Dnb/Aipgmee Model Test 1
FREE MODEL TEST FOR STUDENTS PREPARING FOR DNB/AIPGMEE
No of questions;200 Time:180 mins
Contains image based questions
After completion of test a report complete with answers and explanation will be sent to your e-mail id.
Questions and Answers
- 1.
Eighty-five percent of aggressive lymphomas exhibit which cell type?
- A.
Follicular small cleaved cell lymphoma
- B.
Diffuse small lymphocytic lymphoma
- C.
Diffuse large cell lymphoma
- D.
Adult T -cell leukemia-lymphoma
Correct Answer
C. Diffuse large cell lympHomaExplanation
In non-Hodgkin's lymphoma, the primary determinant of prognosis remains the grade of the tumor. High-grade lymphomas remain potentially curable; low-grade lymphomas are not curable, but they may have a much more indolent clinical course.Rate this question:
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- 2.
True about Non-small cell lung cancer:
- A.
Screening is highly effective in reducing mortality.
- B.
The overall five-year survival exceeds 25%.
- C.
Cigarette smokers exposed to asbestos are at risk for lung cancer and mesothelioma.
- D.
Less than half of all lung cancers are related to smoking.
Correct Answer
B. The overall five-year survival exceeds 25%.Explanation
Small cell cancer of the lung represents approxi¬mately one-fourth of all lung malignancies. It frequently spreads beyond the thorax. The response to chemotherapy remains good, but the median survival without chemotherapy is extremely poor. Superior vena cava obstruction may be treated primarily with chemotherapy alone. Non-small cell cancer of the lung continues to be resistant to many therapeutic modalities, especially if surgical resection is not complete. Adjuvant therapy has never been demonstrated to be effective. There is an increasing tendency to resect solitary metastatic foci because prolonged survival may be evidenced.Rate this question:
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- 3.
Which disease disseminates rapidly in immunosuppressed patients.
- A.
Kaposi's sarcoma
- B.
Ewing's sarcoma
- C.
Osteogenic sarcoma
- D.
Chondrosarcoma
Correct Answer
A. Kaposi's sarcomaExplanation
Kaposi's sarcoma is described as an indolent disease affecting elderly men and responding well to local therapeutic intervention. The disseminated form of the disease is now seen more frequently in severely immunologically compromised patients, such as AIDS patients. Ewing's sarcoma does respond well to chemotherapy and radiation, but it may be difficult to diagnose without sophisticated immunohistochemical techniques. The clinical course of ontogenic sarcoma has been dramatically altered by the effectiveness of chemotherapy in combination with surgical techniques, which has enabled patients to avoid amputation in many cases.Rate this question:
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- 4.
Plasma factor VIII is stabilized by
- A.
Von Willebrand factor
- B.
Factor IX
- C.
Prothrombin
- D.
Glycoprotein Ib
Correct Answer
A. Von Willebrand factorExplanation
Circulating factor VIII is bound to von Willebrand factor, which stabilizes factor VIII. In addition, von Willebrand factor is important to the binding of platelets to injured vessel walls, and it enhances platelet-platelet interactions. The hemostatic defect in p3fiellls with yon WillelJr3t1.d disease results perinodally from impaired interactions of platelets with vessel walls.Rate this question:
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- 5.
Clinical manifestations of Listeria monocytogenes infection include
- A.
Meningitis
- B.
Primary bacteremia
- C.
Endocarditis
- D.
All of the above
Correct Answer
D. All of the aboveExplanation
Listeria monocytogenes causes meningitis. Findings in CSF are similar to findings in other types of purulent meningitis; a relative lymphocytosis is seen in 25% to 40% of cases. Patients may present with primary bacteremia without evidence of central nervous system infection. Listeria can cause endocarditis, with either normal or abnormal valves. These listerial infections are more common in immunosuppressed patients, specifically patients using chronic steroid therapy, renal transplant pa¬tients, and cancer patients. If a pregnant woman experiences bacteremia, transplacental infection can occur, leading to stillbirth or spontaneous abortion.Rate this question:
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- 6.
True statements regarding diarrhea in HIV infection include all of the following except:
- A.
Diarrhea due to Salmonella has a greater incidence of associated bacteremia and may require chronic suppressive antibiotic therapy.
- B.
The most common parasites associated with diar¬rhea are Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
- C.
Mycobacterium avium complex may cause diarrhea due to malabsorption, which responds well to treat¬ment.
- D.
Cryptosporidium is diagnosed by acid-fast stain of intestinal biopsy or stool specimens; there is no proven effective treatment.
Correct Answer
C. Mycobacterium avium complex may cause diarrhea due to malabsorption, which responds well to treat¬ment.Explanation
Diarrhea is a common complaint of HIV -infected patients. A wide variety of pathogens have been described, but frequently no specific pathogen can be found. Routine cultures, ova and parasite examination, and acid-fast stains for Cryptosporidium should be obtained. If initial specimens are negative, repeating ova and parasite and Cryptosporidia studies may be useful. Salmonella is more difficult to treat in HIV -infected patients. Enteritis may be accompanied by bacteremia, which may be difficult to eradicate and may require chronic suppressive therapy. The most common parasites described in conjunction with diarrhea and HIV infection are Giardia lamblia, Entamoeba histolytica, and Cryptosporidium. Effective therapy is available for Giardia and Entamoeba, but no treatment has proven effective for Cryptosporidium. Isospora belli can cause watery diarrhea, which resolves with trimethoprim/sulfamethoxazole therapy. Diarrhea secondary to mycobacterium avium complex does not respond well to directed therapy.Rate this question:
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- 7.
Most interstitial lung diseases have a predilection for lower lung zones. However, there are a few diseases with a predilection for the upper lung zones. These diseases include all of the following except
- A.
Eosinophilic granuloma (histiocytosis X)
- B.
Silicosis
- C.
Late stages of sarcoidosis
- D.
Idiopathic pulmonary fibrosis
Correct Answer
D. Idiopathic pulmonary fibrosisExplanation
Most interstitial lung diseases have a predilection for the lower lung zones, including idiopathic pulmonary fibrosis. However, there are several diseases that tend to present predominantly in the upper lung zones, including silicosis, berylliosis, coal worker's pneumoconiosis, cystic fibrosis, eosinophilic granuloma, ankylosing spondylitis, nodular rheumatoid arthritis, late stages of sarcoidosis, lymphan¬gioleiomyomatosis, mycosis, Mycobacterium, and Pneumocystis carinii pneumonia (PCP) found in AIDS patients who are on inhaled pentamidine prophylaxis.Rate this question:
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- 8.
All of the following comments about cystic fibrosis (CF) are true except:
- A.
It can cause diarrhea
- B.
Staphylococcus aureus, Hemophilus influenzae, and Pseudomonas aeruginosa are common causes of respi¬ratory infections.
- C.
A low concentration of sodium or chloride in sweat is diagnostic of CF.
- D.
Rhinosinusitis is a common finding in CF.
Correct Answer
C. A low concentration of sodium or chloride in sweat is diagnostic of CF.Explanation
CF an autosomal recessive disorder. Approximately 50% will survive to the age of25. In 1989, the CF gene was found to be located on the long arm of chromosome 7. The CF protein is called the cystic fibrosis transmembrane regulatory protein (CFTR). The most common mutation is the three-base deletion removing a phenylalanine residue at position 508 of CFTR, called the F508 mutation. The basic defect is due to a defect in chloride permeability, which can result in the accumulation of mucus and can lead to stasis and obstruction. Both the upper and lower airways can be involved, and they can lead to frequent bronchial infections predominated early by Staphylococcus aureus and Hemophilus influenzae and in late disease by Pseudomonas aeruginosa. The diagnosis is usually made by the sweat test performed by quantitative pilocarpine iontophoresis. CF diagnosis is confirmed by an elevated sweat chloride concentration greater than 60 mEq/L.Rate this question:
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- 9.
Which of the following sets of data might be obtained in a patient with Cushing's syndrome caused by an adrenal adenoma?
- A.
Decreased adrenocorticotrophic hormone (ACTH), increased serum cortisol, and increased dehydroepi¬androsterone sulfate (DHEAS) levels
- B.
Decreased ACTH, increased serum cortisol, and decreased DHEAS levels
- C.
Normal ACTH, increased serum cortisol, and de¬creased DHEAS levels
- D.
Increased ACTH, increased serum cortisol, and in¬creased DHEAS levels
Correct Answer
B. Decreased ACTH, increased serum cortisol, and decreased DHEAS levelsExplanation
A patient with Cushing's syndrome produced by an adrenal adenoma has decreased plasma ACTH. The plasma cortisol is increased, and DHEAS is either normal or reduced. The overproduction of cortisol by these tumors suppresses endogenous ACTH release and therefore adrenal androgen synthe¬sis. Adrenal carcinoma also has decreased ACTH but is inefficient and produces various adrenal androgens, including DHEAS. Thus, patients with adrenal carcinoma have high levels of DHEAS. Patients with Cushing's disease and ectopic production of ACTH have normal or elevated DHEAS levels.Rate this question:
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- 10.
32-year-old woman is found to have an empty sella. Which is the most common endocrine evaluation you would expect to find in this patient?
- A.
Hyperprolactinemia
- B.
ACTH deficiency
- C.
Hypogonadotropic hypogonadism and hyposmia
- D.
No abnormalities
Correct Answer
D. No abnormalitiesExplanation
The empty sella syndrome is frequently encountered as the result of x-ray examination of the head for reasons other than suspected pituitary disease. It occurs commonly in obese multiparous women with hypertension. An incomplete diaphragm sella is thought to allow an arachnoid diverticu¬lum containing cerebrospinal fluid to protrude into the sella, which in turn displaces and compresses the pituitary gland. Pituitary function remains intact, and no further workup is indicated unless there is clinical evidence of endocrine abnormalities. Occasionally hyperprolactinemia may occur as the result of stretching of the pituitary stalk or of a coincidental microprolactinoma.Rate this question:
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- 11.
All of the following symptoms are commonly seen in patients with delirium except
- A.
Clouding of consciousness
- B.
Difficulty with concentration
- C.
Insidious onset
- D.
Hallucinations and illusions
Correct Answer
C. Insidious onsetExplanation
The hallmark symptom of delirium is an impairment of consciousness usually seen in association with impairments of cognitive functioning. Psychiatric symptoms include abnormalities of mood, perception, and behavior. Tremor, asterixis, nystagmus, incoordination, and incontinence are common neurologic symptoms. The classic presentation of delirium is a sudden onset, a fluctuating course, and a rapid recovery when the causative factor is identified and eliminated.Rate this question:
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- 12.
All of the following are findings of patients with schizophrenia except
- A.
Lateral and third ventricle enlargement
- B.
Deficits in smooth-pursuit eye movements
- C.
Increased incidence of abnormally slow electroen¬cephalogram tracings
- D.
Cerebellar dysfunction
Correct Answer
D. Cerebellar dysfunctionExplanation
Studies using CT have consistently shown that the brains of patients with schizophrenia have lateral and third ventricular enlargement and some degree of reduction in cortical volume. Disorders of smooth visual pursuit and the disinhibition of saccadic eye movements are commonly seen in patients with schizophrenia. Electroencephalographic studies of patients with schizophrenia indicate that a high number have abnormal records, increased sensitivity to activation procedures, decreased a-activity, and increased 7- and 8-activity. No studies have shown impaired cerebellar functioning.Rate this question:
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- 13.
All of the following statements about normal-pressure hydrocephalus are true except:
- A.
It can occur after subarachnoid hemorrhage or men¬ingitis
- B.
It has a diagnostic triad of dementia, incontinence, and gait apraxia.
- C.
It is also known as communicating hydrocephalus.
- D.
It is rarely idiopathic.
Correct Answer
D. It is rarely idiopathic.Explanation
Normal-pressure hydrocephalus (NPH) results from failure of the arachnoid granulations to absorb normal amounts of cerebrospinal fluid (CSF) into the sagittal sinus and, in turn, into the venous circulation. Because there is no obstruction of the CSF flow from the ventricles through the aqueduct and basilar foramina, it is called "communicating" hydrocephalus. The imaging hallmark is large ventricles without atrophy. Large ventricles with atrophy can be seen in disorders that cause loss of brain volume; for example, the degenerative dementia of Alzheimer's disease. The idiopathic form of NPH is most likely the most common type seen clinically. This occurs when there is no known antecedent event contributing to the decreased function of arachnoid granulations.Rate this question:
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- 14.
All of the following symptoms are commonly seen in the patient with major depressive disorder except
- A.
Insomnia
- B.
Poor concentration
- C.
Decreased appetite with weight loss
- D.
Amnesia
Correct Answer
D. AmnesiaExplanation
A depressed mood and a loss of interest or pleasure are the key symptoms of depression. Approxi¬mately 65% of all depressed patients have suicidal ideation, and 10% to 15% of patients commit suicide. Most depressed patients have loss of energy, insomnia, decreased appetite, and weight loss. Anxiety is also a common symptom of depression. Other vegetative symptoms include abnormal menses and decreased interest and performance in sexual activities. The changes in food intake and rest can aggravate coexisting medical illnesses such as diabetes, hypertension, chronic obstructive pulmonary disease, and heart disease. Amnesia is not a symptom of depression.Rate this question:
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- 15.
In a patient undergoing warfarin therapy, which of the following factors is measured in PTT rather than the PT
- A.
II
- B.
VII
- C.
IX
- D.
X
Correct Answer
C. IXExplanation
Warfarin inhibits epoxide reductase, thus inactivating vitamin K and the vitamin K-dependent factors: prothrombin (II),VII, IX, X, protein C, and protein S. The prothrombin time (PT) measures the extrinsic system down to the formation of a clot (VII, X, V, II, fibrinogen --7 clot), whereas the partial thromboplastin time (PTT) is a measure of the intrinsic system down to the formation of a clot (XII, XI, IX, VIII, X, V, II, fibrinogen --7 clot). Therefore, both the PT and PIT are prolonged in a patient on a warfarin deriva¬tive, but the deficiency in factor IX is only measured in the PTT, not the PT. Protein C and S are not measured in either the PT or the PTT.Rate this question:
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- 16.
Anemia associated with a corrected reticulocyte count less than 2% would most likely be seen in which of the following patient? A patient
- A.
With anemia of chronic inflammation who is taking iron
- B.
With rheumatoid arthritis who has a normocytic anemia and a positive direct Coombs test
- C.
Who received an intramuscular injection of B 12 for treatment of pernicious anemia one week ago
- D.
With a gastrointestinal bleed 6 days ago
Correct Answer
A. With anemia of chronic inflammation who is taking ironExplanation
Anemia associated with a corrected reticulocyte count less than 2% would most likely be seen in a patient with anemia of chronic inflammation (ACD) who is taking iron. In ACD, iron is blockaded in macro phages and is unavailable for hemoglobin synthesis. Iron ther¬apy does not produce any reticulocyte response.
A patient with rheumatoid arthritis who has a nor¬mocytic anemia and a positive direct Coombs test has an autoimmune hemolytic anemia. The corrected reticulocyte count is increased in hemolytic anemias. A patient who received an intramuscular injection of B12 for treatment of pernicious anemia one week ago will have an increased reticulocyte response because the missing raw material for DNA synthesis is now available. A patient with a gastrointestinal bleed 6 days ago will have an increased reticulocyte response because the marrow has had enough time for acceler¬ated erythropoiesis. However, if the bleed was less than 5 days ago, the reticulocyte count would not be increased because the marrow has not had time to produce and release RBCs. A patient with agnogenic myeloid metaplasia has an inappropriate increase in the reticulocyte count because it is not related to eryth¬ropoietin stimulation of the bone marrow.Rate this question:
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- 17.
Patient sustains a knife wound through the right fouth intercostals space, 7 cm to the right of the sternum. The area most likely penetrated by the knife is the
- A.
Right upper lobe of the lung
- B.
Right middle lobe of the lung
- C.
Right lower lobe of the lung
- D.
Right atrium of the heart
Correct Answer
B. Right middle lobe of the lungExplanation
The right border of the heart is approximately 1 to 2 cm to the right of the right border of the sternum; therefore, the knife probably did not hit the heart. The middle lobe of the right lung extends from the level of the fourth costochondral junction to the level of the fifth intercostal space. The middle lobe is most likely at the level of the fourth intercostal space.Rate this question:
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- 18.
45 year old male patient complains that he is often tired and has a headache almost every morning His wife says that her sleep is disturbed because of the patient’s loud snoring. Physical examination reveals leg edema. Hypertension, and cardiac arrhythmia. From which disorder is this patient most likely suffering?
- A.
Sleep wake schedule disorder
- B.
Obstructive sleep apnea
- C.
Narcolepsy
- D.
Delayed sleep phase syndrome
Correct Answer
B. Obstructive sleep apneaExplanation
In obstructive sleep apnea, airway obstruction results in snoring as well as failure to breathe during the night. The resulting anoxia causes frequent awaken¬ings during the night so that the patient feels tired in the morning. Decreased oxygen availability may result in leg edema, hypertension, morning headaches, car¬diac arrhythmias, and stroke in patients with obstruc¬tive sleep apnea.Rate this question:
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- 19.
Which of the following measures is most likely to decrease the risk of myocardial infraction?
- A.
Cessation of smoking
- B.
Postmenopausal estrogen replacement
- C.
Maintenance of an excise program
- D.
Low dose aspirin administration
Correct Answer
A. Cessation of smokingExplanation
Cessation of smoking decreases the risk of myocardial infarction by 50% to 75% within 5 years of cessation. The reduced risk for the other therapies are as follows:
• Postmenopausal estrogen replacement has a 44% decreased risk
• Mild to moderate alcohol consumption has a 25% to 45% decreased risk
• Exercise has a 45% decreased risk .
• Prophylactic low dose aspirin has a 33% decreased risk, particularly in the incidenc of the first acute myocardial infarction in middle aged men and women; however, there is no reduction in overall total cardiovascular mortality. Patients over 50 years of age with risk factors for coronary artery disease are the group most likely to benefit. It is not good for prophylaxis if the patient has poorly controlled hypertension, because there is a danger for a hemor¬rhagic stroke.Rate this question:
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- 20.
Two months after an acute anterior myocardial infarction, a 68 year old man has an abnormal bulge on the precordium during systole. The most common complication associated with this abnormality is
- A.
Rupture
- B.
Chronic heart failure
- C.
Infective endocarditis
- D.
Valvular dysfunction
Correct Answer
B. Chronic heart failureExplanation
The patient has a ventricular aneurysm. This is a late complication that develops 4 to 8 weeks after acute myocardial infarction in 10% to 20% of cases. Patients observe an abnormal bulge on the precordium. Aneu¬rysms located on the anterior wall bulge during systole as they fill with blood. The diagnosis is verified by two-dimensional echocardiography or ventriculogra¬phy. The electrocardiogram shows persistent ST eleva¬tion. Complications include:
• Chronic heart failure, if more than 40% of the left ventricle is involved (this is the most common cause of death)
• Thrombo embolization.
• Ventricular arrhythmias
• Rupture is uncommon, because the aneurysm is composed of scar tissue.
A ventriculectomy is the treatment of choice in selected cases.Rate this question:
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- 21.
Physiological locking involves?
- A.
Internal rotation of femur over stabilized tibia
- B.
Internal rotation of tibia over stabilized femur
- C.
External rotation of tibia over stabilized femur
- D.
External rotation of femur over stabilized tibia
Correct Answer
A. Internal rotation of femur over stabilized tibiaExplanation
• When the foot is fixed (tibia stabilized) the femur rotates medially to lock the knee.
• Locking happens in the last 30 degree of extension and makes all the ligaments taut.
• This locked position is very stable and keeps the lower limbs like 2 pillars.
• Here the knee remains in full extension without much muscular efforts.
• Knee locking is carried out by the same muscle which has carried out extension, i.e., quadriceps femoris.
• Unlocking is carried out by the popliteus muscle, which moves femur laterally on stabilized tibia (fixed foot).
• Unlocking is needed to initiate flexion at the knee before we start walking from the knee locked position.Rate this question:
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- 22.
During Digital Subtraction Angiography study the Guidewire-induced spasm of the distal superficial femoral artery is best treated with?
- A.
Nitroglycerine
- B.
Tolazoline
- C.
Papaverine
- D.
Nifedipine
Correct Answer
B. TolazolineExplanation
Tolazoline is a direct muscle relaxant (15-25 mg IA dose), preferred in peripheral spasm. Nitroglycerine is similar, also acts as a direct muscle relaxant (l00ug IA), but is not as frequently used. Nifedipine is a calcium channel blocker (l0mg SL), also used for peripheral spasm. Papaverine is a smooth muscle relaxant (1mg / min infusion) used for mesenteric ischemia.Rate this question:
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- 23.
All of the following are methods of survival analysis except:
- A.
) Kaplan Meier
- B.
Kruskal Wallis
- C.
) Actuarial method
- D.
Survival rate
Correct Answer
B. Kruskal WallisExplanation
Survival analysis is a branch of statistics which deals with death in biological organisms and failure in mechanical systems. This topic is called reliability theory or reliability analysis in engineering, and duration analysis or duration modeling in economics or sociology. More generally, survival analysis involves the modelling of time to event data; in this context, death or failure is considered an "event" in the survival analysis literature. Another example of time to event modeling could be the rate or time to which former convicts commit a crime again after they've been released. In this case, the 'event' of interest would be committing a crime. Many concepts in Survival analysis have been explained by the Counting Process Theory, which has emerged more recently. The flexibility of a counting process is that it allows modeling multiple (or recurrent) events. This type of modeling fits very well in many situations (e.g. people can go to jail multiple times, alcoholics can start and stop drinking multiple times, people can get married and get a divorce many times).
Survival analysis attempts to answer questions such as: what is the fraction of a population which will survive past a certain time? Of those that survive, at what rate will they die or fail? Can multiple causes of death or failure be taken into account? How do particular circumstances or characteristics increase or decrease the odds of survival?
To answer such questions, it is necessary to define "lifetime". In the case of biological survival, death is unambiguous, but for mechanical reliability, failure may not be well-defined, for there may well be mechanical systems in which failure is partial, a matter of degree, or not otherwise localized in time. Even in biological problems, some events (for example, heart attack or other organ failure) may have the same ambiguity. The theory outlined below assumes well-defined events at specific times; other cases may be better treated by models which explicitly account for ambiguous events.
The theory of survival presented here also assumes that death or failure happens just once for each subject. Recurring event or repeated event models relax that assumption. The study of recurring events is relevant in systems reliability, and in many areas of social sciences and medical research.
Kruskal–Wallis one-way analysis of variance
In statistics, the Kruskal–Wallis one-way analysis of variance by ranks is a non-parametric method for testing equality of population medians among groups. It is identical to a one-way analysis of variance with the data replaced by their ranks. It is an extension of the Mann–Whitney U test to 3 or more groups.
Since it is a non-parametric method, the Kruskal–Wallis test does not assume a normal population, unlike the analogous one-way analysis of variance. However, the test does assume an identically-shaped and scaled distribution for each group, except for any difference in medians.Rate this question:
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- 24.
Which enzyme is defective in Refsum’s disease
- A.
Phytanic acid oxidase
- B.
Succinate thiokinase
- C.
Malonate dehydrogenase
- D.
Thiophorase
Correct Answer
A. pHytanic acid oxidaseExplanation
Ref: Harrison’s 17th edition, chapter 379
Refsum Disease
This is an autosomal recessive hypertrophic neuropathy caused by defective oxidation of phytanic acid, a branched-chain fatty acid found in dairy products, beef, lamb, and fish. The onset is in late childhood or adolescence, with a slowly progressive course of a sensorimotor demyelinating neuropathy with sensorineural deafness, cerebellar ataxia, and anosmia. Retinitis pigmentosa presenting as night blindness often precedes the onset of neuropathy. Thickened skin (ichthyosis), syndactyly and shortening of the fourth toe, cardiomyopathy, and cataracts are other features. CSF protein is typically elevated. Abnormally high plasma and urinary levels of phytanic acid are diagnostic. Although a diet low in phytanic acid may prevent the onset of some of the complications, compliance with this diet is usually poor. Plasma exchange and dialysis may be helpful for episodes of worseningRate this question:
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- 25.
The proliferative phase of wound healing occurs how many days after the injury?
- A.
1
- B.
2
- C.
7
- D.
14
Correct Answer
C. 7Explanation
Normal wound healing follows a predictable pattern that can be divided into
a) Hemostosis and inflammation
b) Proliferation
c) Maturation and remodeling
The proliferative phase is the second phase of would healing and roughly spans day 4 through 12. it is during this phase that tissue continuity is re-established.Rate this question:
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- 26.
Centro medial area in retroperitoneum belong to which trauma zone?
- A.
I
- B.
. II
- C.
. III
- D.
None of the above
Correct Answer
A. IExplanation
Centro medial area in retroperitoneum belong to zone I.
Renal area & area lateral to centro medial area is zone II.
Entire pelvis belongs to zone IIIRate this question:
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- 27.
Which type of collagen is most important is most important in wound healing
- A.
Type III
- B.
Type V
- C.
Type VII
- D.
Type XI
Correct Answer
A. Type IIIExplanation
Type I collagen is the major component of extracellular matrix in skin. Type III, which is also normally present in skin, becomes more prominent and important during the repair processRate this question:
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- 28.
Triflusal is a?
- A.
Antiepileptic drug
- B.
Antiplatelet drug
- C.
Anticoagulant drug
- D.
Thrombolytic drug
Correct Answer
B. Antiplatelet drugExplanation
Triflusal inhibit cyclooxygenase-2. It is the use as a prophylactic drug in cases of CAD, CVA.Rate this question:
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- 29.
After completion of the vascular anastomosis, drainage of a transplanted pancreas is accomplished by anastomosis to:
- A.
Right colon
- B.
. Left colon
- C.
Duodenum
- D.
Bladder or small bowel
Correct Answer
D. Bladder or small bowelExplanation
Some centres use enteric drainage. Others always use bladder drainage, and others tailor the approach according to the recipient category. Both enteric drainage and bladder drainage now have a relatively low surgical risk. The main advantage of bladder drainage is the ability to directly measure enzyme activity in the pancreatic graft exocrine secretions by measuring the amount of amylase in the urine. A decrease in urine amylase is a sensitive marker for rejection, even through it is not entirely specific. Urine amylase always decreases before hyperglycemia ensues. Most centres now use enteric drainage for simultaneous pancreas and kidney (SPK) transplant. If the kidney and pancreas are from different donors, or if a pancreas transplant alone (PTH) is performed, then bladder drainage is preferred, so rejection of the pancreas can be detected earlier.Rate this question:
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- 30.
In SCUF (Slow Continuous Ultrafiltration) type of dialyses, Which of the following component of the blood is mainly removed?
- A.
Potassium
- B.
BUN
- C.
Water
- D.
Sodium
Correct Answer
C. WaterExplanation
SCUF is the removal of water from the patient’s blood as it travels through the filter. Water removal is referred to as ultrafiltration. SCUF is a therapy designed to only remove surplus water. The amount of water removed is not sufficient to remove wastes. SCUF does not require the use of replacement fluid, and fluid removal is 300ml to 500ml per hourRate this question:
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- 31.
All of the following are true with regard to Malaria drug policy 2008 except
- A.
ACT is the regimen of choice for chloroquine resistant P. falciparum
- B.
Presumptive treatment is indicated for all fever cases
- C.
Rapid diagnostic kit is used to confirm the diagnosis of malaria
- D.
Quinine is the drug of choice for severe and complicated malaria
Correct Answer
B. Presumptive treatment is indicated for all fever casesExplanation
All clinical suspected cases should preferably be investigated for malaria by Microscopy or Rapid Diagnostic Kit (RDK).
2. The first line of treatment is chloroquine and the ACT (Artesunate + Sulpha Pyrimethamine) combination is recommended for the treatment of Pf cases in qualified areas like chloroquine resistant areas, cluster of Blocks and identified districts on the basis of epidemiological situation.
3. Pf cases should be treated with chloroquine in therapeutic dose of 25 mg/kg body weight divided over three days. This practice is to be followed at all levels including VHWs like FTDs/ASHA as well in chloroquine sensitive areas. In high risk area in addition to chloroquine, single dose of Primaquine 0.75 mg/kg bw should be given on first day.
4. Microscopically positive Pv cases should be treated with chloroquine in full therapeutic dose of 25 mg/kg body weight divided over three days. This practice is to be followed at all levels including VHWs like FTDs/ASHA etc. Primaquine should be given in dose of 0.25mg/kg bw daily for 14 days as per prescribed guidelines only to prevent relapse except in contraindicated patients which include G6PD patients, infants and pregnant women.
5. Artesunate tablets should not be administered as mono therapy. It should invariably be combined with sulpha pyrimethamine tablets in prescribed dosages.
6. Resistance should also be suspected if in spite of full treatment with no history of vomiting, diarrhea, patient does not respond within 72 hours parasitologically. Such individual patients should be reported to concerned District Malaria /State Malaria Officer/ROHFW Pf monitoring teams for monitoring of drug sensitivity status.
7. In cases resistant to chloroquine and SP-ACT, oral quinine with tetracycline or doxycline can be prescribed.
8. In severe and complicated P. falciparum malaria cases intra-venous Quinine/ parenteral Artemisinine derivatives are to be given irrespective of chloroquine resistance status. This treatment may continue till such time oral Quinine/Artemesinine derivatives become available.Rate this question:
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- 32.
When following ovulation by Transvaginal ultrasound, a Graafian follicle is most likely to rupture soon after it reaches
- A.
10 mm
- B.
20 mm
- C.
30 mm
- D.
40 mm
Correct Answer
B. 20 mmExplanation
A mature graffian follicle would be seen at midcycle and attains a size of approximately 20mm, but not infrequently, it achieves a size of 25 mm.Rate this question:
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- 33.
Mammographic characteristics of benign calcifications:
- A.
Coarse
- B.
Amorphous
- C.
Casting
- D.
). Dendritic
Correct Answer
A. CoarseExplanation
Malignant calcifications are cast and branching, dot dash linear calcifications. If dendritic means branching then they are malignant. Coarse calcifications are generally seen with benign processes. However, amorphous can be seen with malignancy. Clearly benign calcifications are popcorn or crescentic, egg shell, cyst fat necrosis, Arterial Calc, two parallel lines, duct ectasia oval/round, large oriented to nipple.Rate this question:
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- 34.
Which of the following is true with regard to Bhore Committee report of 1946
- A.
1 PHC for every 10000 - 20000 population
- B.
1 PHC for every 40000 - 50000 population
- C.
1 PHC for every 30000 – 40000 population
- D.
1 SC for every 50000-60000 population
Correct Answer
A. 1 pHC for every 10000 - 20000 populationExplanation
1 PHC for every 10000 - 20000 population
Primary health centre level
The concept of primary health centre is not new to India. The Bhore committee in 1946 gave the concept of a primary health centre as a basic health unit, to provide, as close to the people as possible, an integrated curative and preventive health care to the rural population with emphasis on preventive and promotive aspects of health care. The Bhore Committee aimed at having a health centre to serve a population of 10,000 to 20,000 with 6 medical officers,6 public health nurses and other supporting staff. But in view of the limited resources, the Bhore committee’s recommendations could not be fully implemented, even after a lapse of 60 years.Rate this question:
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- 35.
In CSF, low level of which of the following substance is seen in those who committed suicide?
- A.
CSF serotonin
- B.
CSF 5 HIAA
- C.
). Brain derived growth factor
- D.
CSF dopamine
Correct Answer
B. CSF 5 HIAAExplanation
Low levels of CSF 5 HIAA levels (metabolite of serotonin) are found in CSF in patients who committed suicide.
Recent research has proven that in E.C.T the action is by the redistribution of amines in the brain.
The markers of effective E.C.T were studied and increased levels of brain derived nerve growth factor is the marker of E.C.T.Rate this question:
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- 36.
For the eye to adapt to intense light, which of the following may occur ?
- A.
Bipolar cells continuously transmit signals at the maximum rate possible
- B.
Photochemical in both rods and cones are reduced to retinal and opsins
- C.
Levels of rhodopsin are very high
- D.
Pupil size increase
Correct Answer
B. pHotochemical in both rods and cones are reduced to retinal and opsinsExplanation
The reduction of rhodopsin and cone pigments by light decreases the concentrations of photosensitive chemicals in rods and cones. Thus, the sensitivity of the eye to light is correspondingly reduced. This is called light adaptation.Rate this question:
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- 37.
Oseltamivir the drug available for the treatment of ' Ava in flu' belongs to which pharmacological class?
- A.
Reverse transcriptase inhibitor
- B.
Hemagglutinase inhibitor
- C.
Neuraminidase inhibitors
- D.
Ribonuclease inhibitor
Correct Answer
C. Neuraminidase inhibitorsExplanation
Oseltamivir and Zanamivir are two drugs of neuraminidase inhibitor group which are known to reduce the severity and duration of illness caused by avian influenza. Oseltamivir is given 75 mg orally bid for 5 days, to be started within 48 hours of symptom onset. Zanamivir is to be given by inhalationRate this question:
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- 38.
Anakinra is a?
- A.
TNF-Alpha neutralizing drug
- B.
Anti CD20 drug
- C.
Immuno suppressive drug
- D.
IL-1 receptor antagonist
Correct Answer
D. IL-1 receptor antagonistExplanation
Anakinra is an interleukin-1 (IL-1) receptor antagonist. Anakinra blocks the biologic activity of naturally occurring IL-1, including inflammation and cartilage degradation associated withrheumatoid arthritis, by competitively inhibiting the binding of IL-1 to the Interleukin-1 type receptor, which is expressed in many tissues and organs. IL-1 is produced in response to inflammatory stimuli and mediates various physiologic responses, including inflammatory and immunologic reactions. IL-1 additionally stimulates bone resorption and induces tissue damage like cartilage degradation as a result of loss of proteoglycans. In patients with rheumatoid arthritis the natural IL-1 receptor antagonist is not found in effective concentrations in synovium and synovial fluid to counteract the elevated IL-1 concentrations in these patients.
Anakinra is not considered a 'Disease-modifying antirheumatic drug' (DMARD) but rather a 'Biological Response Modifier' (BRM) because its able to selectively target the pathologic element of the disease.Rate this question:
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- 39.
Problem village” include all EXCEPT
- A.
Where no water source in a distance of 1.6 km from community
- B.
Water is more than depth of 15 meter
- C.
There is excess of Na+, K+, Fl+ salts in water
- D.
Risk of Guinea worm infection
Correct Answer
D. Risk of Guinea worm infectionExplanation
(Ref. Park PSM 19th ed. 205)
A “problem village” has been defined as one where no source of safe water is available within a distance of 1.6 km Q,
or where water is available at depth of more than 15 meters Q,
or water source has excess salinity, iron, fluorides Q and other toxic elements Q
or where water is exposed to the risk of cholera. QRate this question:
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- 40.
Warm up phenomenon is seen in?
- A.
). Myasthenia gravis
- B.
Myotonia
- C.
Polymyositis
- D.
Lambert eaten syndrome
Correct Answer
B. MyotoniaExplanation
up phenomenon
Definitions: Progressive diminution of the myotonic response of a muscle during repeated contraction.
Myotonia is a clinical phenomenon consisting of uncontrolled temporary muscle stiffness after voluntary or evoked muscle contractions. It is a cardinal symptom in non-dystrophic myotonias, including chloride and sodium channelopathies. Myotonia typically occurs after a period of rest and decreases with continuing exercise, commonly referred to as the warm-up phenomenon. This is in contrast with what occurs in paradoxical myotonia, where muscle stiffness increases as a result of continuing exercise.
The warm-up phenomenon is an established clinical feature in chloride channelopathies, both in recessive myotonia congenita (Becker’s disease) as well as in dominant myotonia congenita (Thomsen’s disease). It has also been shown to occur in limb muscles of patients with a sodium channelopathy. By contrast, paradoxical myotonia has been established by others as the characteristic feature of sodium channel myotonias.
Thus, unlike the phenotypic homogeneity of chloride channelopathies, sodium channel mutations are associated with a broad spectrum of clinical phenotypes. Here we report three patients with a predominant and generalised warm-up phenomenon associated with the V445M missense mutation of the SCN4A gene encoding the alpha-subunit of the voltage gated sodium channel.Rate this question:
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- 41.
At what pressure is operative decompression of a compartment mandatory?
- A.
15 mmHg
- B.
25 mmHg
- C.
35 mmHg
- D.
45 mmHg
Correct Answer
D. 45 mmHgExplanation
In comatose or obtunded patients, the diagnosis is more difficult to secure. A compatible history, firmness of the compartment to palpation, and diminished mobility of the joint are suggestive. The presence or absence of a pulse distal to the effected compartment is notoriously unreliable in the diagnosis of a compartment syndrome. A frozen joint and myoglobinuria are late signs and suggest a poor prognosis. As in the abdomen, compartment pressure can be measured. Pressure greater than 45 mmHg usually require operative intervention. Patient with pressure between 30 and 45 mmHg should be carefully evaluated & closely watched.Rate this question:
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- 42.
162. Which of the following is a common sequelae of electric injury?
- A.
Deafness
- B.
Paralysis
- C.
. Brain damage
- D.
Cataract
Correct Answer
D. CataractExplanation
Cardiac damage, such as myocardial confusion or infarction, may be present. More likely, the conduction system may be deranged. Household current at 110 V either does no damage or induces ventricular fibrillation. If there are no electrocardiographic rhythm abnormalities present upon initial emergency department evaluation, the likelihood that they will appear later is minuscule. Even with high voltage injuries, a normal cardiac rhythm on admission generally means that subsequent dysrhythmia is unlikely. Mandatory ECG monitoring & cardiac enzyme analysis in ICU setting for 24 hr. following injury is unnecessary in patient with electrical burns, even those resulting from high-voltage current, in patient who have stable cardiac rhythm on admission. Cataracts are a well-recognized sequela of high – voltage electric burn. They occur in 5-7% of patients, frequently are bilateral, occur even in the absence of contact points on head & typically manifest within 1-2 years of injury. Electrical injured patients should undergo a thorough ophthalmologic examination early during their acute care.Rate this question:
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- 43.
Successful antibiotic penetration of a burn eschar can be achieved with
- A.
Mafenide acetate
- B.
Neomycin
- C.
Silver nitrate
- D.
Silver sulfadiazine
Correct Answer
A. Mafenide acetateExplanation
Mafenide acetate is the antibiotic agent that penetrates burn eschar to reach the interface with the patient’s viable tissue. This agent has the disadvantage that it is quite painful on any partial thickness areas & it is a carbonic anhydrase that interferes with renal buffering mechanism. Chloride is retained, and metabolic acidosis results. For these reasons, the silver sulfadiazine is more commonly used in burn centres.Rate this question:
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- 44.
Ohngren's line is from?
- A.
Medial canthus to angle of mandible.
- B.
Medial canthus to alveolar process.
- C.
Lateral canthus to angle of mandible
- D.
Lateral canthus to alveolar process.
Correct Answer
A. Medial canthus to angle of mandible.Explanation
• An imaginary plane is drawn extending between medial canthus of eye and the angle of mandible.
• Growths situated above this plane (supra structural) have a poorer prognosis than those below it (infra structural).Rate this question:
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- 45.
International prognostic index” for lymphoma includes the following prognostic factors except:
- A.
(A). Age of patient and performance status
- B.
(B). Number of extranodal sites involved
- C.
(C). Albumin and Hemoglobin levels
- D.
(D). Serum LDH levels
Correct Answer
C. (C). Albumin and Hemoglobin levelsExplanation
International Prognostic Index for NHL
Five clinical risk factors:
Age ≥60 years
Serum lactate dehydrogenase levels elevated
Performance status ≥2 (ECOG) or ≤70 (Karnofsky)
Ann Arbor stage III or IV
>1 site of extranodal involvement
Patients are assigned a number for each risk factor they have
Patients are grouped differently based upon the type of lymphoma
For diffuse large B cell lymphoma:
0, 1 factor = low risk: 35% of cases; 5-year survival, 73%
2 factors = low-intermediate risk: 27% of cases; 5-year survival, 51%
3 factors = high-intermediate risk: 22% of cases; 5-year survival, 43%
4, 5 factors = high risk: 16% of cases; 5-year survival, 26%
For diffuse large B cell lymphoma treated with R-CHOP:
0 factor = very good: 10% of cases; 5-year survival, 94%
1, 2 factors = good: 45% of cases; 5-year survival, 79%
3, 4, 5 factors = poor: 45% of cases; 5-year survival, 55%Rate this question:
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- 46.
PAIR stands for:
- A.
Percutaneous angiography and imaging radiology
- B.
) Per abdominal intense radiotherapy
- C.
Percutaneous aspiration, infusion and respiration
- D.
Percutaneous air infused radiography
Correct Answer
C. Percutaneous aspiration, infusion and respirationExplanation
PAIR - Percutaneous aspiration of hydatid cyst, infusion of scolicidal drugs and then respiration is used as a minimally invasive procedure for treatment of hydatid cystRate this question:
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- 47.
Which is not a deep heat therapy?
- A.
Short wave diathermy
- B.
). Infrared therapy
- C.
Ultrasound therapy
- D.
Microwave therapy
Correct Answer
B. ). Infrared therapyExplanation
There are two types of heat treatments:
Superficial (Surface) and deep.
Superficial heat therapy applies heat to the outside of the body. Deep heat therapy direct heat toward specific inner tissues through ultrasound or by electric current. Heat therapies are beneficial prior to exercise, providing a warm-up effect to the soft tissues involved.
Surface heat
1. Hot water bottle
2. Warm bath
3. Hot socks or compressor
4. Infrared lamp
5. Wax bath.
Deep Heat
1. Shortwave diathermy (heat produced by high frequency alternative current).
2. Ultra sonic therapy
3. Microwave
• Heat produces a soothing effect on many aches and pains, by increasing the blood flow.
• Heat must not be applied to insensitive or ischaemic skin and if there is underlying acute infection or neoplastic tissue.
• Superficial heat - only the skin and subcutaneous tissue are heated
• Deep heat - deeper Structures are heated
• The ultrasonic waves and microwaves penetrate to a considerable depth.
• When the, wave strike the tissue the energy is converted into heat. It is most useful for localised tender fibrous nodules.Rate this question:
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- 48.
What is the mechanism of action of Alemtuzumab?
- A.
Anti CD33
- B.
Anti CD52
- C.
Anti CD28
- D.
Anti CD20
Correct Answer
B. Anti CD52Explanation
Monoclonal Antibodies
Drugs Molecular Target Disease Mechanism of Action
Trastuzumab HER2/neu (ERBB2) Breast cancer Binds HER2 on tumor cell surface and induces receptor internalization.
Cetuximab EGFR Colon cancer, squamous cell carcinoma of the head and neck Binds extracellular domain of EGFR and blocks binding of EGF and TGF alpha induces receptor internalization. Potentiates the efficacy chemotherapy and radiotherapy.
Panitumomab EGFR Colon cancer Like cetuximab; likely to be very similar in clinical activity
Rituximab CD20 B cell lymphomas and leukemias that express CD20 Multiple potential mechanisms including direct induction of tumor cell apoptosis and immune mechanisms.
Alemtuzumab CD52 Chronic lymphocytic leukemia and CD52-expressing lymphoid tumors Immune mechanisms
Bevacizumab VEGF Colon, lung, breast cancers; data pending in other tumors Inhibits angiogenesis by high-affinity binding to VEGF.Rate this question:
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- 49.
Two months after knowing that his son was suffering from leukemia, a 45-year-old father presents with sleep deprivation, lethargy, headache, and low mood. He interacts reasonably well with others, but has absented himself from work. The most probable diagnosis is:
- A.
Depression
- B.
Psychogenic headache
- C.
Adjustment disorder
- D.
Somatization disorder
Correct Answer
C. Adjustment disorderExplanation
• He is suffering form Adjustment of disorder (Depressive type)in this the symptoms of depression are there, however, the person does not meet full criteria of depression, i.e., Sadness of mood, Lack of interest and Suicide ideas, Death wishes, Hopelessness, hence the answer is Adjustment disorder.
The diagnostic criteria in the DSM-IV are:
1.The development of emotional or behavioral symptoms in response to an identifiable stressor(s)occurring within 3 months of the onset of the stressor(s).
2.These symptoms or behaviors are clinically significant as evidenced by either of the following:
a. Marked distress that is in excess of what would be expected from exposure to the stressor
b. Significant impairment in social or occupational (academic) functioning
The stress-related disturbance does not meet the criteria for another specific Axis I disorder and is not merely an exacerbation of a preexisting Axis I or Axis II disorder.
4.The symptoms do not represent Bereavement.
5.Once the stressor (or its consequences)has terminated, the symptoms do not persist for more than an additional 6 months.
• The primary treatment for adjustment disorder is talking. This reduces the pressure of the stressor and enhances coping.
• It allows the patient to put his or her rage into words rather than into destructive actions.
• Counseling, psychotherapy, crisis intervention, family therapy, and group treatment are often used to encourage the verbalization of fears, anxiety, rage, helplessness, and hopelessness.
• Sometimes small doses of antidepressants and anxiolytics are also used.
• In patients with severe life stresses and a significant anxious component, Benzodiazepines are used although, Tricyclic antidepressants or buspirone has been recommended for patients with current or past heavy alcohol use because of the greater risk of dependence.
• Tianeptine, alprazolam, and mianserin were found to be equally effective in patients with AD with anxiety.Rate this question:
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- 50.
. Difference between typical cervical & thoracic vertebra
- A.
Has a triangular body
- B.
Has a foramen transversarium
- C.
Superior articular facet directed backwards & upwards
- D.
Has a large vertebral body
Correct Answer
B. Has a foramen transversariumExplanation
• Typical cervical vertebrae - 3rd, 4th, 5th, 6th
• Atypical cervical vertebrae - 1st, 2nd, 7th
• Small triangular body
• Vertebral foramen -larger than body
• Transverse processes pierced by foramen transversarium
• The second part of the vertebral artery traverses the foramen transversarium of the 2nd to the 6th cervical vertebrae.
• Superior articular facet directed backwards & upwards. {These features are found in thoracic vertebrae also.}
• Inferior articular facet directed forwards & downwards
• Together they form the lateral pillars
• Anterior tubercle of 6th cervical vertebra - carotid tubercle
• Short & bifid spinous processRate this question:
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