacts and susceptible cont in the
community. This property of OPV has been exploited in controlling epidemics of polio by administering the vaccine. Nevertheless, several studies
show that among breastfed infants, who are fed OPV in the first three days of life 24 simultaneously in a short period to all susceptibles in a
community. percent develop serum antibodies and 30-60 percent excrete vaccine virus. Colostrum produced in the first three days after child-birth
contains secretory IgA antibody which might intern with the production of immune response to "OPV " The OPV progeny excreted in the feces and
secondary spread occurs to household contacts and susceptible contacts i community. Non-immunized persons may therefore be immunized. Thus,
widespread 'herd immunity' results, even approximately 66 percent of the community is immunized. This property of OPV has been exploited in
controlling epidemi polio by administering the vaccine simultaneously in a short period to all susceptibles in a community. This procedure ima
eliminates the wild polio strains in the community and replaces them with attenuated strains. Reference : Park's Textbook of Preventive and Social
Medicine, 27th edition, Page no 241, 242.

Q82. For what purposes does HIV sentinel surveillance provide data?

1. To monitor disease trends ✅

2. To identify high risk population

3. To estimate disease incidence

4. To assess the quality of related services

Answer: (1) — To monitor disease trends

Explanation: Sentinel surveillance provides essential information to understand the trends and dynamics of HIV epidemic among different risk
groups in the country. Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 395.

Q83. A dog in the neighborhood allegedly bit a boy without cause. The dog was later captured by the neighborhood animal authority and seemed to
be in good condition. What would be the best course of action?

1. Give post-exposure prophylaxis to the bitten person with culture-derived vaccine ✅

2. Withhold vaccination, keep the dog under observation for ten days for signs of rabies

3. Test the dog for rabies antibodies

4. Immediately carry out euthanasia of the dog

Answer: (1) — Give post-exposure prophylaxis to the bitten person with culture-derived vaccine

Explanation: The given scenario is suggestive of Category III dog bite. Hence , the management is according to the given table below. Reference :
Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 325, 326.

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 Q84. Which of the following is not evidence of decreased risk of cardiovascular disease?

1. Vitamin E supplementation ✅
2. Low to moderate daily alcohol consumption

3. Regular physical activity

4. Potassium

Answer: (1) — Vitamin E supplementation

Explanation: Vitamin E does not have any overall benefit in reducing mortality or decreasing the risk of heart death or stroke , and thus should not
be recommended for heart disease prevention. On the other hand, drinking in moderation may help protect against cardiac diseases and death, and
regular physical activity has been proven to d ecrease risk of cardiovascular diseases. Furthermore, optimal levels of potassium are critical for CVD
health and for the prevention of arrhythmia s. Amongst option 1 and 2, 1 is a better answer . Reference : Park's Textbook of Preventive and Social
Medicine, 27th edition, Page no 418.

Q85. In accordance with the school vision screening programme, who carries out the vision testing in schools?

1. Ophthalmologist

2. Optometrist

3. NGO worker

4. Teacher ✅
Answer: (4) — Teacher

Explanation: School eye screening program : a. Vision testing in schools done by trained school teacher. b. Those who were suspected of having
refractive error are referred to ophthalmologic assistant where the vision testing is done c. Spectacles are made available free to those who are below
poverty line. Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 659.

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 Q86. An ASHA will be compensated financially for all of the following under the National Rural Health Mission, with the exception of?

1. To promote Institutional deliveries

2. Measuring the birth weight of neonates

3. Zero dose of DPT and OPV ✅

4. Registration of births

Answer: (3) — Zero dose of DPT and OPV

Explanation: Among the given options, administration of zero dose of DPT and OPV is not a function of ASHA worker. Rather, it is administered
by the auxillary nurse midwife. Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 701.

Q87. Which of the following is not included in the provisions under the Janani Shishu Suraksha Karyakaram (JSSK)?

1. Free food to the mother in the hospital

2. Cash incentive for institutional deliveries ✅

3. Free transport to the mother and baby to/from hospital

4. Free treatment of the neonate and infant in all public health facilities

Answer: (2) — Cash incentive for institutional deliveries

Explanation: Janani Shishu Suraksha Karyakaram (JSSK) is a 100% centrally sponsored scheme with main objective to improve the institutional
deliveries . The Indian government has started the Janani Shishu Suraksha Karyakram (JSSK) to persuade expectant mothers who still choose to
give birth at home to choose institutional births. This programme hopes that states would step up and make sure that every pregnant woman in need
who enters a government institution receives benefits under the JSSK. The free entitlements listed below are available to expectant mothers:
Deliveries, C-sections, medications and supplies, diagnostics, diet during hospital stays, blood donations, transportation from home to hospitals,
transportation between facilities in the event of a referral, and discharge from hospitals after a 48-hour stay. Newborns with illnesses also are now
covered by Free Entitlements for up to 30 days following birth. Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page
no 522.

Q88. If there were 212 stillbirths, 450 neonatal deaths, and 12,450 live births overall in 2012, what would be the population's neonatal mortality
rate?

1. 36 ✅
2. 15

3. 90

4. 56

Answer: (1) — 36

Explanation: Neonatal death - 450 Stillbirth - 212 Total live birth - 12450 NMR = Total no. neonatal deaths /Total No. of live births * 1000 =450
/12450*1000 = 36.144 = 36 Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 643.

Q89. Which of the following does not include the infant mortality rate?

1. Early neonatal deaths

2. Late neonatal deaths

3. Post neonatal deaths

4. Stillbirths ✅
Answer: (4) — Stillbirths

Explanation: Infant mortality rate is defined as the number of deaths of children under 1 year of age per 1000 live births within a given period. As,
stillbirth includes death of unborn fetus , it does not form part of infant mortality rate. Reference : Park's Textbook of Preventive and Social
Medicine, 25th edition, Page no 617.

Q90. The hair of a girl is white. In addition to her, 40% of her classmates experience this issue. The other villagers in the same region don't have any
residents with white hair. Her sibling, who is staying with an aunt in a village nearby, is also normal and does not have white hair. Which statement
best describes why her hair is likely to be white?

1. Environmental ✅
2. Genetic

3. Nutritional

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 4. Infection

Answer: (1) — Environmental

Explanation: Given scenario is : The girl and 40% of her classmates have white hair. Her sibling living in the nearby village is normal and has no
white hair. In the given question, the girl and many of her classmates from a single geographical area , in this case, the school) have developed grey
hair , answer can be environmental as the girl's brother living in a different village does not have white hair, the cause of the white hair is unlikely to
be genetic . Similarly, as many other children from the same school have white hair , the cause is also unlikely to be nutritional . Reference : Park's
Textbook of Preventive and Social Medicine, 25th edition, Page no 25.

Q91. What is the definition of severe acute malnutrition (SAM) in India?

1. Very low weight for age (below -3 Z scores of the mean WHO standards for growth), by visible severe wasting, or presence of nutritional edema

2. Very low weight for age (below -3 Z scores of the mean WHO standards for growth), only

3. Visible severe wasting, or presence of nutritional edema

4. Very low weight for height (below -3 Z scores of the mean WHO standards for growth), by visible severe wasting, or presence of nutritional
edema ✅
Answer: (4) — Very low weight for height (below -3 Z scores of the mean WHO standards for growth), by visible severe wasting, or presence of
nutritional edema

Explanation: Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 755.

Q92. What is the most sensitive indication of an iodine shortage in the environment?

1. Serum T4 levels

2. Serum T3 levels

3. Urine iodine concentration

4. Neonatal hypothyroidism ✅
Answer: (4) — Neonatal hypothyroidism

Explanation: Urinary iodine excretion is the principal impact indicator and neonatal hypothyroidism rates is the most sensitive indicators.
Following indicators are useful in assessment of iodine deficiency: prevalence of goitre prevalence of cretinism urinary iodine excretion
measurement of thyroid function. prevalence of neonatal hypothyroidism Since, the objective of goitre control program is to increase iodine intake
,indices of urinary excretion are particularly recommended for use in surveillance. Reference : Park's Textbook of Preventive and Social Medicine,
27th edition, Page no 739.

Q93. Which of the following cannot cause an epidemic in the post-disaster period?

1. Leishmaniasis ✅
2. Leptospirosis

3. Rickettsiosis

4. Acute respiratory infections

Answer: (1) — Leishmaniasis

Explanation: Leishmaniasis is not a cause of epidemic after a disaster. As all of the other options has risk factors that increases due to disaster. The
strategies for avoiding and curbing the spread of communicable illnesses i n the wake of a disaster can be summarized as follows: (a) Establish
immediately all necessary public health procedures to reduce the risk of disease transmission. (b) Establish an efficient illness notification protocol
to detect outbreaks and begin control measures quickly. (c) Execute detailed investigations for all reported cases of illness quickly. Reference :
Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 925.

Q94. The hemoglobin levels of pregnant females in a community was found to have a mean of 10.6 g /dL and a standard deviation of 2 g/dL. What
is the minimum hemoglobin level below which 5% of the pregnant females will have their hemoglobin levels?

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 1. 7.32 ✅
2. 8.64

3. 6.68

4. 8.96

Answer: (1) — 7.32

Explanation: Since the mean is 10.6 and SD is 2 , therefore, It can be concluded that 68% of the population will have hemoglobin values between
10.6 minus two (8.6) and 10.6 plus two (12.6) , while 95% of the population will have hemoglobin values between 10.6 minus four (6.6) and 10.6
plus four (14.6) . The lowest 5% of the population will have values between 8.6 (34% of the population) and 6.6 (2.5% of the population) , so the
answer is 7.32. Reference : High Yield Biostatistics, Epidemiology and Public Health, 4th edition, Page no 21, 22, 23.

Q95. Which of the following committees recommended universal health coverage in India?

1. Multipurpose worker committee

2. Health development and planning committee

3. High-level expert committee ✅

4. Medical education committee

Answer: (3) — High-level expert committee

Explanation: The High Level Expert Group (HLEG) on Universal Health Coverage (UHC) was constituted by the Planning Commission of India
in October 2010, with the mandate of developing a framework for providing easily accessible and affordable health care to all Indians. Reference :
Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 1003.

Q96. According to the Alma Ata Declaration, which of the following provisions is not included in primary health care?

1. Adequate supply of safe drinking water

2. Provision of food supply

3. Provision of free medicines ✅

4. Basic sanitation

Answer: (3) — Provision of free medicines

Explanation: There are eight essential components : (a) Education about common health problems and what can be done to prevent and control
them; (b) Maternal and child health care, including family planning; (c) Promotion of proper nutrition; (d) Immunization against major infectious
diseases; (e) An adequate supply of safe water; (f) Basic sanitation; (g) Prevention and control of locally endemic diseases; (h) Appropriate
treatment for common diseases and injuries. Reference : Park's Textbook of Preventive and Social Medicine, 27th edition, Page no 693.

Q97. Which of the following is not a characteristic of multiple myeloma?

1. Increased Ig levels in serum

2. Positive ANA ✅
3. Plasmacytosis

4. M spike on electrophoresis

Answer: (2) — Positive ANA

Explanation: Correct Answer is (Option 2) Positive ANA ANA positivity is seen in multiple Rheumatological disorders like SLE, Systemic
sclerosis but is not characteristic of Multiple Myeloma. Major criteria for diagnosis of Multiple Myeloma: Plasmacytoma on tissue biopsy Bone
marrow plasmacytosis with >30% plasma cells Monoclonal globulin spike on serum electrophoresis exceeding 3.5 gm/dl for IgG or 2 gm/dL for
IgA,21 gm/24 of K or λ light-chain excretion on urine electrophoresis in the presence of amyloidosis. Reference: Robbins and Cotran Pathological
basis of disease, 10 th edition, Page No 607.

Q98. A pelvic fracture caused by a fall from height is present in an obese 60-year-old man who has smoked continuously since he was a child and
has a history of chronic smoking. On the fourth day of his ICU hospitalization, he suddenly became tachypneic, his SPO2 dropped, and his blood
pressure dropped. What would be the immediate next step if the right ventricle was dilated and the tricuspid regurgitation was present on a 2D echo?

1. D-dimer assay

2. Administration of heparin

3. Pericardiocentesis

4. Systemic thrombolysis ✅

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 Answer: (4) — Systemic thrombolysis

Explanation: The given clinical scenario points towards diagnosis of acute decompensated right heart failure secondary to pulmonary
thromboembolism due to prolonged immobilization post pelvic surgery. Presence of right heart failure or hemodynamic instability in a patient of
pulmonary embolism is an indication of thrombolysis. Reference: Bailey & Love’s SHORT PRACTICE of SURGERY, 28th Edition, Page No 384.

Q99. A 5-year-old girl has a viral fever. She later has severe vomiting for five days and is admitted to the hospital. She develops cerebral edema
while in the hospital. Which of the following is most likely to be seen in a liver biopsy?

1. Centrizonal hemorrhagic necrosis

2. Non-alcoholic steatohepatitis

3. Ring granulomas

4. Marked microvesicular steatosis ✅

Answer: (4) — Marked microvesicular steatosis

Explanation: Correct Answer is (Option 4) Marked micro vesicular steatosis Marked Micro vesicular steatosis can be seen in liver biopsy of this
child, as the features are suggesting Reye Syndrome which is a genetic disorder that is triggered by a viral infection, such as influenza or varicella,
and the use of salicylates. Symptoms can include vomiting, encephalopathy, seizures, coma, and increased intracranial pressure that can lead to
death. Liver biopsy typically shows micro vesicular steatosis without liver inflammation or necrosis. Treatment includes screening for fatty-acid
oxidation and fatty-acid transport defects as well as supportive care for symptoms. Fig: Microvesicular Steatosis Reference: Robbins and Cotran
Pathological basis of disease, 10 th edition, Page No 826.

Q100. The right upper quadrant of the abdomen is full in a 40-year-old obese woman. Her medical history is significant for both hyperlipidemia and
Type 2 diabetes mellitus. Which of the following diagnoses is the most likely one that a liver biopsy would point to?

1. Non-alcoholic steatohepatitis ✅
2. Peliosis hepatis

3. Autoimmune hepatitis

4. Primary biliary sclerosis

Answer: (1) — Non-alcoholic steatohepatitis

Explanation: Non alcoholic steatohepatitis (NASH) is used to describe clinical features of liver injury, such as elevated transaminases. Commonly
associated abnormalities are: - a. Type 2 diabetes b. Obesity, primarily central obesity) c. Dyslipidemia d. Hypertension Reference : Harrison's
Principles of Internal Medicine, 21st Edition, Page no 2622.

Q101. Jaundice and increased liver enzymes are seen in a young female patient. She had already experienced two instances that are comparable.
Her IgG level was 2400 IU, and her serum ANA was 1:40. Her viral indicators were negative, and her serum copper levels were normal. After a
liver biopsy, you administered immunosuppressants based on the pathology report, and the patient's condition got better. What was the pathology
report's most probable finding and the recommended course of treatment?

1. Non-alcoholic steatohepatitis

2. Hemosiderosis

3. Autoimmune hepatitis ✅

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 4. Primary biliary cirrhosis

Answer: (3) — Autoimmune hepatitis

Explanation: Correct Answer is (Option 3) Autoimmune hepatitis Autoimmune hepatitis has a variable clinical presentation. Patients may be
asymptomatic or present in acute liver failure (rare), or anywhere between. It tends to have a relapsing-remitting course . There is an association
with other autoimmune conditions. * Depending on the phase , the patient may present with; hepatomegaly +/- splenomegaly jaundice elevated
aminotransferases (ALT and AST) * Diagnostic criteria of autoimmune hepatitis include: elevated antinuclear antibodies, anti-smooth muscle
antibodies globulin level of more than 20 g/L coexistence of non-hepatic autoimmune diseases, including autoimmune thyroiditis, rheumatoid
arthritis, and systemic lupus the elimination of other forms of hepatitis such as viral or toxic hepatitis histologic examination findings consistent
with AIH Reference: Robbins and Cotran Pathological basis of disease, 10 th edition, Page No 839.

Q102. What are the effects of laxative abuse?

1. Hypokalemia ✅
2. Hypomagnesemia

3. Hypoglycemia

4. Colonic spasticity

Answer: (1) — Hypokalemia

Explanation: Correct Answer is (Option 1) Hypokalemia * Following are the complications of Chronic Laxative Abuse: a. Hypokalemia b. Renal
tubular acidosis c. Secondary hyperaldosteronism d. Hypermagnesemia - magnesium containing preparations e. Acute phosphate nephropathy f.
Metabolic alkalosis g. Pancreatic damage (but no changes in glucose levels) h. Ileocecal sphincter dilatation i. Colonic inflammation j. Urolithiasis
Reference: Basic & Clinical Pharmacology, Bertram G. Katzung, 14 th edition, Page No 1128.

Q103. Which of the following does not qualify as a diagnostic criterion for brainstem death?

1. Absence of brainstem reflexes

2. A positive apnea test

3. Lack of cerebral motor response to pain in all extremities

4. Absence of stretch reflex from all extremities is essential ✅

Answer: (4) — Absence of stretch reflex from all extremities is essential

Explanation: Brain death is a state of complete cessation of cerebral function in which somatic function is maintained and the heart continues to
pump through artificial means. Diagnosis is based on the observation of three essential elements of clinical evidence: coma, absent pupillary light
response, oculovestibular and corneal reflexes, and cessation of respiration. Loss of deep tendon reflex and Loss of stretch reflex is not required for
diagnosis. Reference: THE ESSENTIALS OF FORENSIC MEDICINE AND TOXICOLOGY, Dr. K.S. NARAYAN REDDY, 33 rd Edition, Page
No 135.

Q104. As shown in the figure, which of the following is not a clinical feature of a lesion at the mid-brainstem level?

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 1. Deviation of the tongue to opposite side ✅
2. Contralateral loss of pain and temperature below the neck

3. Nystagmus

4. Paralysis of soft palate

Answer: (1) — Deviation of the tongue to opposite side

Explanation: The area affected shown in the MRI scan is of Midbrain. Deviation of tongue to the opposite site of lesion will be seen in when there
is injury to hypoglossal nerve or its nucleus which arises at the level of medulla oblongata and not midbrain. Reference-: Harrison's Principles of
Internal Medicine, 21th Edition Page no 231

Q105. A and B were instructed to create a square from the empty and filled circles, respectively. A drew a square that isn't really a square. What
could be the potential reason?

1. Lesion in basal ganglia

2. Lesion in subthalamic nucleus

3. Lesion in cerebellum ✅
4. Physiological tremors

Answer: (3) — Lesion in cerebellum

Explanation: Image A shows the phenomenon of past-pointing and intentional tremor while joining the empty and filled circles, seen in case of
cerebellar lesions . Reference : Harrison's Principles of Internal Medicine, 21st Edition, Page no 3280, 3400.

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 Q106. Which of the following drugs is used in the treatment of acute bacterial meningitis?

1. Erythromycin

2. Sulfamethoxazole

3. Ceftriaxone ✅
4. Streptomycin

Answer: (3) — Ceftriaxone

Explanation: Ceftriaxone- a third generation cephalosporin is the empirical drug of choice for treatment of acute bacterial meningitis before culture
reports are awaited. Once culture reports are available, organism sensitive antibiotic will be used in the treatment. For eg- In case of listeria
meningitis, the drug of choice becomes ampicillin. Reference : Ananthanarayan and Paniker's Textbook of Microbiology, 10th edition, Page no 233.

Q107. A P wave greater than _____ indicates a persistent right atrial overload.

1. 2.5 mm ✅
2. 3.5 mm

3. 4.5 mm

4. 5.5 mm

Answer: (1) — 2.5 mm

Explanation: Correct option: 1. 2.5 mm Right atria chronic overload or acute overload is indicated by P wave of more than 2.5 mm . The electrical
signal for atrial depolarization originates at the sinus node and then spreads from the right to the left atrium, resulting in a downward and left-
pointing vector in the electrocardiogram (ECG). This vector is recorded in leads I and aVR as positive and negative, respectively. Normal p wave is
less than 2.5mm in lead II . If it is more than 2.5, this indicate right atrial overload. Reference : Douedi S, Douedi H. P wave. [Updated 2023 Jul 24].
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: [Link]

Q108. Where are c-anti-neutrophil cytoplasmic antibodies (ANCA) found?

1. Wegener's Granulomatosis ✅
2. Diabetes mellitus

3. Rheumatoid arthritis

4. Churg-strauss syndrome

Answer: (1) — Wegener's Granulomatosis

Explanation: Correct Answer is (Option 1) Wegener's Granulomatosis Anti-neutrophil cytoplasmic antibodies (ANCAs) are auto antibodies, mainly
of the IgG type, which are targeted against antigens in the cytoplasm of neutrophil granulocytes and monocytes and detected through a blood test.
They are associated with systemic vasculitis, known as ANCA-associated vasculitis and the antigen specifically targeted is proteinase. A c-ANCA
positive test result can indicate Wegener's granulomatosis. ANCA Memorizing trick:- PCM- p- ANCA- C hurg's Strauss, M icroscopic polyangitis c-
ANCA- Wegener's Reference: Robbins and Cotran Pathological basis of disease, 10 th edition, Page No 514.

Q109. What should be done first in the management of a head injury case with an open femur shaft fracture?

1. Neurosurgery consultation

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 2. Give IV fluids

3. Intubation ✅
4. Splintage of fracture

Answer: (3) — Intubation

Explanation: The ABCs of trauma assessment -airway, breathing/oxygenation and circulation-represent the first steps in determining the extent of
injury and patient care priorities. In the question patients GCS has not been mentioned. If less than 9, patient should be intubated. Better answer for
option 3 instead of intubation would be assessment of Airway and protection. Reference: Bailey & Love’s SHORT PRACTICE of SURGERY, 28th
Edition, Page No 364.

Q110. What are the characteristics of neurogenic shock?

1. Hypertension and tachycardia

2. Hypertension and bradycardia

3. Hypotension and tachycardia

4. Hypotension and bradycardia ✅

Answer: (4) — Hypotension and bradycardia

Explanation: Neurogenic shock: In addition to arteriolar dilation, venodilation causes pooling in the venous system, which decreases venous return
and cardiac output." Interruption of sympathetic vasomotor input after a high cervical spinal cord injury, inadvertent cephalad migration of spinal
anesthesia, or devastating head injury may result in neurogenic shock. The extremities are often warm, in contrast to the usual sympathetic
vasoconstriction-induced coolness in hypovolemic or cardiogenic shock Reference: Online Resource
[Link]

Q111. What are the most frequent artefacts of rib fractures during resuscitation?

1. 2nd - 4th ribs

2. 3rd - 5th ribs ✅

3. 4th - 6th ribs

4. 5th - 7th ribs

Answer: (2) — 3rd - 5th ribs

Explanation: Correct option: 2. 3rd - 5th ribs Studies have generally shown that rib fractures resulting from conventional CPR are quite common,
with the left side being more fractured than the right . The majority of rib fractures (65%-70%) occur at the 3rd-6th ribs , and the majority of sternal
fractures (1.3-43.3%) occur in the middle or lower third of the sternum. Most patients present with multiple anterior rib fractures with ribs no. 3-6
on the left side get injured most commonly during CPR , esp. rib no 3,4 and 5. [Controversial question] Answer depends on the Answer key used
{However, 3–5 ribs better answer than 4–6th ribs}. Reference : Deliliga, Aspasia et al. “Cardiopulmonary resuscitation (CPR) complications
encountered in forensic autopsy cases.” BMC emergency medicine vol. 19,1 23. 28 Feb. 2019, doi:10.1186/s12873-019-0234-5. Jaeger, Deborah et
al. “Left rib fractures during cardiopulmonary resuscitation are associated with hemodynamic variations in a pig model of cardiac
arrest.” Resuscitation plus vol. 15 100429. 14 Jul. 2023, doi:10.1016/[Link].2023.100429

Q112. A 12-year-old girl is diagnosed with a nodular goiter. Which of the following statements regarding her evaluation and management is
incorrect?

1. 99 m-Tc scan should be performed to determine whether the nodules are hypo-functioning or hyperfunctioning

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 2. Functional thyroid nodules are usually benign

3. All nodules >1 cm should be resected irrespective of cytology ✅

4. FNAC ideally should be performed for all nodules >2 cm in diameter

Answer: (3) — All nodules >1 cm should be resected irrespective of cytology

Explanation: Correct Answer is (Option 3) All nodules >1 cm should be resected irrespective of cytology Subjects with a benign cytology are
considered true negative if they are followed up for a period of at least 2 years – this will allow identification of those with changing symptoms for a
repeat FNAB, and true negativity is confirmed if a diagnosis of thyroid neoplasia has not been made after a 2-year follow-up. Surgery is required if
malignant or suspicious cytology is reported. Rapid growth and increasing pressure effects (breathing difficulty) will signal the need for surgery.
Some patients may undergo surgery for pressure effects like dysphagia, and other patients may opt for surgery because of cosmetic reasons due to
the size of the goiter. It has been suggested that in subjects with a suspicious FNAB report , the rate of surgery may be reduced further by subjecting
patients to radio nuclide scanning and performing surgery on those nodules that are cold or warm, and simply following up those with hot nodules
without surgery as the risk of malignancy in these nodules is very low. Online Reference: Unnikrishnan AG, Kalra S, Baruah M, Nair G, Nair V,
Bantwal G, Sahay RK. Endocrine Society of India management guidelines for patients with thyroid nodules: A position statement. Indian J
Endocrinol Metab. 2011 Jan;15(1):2-8. doi: 10.4103/2230-8210.77566. PMID: 21584159; PMCID: PMC3079862.

Q113. What incision from the list below is used for diaphragmatic surgery?

1. Transverse

2. Circumferential ✅
3. Vertical

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 4. Radial

Answer: (2) — Circumferential

Explanation: Correct Answer is (option 2) Circumferential Circumferential incisions in diaphragm are the safest incisions as they result in little loss
of function. These circumferential incisions, however, must be at least 5 cm lateral to the edge of the central tendon to avoid the posterolateral and
anterolateral branches of the phrenic nerve. Reference: Filosso PL, Guerrera F, Sandri A, Lausi PO, Lyberis P, Bora G, Roffinella M, Ruffini E.
Surgical management of chronic diaphragmatic hernias. J Thorac Dis. 2019 Feb;11(Suppl 2):S177-S185. doi: 10.21037/jtd.2019.01.54. PMID:
30906583; PMCID: PMC6389560.

Q114. Which of the following is not an etiological cause for pancreatitis?

1. Abdominal trauma

2. Hyperlipidemia

3. Islet cell hyperplasia ✅

4. Germline mutations in the cationic trypsinogen gene

Answer: (3) — Islet cell hyperplasia

Explanation: Correct answer is (Option 3) Islet cell hyperplasia Islet cell hyperplasia does not cause pancreatitis. Pancreatitis is inflammation of the
pancreas. The most common cause of pancreatitis is alcohol abuse and chronic usage of certain medications, such as steroids and diuretics. Other
potential causes include gallstones, infections, abdominal trauma, auto-immune disorders, genetic disorders, and certain medications. In some cases,
the cause of pancreatitis can be unknown. * [Extra Edge]: Etiologic Factors in Acute Pancreatitis Reference: Robbins and Cotran Pathological basis
of disease, 10 th edition, Page No 882.

Q115. A 50-year-old male patient arrives with massive bowel diarrhea and rectal bleeding. A growth that resembles a cauliflower is visible on
sigmoidoscopy in the rectum. Histopathological analysis of a colectomy specimen reveals cancer. Which of the following prognostic studies is not
necessary?

1. Microsatellite instability

2. c-myc mutations

3. EGFR mutations ✅

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 4. k-RAS mutations

Answer: (3) — EGFR mutations

Explanation: Correct Answer is ( Option 3) EGFR mutations Kras and Cmyc have been found to have prognostic value in advanced colonic
cancers (stage 4) , where genotyping for Kras mutations is now standard practice. ErbB2 amplification is associated with advanced disease stage and
poor survival outcomes, however it is only amplified in less than 5% of subjects. MSI has well-established prognostic value in colonic cancers and
is often tested regularly. While all these options have some prognostic value, in a scenario where a patient has early stage cancer (no more than a
symptom of diarrhoea and a tumor excised during sigmoidoscopy), EGFR may have no prognostic value. Reference: Bailey & Love’s SHORT
PRACTICE of SURGERY, 28th Edition, Page No 195.

Q116. Which of the following medications is effective in treating advanced prostate cancer?

1. Ganirelix

2. Cetrorelix

3. Abarelix

4. Goserelin ✅
Answer: (4) — Goserelin

Explanation: Goserelin is used as a depot formulation. Goserelin is a synthetic decapeptide analogue of gonadotropin releasing hormone that acts
as a partial agonist of the gonadotropin receptors in the pituitary that regulate luteinizing hormone (LH) and follicle stimulating hormone (FSH)
secretion The continued receptor occupancy by goserelin, however, ultimately causes a down-regulation of production of LH and FSH and a
resultant decrease in testosterone and estrogen levels. They produce effects similar to that of orchiectomy and are approved in the treatment of
advanced prostatic cancer. Goserelin and the other GnRH analogues cause a profound hypogonadism ("chemical castration") and its common side
effects are typical of androgen deprivation, including hot flashes, loss of libido, erectile dysfunction, depression, nausea, diarrhea, weight gain and
fluid retention Memorizing trick for GnRH- relix- relax- GnRH antagonist relin- GnRH agonist Reference: Schwartz’s Principles of Surgery, 11th
Edition, Page No 598.

Q117. 8 months after receiving a kidney transplant, an older man with nephropathy presents. Which of the following could be the cause of a viral
infection?

1. Polyomavirus BK ✅
2. Human herpes virus type 6

3. Hepatitis C

4. Human papilloma virus, high risk types

Answer: (1) — Polyomavirus BK

Explanation: BK polyoma virus is transmitted through respiratory fluids or urine, since infected individuals periodically excrete virus in the urine.
It then disseminates to the kidneys and urinary tract where it persists for the life of the individual. Typically, this is in the setting of kidney
transplantation or multi-organ transplantation. BK virus is a latent polyomavirus that lies dormant in the kidney and urothelial tract and can be
activated in the setting of immunosuppression . Reactivation of BK, if left untreated, will lead to progressive fibrosis and loss of the graft within 1
year in most cases. Presentation in these immunocompromised individuals is much more severe. Clinical manifestations include renal dysfunction
(seen by a progressive rise in serum creatinine), and an abnormal urinalysis revealing renal tubular cells and inflammatory cells ( Decoy cells ).
Reference : Harrison's Principles of Internal Medicine, 21st Edition, Page no 2330.

Q118. A 7-year-old kid arrives with a right-sided hemangioma and left-sided focal convulsions. What is the most likely diagnosis?

1. Neurofibromatosis

2. Incontinentia Pigmenti

3. Hypomelanosis of Ito

4. Sturge-Weber disease ✅
Answer: (4) — Sturge-Weber disease

Explanation: Sturge-Weber syndrome , or encephalotrigeminal angiomatosis, is a phakomatosis characterized by facial port wine stains and pial
angiomas. The diagnosis is usually obvious on account of a congenital facial cutaneous capillary malformation (also known as port wine stain or
facial nevus flammeus ). This feature is almost always present and usually involves the ophthalmic division (V1) of the trigeminal nerve ; if this
territory is not involved, Sturge-Weber syndrome is unlikely. In ~5%, it has intracranial involvement present without associated cutaneous nevus. In
the majority of cases (~70%) the nevus is unilateral and ipsilateral to the intracranial abnormality. The most common clinical manifestation is with
childhood focal seizures , present in 71-89% of cases , which is often refractory to medical therapy . These usually begin in the first few years of life
and are often associated with developmental delay and hemispheric symptoms including hemiplegia/hemiparesis and hemianopsia. Approximately a
third of patients have choroidal or scleral angiomatous involvement, which may be complicated by retinal detachment, buphthalmos or glaucoma.
Reference : Essential Pediatrics by OP Ghai, 9th edition, Page no 558, 559.

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 Q119. Which of the following scenarios does not involve preeclampsia on top of chronic hypertension in a pregnant woman?

1. New onset proteinuria

2. Platelet count <75,000

3. Increase in systolic BP by 30 mm Hg and diastolic by 15 mm Hg ✅

4. Fresh retinal hypertensive changes

Answer: (3) — Increase in systolic BP by 30 mm Hg and diastolic by 15 mm Hg

Explanation: Increase in systolic BP by 30 mm Hg and diastolic by 15 mm Hg Classification of Hypertensive Disorders in Pregnancy Preeclampsia
to eclampsia Hypertension and proteinuria \(\geq\) 300 mg per 24 hours after 20 weeks' gestation. Eclampsia is the convulsive form of preeclampsia
Gestational hypertension Hypertension induced in pregnancy after 20 weeks' gestation without proteinuria Chronic hypertension Blood pressure \
(\geq\) 140/90 mm Hg pre-pregnancy or before 20 weeks' gestation Preeclampsia superimposed on chronic hypertension Chronic hypertension,
developing preeclampsia and presenting with proteinuria, sudden increase in blood pressure, elevated or abnormal liver function tests,
thrombocytopenia or a sudden increase in blood pressure in a patient with previously controlled blood pressure Reference-Williams Obstetrics 26th
edition Page no 689,690

Q120. Which antihypertensive is not administered during pregnancy?

1. Enalapril ✅
2. α-methyldopa

3. Labetalol

4. Nifedipine

Answer: (1) — Enalapril

Explanation: Enalapril ACE inhibitors and Angiotensin receptor blockers are contraindicated in pregnancy. Completely safe drugs among the
options are alpha methyl dopa and labetalol. Reference-Williams Obstetrics 26th edition Page no 144,150

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 Q121. Which of the following cannot be administered to treat acute hypertension during labor?

1. IV labetalol

2. IV nitroprusside ✅
3. IV hydralazine

4. S/L Nifedipine

Answer: (2) — IV nitroprusside

Explanation: IV nitroprusside is generally NOT used to treat acute hypertensive crisis during labor Several drugs can be used to treat severe
hypertension in pregnancy viz.: Oral/sublingual nifedipine IV/oral labetalol Oral methyldopa IV hydralazine etc. Sodium nitroprusside has been
used to alter blood pressure in severe hypertensive disease of pregnancy or in Refractory cases ; however, concern exists in regard to potential lethal
complications from cyanide toxicity in both mother and fetus . Reference : Williams Obstretics, 26th edition, Page no 713, 723.

Q122. Which of the following conditions does not fall within the HELLP syndrome?

1. Hemolysis

2. Elevated liver enzymes

3. Thrombocytopenia

4. Retroplacental hemorrhage ✅
Answer: (4) — Retroplacental hemorrhage

Explanation: Laboratory Diagnostic Signs of HELLP syndrome H- H emolysis EL- E levated L iver enzymes LP- L ow P latelet Hemolysis •
Abnormal misshapen erythrocytes in peripheral smear • Increased indirect serum bilirubin • Increased lactic dehydrogenase • Low serum
haptoglobin • Microangiopathic anemia Elevated liver enzymes • Alanine aminotransferase • Aspartate aminotransferase Low platelets •
<100,000/mcL (no clear cutoff value) Reference: Williams Obstetrics, 26th edition, Page no 699.

Q123. The previous pregnancy ended in a caesarean section. Which of the following is not an indication for an elective caesarean section?

1. Breech

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 2. Macrosomia

3. Polyhydramnios ✅
4. Post-term

Answer: (3) — Polyhydramnios

Explanation: Rest all are indications for repeated cesarean section . Indication for Caesarean section 1. Absolute: • Vaginal Atresia • Advanced
carcinoma of cervix • Cervical or broad of contracted pelvis • Severe degree of contracted pelvis 2. Relatives: • Cephalopelvic disproportion •
Previous uterine scare • Fetal distress • Malpresentations • Antepartum hemorrhage • Elderly primigravidae • Chronic hypertension • Diabetes •
Pelvis atresia Reference: Williams Obstetrics, 26th edition, Page no 548. DC Dutta's Textbook of Obstetrics, 8th edition, Page no 670.

Q124. Which of the following factors causes female pubertal development?

1. Decreased level of adrenal androgens at puberty

2. High level of estrogen at puberty

3. Pulsatile release of GnRH during sleep ✅

4. Increased sensitivity of HPO axis to estrogen

Answer: (3) — Pulsatile release of GnRH during sleep

Explanation: Pulsatile release of GnRH during sleep Pulsatile release of GnRH is facilitated by Kisspeptin during puberty. Puberty is initiated
when GnRH is secreted in a pulsatile manner by hypothalamic neurons. This pulsatile release of GnRH allows pituitary gonadotrophs to release LH
and FSH. LH begins androstenedione production in ovarian theca cells, while FSH allows aromatase in follicular cells to synthesize estradiol. An
increase in serum estradiol allows breast tissue to enlarge and influences linear bone growth and epiphyseal fusion, playing a significant role in the
pubertal growth spurt. Reference : Shaw's Textbook of Gynaecology,17th edition, Page no 75.

Q125. On which of the following does sex chromatin testing depend?

1. Barr body ✅
2. Testosterone receptors

3. Hormone levels

4. Phenotypic features

Answer: (1) — Barr body

Explanation: In females, 1-15% of polymorphonuclear leukocytes can be seen with a small "drumstick" shaped segment of chromatin known as
barr body protruding from the nucleus, which indicates the presence of an inactive X chromosome. This is not visible in males. The Lyon hypothesis
suggests that one of the two X chromosomes in female cells is randomly inactivated, and that all but one of the X chromosomes present in a cell
with more than two X chromosomes will be inactivated. This can be observed in a variety of types of cells, most notably within the nuclei of
polymorphonuclear leukocytes, with the inactive X chromosome being visible in the form of a "drumstick" of chromatin known as a Barr body.
Reference- Ganong's Review of Medical Physiology Edition 26 th Page no 385

Q126. Hysteroscopic myomectomy scores over open myomectomy in all of the following except?

1. Less recurrence ✅
2. Less post-operative pain

3. Less bleeding

4. Early ambulation

Answer: (1) — Less recurrence

Explanation: Correct option: 1. Less recurrence In minimally invasive surgery, bleeding and post operative pain is less and ambulation is early.
However, recurrence and pregnancy rates are same in minimally invasive vs open method Advantages of Hysteroscopic myomectomy: Rapid
postoperative recovery Less postoperative pain and reduced need of postoperative analgesia Excellent visualization of organs and tissues Shorter
hospital stay and reduced concomitant cost Quicker resumption of day-to-day activity Less adhesion formation Minimal abdominal scars (cosmetic
value) Reduced blood loss No large incisions Less risk of incisional hernia Increased patient’s satisfaction. Less morbidity than laparotomy
Reference : DC Dutta's Textbook of Gynecology, 8th edition, Page no 512, 523.

Q127. A primigravida gives birth to a 1410 gram neonate at 32 weeks. The infant's vital were stable, and resuscitation was not required at birth. The
infant was moved to the NICU for care. How can we manage the infant's feeding?

1. Start total enteral feeding and IV feeding not required ✅

2. Start IV feeding with minimal enteral feeding

3. Start IV feeding and introduce feeding on 2nd day of life

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 4. Start parenteral feeding and institute oral feeding on 2nd day of life

Answer: (1) — Start total enteral feeding and IV feeding not required

Explanation: A 32 week preterm infant, weighing 1400 gm, with stable vitals admitted in NICU should be kept on total enteral nutrition. IV
fluids/nutrition is not required. Reference-Ghai Essential Pediatrics 9th Edition Page No 156

Q128. Which of the following is not included in Kangaroo Mother Care (KMC)?

1. Skin-to-skin contact

2. Free Supplementary nutrition ✅

3. Exclusive breastfeeding

4. Early discharge and follow-up

Answer: (2) — Free Supplementary nutrition

Explanation: Option (2) is incorrect. Free nutritional supplements are not considered a part of kangaroo mother care. Key Components/Elements of
Kangaroo Mother care(KMC) are: Reference AIIMS NICU Protocols 2nd Edition, page no. 617

Q129. A mother with eclampsia who received IV magnesium sulphate gave birth to a baby at 32 weeks. The infant was revived and taken to the
NICU. Twelve hours later, the infant displayed hypotonia, sluggishness, constricted pupils, and two seizures. Identify the stage of HIE?

1. Stage I

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 2. Stage II ✅
3. Stage III

4. There is no HIE

Answer: (2) — Stage II

Explanation: The presence of hypotonia , constricted pupils, and seizures indicates HIE stage 2. In HIE Stage II - there is parasympatetic
overactivity - this leads to bradycardia, miosis (constricted pupils) , low tone and lethargy/depressed reflexes in the neonate. Seizures are known to
occur only in stage II HIE, they donot occur either in stage I or stage III HIE. Reference - Nelson textbook of Pediatrics 21st edition Page no 918,
Table- 120.7

Q130. What does Moro's asymmetric reflex at birth indicate?

1. HIE

2. Brain damage

3. Erb's palsy ✅
4. Kernicterus

Answer: (3) — Erb's palsy

Explanation: Moro's asymmetric reflex at birth may indicate Erb's palsy . This condition can occur when there is damage to the upper trunk of the
brachial plexus, often resulting from birth trauma, leading to asymmetric arm movement during the Moro reflex. Asymmetric Moro's reflex could
also be seen in case of - 1. Congenital hemiplegia 2. Erb's palsy 3. Fracture clavicle 4. Shoulder dislocation Reference- Nelson Essentials Of
Pediatrics Edition 21 st Page No 3059

Q131. On day 6 of life, a very preterm baby receiving 30 mL/kg of internal feeding suddenly experienced significant abdominal distension with
apparent bowel loops. Lethargy and fluctuating temperatures were also present in the infant. Portal venous gas was visible on the abdomen's X-ray.
What is his NEC's staging?

1. 1b

2. 2a

3. 2b ✅
4. 4

Answer: (3) — 2b

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 Explanation: In stage IIb (Bell's classification of NEC) , portal venous gas is seen in imaging.
Reference:[Link]

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 Q132. Which of the following infants has the lowest risk of getting hypoglycemia?

1. A baby born to a mother treated with beta-blockers

2. Infants of diabetic mothers

3. Appropriate for gestational age babies ✅

4. IUGR babies

Answer: (3) — Appropriate for gestational age babies

Explanation: Appropriate for gestational age babies are not at risk for hypoglycemia(lowest risk amongst the given options). A baby born to a
mother treated with beta-blockers/Infants of diabetic mothers and IUGR babies - all are at risk of getting hypoglycemia. Neonates at risk of
hypoglycemia include : 1. Birth weight <2000g 2. Gestational age <35 weeks 3. Small for gestational age infants (SGA): birth weight<10th
percentile 4. Infants of diabetic mothers (IDM) 5. Large for gestational age (LGA) infants: birth weight>90th percentile 6. Neonates with Rh-
hemolytic disease 7. Neonates born to mothers receiving therapy with Propranolol/Labetolol/oral hypoglycemic agents 8. Neonates with
morphological features of growth restriction like three or more loose folds of skin around buttocks and thighs, loss of subcutaneous fat, difference of
HC and CC>3cm 9. Any sick neonate e.g, those with perinatal asphyxia, polycythemia, sepsis, shock, etc 10. Family history of a genetic form of
hypoglycemia 11. Congenital syndromes (e.g. Beckwith-Wiedermann), abnormal physical features (e.g., midline facial malformations,
microphallus) 12. Neonates on parenteral nutrition. Reference - Nelson Essentials Of Pediatrics Edition 21 st Page No 339,984,985

Q133. What is the most common fungal infection transmitted by health caregivers' hands to neonates among the given options?

1. Candida krusei

2. Candida glabrata

3. Candida tropicalis

4. Candida parapsilosis ✅
Answer: (4) — Candida parapsilosis

Explanation: Candida parapsilosis is an emerging major human pathogen that has dramatically increased in significance and prevalence over the
past 2 decades, such that C. parapsilosis is now one of the leading causes of invasive candidal disease in neonates ( most common non-albicans
cause of invasive candidiasis ) Multiple studies suggest C. parapsilosis is primarily a nosocomial pathogen/ associated with the colonization of
healthcare workers' hands while C. albicans is acquired from the maternal genital tract. [Link] infections are also especially associated with
TPN and its preparation Reference : Cloherty a nd Stark's Manual of Neonatal Care South Asian Edition 2021 Print Page 733/734

Q134. A child's bones are not mineralizing properly due to low serum calcium, high serum phosphorus, poor urine excretion of phosphorous, and
higher levels of alkaline phosphatase. What is the most likely diagnosis in this case?

1. Nutritional rickets

2. Renal tubular rickets

3. Renal glomerular rickets ✅

4. Celiac disease

Answer: (3) — Renal glomerular rickets

Explanation: The child is having rickets with high phosphorus and low calcium. Amongst the given options - only Chronic renal failure ie Renal
glomerular rickets would cause high phosphate and low calcium. The question further states that there is poor urinary excretion of phosphorus again
suggesting its CRF(Chronic renal failure) Nutritional and RTA - both will have low phosphorus. Celiac disease too can cause Rickets - but that
again is due to poor Vit D absorption leading to Vit D deficiency. Reference-: Essential Orthopaedics by Maheshwari Edition 7th Page no 310

Q135. Which of the following conditions shows a "bull-neck" in extreme cases?

1. Diphtheria ✅
2. Tubercular Lymphadenitis

3. Mumps

4. Goitre

Answer: (1) — Diphtheria

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 Explanation: Bull neck is seen in diphtheria which is a Cornybacterium diphtheriae infection. Incubation of the disease is typically 2-6 days and
mostly affects children. Symptoms include a greyish-white membrane that forms over the tonsils, which can spread to the soft palate and posterior
pharyngeal wall. This membrane is tenacious and can cause bleeding when removed. Cervical lymph nodes, especially jugulodigastric, can become
enlarged and tender, giving the affected person a "Bulldog appearance". In addition, the patient will be ill and experience a low grade fever.
Reference : Ananthanarayan and Paniker's Textbook of Microbiology, 10th edition, Page no 241.

Q136. A woman brings her malnourished 3-year-old daughter to a remote clinic. She had a hemoglobin of 5 g/dL. Along with a subtle rash on her
knees, ankles, and elbows, the girl also has edema over her knees and ankles. What is the most likely type of worm infection causing these
symptoms?

1. Hookworm ✅
2. Roundworm

3. Whipworm

4. Pinworm

Answer: (1) — Hookworm

Explanation: The given features are suggestive of a Hookworm infection as the child is suffering from anemia caused by loss of blood from
hookworm infestation, which can lead to general weakness, joint swelling, and hemoarthrosis. Hookworms are parasites which feed on human
blood and can cause anemia, due to the anti-coagulant they secrete which prevents clotted blood. It is not known to cause bleeding from areas other
than the gut. Reference-Ghai Essential Pediatrics 9th Edition Page no 265,266

Q137. A 6-month-old baby who has had a cough and cold for the past three days presents to the OPD. The rate of respiration is 48/min. The patient
has wheezing but no chest indrawing when examined. Which of the statements below is false?

1. Child has pneumonia ✅

2. Antibiotics are not required

3. Wheezing to be treated

4. Bronchiolitis is a likely cause

Answer: (1) — Child has pneumonia

Explanation: Due to the absence of fast breathing for the age and any other serious symptoms, the child can be said to not have pneumonia. Hence,
option (1) is a false statement. Criteria for fast breathing - 0-2 months >60 bpm 2 months-1year >50 bpm 1- 5 yrs >40 bpm Reference-Ghai
Essential Pediatrics 9th Edition Page no 380

Q138. Edema, oliguria, and foamy urine are symptoms that a 10-year-old child exhibits. He has never before been subject to comparable
complaints. Examining his urine revealed that it contained 3+ proteinuria, no RBCs or WBCs, and no casts. He had a blood albumin level of 2.5 g/L
and a creatinine level of 0.5 mg/dL. What is the most likely diagnosis in this case?

1. IgA nephropathy

2. Minimal change disease ✅

3. Acute interstitial nephritis

4. Membranous nephropathy

Answer: (2) — Minimal change disease

Explanation: Correct Answer is (Option 2) Minimal change disease The symptoms and laboratory findings described in the question are
characteristic of minimal change disease (MCD) , which is the most common cause of nephrotic syndrome in children. MCD is characterized by
diffuse effacement of podocyte foot processes on electron microscopy, which leads to increased permeability of the glomerular filtration barrier and
proteinuria. Fig: Minimal Change Disorder * Other options: IgA nephropathy is characterized by the deposition of IgA immune complexes in the
glomeruli, typically presenting with hematuria. Acute interstitial nephritis is an inflammatory condition involving the renal interstitium and is
usually associated with drug hypersensitivity or infections. Membranous nephropathy is characterized by thickening of the glomerular basement
membrane due to immune complex deposition. * [Extra Edge]: Nephritic syndromes Reference: Robbins and Cotran Pathological basis of disease,
10 th edition, Page No 914.

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 Q139. A 6-year-old child is diagnosed with a strawberry tongue, widespread erythematous rash, cervical lymphadenopathy( 2cm), and fever over
the past five days. What is the most likely diagnosis in this case?

1. Kimura disease

2. Kawasaki disease ✅
3. Scarlet fever

4. Rosie-Dorfman syndrome

Answer: (2) — Kawasaki disease

Explanation: Correct Answer is (Option 2) Kawasaki disease Strawberry tongue, rash, fever are common for both scarlet fever and Kawasaki
disease . Only distinguishing feature is adenopathy more than 1.5 cm is more characteristic of Kawasaki disease. This clinical picture can resemble
TSS and scarlet fever, but clues to the diagnosis of Kawasaki disease are cervical lymphadenopathy, cheilitis, and thrombocytosis. Fig: Strawberry
Tongue and Cheilitis * Table: Warm CREAM and FEBRILE Mnemonics for KD Criteria Warm = Fever for > 5 days C = Conjunctivitis without
exudate R = Rash E = Edema or erythema of hands or feet, followed by desquamation and nail changes A = Adenopathy, often unilateral, cervical
node > 1.5 cm M = Mucosal erythema, fissures or crusting of lips or strawberry tongue F = Fever for > 5 days E = Enanthem of mucosal membranes
B = Bulbar conjunctivitis R = Rash, erythematous, polymorphous I = Internal organ involvement: coronary, abdominal, pneumonitis, hepatitis,
orchitis E = Extremity changes, initial edema, and erythema, desquamation, nail changes Reference: Robbins and Cotran Pathological basis of
disease, 10 th edition, Page No 513.

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 Q140. All of the following conditions are eligible for enzyme replacement therapy except?

1. Gaucher's disease

2. Pompe disease

3. Sanfilippo disease ✅
4. Fabry's disease

Answer: (3) — Sanfilippo disease

Explanation: ERT(Enzyme Replacement therapy) is not yet available for Sanfilippo disease (option 3) - hence, that is the answer. Enzyme
replacement therapy is available for the following diseases Gaucher's (Glucocerebrosidase) Pompe's (Lysosomal Acid Maltase) MPS I -
Hurler disease (Alpha- Iduronidase) MPS II - Hunter disease (Iduronate Suplhatase) MPS IV-A - Morquio A (Galactosamine-6-sulfatase) Fabry's
(α-galactosidase A) It is not yet available for San-filippo disease/Metachromatic leucodystrophy/Tay -Sachs/Neiman Pick/Krabbe's disease.
Reference -Ghai Essential Pediatrics 9th Edition Page no 566,654

Q141. A young child has been diagnosed with albinism. For what reason should he be assessed?

1. ENT consultation

2. Eye consultation ✅
3. Electrocardiography

4. Neurosurgery

Answer: (2) — Eye consultation

Explanation: Any albinic child should be evaluated for eye consultation as Generalised albinism can further be divided into ocular or oculo-
cutaneous. Eye manifestations of albinism include foveal hypoplasia with reduced visual acuity, refractive errors, nystagmus, alternating strabismus
and a red reflex of the iris during examination. Additionally, albinism affects the melanin present in the cochlea, making those with albinism more
susceptible to ototoxic agents such as aminoglycoside antibiotics. Reference- Nelson Essentials Of Pediatrics Edition 21 st Page No 3477,3478,3343

Q142. As indicated below, a 34-week-old female foetus was born. Determine the congenital anomaly.

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 1. Anencephaly

2. Iniencephaly

3. Anen-iniencephaly

4. Complete craniospinal rachischisis ✅

Answer: (4) — Complete craniospinal rachischisis

Explanation: The given image shows a cleft through the developing brain and entire spine- s/o complete craniospinal rachischisis.
Reference-:[Link]

Q143. A 1.5-year-old girl is brought to the clinic complaining of severe undernourishment, intolerance to feeds, and extreme head enlargement. A
medulloblastoma causing obstructive hydrocephalus was suggested by MRI imaging. Which of the following describes an incorrect approach to
patient management?

1. Craniotomy and sub-total excision/gross total excision of the tumor.

2. First ventriculoperitoneal shunt is done

3. Vincristine/Methotrexate was given as chemotherapy

4. Radiotherapy 35-40 Gy was given to the whole craniospinal axis. ✅

Answer: (4) — Radiotherapy 35-40 Gy was given to the whole craniospinal axis.

Explanation: Radiotherapy 35-40 Gy was given to the whole craniospinal axis. A multimodal treatment approach is pursued in medulloblastoma
which includes chemotherapy, radiation therapy, and neurosurgery. Craniospinal radiation in children less than 3 years old results in late
neurological sequelae including microcephaly, cognitive impairment, neuroendocrine dysfunction, and secondary malignancies. This observation
has resulted in not giving radiotherapy to children less than 3 years of age for treatment of Medulloblastoma. Treatment is stratified according to age
groups Surgical resection is done in all of them. Reference- Nelson Essentials Of Pediatrics Edition 21 st Page No 2674-2676

Q144. Which of the following syndromes is not caused by uniparental disomy?

1. Prader-Willi syndrome

2. Angelman syndrome

3. Russell-Silver syndrome

4. Bloom syndrome ✅
Answer: (4) — Bloom syndrome

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 Explanation: Prader Willi Syndrome - Hypotonia, feeding difficulties, Intellectual disability, hyperphagia, and obesity. Paternal deletion of
chromosome 15 or uniparental disomy of maternal chromosome 15. Angelman Syndrome - "Happy Puppets" - ataxia, seizures, developmental
delay, frequent laughter. Maternal deletion of chromosome 15 or uniparental disomy of paternal chromosome 15 Russel Silver Syndrome -
Characterized by Skeletal asymmetry in limbs, Small triangular forehead prominence, small chin, and incurved fifth finger (clinodactyly). One of
the causes is maternal uniparental disomy 7, seen in 10% of cases. Bloom Syndrome is not caused due to uniparental disomy but due to DNA repair
defect. So, answer is 4 Reference:Nelson Essentials Of Pediatrics Edition 21 st Page No 676

Q145. What is the first indication of cord compression in a case of thoracic spine tuberculosis?

1. Bladder dysfunction

2. Extensor plantar

3. Motor weakness ✅
4. Sensory loss

Answer: (3) — Motor weakness

Explanation: The first signs of spinal cord compression in thoracic spine tuberculosis are usually pain, weakness , and numbness in the upper and
lower extremities . These symptoms may progress over time, leading to paraplegia. Other symptoms of spinal cord compression include: Loss of
bladder and bowel control Loss of sensation in the limbs and trunk Difficulty walking Tightness in the lower limbs Loss of dexterity and weakness
in hand grip Loss of balance and spasticity in legs Reference : Garg, Ravindra Kumar, and Dilip Singh Somvanshi. “Spinal tuberculosis: a
review.” The journal of spinal cord medicine vol. 34,5 (2011): 440-54. doi:10.1179/2045772311Y.0000000023. URL:
[Link]

Q146. In the diaphysis of the tibia, a 5-year-old kid complains of pain and swelling. Additionally, he laments having a temperature. His ESR
increased during the assessment. What is the most likely diagnosis among the following?

1. Ewing sarcoma ✅
2. Chondrosarcoma

3. Osteogenic sarcoma

4. Fibrosarcoma

Answer: (1) — Ewing sarcoma

Explanation: Ewing's sarcoma is characterized by a destructive lesion in diaphysis of long bone with onion peel like periosteal reaction. It
originates from bone marrow. Therefore, bone marrow biopsy is mandatory for complete evaluation of tumor. In biopsy, the neoplastic cells are
MIC 2 ( CD 99 ) positive and contain glycogen giving them PAS positivity which is diastase sensitive. Most common translocation- 11;22. Poor
prognostic factors- fever, anemia, males > 12 years, chemoresistant, relapse, distant metastasis. Reference-: Essential Orthopaedics by Maheshwari
Edition 7th Page no 243

Q147. Which of the following are not signs of malignant transformation in osteochondroma?

1. Pain

2. Weight loss ✅
3. Increase in size

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 4. Increase in thickness of cartilage cap

Answer: (2) — Weight loss

Explanation: Osteochondroma i.e Exostosis is a benign tumor of bone occuring before skeletal maturity. It is a bony outgrowth with a
cartilagenous cap which grows towards diaphysis. it can turn malignant . Signs include: cartilage thickness >2cms , rapid increase in size, growth
after skeletal maturity, loss of cortico-medullary differentiation. While sudden onset of pain in any benign tumor raises suspicion of malignant
tumor, weight loss can be due to other systemic reasons. More appropriate answer in this case would be weight loss R eference-: Essential
Orthopaedics by Maheshwari Edition 7th Page no 247,248

Q148. A 27-year-old man complains of low back pain that starts in the morning, is accompanied by stiffness, and lasts for longer than 30 minutes.
His chest expansion is likewise constrained upon examination. What is the most likely diagnosis?

1. Rheumatoid arthritis

2. Osteoarthritis

3. Gouty arthritis

4. Ankylosing spondylitis ✅
Answer: (4) — Ankylosing spondylitis

Explanation: Given features suggest a diagnosis of Ankylosing Spondylitis . ( Option 4 ) Rheumatoid Arthritis (RA) and Ankylosing Spondylitis
(AS) manifest differently in people: AS tends to onset at a younger age , and is more common among men with a 3:1 ratio, while RA is more
common among women and tends to onset later in life after 40-50 years. RA causes peripheral polyarthritis, mainly in hands and feet, while AS
affects mainly the spine and sacroiliac joints , with only oligoarthritis in larger joints. Reference : Harrison's Principles of Internal Medicine, 21st
Edition, Page no 2791-2793.

Q149. What is the critical angle of the cornea-air interface?

1. 36°

2. 46° ✅
3. 56°

4. 66°

Answer: (2) — 46°

Explanation: Critical angle of the air-corneal interface is 46 degrees . Normally, the angle of the anterior chamber cannot be seen directly through
the slit lamp due to the phenomenon of total internal reflection, where rays of light emitted from the angle structures are reflected back into the eye
by the cornea. This effect is caused by the angle at which these rays hit the cornea-air interface being higher than the critical angle of approximately
46°. Gonioscopy works on this principle of Total internal reflection . If light from the interior of the eye strikes the cornea at an angle steeper than
46° ( the critical angle ), the light will exit the eye and the trabecular meshwork will be visible. Reference : Principles of Gonioscopy, American
Academy of Ophthalmology (2017), URL: [Link]

Q150. Which of the following diagnostic procedures is not performed in a dilated pupil?

1. Gonioscopy ✅
2. Laser interferometry

3. Fundus examination

4. Electroretinograph

Answer: (1) — Gonioscopy

Explanation: Correct option: 1. Gonioscopy Out of the following gonioscopy does not need dilation of the pupil . All other procedures can be done
under pupil dilatation as the angle structures cannot be properly evaluated under dilated pupil because the angle is reduced. All the anterior segment
evaluation can be done without dilation but for posterior segment evaluation pupils should be dilated . Reference : Ophthalmology by Yanoff and
Duker, 5th edition, Page no 1029, 1030. Comprehensive Ophthalmology by AK Khurana, 7th edition, Page no 589, 590.

Q151. 59-year-old male patient complains of blurry near vision. Examining the media revealed that it was clear in both eyes. What would be the
next step?

1. Refraction with near add ✅

2. Refraction under atropine

3. Radial keratotomy

4. Cataract surgery

Answer: (1) — Refraction with near add

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 Explanation: In this question, age of the patient is 59 year with both eye media clear that means patient doesn’t have cataract. So according to age
patient is presbyopic and best management is refraction with near correct . Radial keratotomy is no longer performed and LASIK is not the
preferred choice for this particular patient. ( Option 2 ) Refractive surgery is not helpful in this age group. ( Option 3 ) Refraction with atropine is
mainly done in children with age group less than 7 year. ( Option 4 ) Reference : Ophthalmology by Yanoff and Duker, 5th edition, Page no 33.

Q152. Which organismal infection is extremely virulent and may result in the perforation of a corneal ulcer within 48 hours?

1. Herpes simplex

2. Pseudomonas ✅
3. Staphylococci

4. Aspergillus

Answer: (2) — Pseudomonas

Explanation: Eighty percent of bacterial corneal ulcers are caused by Staphylococcus aureus, Streptococcus pneumoniae and Pseudomonas species.
Pseudomonas aeruginosa is the most pathogenic ocular pathogen which can cause corneal perforation in just 72 hours. The organism readily adheres
to damaged epithelium. Stromal invasion is rapid. Pseudomonas keratitis tends to progress rapidly if inadequately treated . Most commonly, the
organism produces destructive enzymes , such as protease, lipase, elastase, and exotoxin, which result in necrotic, soupy ulceration. Reference :
Ophthalmology by Yanoff and Duker, 5th edition, Page no 222.

Q153. What deficit is associated with circumcorneal vascularization?

1. Vitamin D

2. Thiamine

3. Riboflavin ✅
4. Biotin

Answer: (3) — Riboflavin

Explanation: Riboflavin (Vitamin B2) deficiency is manifested principally by lesions of the mucocutaneous surfaces of the mouth and skin like
cheilitis, glossitis, angular stomatitis. In addition, corneal vascularization , anemia, and personality changes have been described with riboflavin
deficiency. circumcorneal vascularization Reference : Harrison’s Principles of Internal Medicine, 21st edition, Page no 2526.

Q154. Which of the following is an immediate management strategy for a patient who gives a history of chuna falling into his eyes?

1. Irritation of both eyes with copious amounts of normal saline ✅

2. Frequent sodium citrate drops

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 3. Thorough slit-lamp examination on presentation

4. Removal of chuna particles by double eversion of upper eyelids

Answer: (1) — Irritation of both eyes with copious amounts of normal saline

Explanation: Correct option: 1. Irritation of both eyes with copious amounts of normal saline Immediate Phase: Initial treatment of any chemical
burn should begin immediately at the time and place of the injury. Because the area and duration of contact determines the extent of subsequent
injury and prognosis, immediate copious irrigation with any available noncaustic fluid upon exposure is of paramount importance. Irrigation should
be continued for at least 15 minutes with at least 1 L of irrigant , until the pH of the ocular surface reaches neutrality i.e. between 7.0 and 7.2. Some
evidence has shown a benefit when a borate buffer (Cederroth Eye Wash) is used for irrigation, compared with saline or tap water. Acute and
Reparative phase: The pH should be rechecked with narrow-range pH test strips (between 6 and 8) at 15- to 30-minute intervals after stabilization to
confirm that there has not been a change outside normal range. Such a change can signify the presence of a hidden particle in the eye that continues
to elute chemicals onto the ocular surface. A Morgan lens may be used with topical anesthesia to facilitate the irrigation process in a patient who is
uncomfortable. Ophthalmic examination: Once pH has been neutralized reliably, a complete ophthalmic examination is required to characterize the
extent of the injury and plan further treatment. The initial screen should include a thorough sweep of fornices with eyelid eversion to detect and
remove occult particles such as lime and plaster. As discussed above, it is important to thoroughly assess the presence and degree of limbal ischemia
as well as the degree of corneal epithelial defect and opacification. In eyes with chemosis, it is necessary to gently push aside chemotic conjunctiva
from the limbus with a sterile ophthalmic sponge to gain good access to the limbus. Fluorescein should be used to assess the status of the corneal
and conjunctival epithelium, with the knowledge that fluorescein staining may be difficult to appreciate in the presence of a complete epithelial
defect. Intraocular pressure (IOP) should be checked, as serious chemical burns can greatly increase or lower the pressure. Examination of the rest
of the eye should be attempted, although the initial exam may be limited due to the view through the cornea and patient discomfort. Finally, even in
cases of purported unilateral chemical injury, the contralateral eye must still be examined carefully (including a check of the pH) in order to confirm
that both eyes are not involved. Reference : Ophthalmology by Yanoff and Duker, 5th edition, Page no 295, 296 .

Q155. Which of the following medications alters the aqueous outflow by acting on the trabecular meshwork?

1. Timolol

2. Pilocarpine ✅
3. Brimonidine

4. Brinzolamide

Answer: (2) — Pilocarpine

Explanation: Correct option: 2. Pilocarpine 1. Timolol- Beta blockers - MOA: Act on beta adrenergic receptor on the ciliary body and decrease
aqueous production. 2. Pilocarpine- Cholinergic agonists - MOA: Constricting the ciliary body muscles that are connected to the scleral spur to open
the trabecular meshwork mechanically and increase the outflow of aqueous humor through trabecular meshwork . 3. Brimonidine-Alpha adrenergic
agonists -MOA: Act on alpha adrenergic receptors on ciliary vasculature and decrease aqueous production and also increase uveoscleral outflow. 4.
Brinzolamide-Carbonic anhydrase inhibitors -MOA: decrease aqueous production by inhibiting carbonic anhydrase enzyme in the ciliary processes.
Reference : Ophthalmology by Yanoff and Duker, 5th edition, Page no 1121, 1122.

Q156. What is the Express glaucoma implant made of?

1. Silicone

2. Titanium

3. Gold

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 4. Stainless steel ✅
Answer: (4) — Stainless steel

Explanation: Ex-Press glaucoma implants are made of stainless steel . The Ex-Press Mini Glaucoma Shunt is a biocompatible device designed by
Optonol Ltd. (Neve Ilan, Israel) to reduce intraocular pressure. It is 3 mm long and has a diameter of 400 microns. It is a non-valved, MRI
compatible, stainless steel device with a 50 micron lumen and a disc on one end and a spur-like extension on the other to prevent extrusion. The Ex-
PRESS implant is a biocompatible, non-valved stainless steel device that was initially designed to be implanted under the conjunctiva to allow
drainage of aqueous humor into the subconjunctival space. Implantion under a scleral flap is recommended to limit excessive aqueous flow and to
decrease postoperative complications of subconjunctival implantation such as hypotonia and conjunctival erosion Reference : Altinel, Meltem
Guzin et al. “Ex-PRESS implantation for different types of glaucoma.” International journal of ophthalmology vol. 12,8 1290-1297. 18 Aug. 2019,
doi:10.18240/ijo.2019.08.09

Q157. What along with ascorbate and \(\alpha-\) tocopherol keeps lens protein in a reduced condition?

1. Glucose

2. Glycoprotein

3. Glutathione ✅
4. Fatty acid

Answer: (3) — Glutathione

Explanation: Correct option: 3. Glutathione Antioxidant enzymes and antioxidants such as ascorbate, glutathione, tocopherols, and carotenoids
maintain lens proteins in the reduced state and are the primary defense mechanisms. Glutathione prevents lens opacity by free radical scavenging.
Principle mechanism is it keeps protein thiols in the reduced state , which helps to maintain lens transparency by preventing the formation of high
molecular weight crystallin aggregates. Glutathione peroxidase is found in significant amounts in both epithelial cells and fibres of the lens. It
provides most of the protection against oxidative damage in the lens. Reference : Ophthalmology by Yanoff and Duker, 5th edition, Page no 326e5,
332.

Q158. A male 7-year-old child is seen with normal vision in his right eye (6/6) and the ability to see hand movements close to the face in his left
eye. On fundoscopy, the left eye had a retinal detachment, subretinal yellow exudates, and telangiectatic vessels, while the right eye was normal.
What is the most likely diagnosis?

1. Coats' disease ✅
2. Sympathetic ophthalmitis

3. Familial exudative vitreoretinopathy

4. Retinopathy of prematurity

Answer: (1) — Coats' disease

Explanation: The given features are suggestive of Coat’s disease , it’s an idiopathic retinal telangiectasia, generally of onset in early childhood. It is
associated with intraretinal and subretinal exudation, and frequently exudative retinal detachment, without signs of vitreoretinal traction. Definition :
a localized, congenital, retinal vascular disorder consisting of abnormal telangiectatic segments of blood vessels that result in leakage. Key Features:
• Retinal telangiectasia. • Retinal capillary nonperfusion. • dilated intercapillary spaces. • Lipid exudate. • subretinal fluid. Associated Features: •
Usually unilateral. • Male predominance. • Fibrovascular macular scars. • Leucocoria. • Rare systemic associations, especially muscular dystrophies.
Reference : Ophthalmology by Yanoff and Duker, 5th edition, Page no 562.

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 Q159. A young man appears with a central scotoma in his left eye. His right eye had a 6/6 vision rating. Upon examination, there was focal foveal
detachment in the left eye. What would be the following course of action?

1. Examine retrolental cells

2. Inquire about the use of steroids ✅

3. Ask for history of trauma in the other eye

4. Examination under slit-lamp

Answer: (2) — Inquire about the use of steroids

Explanation: The next step would be to inquire about the use of steroids . Central serous chorioretinopathy (CSCR) is an idiopathic eye disorder
observed in mostly young to middle-aged Caucasian males. It is characterized by leakage from the choriocapillaris resulting in a localized serous
detachment of the sensory retina. Risk factors may include psychological stress, type A personality, steroid administration , Cushing syndrome,
systemic lupus erythematosus, and pregnancy. Reference : Ophthalmology by Yanoff and Duker, 5th edition, Page no 607.

Q160. A 28-week-old infant was born with respiratory distress syndrome. His infection manifested on day fourteen of birth. There were no other co-
morbidities found. At what postnatal age should he be examined for retinopathy of prematurity?

1. 2 weeks

2. 4 weeks ✅
3. 6 weeks

4. 8 weeks

Answer: (2) — 4 weeks

Explanation: Suspected ROP screening is done at 4 weeks of the postnatal period(PNA) or 32 weeks of PMA (Post Menstrual age) - whichever is
later. The question specifically mentions time from birth, for it should be 4 weeks. Retinopathy of Prematurity is an eye condition that affects
premature infants of very low birth weight who have been exposed to high concentrations of oxygen. These infants have an incompletely
vascularized retina which makes them susceptible to oxygen damage. The vascular complex structures of the retina grow from the hyaloid vessels of
the optic disc towards the nasal and temporal peripheries but do not reach the temporal periphery until a month after delivery. Given the progressive
nature of ROP, as well as the proven benefits of early diagnosis and timely intervention to minimize the risk of severe visual loss, a joint statement
outlining the principles of a screening program for ROP has been set forth: Screening for ROP should be performed in all infants with a birth weight
at or above 1500 g or gestational age of 30 weeks or less (as defined by the attending neonatologist) and selected infants with a birth weight between
1500 and 2000 g or gestational age of more than 30 weeks with an unstable clinical course. In most cases, at least two examinations should be
performed. One examination may suffice if it shows unequivocally that retinal vascularization is complete bilaterally. The first examination should
be performed between 4 and 6 weeks of chronological (postnatal) age or between 31 and 33 weeks of postmenstrual age (PMA) (calculated as GA
plus chronological age), whichever is later. Infants with immature retinas (no ROP) vascularized into zone II or III may be examined at 2-week
intervals. Infants with type 2 prethreshold disease require weekly or twice weekly exams. Infants with type 1 prethreshold disease should be
considered for peripheral laser ablation. Reference : Ophthalmology by Yanoff and Duker, 5th edition, Page no 538.

Q161. On his 45th birthday, a person is identified as diabetic. When do you intend to advise a dilated fundoscopic examination? th birthday

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 1. Immediately ✅
2. Before his 50

3. When he turns 50 years of age

4. When he complains dimness of vision

Answer: (1) — Immediately

Explanation: The patient should visit an ophthalmologist immediately at the time of diagnosis , as there can be a large sub clinical phase of the
disease which would have already caused a lot of damage to the eye. In case of Type 1 DM, it is 5 yr after diagnosing or during puberty. Both should
be routinely observed yearly. Although all agree that screening of asymptomatic diabetic patients is critical, the most cost-effective timing remains
controversial. It generally is agreed that type 2 diabetics should be examined at the onset of their disease , then yearly thereafter . Type 1 diabetics
do not have to be examined until 5 years into their disease course, but no sooner than puberty, then yearly thereafter. If retinopathy is detected, the
frequency of examinations should be increased appropriately. Reference : Ophthalmology by Yanoff and Duker, 5th edition, Page no 552.

Q162. The initial sign of diabetic retinopathy is microaneurysms. In which of the following layers is diabetic retinopathy involved?

1. Outer plexiform layer

2. Inner nuclear layer ✅

3. Layer of rods and cones

4. Retinal pigment epithelium

Answer: (2) — Inner nuclear layer

Explanation: While DR involves both OPL and INL, Inner nuclear layer(INL) is involved in microaneurysms of diabetic retinopathy.
Microaneurysms are out-pouchings of capillary walls, which form due to a lack of pericytes or two arms of a capillary loop fusing. They usually
develop in the inner nuclear layer and can lead to plasma leakage into the retina due to a breakdown in the blood-retinal barrier, or can become
thrombosed. Reference : Ophthalmology by Yanoff and Duker, 5th edition, Page no 544.

Q163. Retinal detachments are sealed using air insufflation during a non-invasive surgery called pneumatic retinopexy. Which of the following
gases is used in pneumatic retinopexy?

1. Sulphur hexafluoride ✅
2. Carbon dioxide

3. Nitrous oxide

4. Oxygen

Answer: (1) — Sulphur hexafluoride

Explanation: Sulphur hexa fluoride is used in retinopexy. Pneumatic retinopexy is an outpatient procedure used to reattach a retina without scleral
buckling by using an expanding gas bubble. It is a fast and minimally invasive procedure with lower success rates than conventional surgery, and is
typically used for retinal detachment in the higher two-thirds of the peripheral retina. Reference : Ophthalmology by Yanoff and Duker, 5th edition,
Page no 476, 668.

Q164. What types of cells are affected by glaucomatous optic atrophy?

1. Amacrine cells

2. Bipolar cells

3. Ganglion cells ✅
4. Rods and cones

Answer: (3) — Ganglion cells

Explanation: Progressive optic neuropathy results from death of retinal ganglion cells(RGCs ) in a typical pattern which results in characteristic
optic disc appearance and specific visual field defect. RGCs death is initiated when some pathological event blocks the transport of growth factors
(neurotrophins) from the brain to the RGCs. The blockage of these neurotrophins initiates a damaging cascade and the cell is unable to maintain its
normal functions. The RGCs losing their ability to maintain normal functions undergo apoptosis and trigger apoptosis of adjacent cells. Reference :
Parsons' Diseases of the Eye, 23rd edition, Page no 261.

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 Q165. Inflammation with lipogranulomatous is observed in?

1. Fungal infection

2. Tuberculosis

3. Chalazion ✅
4. Viral infection

Answer: (3) — Chalazion

Explanation: A chalazion is a focal inflammatory lesion of the eyelid that results from the obstruction of a sebaceous gland , either meibomian or
Zeis . Extravasated lipid material produces a surrounding, chronic, lipogranulomatous inflammation . The proper diagnosis given by pathologists for
this lesion in paraffin sections. Clear circular empty spaces presumably represent lipids that have dissolved in the organic solvents during
processing. The clear spaces are surrounded by nodular collections of epithelioid histiocytes. Special stains are generally performed in cases that
show lipogranulomatous inflammation. Reference : Ophthalmology by Yanoff and Duker, 5th edition, Page no 1301.

Q166. Which one of the following doesn't demonstrate a negative Rinne test in the right ear?

1. Sensorineural hearing loss of 45 dB ion left ear and normal right ear ✅
2. Profound hearing loss

3. Conductive hearing loss of 40 dB in both ears

4. Conductive hearing loss of 40 dB in right ear and left ear normal

Answer: (1) — Sensorineural hearing loss of 45 dB ion left ear and normal right ear

Explanation: Rinne's Negative in Right ear means BC>AC in right ear. All the options will have BC>AC except 1 which has a normal Right ear.
Reference : P L Dhingra Diseases of Ear Nose and Throat and Head and Neck surgery , 7th Edition- page 24

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 Q167. What is the name of the screening procedure for suspected hearing loss in high-risk newborns in the ICU?

1. Otoacoustic emissions ✅
2. Free field audiometry

3. Stapedial reflex testing

4. Pure tone audiometry

Answer: (1) — Otoacoustic emissions

Explanation: OAE is the screening test of choice in neonates as it can be used to Test hearing in the uncooperative/ mentally retarded after sedation
To distinguish cochlear pathology (OAE will be absent) from retrocochlear pathology (OAE present if cochlea and its hair cells are normal). OAE
may be absent in middle ear pathology (sound travelling in reverse direction may not be picked up). Reference : P L Dhingra Diseases of Ear Nose
and Head and Neck surgery ,7th Edition - page 29

Q168. Which of the following is represented by the wave V in the BERA?

1. Lateral lemniscus ✅
2. Superior olivary complex

3. Cochlear nerve

4. Cochlear nucleus

Answer: (1) — Lateral lemniscus

Explanation: Wave 5th (V) in bera is due to Lateral laminiscus. Brainstem Evoked Response Audiometry (BERA) is a non-invasive examination
which is used to determine the integrity of a patient's auditory pathway up to the brain. Electrodes are placed over various parts of the head and
auditory stimuli (clicks/tone bursts) are given to the patient. These responses to the stimulus are picked up by the electrodes and charted by the
computer to measure the patient's hearing sensitivity between 1000 and 4000 Hz. Seven waves are produced in the first 10 milliseconds, with the
first, third, and fifth waves being the most important for analysis. Parameters studied are the absolute latency of each wave, the interwave latency
(between the first and third, the third and fifth, and the first and fifth) and the amplitude of each [Link] of each wave: I distal part of VIII nerve
II proximal part of VIII nerve (towards brainstem) III cochlear nucleus IV sup olivary complex V lateral lemniscus VI inferior colliculus VII Medial
geniculate body Reference : P L Dhingra Diseases of Ear Nose and Throat and Head and Neck surgery , 7th Edition- page 29

Q169. Which of the following is not removed during a stapedotomy?

1. Anterior crus of stapes

2. Posterior crus of stapes

3. Stapedial ligament

4. Lenticular process of incus ✅

Answer: (4) — Lenticular process of incus

Explanation: In stapedotomy, all the given options except lenticular process of incus are removed. Stapes surgery is a surgical procedure used to
treat hearing loss. The steps involved include making an incision in the external ear canal, elevation of the skin, exposing the stapes area, dislocation
of the incudostapedial joint, cutting the stapedial tendon, removal of the stapes superstructure, Incudostapedial joint is dislocated. When the stapes is

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 free, the stapedial tendon is cut and stapes superstructure including anterior and posterior crus are removed. This leaves the whole incus and the
stapes footplate behind and making or removing a hole in the stapes footplate for the insertion of a piston. The aim of the procedure is to improve
hearing levels by restoring the movement of sound from the outer ear to the inner ear. Reference : P L Dhingra Diseases of Ear Nose and Head and
Neck surgery ,7th Edition - page 97

Q170. Which of the following cochlear implant components is implanted during the surgery?

1. Receiver stimulator ✅
2. Transmitting coil

3. Microphone

4. Speech processor

Answer: (1) — Receiver stimulator

Explanation: Receiver/ stimulator parts of cochlear implant is implanted during surgery. Cochlear implants are surgically placed electronic devices
which can provide improved hearing for those with severe to profound hearing loss. They consist of an external speech processor and transmitter,
along with an internal receiver/stimulator and electrode array, implanted surgically. Reference : P L Dhingra Diseases of Ear Nose and Head and
Neck surgery ,7th Edition - page 139

Q171. The external auditory canal of a 75-year-old diabetic patient has granulation tissue, which is causing acute ear pain and face nerve
involvement. What is the most likely diagnosis?

1. Malignant otitis externa ✅

2. Nasopharyngeal carcinoma

3. Acute suppurative otitis media

4. Chronic suppurative otitis media

Answer: (1) — Malignant otitis externa

Explanation: Necrotizing otitis externa (NOE), also known as malignant otitis externa, is a severe invasive infection of the external auditory
canal (EAC) which can spread rapidly to involve the surrounding soft tissue, adjacent neck spaces and skull base. Pathology Predisposing
conditions for necrotizing otitis externa include diabetes and immunosuppression (i.e. diabetes or patients receiving chemo- and/or radiation
therapy), and is usually seen in elderly patients. Pain can be out of proportion for typical otitis externa. Pseudomonas aeruginosa is the pathogen in
98% of cases. The route by which the infection spreads is variable. It can spread anteroinferiorly to involve the suprahyoid neck spaces (parotid
space and masticator space). Alternatively, the infection can also erode the cartilaginous-bone of the external auditory canal resulting in a direct
intracranial spread with resultant serious intracranial complications. Serious complications include: skull base osteomyelitis ( subdural empyema
cerebral abscess meningitis facial nerve palsy temporomandibular joint involvement dural venous sinus thrombophlebitis. IOC- Tc 99m scan
Prognostic IOC- Gallium 67 scan DOC- Ciprofloxacin Reference : P L Dhingra Diseases of Ear Nose and Head and Neck surgery ,7th Edition -
page 55

Q172. Chronic nasal hemorrhage has been diagnosed in a 14-year-old boy. A peripheral smear revealed normocytic hypochromic anemia, and his
hemoglobin level was 6.4 g/dL. What is the most likely diagnosis?

1. Juvenile nasopharyngeal angiofibroma ✅

2. Hemangioma

3. Antrochoanal polyp

4. Carcinoma of nasopharynx

Answer: (1) — Juvenile nasopharyngeal angiofibroma

Explanation: With the given features the diagnosis can be concluded to that of Juvenile angiofibroma from the options. Juvenile nasopharyngeal
angiofibroma (JNA) is a rare, benign tumor of the nasopharynx found mainly in 10-20 year old boys. JNA causes recurrent, unprovoked and profuse
bleeding, at which point many patients present with severe anaemia. Spread of the tumor is limited to local invasion, by spreading to paranasal
sinuses, pterygopalatine fossa, cheek, orbits and cranial cavity. CECT is the preferred investigation and MRI reveals any intracranial or
infratemporal invasion. Reference : P L Dhingra Diseases of Ear Nose and Throat and Head and Neck surgery , 7th Edition- page 279

Q173. A patient is diagnosed with an antrochoanal polyp growing from the maxillary medial wall. Which of the following would be the patient's
best course of action?

1. FESS with polypectomy ✅

2. Medical maxillectomy (TEMM)

3. Caldwell-Luc procedure

4. Intranasal polypectomy

Answer: (1) — FESS with polypectomy

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 Explanation: The primary treatment for antrochoanal polyps is FESS, a functional endoscopic sinus surgery, which includes a polypectomy,
uncinectomy and enlargement of the maxillary ostium. In some cases, such as where the polyp is arising from the floor, lateral wall, or anterior wall
of the maxilla, the caldwell luc approach is added to the FESS. Medial maxillectomy is used primarily to remove inverted papillomas or limited
malignancies of the lateral nasal wall. Reference : P L Dhingra Diseases of Ear Nose and Throat and Head and Neck surgery , 7th Edition- page 193

Q174. What treatment options are available for a senior citizen who has been diagnosed with T3N0 laryngeal cancer?

1. Neo-adjuvant chemotherapy followed by radiotherapy

2. Concurrent chemoradiotherapy ✅
3. Radical radiotherapy followed by chemotherapy

4. Radical radiotherapy without chemotherapy

Answer: (2) — Concurrent chemoradiotherapy

Explanation: Concurrent chemoradiation out of the following can be an options for Ca larynx T3N0 treatment, as T3 stage laryngeal cancers have
caused fixity of the cord or hemilarynx and minor invasion of adjacent structures such as pre-epiglottic or paraglottic spaces or the post-cricoid but
without any spread beyond the laryngeal framework. Reference : P L Dhingra Diseases of Ear Nose and Throat and Head and Neck surgery , 7th
Edition- page 351

Q175. Olympian brow and rhagades are observed in which disease?

1. CMV inclusion disease

2. Ectodermal dysplasia

3. Congenital syphilis ✅
4. Hyper IgE Syndrome

Answer: (3) — Congenital syphilis

Explanation: Correct Answer is (Option 3) Congenital syphilis Olympian Brow is bony prominence of the forehead due to persistent recurrent
periostitis and Rhagades refer to Linear scars that extend in a spoke-like pattern from previous mucocutaneous fissures of the mouth, anus and
genitalia are late manifestations of Congenital syphilis. * [Extra Edge]: Congenital Syphilis Manifestations of congenital syphilis may appear early
(within the first 2 years of life, often at 2–10 weeks of age) or late (after 2 years). In early congenital syphilis, periarticular swelling and
immobilization of the involved limbs ( Parrot’s pseudo paralysis ) complicate osteochondritis of long bones. Clutton’s joint, a late manifestation of
congenital syphilis that typically develops between ages 8 and 15 years, is caused by chronic painless synovitis with effusions of large joints,
particularly the knees and elbows. Classic stigmata include Hutchinson’s teeth (centrally notched, widely spaced, peg-shaped upper central
incisors), “mulberry” molars (sixth-year molars with multiple, poorly developed cusps), saddle nose, and saber shins. Reference: Harrison's
Principals of Internal Medicine, 21 st edition, Page No 1410.

Q176. In the T3 dermatome region of the trunk, a 60-year-old man is diagnosed with painful, clustered vesicles over erythematous plaques. Which
of the following organisms are most likely to be the cause?

1. Varicella zoster ✅
2. Herpes simples

3. Pox virus

4. Papilloma virus

Answer: (1) — Varicella zoster

Explanation: Varicella Zoster can recur in Immunocompromised elderly patients who have had Chickenpox in the past. This is called Shingles. It is
characterised by Painful Vescicular rash ,Unilaterally present mostly, along a single dermatomal area. Varicella Zoster virus (VZV) causes Zoster or
shingles following reactivation of latent VZV, present in the trigeminal ganglia that occurs mainly in adult life. Vesicular rashes are painful,
unilateral and segmental being confined to skin innervated by a single sensory ganglion. Reference : Ananthanarayan and Paniker's Textbook of
Microbiology, 10th edition, Page no 478.

Q177. A 19-year-old man has multiple comedones, papules, and pustules on his face and body. Which medicine would be the best option for the
patient?

1. Topical retinoic acid

2. Topical retinoic acid + Oral doxycycline ✅

3. Topical clindamycin

4. Topical azithromycin

Answer: (2) — Topical retinoic acid + Oral doxycycline

Explanation: The given clinical scenario is s/o grade 3 acne which requires treatment with oral antibiotics along with topical retinoids. Reference-
Rook's Textbook of Dermatology, 9th edition, Page number 90.39

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 Q178. A 37-year-old woman arrives with several linear, scratchy wheals that have been itching for 30 minutes at the spot. What is the most likely
diagnosis?

1. Dermatographic urticaria ✅
2. Pressure urticaria

3. Acute urticaria

4. Chronic urticaria

Answer: (1) — Dermatographic urticaria

Explanation: Dermographism (or 'skin writing') is a physical urticaria characterised by the appearance of linear wheals that develop after moderate
stroking of the skin, or at sites of friction such as collars and cuffs. There are two types of dermographism; Simple immediate dermographism and
delayed dermographism, which appears at least 30 minutes after a stroking stimulus. Pressure urticaria is a type of physical urticaria that occurs in
response to pressure on the skin, such as from tight clothing or sitting for long periods of time. The wheals are often more diffuse and irregular in
shape than those seen in dermatographic urticaria, and may take several hours to develop. Acute urticaria is a type of urticaria that lasts less than six
weeks and is often caused by an allergic reaction to a food, medication, or other substance. The wheals are usually round or oval in shape and may
be accompanied by other symptoms such as swelling, itching, and difficulty breathing. Chronic urticaria is a type of urticaria that lasts longer than
six weeks and may have no identifiable cause. The wheals may be similar in appearance to those seen in acute urticaria, but may also be more
persistent and widespread Reference- Rook's Textbook of Dermatology, 9th edition, Page number 42.8

Q179. A young 8-year-old kid exhibits numerous distinct, shiny, pin-head-sized papules on the dorsal part of his hands, forearms, and penis shaft.
What is the most likely diagnosis?

1. Molluscum contagiosum

2. Scabies

3. Lichen planus

4. Lichen nitidus ✅
Answer: (4) — Lichen nitidus

Explanation: Lichen nitidus (LN) is an uncommon chronic skin eruption characterised by multiple, tiny, discrete, skin-colored papules with a shiny
surface, often arranged in large clusters. It is typically found on the flexor aspects of the upper extremities, genitalia, chest and abdomen of children
or young adults. Upto 10% of patients may have nail involvement with changes including pitting, longitudinal ridging, and terminal splitting. The
Koebner phenomenon may also be present. Pruritus is an uncommon feature. Scabies on the other hand, presents with burrows in the skin folds and
flexor aspects. Reference- Rook's Textbook of Dermatology, 9th edition, Page number 37.10

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 Q180. Flaccid bullae with an erythematous foundation and erosions over the oral mucosal membrane are seen in a 30-year-old male patient. What
would the immunofluorescent study of this patient's skin biopsy most likely reveal?

1. Linear IgA deposition in the dermo-epidermal junction

2. Linear IgG deposition in the dermo-epidermal junction

3. Fishnet IgG deposition in the epidermis ✅

4. Granular deposits of IgA in dermal papillae

Answer: (3) — Fishnet IgG deposition in the epidermis

Explanation: Flaccid bullae with an erythematous foundation and erosions over the oral mucosal membrane point towards a diagnosis of
Pemphigus vulgaris. Fishnet IgG deposition in the epidermis is seen in the case of Pemphigus vulgaris. Biopsy typically shows acantholysis and an
intraepidermal blister. Fish net appearance in DIF. Reference- Rook's Textbook of Dermatology, 9th edition, Page number 50.2, 50.8

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 Q181. A patient had onycholysis, thinned nails, and flat-topped violaceous papules. What microscopic phenomenon was seen in this patient?

1. Prominent necrotic cell

2. Suprabasal split

3. Basal cell degeneration ✅

4. Acantholysis

Answer: (3) — Basal cell degeneration

Explanation: The given clinical scenario is of Lichen Planus. Autoimmune disorder T cell mediated response Antigen is not known. Caused by
known drugs and dental Amalgams Clinical Features -5P's : Purple, Plane topped, pruritic, Papules, Polygonal. Characterstics- Involves skin mucosa
and nails Koebner -Positive Wickhams striae - Reticular whitish lines that are seen on a plaque of lichen planus due to hypergranulosis. HPE-
Hyperkeratosis, Hypergranulosis, Basal cell Degeneration, Colloid/civet bodies, Saw tooth rete ridges and Max Joseph Space {between infiltrate
and epidermis} Reference- Rook's Textbook of Dermatology, 9th edition, Page number 37.12

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 Q182. Which of the following is not an alopecia areata association for a patient with focal alopecia areata?

1. Nail pitting

2. Atopy

3. Geographic tongue ✅
4. Exclamatory mark

Answer: (3) — Geographic tongue

Explanation: Alopecia areata commonly presents as bald, round or oval patches without scarring. Hairs at the margins may be visible, with other
presentations including total loss of scalp hair (alopecia totalis), loss of scalp and body hair (alopecia universalis), or a band-like pattern along the
scalp. Regrowth may initially be grey or white, but usually repigmentation is seen in a few weeks or months. Nail abnormalities can also be seen
including pitting, roughness, brittleness and separation. Geographic tongue is not a feature. Reference :Rook's Textbook of Dermatology, 9th
edition, Page number 89.31

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 Q183. A man arrives with facial rashes and also reports feeling less mentally sharp. On his skin, he also has a few macular lesions. Intracranial
calcification was discovered during a CT scan. His spouse is normal. While his 10-year-old daughter seems well, his 6-year-old son similarly
exhibits the same skin blemishes. What is the most probable diagnosis?

1. Neurofibromatosis-1

2. Neurofibromatosis-2

3. Xeroderma pigmentosum

4. Autosomal dominant inheritance ✅

Answer: (4) — Autosomal dominant inheritance

Explanation: In the question posed, the patient has facial angiofibromas as well as an ash leaf macule, mental retardation, seizures, and a positive
family history in a child. These features strongly indicate a diagnosis of tuberous sclerosis, which is characterised by autosomal dominant
inheritance. Therefore, the answer is option D. Reference- Rook's Textbook of Dermatology, 9th edition, Page number 80.9

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 Q184. A head injury victim is ventilated and intubated. What would be the best mode of ventilation for him?

1. CMV ✅
2. CPAP

3. AMV

4. SIMV

Answer: (1) — CMV

Explanation: Initially, controlled mechanical ventilation (CMV) is employed to maintain oxygenation and to prevent hypercarbia. When the
patient's condition improves, assist modes (AMV), synchronised intermittent mandatory ventilation (SIMV) and continuous positive airway
pressure (CPAP) can be used for weaning. Reference: Sabiston Textbook of Surgery, The BIOLOGICAL BASIS of MODERN SURGICAL
PRACTICE, 21st Edition, Page No 529.

Q185. What is the appropriate LMA size for an average adult patient weighing 55 kg?

1. 2.5

2. 3

3. 4 ✅
4. 5

Answer: (3) — 4

Explanation: According to the weight of 55 kgs, the size used should be 4. Reference : Tetsuro Kagawa, Hidefumi Obara; An Easy Formula to
Remember the Laryngeal Mask Airway Size–Patient Weight Relationship. Anesthesiology 2000; 92:631 doi: [Link]
200002000-00063 Miller's Anesthesia, 9th edition, Page no 1389.

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 Q186. At concentrations above MAC, anesthetics cause a shift of EEG wave from? \(\alpha\) to \(\beta\) waves \(\theta\) to \(\delta\) waves \(\delta\)
to \(\theta\) waves \(\theta\) to \(\alpha\) waves

1. (1)

2. (2) ✅
3. (3)

4. (4)

Answer: (2) — (2)

Explanation: As the dose increases, the EEG transitions from theta to delta with decreased amplitude, burst suppression and eventually an
isoelectric EEG. Reference : Beekoo, Deepti et al. “Analyzing Electroencephalography (EEG) Waves Provides a Reliable Tool to Assess the Depth
of Sevoflurane Anesthesia in Pediatric Patients.” Medical science monitor : international medical journal of experimental and clinical research vol.
25 4035-4040. 30 May. 2019, doi:10.12659/MSM.915640

Q187. What is the definition of the plane of surgical anesthetic during ether anesthesia?

1. Loss of consciousness

2. Loss of consciousness to the onset of spontaneous respiration

3. From onset of cessation of spontaneous breathing by paralysis of intercostal muscles ✅

4. Absence of reflexes

Answer: (3) — From onset of cessation of spontaneous breathing by paralysis of intercostal muscles

Explanation: Correct option: 3. From onset of cessation of spontaneous breathing by paralysis of intercostal muscles The plane of surgical
anesthesia during ether anesthesia refers to the depth of anesthesia that is required to perform a surgical procedure Guedel divided General
anesthesia into 4 stages, in which Stage 3 is a stage which allows adequate anesthesia to perform surgery . It starts from beginning to completion of
intercostal muscle paralysis . Diaphragmatic respiration persists but there is progressive intercostal paralysis, pupils dilated and light reflex is
abolished. It is important to maintain the patient in this stage of anesthesia during the surgical procedure to ensure that the patient does not
experience pain or recall the procedure. Reference : Siddiqui BA, Kim PY. Anesthesia Stages. [Updated 2023 Jan 29]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: [Link]

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 Q188. Which of the following medications has no effect on CSF absorption or secretion?

1. Halothane

2. Nitrous oxide ✅
3. Ketamine

4. Thiopentone sodium

Answer: (2) — Nitrous oxide

Explanation: Correct Answer is (Option 2) Nitrous oxide Thiopentone sodium decreases CNS oxygen utilization, CBF and ICP. Ketamine
increases CMRO, CBF and ICP and is relatively contraindicated in cases with an intracranial mass, increased ICP or have suffered recent head
trauma. Nitrous oxide increases CBF and cerebral blood volume, resulting in a mild elevation of ICP. Halothane dilates cerebral vessels and
increases CBF, however auto regulation is blunted resulting in a rise in ICP. Thus, Nitrous Oxide concludes the best option. Reference: Essentials of
Medical Pharmacology, KD Tripathi, 8 th edition, Page No 405.

Q189. Which of the following intravenous anesthetics is not recommended for use in patients who have been scheduled for general anesthesia and
have epilepsy?

1. Ketamine ✅
2. Thiopentone

3. Propofol

4. Midazolam

Answer: (1) — Ketamine

Explanation: Correct option: 1. Ketamine Ketamine is a sympathomimetic drugs as it inhibits the metabolism of catecholamines and can, therefore
trigger seizures. Ketamine increases cerebral metabolism, CBF, and ICP. Because of its excitatory CNS effects , which can be detected by
generalized EEG development of theta wave activity and by petit mal seizure-like activity in the hippocampus Option 3 : Propofol may suppress
seizure activity via GABA agonism, inhibition of NMDA receptors, and modulation of slow calcium ion channels Option 2 & 4 : Thiopentone and
Midazolam has anti-epileptic property as they act via the GABA-A receptors to release GABA. Reference : Miller's Anesthesia, 9th edition, Page no
641, 642, 656, 663.

Q190. Which of the following is not caused by midazolam?

1. Anterograde amnesia

2. Retrograde amnesia ✅

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 3. Causes tachyphylaxis during high-dose infusion

4. Decreased cardiovascular effects as compared to propofol

Answer: (2) — Retrograde amnesia

Explanation: Correct Answer is (Option 2) Retrograde amnesia Midazolam only causes Anterograde amnesia * Some important points Water
soluble Rapid onset Short acting Anticonvulsant, Muscle relaxant Anterograde amnesia High margin of safety due to clinically inactive metabolites
Intranasal administration possible Reversal agent – Flumazenil Reference: Goodman & Gilman’s the Pharmacological Basis of Therapeutics, 14 th
edition, Page No 431.

Q191. The effects of non-depolarizing muscle relaxants are enhanced by lithium. How soon should lithium be stopped once the muscle relaxant has
been planned to be administered?

1. 1 day

2. 2 day ✅
3. 3 days

4. 4 days

Answer: (2) — 2 day

Explanation: Correct Answer is (Option 2) 2 days Lithium tends to potentiate the action of non-depolarizing muscle relaxants given during surgery.
In addition, during the perioperative period - dehydration, use of diuretics, and hyponatremia can occur which can exacerbate the toxicity of lithium.
Lithium has a half-life of 18-24 hours - hence it's advised to stop it 48-72 hours prior to surgery or the use of any non-depolarizing muscle relaxants.
* [Extra Edge]: Lithium Reference: Essentials of Medical Pharmacology, KD Tripathi, 8 th edition, Page No 474.

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 Q192. Where does a puff of smoke appear during a cerebral angiography?

1. ACA aneurysm

2. Cavernous thrombosis

3. Moyamoya disease ✅
4. Vein of Galen malformation

Answer: (3) — Moyamoya disease

Explanation: The puff of smoke sign describes the characteristic angiographic appearance of tiny abnormal intracranial collateral vessel networks
in Moya Moya disease. Progressive narrowing of the supraclinoid internal carotid arteries and circle of Willis vessels which is the hallmark of Moya
Moya disease results in extensive small collateral arterial networks originating from the lenticulostriate and choroidal arteries. When viewed
angiographically, the abnormal collaterals simulate smoke emanating away from the major supplying artery. Associations include Sickle cell
disease, NF-1, Down’s syndrome, HIV, Tuberculous meningitis accounts for ~ 30% of cerebral vasculopathy in pediatric stroke Treatment- External
to internal carotid bypass In Japanese, moya moya translates to a puff or spiral of smoke, which is a fitting description of Moya Moya Disease. This
idiopathic progressive arteriopathy causes a narrowing of the supraclinoid distal Internal Carotid Artery and proximal Circle of Willis. As such, the
narrowing affects the anterior circulation, but is complemented by the collateral network of lenticulostriate arteries, which provide an X-ray
angiography image of a “puff of smoke” surrounding the occlusive lesion. Reference : Sabiston Textbook of Surgery, 21st edition, Page no 1892.

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 Q193. A 7-year-old kid is diagnosed with a severe headache, paralysis of the upward gaze, loss of accommodation and perception of light,
nystagmus, and failure to congregate A homogenous, hyperdense lesion was detected on a CT scan above the sella and in the third ventricle's
posterior region. On T1-weighted imaging, MRI revealed homogenous isointense lesions, and on T2-weighted imaging, isointense lesions with
strong contrast enhancement. What is the most likely diagnosis?

1. Teratoma

2. Germinoma ✅
3. Dermoid

4. Choroid plexus carcinoma

Answer: (2) — Germinoma

Explanation: Germinomas are tumors of young patients with a peak incidence of 10-12 years of age (90% of patients being younger than 20 at the
time of diagnosis). They are the most common tumor of the pineal region. When occuring intracranially as a midline tumor they present with doll
like eyes( upward gaze paralysis), nystagmus, loss of accomodation due to pressure on CN2, 3, Superior colliculi etc. MRI features- isointense or
slightly hyperintense to adjacent brain. may have areas of cyst formation. may have areas of hemorrhage (low signal) have a predilection for
invading adjacent brain (edema) central calcification appears low signal (engulfed pineal gland). Reference : Grainger & Allison's Diagnostic
Radiology, 7th edition, Page no 1435. Sabiston Textbook of Surgery, 21st edition, Page no 1897.

Q194. Which of the following statements is incorrect about blackouts?

1. The person appears confused to the onlooks ✅

2. Remote memory is relatively intact during the blackout

3. It is a discrete episode of anterograde amnesia

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 4. It is associated with alcohol intoxication

Answer: (1) — The person appears confused to the onlooks

Explanation: Correct Option is 1: The person appears confused to the onlooks A blackout is defined as temporary loss of consciousness due to
fainting, drug intoxication or injury. A person more often loses consciousness than looks confused Option 2 : is true as the person only experiences
short term anterograde amnesia, retrograde and remote memories stay intact. Option 3 and 4 are also true. Reference-: Harrison's Principles of
Internal Medicine, 21st Edition 3315,3558

Q195. According to the ICD-10 revision for establishing a diagnosis of mania, the symptoms should persist for at least how many weeks?

1. 1 week ✅
2. 2 weeks

3. 3 weeks

4. 4 weeks

Answer: (1) — 1 week

Explanation: Correct option: 1. 1 week According to ICD 10, symptoms should persist for at-least 7 days to diagnose mania and for "several days"
to diagnose hypomania. A manic episode is a distinct period of an abnormally and persistently elevated, expansive, or irritable mood lasting for at
least 1 week or less if a patient must be hospitalized. A hypomanic episode lasts at least 4 days and is similar to a manic episode except that it is not
sufficiently severe to cause impairment in social or occupational functioning, and no psychotic features are present Reference : Kaplan and Sadock's
Synopsis of Psychiatry, 11th edition, Page no 348.

Q196. What is the preferred evidence-based psychological treatment for depression?

1. Group discussion therapy

2. Counselling

3. Cognitive behavior therapy ✅

4. Psychological psychotherapy

Answer: (3) — Cognitive behavior therapy

Explanation: Cognitive Behaviour Therapy is focussed on correction of biased interpretations which had lead to a maladaptive emotional distress.
Thus the emphasis is on a person's views of self, world and future( the "cognitive triad"). Its a short-term lasting about 25 weeks, structured therapy
using active collaboration between patient and therapist to achieve goals of therapy oriented towards current problems and their resolution.
Reference : Kaplan and Sadock's Synopsis of Psychiatry, 11th edition, Page no 372.

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