The Correct option is E

Papillary necrosis is complication of pyelonephritis.
Kidney stones formation or urolithiasis is comprised of calcium carbonate crystals in the presence of hypercalciuria and a common complication is chronic pyelonephritis.

The Correct option is B

Fanconi Syndrome (Toni-Debre-Fanconi Syndrome)

Fanconi syndrome is a generalized disorder of the PT. The defect can lead to glycosuria, aminoaciduria, phosphaturia, bicarbonaturia and excessive urinary loss of K+, Na+, Ca++, Mg++, uric acid and other organic acids.

It appears that the common denominator in most of the inherited forms is that a toxin builds up in the tubular cells (e.g. cystinosis--cystine in lysosomes, Wilson’s disease-copper). In the idiopathic forms, the presumed tubular toxin is unknown. Because of the number of different transport mechanisms involved in Fanconi syndrome, it is likely that individual transporters themselves are affected. It is speculated that a generalized membrane defect exists (permeability theory), or alternatively, there is a defect in intracellular energy production or utilization (energy theory). In experimentally induced Fanconi syndrome (maleic acid), decreased intracellular ATP has been noted.

Clinical signs of Fanconi syndrome include polyuria and those secondary to electrolyte and bicarbonate losses. In children growth retardation and rickets may develop. Idiopathic Fanconi syndrome often progresses to chronic renal failure.

The Correct option is B

Renal Carcinoma

• Renal Cell Carcinoma – hypernephroma/Grawitz tumour
• Arises from proximal renal tubular epithelium
  

Epidemiology

• 90% renal cancers
• Mean age 55 years, male: female is 2:1
• 15% those on renal dialysis develop renal cell carcinoma
  

Clinical features

• 50% incidental findings during abdominal imaging for other symptoms
  
• Haematuria, loin pain, abdominal mass, anorexia, malaise, weigh loss and PUO may all occur
  
• Rarely, invasion of left renal vein compresses testicular vein causing a left varicocele
  
• Spread may be direct, via lymph nodes, or haematogenous (bone, liver, brain)
  

Tests

• Bloods – FBC (polycythemia from epo secretion), ESR, U+E, alk phos (bony mets)
• Urine – RBC, cytology
• Imaging – USS, CT/MRI, IVU (filling defect in kidney and calcification)
• Renal angiography if partial nephrectomy or palliation are being considered
• CXR – cannon ball mets

The Correct option is C

Minimal change disease

Is a commonest cause of nephrotic syndrome in children in whom this disease occur frequently. Despite massive proteinuria, the renal function remains normal. Over 90% of patients are corticosteroid sensitive while small numbers of patients are corticosteroid dependent or resistant. The later can be treated by immunosuppressive agents. The disease is characterized by normal appearing glomeruli on light and immunofluorescence microscopy and the only abnormality detected is effacement of epithelial cell foot processes which is identified on electron microscopy only. No immune-complexes are identified and so the disease is not an immune complex in origin but several associated features suggests immune mediation. The current hypothesis is that the cell-mediated immunity seems to play an important role where T-lymphocytes are said to produce vascular permeability factor which is responsible for massive proteinuria.

The Correct option is A

IgA NEPHROPATHY

General: a.k.a Berger Disease. Causes: Nephrotic syndrome

Epidemiology/At risk individuals: Most common type of GN worldwide, occurs 1-2 days after URTI/GIT infections in patients

Clinical features / course: There is an acquired or genetic defect in regulating production of IgA antibodies. After URTI / GIT infection, too much IgA is produced à forms immune complexes à trapped in mesangium à elicit alternate complement pathway à injury. Proteinuria + haematuria (Nephrotic syndrome). Progress to ESRF in 25-50% of patients.

Morphology: LM: mesangial proliferation, matrix deposition. IF: IgA in mesangium + C3.

Treatment: none.

The Correct option is C

“Extrahepatic bile duct obstruction” is a blockage of the biliary tree at the level of the extrahepatic or common bile duct or at the level of the liver bile ducts (may involve one, several, or all ducts, depending on the disorder) that results in the flow of bile being decreased or stopped (known as “cholestasis”)

CAUSES

· Associated with diverse disorders

· Presence of hard, solid material in the bile duct or gall bladder (known as “cholelithiasis”)

· Inflammation of the common bile duct (known as “choledochitis”); the extrahepatic or common bile duct empties into the upper small intestine

· Cancer

· Malformation of bile ducts

· Parasitic infestation (flukes)

· Compression of the bile duct from surrounding tissues (such as lymph nodes, cancer, inflammation of the pancreas [pancreatitis], diaphragmatic hernia)

· Scarring of the bile duct (known as “duct fibrosis”), such as secondary to trauma, inflammation of the lining of the abdomen (known as “peritonitis”), inflammation of the pancreas (pancreatitis); major duct involvement in some cats with inflammation of the bile duct or biliary tree (known as “cholangitis”) and inflammation of the bile ducts and liver (known as “cholangiohepatitis”)

· Narrowing of the bile duct, secondary to blunt trauma, surgical manipulations/procedures

The Correct option is A

Explanation:

Primary biliary cirrhosis (PBC)

first stage- destructive inflammatory lesions of multiple interlobar and septal small bile ducts characterized by granulomatous inflammation accompanied by dense mixed infiltrate in portal tracts

progressive lesion- global involvement of hepatic portal tracts with secondary obstructive changes and eventually with development of cirrhosis

end stage- indistinguishable from other forms of cirrhosis

The Correct option is E

Explanation:

Chronic active hepatitis- more progressive liver destruction

Micro: severe portal and periportal infiltrates of lymphocytes, plasma cells and macrophages, active destruction of hepatocytes in the vicinity of portal tracts- so-called piecemeal necroses, fibrosis and cirrhosis it is getting to be evident now that both forms are related may overlap

The Correct option is B

Explanation:

Patients with unconjugated hyperbilirubinemia should be examined for evidence of hemolysis. This includes reticulocyte count, examination of a peripheral smear, serum level of lactic dehydrogenase, and haptoglobin levels. The diagnosis of exclusion for unconjugated hyperbilirubinemia is Gilbert’s disease, which is a benign disease of a partial defect in the enzyme uridine diphosphoglucuronyl transferase (UDPGT), characterized by mild, chronic, and intermittent unconjugated hyperbilirubinemia.

The Correct option is B

Inhibition of H1 receptors results in sedation, increased appetite and weight gain.

All the options are correct

All effects mentioned above are due to antidepressant treatment (overdose).

The correct option is C



Selegilin belongs to MAOI -B. Other responses are true.

The Correct option is C

Hallucinations, delusions, feelings of external control and thought disorders are positive symptoms of schizophrenia. Apathy and withdrawal are negative symptoms of schizophrenia. All these symptoms can be treated using neuroleptics. (Schizophrenia is psychosis). Tremor and muscle rigidity are not symptoms characterising psychosis. They can be signs of a Parkinsonian syndrome-an adverse effect of neuroleptics.

The Correct option is D

Phenothiazines are chlorpromazine and promazine. Haloperidol belongs to butyrophenones, flupenthixol to thioxanthenes, fluspirilen to diphenylbutylpiperidines.

The Correct option is C

Phenothiazines are used for treatment of schizophrenia, mania and delirium, aggressive and violent behavior, premedication and neuroleptanalgesia. Malignant syndrome is an adverse effect of phenothiazines.

The Correct option is B

Those are symptoms of acute akathisia, the most common movement disturbances caused by antipsychotics. Note that akathisia is an important cause of poor compliance.

The Correct option is C

Malignant neuroleptic syndrome is potentially fatal complication. Its clinical features are rigidity, hyperpyrexia, stupor or coma, and autonomic disorders. It responds to treatment with dantrolene (an intracellular Ca 2 antagonist).

The Correct option is B

Pre-existing epilepsy may be aggravated

The Correct Option is D

No use in motion sickness but is active against drug-induced nausea. Is useful for treatment of hiccough and vestibular disorders. Alcoholism is contraindicated for use of neuroleptics.

The Correct option is B

Thioridazine : moderately sedating, much antimuscarinic action, little extrapyramidal effect, useful for outpatient, with piperidine side chain in the structure

The correct option is C

Perphenazine and prochlorperazine: piperazine side chain in the structure, little sedating, little antimuscarinic action, high extrapyramidal effect, useful for in-patients.

The Correct option is B

Butyrophenones are less sedating, less hypotensive, less antimuscarinic, have more extrapyramidal toxicity. Like phenothiazines are contraindicated in epilepsy.

The Correct option is C

Antidepressants involve thymoleptics and MAOI.

The Correct option is A

Thymoleptics involve TCA, 2nd generation and SSRI.

The correct option is B

The main mechanism is inhibition of reuptake of amines by nerve terminals.

The Correct option is A

Depression results from functionally deficient monoaminergic ( norepinephrine and/or 5-HT transmission) in the CNS. 5-HT =5-hydroxytryptamine = serotonin.

The Correct option is B

Depression is alleviated after 2-3 weeks because of pre-existing up regulation of postsynaptic receptors.

The Correct option is D

TCA affects histamine, muscarinic and 5-HT receptors. Note that antimuscarinic effects are especially responsible for various troublesome adverse effects.

The antimuscarinic effects are: dry mouth, blurred vision and aggravation of narrow-angle glaucoma, constipation, tachycardia and bronchodilation.

Image via Wikipedia

The Correct option is B

Pimozide can potentiate arrhythmic toxicity of cardioactive drugs, is long- acting, serious arrhythmias have been associated with its administration,an ECG must be taken before, should be avoided in children.

Image via Wikipedia

The Correct Option is D

Clozapine can be effective in up to 60% who have not responded to other drugs. Increases risk of cardiac arrhythmias. Is effective against negative as well as positive symptoms of schizophrenia. Induces neutropenia or agranulocytosis. Blood monitoring is mandatory.

Image via Wikipedia

The Correct option is C

Parkinsonian syndrome results from the dopamine receptors blockade in the nigrostriatal area though anticholinergic effects may restore ACH/D balance and compensate.

Related articles

• Test your memory (slideshare.net)
• ADHD brain chemistry clue found - Article (untreatableonline.com)

The Correct option is A

Hepatocellular Adenoma:

• Histologically these tumors compromise of only hepatocytes without hyperplasia of the bile ducts.
• These are truly benign tumors of the liver with a very small risk of malignancy. These tumors also show a tendency to regress spontaneously after a period of time.
• Etiology wise these are usually seen in women on prolonged oral contraceptives and might also be seen in people abusing anabolic steroids.
• Characterized by yellow-tan nodules with sheets and cords of hepatocyte-like cells. This tumor is hard to differentiate from well-differentiated hepatocellular carcinoma. However unlike carcinomas, these are not associated with chronic liver disease.
• This tumor has a tendency to rupture leading to intra-peritoneal hemorrhage that may be massive and life threatening. Therefore, it is usually excised.

The Correct option is E


Most gallstones are composed of precipitated cholesterol, which is supersaturated in the bile of most humans. Gallstones need not always be compromised of Cholesterol and may be composed of precipitated unconjugated bilirubin in a minority of cases.


Such gallstones are termed as pigmented gallstones as these are usually dark/black in colour. In addition there might be precipitation of Calcium, forming a complex with bilirubin to form insoluble calcium bilirubinate. These are generally radio-opaque and are among the only gallstones detected by an X-Ray.

Secondary infection may cause change in color of these pigmented stones to a Brown/chocolate color depending upon the amount of inflammation and hemolysis at the site.

The correct option is A

Long treatment with major tranquillisers leads to up regulation (an increase in both density and sensitivity of dopamine receptors), a Parkinsonian syndrome. Major tranquillisers tend to be anti-nauseogenic.

The Correct Answer is B

Effects of chlorpromazine: profoundly sedating, moderately antimuscarinic, moderately extrapyramidal. Anti-emetic effect. Can decrease body temperature.

The Correct option is A

Chlorpromazine was the first to be used in man. It belongs to the group known as phenothiazines. May promote a Parkinsonian syndrome. Can be given orally, rectally or by injection but is irritant to tissue- is therefore given by deep i.m. injection - not repeated at the same site. Cannot be prescribed to out-patients.

The Correct option is D

Neuroleptics= antipsychotics= major tranquillizers

The Correct option is C.

Chlorpromazine does not inhibit nicotinic receptors. Anti-muscarinic effects are responsible for troublesome adverse effects.

Anaemia is a state in which the number of red blood cells or the haemoglobin in them is below normal. When you’re anaemic, your body produces too few healthy red blood cells, loses too many of them or destroys them faster than they can be replaced. As a result, your blood is low on red blood cells to carry oxygen to your tissues - leaving you fatigued.

If you have anaemia, people may say you have tired blood. That’s because anaemia - a condition in which there aren’t enough healthy red blood cells to carry adequate oxygen to your tissues - can make you feel tired. Many types of anaemia exist, each with its own cause. Anaemia can be caused by an iron or vitamin deficiency, blood loss, a chronic illness, or a genetic or acquired defect or disease. It may also be a side effect of a medication. Anaemia can be temporary or chronic. It can range from mild to severe. Women and people with chronic diseases are at increased risk of the condition. Although anaemia is common, it sometimes can be a complex problem to diagnose and treat because of its many causes. If you suspect you may have anaemia, it’s important to pursue a diagnosis and treatment. Anaemia can signal certain illnesses. Left untreated, it can lead to complications, such as a heart rhythm irregularity. Treatments for anaemia range from taking vitamin and iron supplements to undergoing serious medical procedures.

The main symptom of most anaemia’s is fatigue. Other signs and symptoms of anaemia in general include: weakness, pale skin, including decreased pinkness of the lips, gums, lining of the eyelids, nail beds and palms, rapid heartbeat with mild exertion, shortness of breath with mild exertion, chest pain, dizziness, light-headedness, irritability (in children with anaemia ), numbness or coldness in hands and feet. Initially, anaemia can be so mild as to go unnoticed. But signs and symptoms increase as the condition progresses. If you experience unexplained fatigue or other signs and symptoms suggestive of anaemia, see your doctor for an evaluation.

Anaemia is a state in which the number of red blood cells or the haemoglobin in them is below normal. When you’re anaemic, your body produces too few healthy red blood cells, loses too many of them or destroys them faster than they can be replaced. As a result, your blood is low on red blood cells to carry oxygen to your tissues - leaving you fatigued.

Anyone - young or old - whose diet is consistently low in iron and vitamins is at risk of suffering from anaemia. Your body needs iron and vitamins to produce sufficient numbers of red blood cells. Having an intestinal disorder that affects the absorption of nutrients in the small intestine - puts you at risk of anaemia . Surgical removal of or surgery to the parts of the small intestine where nutrients are absorbed can lead to nutrient deficiencies and anaemia.

In general, women are at greater risk of iron deficiency anaemia than men. That’s because women lose blood - and with it, iron - each month during menstruation. Without iron supplementation, iron deficiency anaemia occurs in virtually all-pregnant women because their iron stores have to serve the increased blood volume of the mother as well as be a source of haemoglobin for the growing foetus. If you have cancer, kidney or liver failure, or another chronic condition, you may be at risk of anaemia of chronic disease. These conditions can lead to a shortage of red blood cells. Slow, chronic blood loss from an ulcer or another source within the body can deplete your body’s store of iron, leading to iron deficiency anaemia. Certain infections, blood diseases and autoimmune disorders, exposure to toxic chemicals and the use of some medications can affect red blood cell production and lead to an anaemia. If your family has a history of an inherited anaemia, you also may be at increased risk of the condition. With treatment, many anaemia s can be eliminated. Iron deficiency anaemia should go away once the iron stores are restored and any source of internal bleeding is stopped. Vitamin deficiency anaemia s often can be successfully treated with supplements.

Many types of anaemia s can’t be prevented. However, you can help avoid iron deficiency anaemia and vitamin deficiency anaemia by eating a healthy, varied diet that includes foods rich in iron, folic acid and vitamin B-12. Foods rich in iron include clams, oysters, meat - red and white - beans and peas, iron-fortified cereals, whole-grain breads and pastas, dark green, leafy vegetables, dried fruit, nuts and seeds. Folic acid is found in fresh fruits and vegetables, meat, dairy products, fortified breakfast cereals and beans. Vitamin B-12 is plentiful in meat and dairy products. Eating plenty of iron-containing foods is particularly important for people who have high iron requirements, such as children - iron is needed during growth spurts - and pregnant and menstruating women. Adequate iron intake is also crucial for infants, strict vegetarians and people following weight-reduction diets.

Doctors may prescribe iron supplements or multivitamins containing iron for people with high iron requirements. But iron supplements are appropriate only when you need more iron than a balanced diet can provide. If you’re feeling fatigued for unexplained reasons, especially if you’re at risk of anaemia, you may want to see your doctor. Some anaemia’s, such as iron deficiency anaemia, are common. But don’t assume that if you’re tired, you must be anaemic. Fatigue has many causes beyond anaemia. Overloading your body with iron also can be serious.

Some people learn that their haemoglobin is low, which indicates anaemia, when they go to donate blood. Low haemoglobin may be a temporary problem remedied by eating more iron-rich foods or taking a multivitamin containing iron. However, it may also be a warning sign of blood loss in your body that may be causing you to be deficient in iron. If you’re told that you can’t donate blood because of low haemoglobin, ask your doctor whether you should be concerned.

If you have a family history of an inherited anaemia, such as sickle cell anaemia, talk to your doctor and possibly a genetic counsellor about your risk and what risks you may pass onto your children.

The Correct option is B

Reliever drugs in asthma:

• beta₂ agonists, e.g. salbutamol (short acting)
• are indicated for the immediate relief of the symptoms of acute attacks
• can be used as needed

Preventer drugs in asthma:

• inhaled corticosteroids, e.g. budesonide and beclomethasone
• must be used twice daily, even when the patient feels well
• Initiate treatment with twice the maintenance dose for 1–2 weeks until control is achieved.
• Nedocromil is another anti-inflammatory that inhibitsneural reflexes to irritants, exercise, cold.
• All in all, Nedocromil reduces bronchial reactivity.
• It is used as a prophylactic against exercise-induced and allergen-induced asthma.
• Nedocromil is very safe to use.
  

The Correct option is C

The Correct option is E

• Terbutaline is a short acting beta- agonist.
  
• Epinephrine and terbutaline are adrenergic agents that can be given subcutaneously to patients with acute severe asthma.
  
• The dose of subcutaneous epinephrine (concentration of 1:1000) is 0.01 mg/kg divided into 3 doses of approximately 0.3 mg given at 20-minute intervals.
  
• The nonselective adrenergic properties of epinephrine may cause an increase in heart rate, myocardial irritability, and increased oxygen demand. But its use (even in patients >35 years of age) is well-tolerated.
• Terbutaline is given in a dose of 0.25 mg subcutaneously and can be repeated in 30 to 60 minutes.
  
• These drugs are more commonly administered to children with acute asthma. Although most studies have shown them to be equally efficacious, one study concluded that terbutaline was superior.

The Correct option is D

Although most people with mitral valve prolapse never have problems, complications can occur. Complications tend to occur in middle-aged or older adults.

• Mitral valve regurgitation.
• Heart valve infection (endocarditis).
• Heart rhythm problems (arrhythmias)
• cerebrovascular ischemic events

The Correct option is C

Causes of cor pulmonlae include:

• Severe, chronic obstructive lung disease, such as emphysema, recurrent pneumonia, bronchiectasis, silicosis, lung cancer, tuberculosis or collagen diseases.
• Small blood clots that travel to the lung from another body site (usually a deep vein in the calf of the leg) and obstruct lung blood vessels.
• Primary diseases of the heart, including rheumatic heart disease and congenital heart disease.

The Correct Answer is B

Sudden cardiac death (SCD) is an unexpected death due to cardiac causes occurring in a short time period (generally within 1 h of symptom onset) in a person with known or unknown cardiac disease in whom no previously diagnosed fatal condition is apparent. Most cases of SCD are related to cardiac arrhythmias. Approximately half of all cardiac deaths can be classified as SCDs. SCD occurs as the first expression of cardiac disease in many individuals presenting as out-of-hospital patients with cardiac arrest. According to the American Heart Association, more than 680 people experience sudden death each day in the United States. That is over 350,000 each year.

Sudden cardiac death (SCD) continues to be challenging problem for several decades due to the high mortality rate (85 to 90%) observed in out of hospital arrests. Also more than 50% of SCD are due to the ventricular tachyarrhythmia without myocardial infarction (MI). Although more than 80% of SCD events occur in individuals with coronary artery disease (CAD), evidence of acute MI is far less common.

The Correct option is D


Ischemia refers to a lack of oxygen due to inadequate perfusion. Ischemic heart disease is a condition of diverse etiologies, all having in common an imbalance between oxygen supply and demand.

When all age groups are considered, ischemic heart disease is the most common cause of death not only in men but also in women. Approximately 25 percent of patients who survive acute myocardial infarction may not reach medical attention, and these patients carry the same adverse prognosis as those who present with the classic clinical syndrome. Sudden death may be unheralded and is a common presenting manifestation of ischemic heart disease. Patients can also present with cardiomegaly and heart failure secondary to ischemic damage of the left ventricular myocardium that caused no symptoms prior to the development of heart failure; this condition is referred to as ischemic cardiomyopathy. In contrast to the asymptomatic phase of ischemic heart disease, the symptomatic phase is characterized by chest discomfort due to either angina pectoris or acute myocardial infarction.

The Correct option is B

Characteristics of Left-Sided Heart Failure

• Hypertrophy and dilation (except in mitral valve or other obstructions)

• 2° atrial enlargement and fibrillation

• Pulmonary congestion and edema: respiratory problems (ie dyspnea, SOB); left side of heart backs up into the lungs

• ¯Renal perfusion --> renin-angiotensin-aldosterone activation & prerenal azotemia (abn inc in urea and nitrogenous substances in blood plasma)

• Hypoxic encephalopathy

Characterisitcs of Right-Sided Heart Failure

All of the following will be due to left sided heart failure but will also be found in Right sided heart failure. The below are SYSTEMIC VENOUS CONGESTION:

• Congestive hepatomegaly: liver with NUTMEG APPEARANCE

• Congestive splenomegaly

• Renal congestion ---> fluid retention/edema

• Venous congestion & hypoxia of CNS

• Pleural & pericardial effusion and ascites

• Dependent (pedal & pretibial) edema and anasarca

The Correct option is C

Syphilitic (Luetic) aneurysms

Occurs exclusively in late tertiary syphilis. Almost always occur in the thoracic aorta and aortic arch. When luetic aortitis involves the aortic valve ring, the ring dilates causing aortic valvular insufficiency. Since the organisms lodge in the vasa vasorum of the aorta, there is an obliterative endarteritis of these vessels rimmed by an infiltrate of lymphocytes and plasma cells. With the subsequent inflammation there is destruction of elastic fibers within the aortic wall and scar formation. As the scars contract, the aortic intima is retracted leading to wrinkling or the "tree-barking" change of the intima.

Syphilitic aneurysms can attain immense size contributing to other clinical problems including

1. respiratory difficulty due to encroachment on lungs and airways

2. difficulty in swallowing due to compression of the esophagus

3. persistent cough due to irritation of or pressure on the recurrent laryngeal nerves

4. pain caused by erosion of bone, e.g. ribs and vertebral column.

The Correct option is C

Perhaps the most important study ever done to reveal the relation of the risk factors to diseases due to atherosclerosis is that of Framingham that started in the early 1950’s. This, and later other studies, clearly showed that the following major modifiable risk factors are causaly related to atherosclerosis and its clinical sequelae:

1. Smoking
2. High blood cholesterol
3. Hypertension
4. Diabetes mellitus
5. Inactivity/obesity

In addition, there are also four unmodifiable risk factors for atherosclerosis, namely:

1. Age
2. Male sex (or postmenopausal status)
3. Family history of vascular disease
4. Personal history of symptomatic vascular disease is another major risk for repeat events.

The Correct option is C

Ulcers are defects in the gastrointestinal mucosa that penetrate the muscularis mucosae.

• A common disease（10% individuals）
• The most common Peptic Ulcers: Duodenal Ulcer & Gastric Ulcer
• DU＞GU，about 3：1

Causes

• Helicobacter Pylori（Hp）
• Acid & Peptic
• Nonsteroidal anti-inflammatory drugs（NSAIDs）
• Genetic factors
• Abnormal motor function
• Stress and psychologic factors
• Others：smoking,food and drink,infection of virus.

The Correct option is C

Remember the ABCD of critical care. This patient has collapsed. Immediate priority would be to resuscitate the patient first while looking for the contributing cause.

The Correct option is C


A high proportion of patients with colon cancer have a Family History of the disease. A history of colon Ca in 1st degree relatives is an important predictor. Even many "sporadic" polyps and cancers may have a genetic basis.

Clinical manifestations:

Rt colon: (occult)

• Slow bleeding leading to anemia.
• Obstructions are infrequent.
• May some day find large mass.

Left colon:

• Narrower diam —> obstruction w/abdominal pain/cramping,
• Hematochezia
• narrowing of stool caliber.
• Much more symptomatic.
• 3/4 of these cancers occur in the distal path.

The Correct option is B

The Correct option is C


Vitamin K metabolism in the bowel can decrease because you are destroying the normal flora in the GI tract that synthesize vitamin K when one of the antibiotics that interfere with the normal flora of the gut .

The Correct option is C

Vitamin E is a fat-soluble vitamin that is gaining considerable attention due to its antioxidant properties. The main role of Vitamin E in the body is to protect the cells from reactive oxygen species (ROS). Oxygen, when unpaired in the body, is unstable and damaging therefore known as ROS. Antioxidants are a safeguard by giving up hydrogen molecules to stabilize the free oxygen. This is a process that inactivates the oxygen molecule from causing serious damage. It is suggested that ROS contribute to the hardening and clogging of the heart artery walls by reacting with low-density lipoproteins (LDL). This clogging and hardening can lead to stroke, heart attack, kidney damage and even death.

The Correct option is E

Toxicities associated with Vitamin C

1. Linus Pauling recommended taking about 10g/day for the common cold (although it probably cut down the course from 7 days to 6.5 days. “Is that significant? Who knows. If it works for some people, great”.
2. 10g/day though is a lot. You can get nausea and diarrhea with that amount of vitamin C.
3. You can also get stones in the bladder.
4. Vitamin C will also acidify urine and cause a sickle cell crisis
5. Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency tend to show hemolysis with large dose of vitamin c. How does this happen?
1. G6PD is needed to produce NADPH. NADPH then will reduce glutathione from GS-SG state to GSH, GSH. This reduced state of glutathione is necessary for the membrane integrity of RBC.
6. Massive doses of vitamin C will induce a large amount of enzyme to chew up the vitamin. Then, if you go cold turkey and stop the vitamin C intake, now all of a sudden, you have this large quantity of enzymes that will chew up every last molecule of vitamin C, thus inducing scurvy.

The Correct option is B

For B12 deficiency, parenteral administration of B12 is usually recommended. The duration of treatment is not as standardized as in case of iron deficiency anemia. Six to eight weeks treatment is usually described as sufficient. Decrease in MCV, reticulocytosis, and improvement in platelet and neutrophil counts are observed within few days.

The Correct option is C


Diphyllobothrium Latum (“fish tapeworm”)

-most infections asymptomatic

-occasionally epigastric pain, abdominal cramping, n/v, and weight loss

-may have low serum levels of vitamin B12, presumably because of the competition between the host and the worm for dietary vitamin B12

-small percentage develop clinical signs of vitamin B12 deficiency (megaloblastic anemia, neurologic manifestations: numbness, paresthesia, loss of vibration sense)

The Correct option is E

Naloxone has been shown to reverse alcohol-induced respiratory depression and coma.

The Correct option is C

Vitamin B12 is stored in the Liver. Stores may last for up to 6 months.

The Correct option is A

The Correct option is A


Hydralazine: May decrease the effect of pyridoxine

Isoniazid: May decrease the effect of pyridoxine

Levodopa: Pyridoxine may decrease the effect of levodopa

The Correct option is C

Pellagra is caused by a deficiency of the B vitamin niacin in the diet. Niacin refers to both nicotinic acid and nicotinamide. Nicotinamide is a component of two coenzymes, nicotinamide-adenine dinucleotide (NAD) and nicotinamide-adenine trinucleotide (NADP). These coenzymes are involved in oxidation-reduction reactions and are essential for metabolic processes in each cell in the body. A deficiency in niacin decreases the cellular function throughout the body. One symptom of niacin deficiency is diarrhea, which is one of the four D’s of pellagra-diarrhea, dermatitis, dementia, and death.

The Correct option is B

FMN and FAD. Like NAD/NADP, these coenzymes are usually bound non-covalently by their enzymes. (Occasional exceptions do occur). FMN is flavin mononucleotide (= riboflavin phosphate) and FAD is flavin adenine dinucleotide. FAD is FMN linked via a phosphate to AMP.

Riboflavin functions as the precursor for flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD).

Riboflavin deficiency can develop in patients with sever liver disease, diabetes mellitus, and achlorhydria.

The Correct option is C


Toxicity

• Vitamin A -HA, dizziness, blurred vision, clumsiness, birth defects,
• Vitamin D-Constipation, weakness, anorexia, weight loss, confusion
• B3-Niacin-Flushing, redness of skin,
• B6-pyridoxine-Numbness, paresthesia, ataxia
• Vitamin C-kidney stones
• Folate-can mask B12 deficiency

The Correct option is A

The Cardiovascular manifestations of beriberi most commonly encountered are dyspnea and palpitation on exertion, tachycardia and edema. The heart is generally enlarged both to the right and to the left. Systolic murmurs are common. Basilar pulmonary rales are frequent.

The important points in establishing the diagnosis of cardiovascular disease dependent on deficiency of Vitamin B1 are, in addition to those points already presented, the presence of other manifestations of Vitamin B1 deficiency, such as polyneuritis, or of deficiencies of other portions of the B complex, such as glossitis and pellagrous skin changes. Indeed it is rare to observe ‘beriberi heart’ without at least minimal signs of polyneuritis; the history of dietary inadequacy or of conditioning factors which lead to Vitamin B1 deficiency in spite of an apparently normal diet; the disappearance of signs and symptoms following adequate B1 therapy.

The Correct option is A


H. pylori is accepted as an etiologic factor in duodenal ulcers, peptic ulcer disease, gastric carcinoma, and primary B-cell gastric lymphoma.

The Correct option is B


Gastric carcinoma -accounts for over 90% of malignant tumors of the stomach

• geographic differences in the incidence- 10 times higher in Japan than in the U.S. for example- environmental factors play role
• precancerous lesions for gastric carcinoma include:
• chronic atrophic gastritis with dysplasia- its association with PA
• adenomatous polyps with dysplasia
• chronic peptic ulcers

Grossly:-

• early cancer- =gastric carcinoma restricted to the mucosa and submucosa
• recognized in Japan- diagnosis by endoscopic examination and biopsy
• advanced gastric cancer- =gastric carcinoma that invades the gastric wall-presents as- endoscopic gross morphology:
• fungating mass that protrudes into the lumen- polypoid
• as a malignant ulceration with raised edges
• as an ulcer resembling the peptic ulcer
• as a diffusely infiltrating lesion that causes diffuse thickening of the gastric wall

Microscopically:

• all gastric carcinomas are adenocarcinomas of varying degree of differentiation
• the most common -poorly differentiated so called diffuse carcinoma of signet-ring cell type
• well differentiated carcinoma resembling the tubular adenocarcinoma of the intestine is less common = intestinal type of gastric cancer

Spread:

• gastric carcinoma is locally aggressive- rapidly spreads through the whole wall of the stomach
  
• lymphatic spread- rapid,
  
• lymph node metastases -spread along the surfaces of the peritoneum
  
• bloodstream spread- to the liver and lungs

Prognosis: depends almost entirely on the depth of invasion of the tumor

• Early gastric cancer- 5-year survival rate of 85%
• Advanced cancer- only 30%

The Correct Option is D


It is important to make sure that the diarrhea is not inflammatory and is non- bloody and that there is a low suspicion for Salmonella gastroenteritis, C. difficile or enterohemorrhagic E. coli.

The Correct option is C

The Correct option is E

• Thiamin is used to help release energy from carbohydrates
• Major sources of thiamin include pork, products, whole grains, ready-to-eat breakfast cereals, enriched grains, green beans, milk, orange, juice, organ meats, peanuts, and dried beans, and seeds
• Thiamine is commonly known as the "nerve vitamin".
  
• Deficiency in thiamine causes beriberi, which is characterized by muscular weakness, swelling of the heart, and leg cramps and may, in severe cases, lead to heart failure and death.

The Correct option is E

Vitamin A deficiency (VAD) causes ocular manifestations, ranging from night blindness to xerophthalmia, resulting in blindness in severe cases. Vitamin A deficiency causes impaired immunity and is responsible for increased overall childhood mortality especially due to various infectious diseases, of which measles, acute respiratory infections, and diarrhoea are the most important ones.

• Vitamin A is found in liver, fish , fish oils, fortified milk and yogurt and eggs
• Provitamin A carotenoids mentioned before are mainly found in dark green and yellow-orange vegetables and some fruits
• Carrots, spinach, and other greens, winter squash, sweet potatoes, broccoli, mangoes, cantaloupe, peaches and apricots are examples of such sources

The Correct option is E

Vitamin K deficiency leads to bleeding tendencies due to deficiency of Vit.K dependent clotting factors. Reproductive problems arise with deficiency of Vitamin E.

The Correct option is D

Both vitamin B12 and folate deficiency cause an identical megaloblastic anemia

The Correct option is A

The Correct option is B


Barbiturates (eg, phenobarbital), methotrexate, nitrofurantoin, phenytoin, primidone, or pyrimethamine decrease the effectiveness of folic acid, leading to folic acid defieciency and anemia.

The Correct option is A

The Correct option is D

The Correct option is E


In a typical case of acute HBV infection, you can detect the surface antigen (HBsAg) early in time – the incubation period is 4-12 weeks – this is one of the events that happens early. HBsAg appears early in the serum, peaks, then DISAPPEARS. Can detect in some patients the E antigen (unreliable marker – not all patients have this during this phase) – appears about the same time, peaks and disappears about the same time as HBsAg. You don’t get the core antigen in the serum (stays in the hepatocytes).

Antibody is formed against E antigen, and against the core antigen (IgM).

The IgM against the core antigen does disappear and then you can detect IgG antibody against the core antigen for an indefinite period of time. Between the disappearance of the IgM and appearance of the IgG to the surface antigen and E antigen is the core window, where you can detect antibody to the core antigen.

The Correct option is D

The Correct option is e

The Correct option is D

The Correct option is D

The Correct option is A


Wilsons disease: occurs in children. Combination of liver disease (elevated AST/ALT), CNS problems (tremor, choreiform movements), and Kayser-Fleishcer ring of the cornea. Affects GP and Putamen.

Patient will have elevated copper in their blood and urine and decreased ceruplasmin (copper binding protein).

The Correct option is D

The Correct option is B


Primary hemochromatosis is an autosomal recessive inherited disorder, resulting in progressive iron absorption through the gastrointestinal tract with accumulation of iron in a variety of organs, including the liver. Without treatment, the disorder leads to cirrhosis and hepatic failure. With involvement of other organs, patients can also develop cardiac failure and various endocrine insufficiency states.

The Correct option is A


Wilson's disease, or hepatolenticular degeneration, is an autosomal recessive disorders of copper (Cu) metabolism characterised by an inability of the liver to excrete Cu into bile and to incorporate Cu into ceruloplasmin.

Clinically, Wilson's disease is characterised by neurologic, psychiatric and/or hepatic abnormalities. Movement disorders associated with Wilson's disease often take the form of action tremor, focal dystonia, rigidity, slowed movements and characteristic speech disorders. The psychiatric profile of Wilson's disease includes disturbances such as anxiety, irritability, and alteration in personality, forgetfulness, depression, mania, and rapid mood swings.

The Correct option is B

Primary sclerosing cholangitis:

• Rare disease characterised by chronic inflammation and fibrosis around bile ducts – diagnosis made by cholangiography and biopsy used to confirm or determine degree of liver damage.
  
• Often associated with inflammatory bowel disease
• Association with development of cholangiocarcinoma
  
• Close resemblance to type I auto-immune hepatitis

The Correct option is A


Primary biliary cirrhosis :

1. Signs of portal hypertension: hepatomegaly, splenomegaly, variceal bleeds, ascites
2. Signs of cholestasis: pigmentation, gallstones, steatorrhoea, pruritis, jaundice
3. Abdominal pain
4. Osteoporosis (important co-existing problem; steroids contra-indicated as can exacerbate this)
5. Associated with other auto-immune diseases: e.g. Sjogren's syndrome; thyroid auto-immunity; SLE; scleroderma; rheumatoid arthritis; CREST; dermatomyositis; renal tubular acidosis

The Correct option is E

Some people remain healthy for years but then as adults develop breathing difficulties due to emphysema. Alpha1 antitrypsin deficiency-related (AAT) emphysema is caused by the inherited deficiency of a protein called alpha1-antitrypsin (AAT) or alpha1-protease inhibitor. AAT, produced by the liver, is a "lung protector." In the absence of AAT, emphysema is almost inevitable. It is responsible for 5% or less of the emphysema in the United States.Symptoms of AAT deficiency emphysema usually begin between 32 and 41 years of age and include shortness of breath and decreased exercise capacity. Smoking significantly increases the severity of emphysema in AAT-deficient individuals.

The Correct option is D

• The hepatitis B virus itself does not directly cause damage to the liver. Rather, the body's immune (protective) response to the virus (a foreign material) paradoxically causes the damage.
  
• An acute hepatitis B viral infection can lead to recovery (the usual outcome), to acute liver failure (rarely), and sometimes to chronic infection.
  
• The chronic infection can result in a healthy carrier state (in which the affected person harbors the virus but remains healthy) or progress to cirrhosis (sever scarring, or fibrosis, of the liver) and its complications, including liver cancer.

The Correct option is D


Hepatitis B is an infectious liver disease that is caused by the hepatitis B virus. This virus is spread when blood or other body fluids from an infected person enters the body of a non-infected person—for example, from an infected mother to her baby during birth. Overall, infants born to infected women have a 4% chance of being infected with hepatitis B at birth.

The Correct option is B

Refer Here

The Correct option is D


Small Cell Carcinoma: highly malignant tumor has a distinctive cell type...the epithelial cells are generally small, have little cytoplasm, and are small, round, and oval and, lack nucleoli...

A high mitotic rate is characteristic, with an average of 60 to 70 mitoses per 10 high-power fields. Necrosis is frequent and extensive. Basophilic nuclear staining of vascular walls by DNA from necrotic tumor cells (the Azzopardi effect) is common in necrotic areas. Although there is no absolute measure for the size of the tumor cells, a useful rule of thumb in small cell carcinoma is the diameter of three small lymphocytes.

The important difference between small cell carcinoma and other lung cancers is its more marked sensitivity to chemotherapy.

The Correct option is D

The Correct option is E

The Correct option is B

The Correct option is D


Leukoplakia is a clinical term that does not connote any specific histologic tissue alteration. Although leukoplakia has been overemphasized in its relationship to cancer, the etiology of any white lesion should be determined or monitored. The causes of leukoplakia are varied and include both intrinsic and extrinsic factors. Extrinsic factors include: tobacco, alcohol, and actinic radiation. Intrinsic factors include: vitamin deficiencies, immunodeficiencies, and genetic predisposition. A classic study by Waldron et al. revealed that 80% of these lesions showed benign changes such as hyperkeratosis, thickening of the epithelium (acanthosis) without any evidence of epithelial dysplasia (a pre-cancerous condition), a male predilection, and occurred mainly in patients in 50-70 years of age.

The Correct option is C

The Correct option is C


CK–MB levels, along with total CK, are tested in persons who have chest pain to diagnose whether they have had a heart attack. Since a high total CK could indicate damage to either the heart or other muscles, CK–MB helps to distinguish between these two sources.

The CK and CK index (a calculated parameter that evaluates the amount of CK-MB relative to the amount of total CK) rapidly rise together in a time course consistent with acute myocardial infarction (AMI).

Even at 8 hours, the laboratory suggests myocardial injury.

In AMI, CK-MB makes up a high percentage of total CK, so the CK index rises with CK-MB. In skeletal muscle injury, CK can be very high, but CK-MB is only a tiny portion of the total CK, so the CK index stays low. Serum CK is only slightly elevated on admission.

The time course of CK elevation is consistent with that expected for infarct-related release of CK. CK-MB rises and falls in parallel with CK, as does the CK index, with a peak at 24 hours. In this case, total CK and CK-MB appear to peak at the same time.

In most cases, CK-MB peaks about 6 hours before total CK and returns to normal levels about 12-24 hours before total CK.

The Correct option is C

The Correct option is E

Management of Iron overdose:

1. Decontamination: Iron is well known to form drug concretions (pharmacobezoar) and/or become adherent to the gastric wall due to its corrosive effect. Activated charcoal is not effective.

• whole bowel irrigation
• gastroscopic removal
• gastrotomy
  

X-ray review following decontamination procedures should be performed to ensure removal of drug from the GIT.

2. Antidote: Desferrioxamine , 15mg/kg/hour - up to 80mg/kg/day in first day…

Continue treatment until serum iron ≤ 60 mcmol/l, patient asymptomatic and urine colour is no longer “vin rosé” (ensure no iron remains in the gut).

Note:

• hypotension following rapid infusion (?anaphylactoid reaction)
• renal failure occur if patient hypovolaemic
• prolonged (greater than 24 hour) infusions associated with ARDS
• interference with serum iron measurement (spurious reduction)
• pre-disposes patient to Yersinia enterocolitica infection

3. Supportive care:

1. aggressive fluid replacement
2. correction of acidosis (sodium bicarbonate)
3. correction of coagulation disorders (fresh frozen plasma)

The Correct Option is B


The most common complication of iron supplementation includes constipation, and patients should be counselled to increase water intake. Other side effects include nausea, epigastric tenderness, or vomiting.

The Correct option is A


The most appropriate form of oral iron therapy is one containing iron salts such as ferrous fumarate, ferrous sulfate, or ferrous gluconate. The recommended daily dose is between 150-200mg of elemental iron daily. No evidence suggests that one preparation is more effective for the treatment of iron deficiency.

Ferrous sulfate at 325 mg TID contains 195 mg of elemental iron. Absorption of iron is best when taken on an empty stomach. This regimen should increase hemoglobin 2 g/dL over the next three weeks.

The Correct option is A

The Correct option is A


Hypochromic Microcytic anemia

• RBC's – smaller, ↑ zone of central pallor.
• Hypochromic = ↓ Hb in each RBC
• Microcytic = ↓ size of each RBC
• also, RBC’s ↑ anisocytosis (variation in size) and ↑ poikilocytosis (variation in shape).
• most common cause: Iron Deficiency
• most common nutritional deficiency: ↓ dietary iron
• most at risk: children and women in reproductive years (from menstrual blood loss and from pregnancy)
  

The Correct option is D

Neurological symptoms are more commonly associated with folic acid and vitamin B12 deficiency, rather than with Iron deficiency anemia.

The Correct option is E

Causes of Mitral regurgitation include:

• Acute rheumatic heart disease
• MVP
  
• Ischemia is responsible for 3-25% of mitral regurgitation.
• Mitral annular calcification
  
• Left ventricular dilatation and heart failure
  
• Tendineae rupture can be due to endocarditis, myocardial infarction, or trauma.
• Papillary muscle dysfunction usually is caused by infarction.
• Other causes include the following:
  • Ehlers-Danlos syndrome
  • Marfan syndrome
  • Osteogenesis imperfecta
  • Systemic lupus erythematosus (SLE)

Reference: Mitral Regurgitation;Daniel DiSandro

The Correct option is C

The small verrucous vegetations seen along the closure line of this mitral valve are associated with acute rheumatic fever. These warty vegetations average only a few millimeters and form along the line of valve closure over areas of endocardial inflammation. Such verrucae are too small to cause serious cardiac problems.

The Correct option is C

The Correct option is C

Syphilitic aneurysms are due to inflammation of Aortic vasa vasorum. The most common sites of arterial involvement are the ascending aorta, the aortic arch and the pulmonary artery.

Syphilis aortitis is characterized by peri-aortic and meso-aortic inflammation with perivascular cuffing of lymphocytes around the vasa vasorum. Obstruction of the vasa vasorum follows, resulting in nutritional impairment of the medial coat together with degeneration of the muscle fibres. Aneurysmal dilatation eventually ensues as a result of weakening of the medial layer. Syphilitic aneurysms are either fusiform or saccular and may attain great size and compress
contiguous structures. Rupture into the thoracic cavity, pericardial sac, oesophagus or vena cava are known complications.

Reference: Rubin's Pathology, Fifth Edition, page 421.

The Correct option is B


Protruding atherosclerotic lesions in the thoracic aorta, often with superimposed mobile thrombi, are an important cause of embolic disease. During the last 6 years, the increasing use of transesophageal echocardiography has shown that atherosclerotic plaque in the thoracic aorta is a source of otherwise unexplained embolic events, including stroke, transient ischemic attack, and peripheral emboli.

An additional, different clinical picture-the classic atheroemboli syndrome-is associated with aortic atherosclerosis. This well-described syndrome consists of renal insufficiency, skin lesions, blue toes, and multisystem findings caused by embolic phenomena. It can occur spontaneously but frequently results from arterial manipulation, such as cardiac catheterization and aortotomy during coronary artery bypass surgery.

Reference: Itzhak Kronzon, MD, and Paul A. Tunick, MD ; Atheromatous Disease of the Thoracic Aorta: Pathologic and Clinical Implications; 15 April 1997 | Volume 126 Issue 8 | Pages 629-637

Pharmacology


1. Which of the following can be given with OCP

a. Mebendazole,
b. Amoxycillin,
c. Phenytoin,
d. Rifampin



2. Mode of action of vigabatrin is

a. Inhibitor of GABA transaminase increasing GABA conc,
b. Suppress Na+ current channels,
c. Inhibit T type Ca 2+ channel,
d. None



3. Mode of action of baclofen is

a. Act as GABA receptor agonist thro hyperpolarising neurons by increasing k+ conductance and altering ca2+ flux ,
b. Depolarise muscle by opening Na+ channel,
c. Both,
d. None



4. Moricizine used as antiarrhythmic causes: -

a. Prolongation of action potential,
b. Decrease action potential,
c. No change in action potential,
d. None of the above.



5. All of the following can be used against chloroquine resistant malaria except

a. Mefloquine,
b. Quinine,
c. Primaquine,
d. Halofantrine.



6. Ethanol elimination is a

a. Linear elimination,
b. Dose dependent,
c. Saturation type,
d. Fixed elimination



7. Prodrug used in prostatic carcinoma with antiandrogenic action is

a. Cyproterone,
b. Clomiphene,
c. Danazol,
d. Tamoxifen



8. Which of the following is not hepatotoxic

a. INH,
b.Rifampin,
c. Ethambutol,
d. Pyarizinamide.



9. Which of the following is a best drug to stop cisplatin induced vomiting

a. Ondensetron,
b. Cisapride,
d. Domperidone,
c. Metoclopramide



10. Drug of choice to be used in SVT with WPW is

a. Verapamil,
b. Amiodarone,
c. Lignocaine,
d. Digoxin



11. Dorazolamide is a

a. Topical carbonic anhydrase inhibitor,
b. Systemic carbonic anhydrase inhibitor,
c. Both,
d. None.



12. Organophosphorus poisoning acts by

a. Adrenergic action,
b. Cholinergic action,
c. Anticholinesterase action,
d. Pseudocholinesterase inhibitor.



13. Cocaine is

a. Vasodilator,
b. Vasoconstrictor and Hypertensive,
c. Vasodilator and bradycardia,
d. Vasodilation followed by vasoconstriction.



14. Caffeine is given along with ergotamine to cause

a. Increased absorption,
b. Toxicity,
c. No advantage,
d. For colouring.



15. Plasma concentration reflects the action in

a. Digoxin,
b. Hit and run drug,
c. Diuretic,
d. Lignocaine



16. Dopamine agonist is

a. Reserpine,
b. Metoclopramide,
c. Bromocriptine,
d. Haloperidol.


Pathology


1. All of the following are due to congestion of blood except

a. brown induration of lung,
b. Strawberry gall bladder,
c. Nutmeg liver,
d. Sago spleen.



2. Poor prognostic factor is liver disease is

a. Bile lake,
b. Collagen formation,
c. Mallory hyaline body,
d. Councilman body.



3. Lymphatic spread is most common in

a. Rhabdomyosarcoma,
b. Dermatofibrosarcoma,
c. Liposarcoma,
d. Osteosarcoma.


4. Renal pathology in SLE is all except: -

a. Lipoid nephrosis,
b. Focal Proliferative,
c. Diffuse proliferation,
d. Diffuse membranous.



5. All are granulomatous except

a. Giardiasis,
b. Histoplasmosis,
c. Schistosomiasis,
d. Leprosy



6. CML is associated with

a. Philadelphia chromosome,
b. Persistent barr body,
c. San Francisco chromosome,
d. XXY.



7. Function of Kupfer cells is

a. Phagocytic,
b. Lytic,
c. Secretory,
d. Excretory



8. Radiation acts by all of these except

a. Autoimmunity,
b. Mutation,
c. Free radical,
d. DNA breakage.



9. Edema is caused by all except

a. Decrease protein in plasma,
b. Decrease protein in interstitial fluid,
c. Increased protein in plasma,
d. none of the above.



10. In fibrocystic disease of breast all are seen except

a. Inflammation,
b. Fibrosis,
c. Dilatation of ducts which appear cystic ,
d. Adenosis



11. Comedocarcinoma of breast

a. Synonym for tubular carcinoma,
b. Variant of paget’s disease of nipple,
c. Synonym of scirrhous carcinoma,
d. On cut section punctate areas of necrotic material is seen


Microbiology


1. Heterophile antibody is seen in

a. Coomb’s test,
b. Casoni’s test,
c. Weil felix reaction,
d. Frei’s test



2. Test to detect echinococcus infection is

a. Napiers Aldehyde test,
b. Sabin Feldman dye test,
c. Casoni’s test,
d. Free’s test.



3. Dimorphic fungus is

a. Cryptococcus,
d. Aspergillus,
c. Histoplasma,
d. sporothrix



4. Characteristic feature of strongyloides infection is

a. Malabsorption,
b.Anemia,
c. Invades satiated muscle,
d. Intestinal obstruction.



5. Food poisoning is caused by all the following except

A.Vibrio Cholera
B. Salmonella
C. Staphylococci
D.Clostridium perfringens



6. Which of the following crosses placenta

a. Ig G,
b. Ig A.
c. Ig M,
d. Ig E.



7. Most effective mode of transmission of the HIV is

a. Blood transfusion,
b. By syringes,
c. Vertical transmission,
d. Heterosexual contact.



8. Bacterial resistance transmission is through

a. Conjugation,
b. transduction,
c. Convocation
d. Transformation


9. Kyasanur forest disease is caused by

a. Virus,
b. Louse,
c. Mite,
d. Tick



10. Ascariasis causes

a. Intestinal obstruction,
b. Bile duct obstruction,
c. Both,
d. neither


Forensic Medicine


1. Double edge sword produces which type of wound

a. Triangular,
b. Elliptical,
c. Wedge shape,
d. Oval.



2. In a case of drowning froth was coming out of mouth froth was

a. Fine and Frothy,
b. Coarse and turbid,
c. Blood stained,
d. Fine and bubbling.



3. Regarding sudden infant death all are true except

a. Mother taking narcotics,
b. Congenital defect,
c. Previous SIDS,
d. Prematurity.



4. While taking dying declaration, a doctor should

a. Call magistrate,
b.Testify the statements made under sound mind,
c. Note down the declaration,
d. Arrange for the witness.



5. Putrefaction occurs over the caecal area after around

a. 12 hours,
b. 12-24 hours,
c. 24-28 hours,
d. 3 days.



6. Blood stain of human origin is tested by,

a. Precipitin test,
b. Hemin test,
c. Hemochromagen test,
d. Benzidine test.


SPM


1. Commonest cause of blindness in India is

a. Malnutrition,
b. Trachoma,
c. Conjunctivitis,
d. Refraction error.


2. What is the treatment of multibacillary leprosy as directed by WHO

a.24 months treatment in 36 months
b.24 months treatment in 30 months
c.24 months treatment in 24 months
d.6 months treatment in 9 months.



3. SET centers are used in

a. Leprosy elimination,
b. TB control,
c. Guineaworm eradication,
d. Malaria survey.



4. Minimum qualification of village health guide should be

a. Should have passed at least VI standard,
b. Can read and write,
c. Passed X standard,
d. Should be a graduate.



5. What is the percentage of weight for height at which severe malnutrition is diagnosed

a.less than 90 per centile
b.less than 80 per centile
c.less than 70per centile
d.less than 60 per centile



6. Mesotheliomas are due to

a. Asbestosis,
b. Silicosis,
c. Byssinosis,
d. Bagassosis



7. Which is the following Arboviral infection is not found in India

a. Yellow fever,
b. Japanese encephalitis,
c. KFD,
d. West Nile fever



8. Most effective method of transmission of leprosy is

a. Skin to skin contact,
b. Droplet infection,
c. Urine,
d. Blood transmission.



9. For malaria control, DDT is sprayed

a. Rice fields,
b. Indoor,
c. Outdoor,
d. wheat fields.



10. Under 5 mortality rate x 100 denotes:
Total deaths during the year

a. Proportional mortality rate,
b. Specific mortality rate,
c. Case fatality rate,
d. Child survival index.



11. Predictive value of a negative test is

a. b x 100,
b. C x 100,
c. d x 100,
d. a x 100

a+b c+d c+d a+b



12. Unmodified risk factors for heart disease is

a. Smoking,
b. Alcohol,
c. family history,
d. Cholesterol.



13. Which of the following comes under UIP

a. Hepatitis B,
b. Rubella,
c. Measles,
d. None



14. Food poisoning is caused by

a. Staphylococci ,
b. Pseudomonas,
c. Streptococci,
d. Vibrio cholera



15. PQLI includes

a. Education, IMR, life expectancy of infant,
b. Per capita income, education, IMR,
c. MMR, IMR education,
d. Life expectancy at age 1m IMR, literacy.



16. Goals to be achieved by 2000 were

a. IMR less than 60, CBR less than 21,
b. IMR less than 80, CBR less than 21,
c. CBR less than 10, IMR less than 60,
d. MMR less than10, IMR less than 60.

17. Worker on roti diet presents with diarrhea and CNS symptoms, freckles over neck and dermatitis. Also rashes are present on exposed parts of body. Probable cause is
a. Vitamin B1 deficiency,
b. Vitamin B2 deficiency,
c. Niacin deficiency,
d. Protein calorie malnutrition.

18. In case control study, control is
a. Chosen before the study, b. free from the disease,
c. Suffering from the disease,
d. Should be different from case in age sex etc.

19. Which of the following has shortest incubation period in case of food poisoning

a. Staphylococci,
b. Salmonella,
c.Clostridium botulinium,
d. Bacillus cereus.