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Mohit Gupta - Diplomate National Board Mohit Gupta - Diplomate National Board Document Transcript

  • Diplomate National Board
  • Diplomate National Board Question Paper Dec-2007 and June-2008 SECOND EDITION Mohit Gupta MBBS, MS (Ophthalmology) GMC, Bhopal India Co-author Anju Singh New Delhi India ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • Ahmedabad • Bengaluru • Chennai • Hyderabad Kochi • Kolkata • Lucknow • Mumbai • Nagpur • St Louis (USA)
  • Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd Corporate Office 4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India, Phone: +91-11-43574357 Registered Office B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi - 110 002, India Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021 +91-11-23245672, Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683 e-mail: jaypee@jaypeebrothers.com, Visit our website: www.jaypeebrothers.com Branches  2/B, Akruti Society, Jodhpur Gam Road Satellite Ahmedabad 380 015, Phones: +91-79-26926233, Rel: +91-79-32988717 Fax: +91-79-26927094, e-mail: ahmedabad@jaypeebrothers.com  202 Batavia Chambers, 8 Kumara Krupa Road, Kumara Park East Bengaluru 560 001, Phones: +91-80-22285971, +91-80-22382956, 91-80-22372664 Rel: +91-80-32714073, Fax: +91-80-22281761 e-mail: bangalore@jaypeebrothers.com  282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza, Pantheon Road Chennai 600 008, Phones: +91-44-28193265, +91-44-28194897, Rel: +91-44-32972089 Fax: +91-44-28193231 e-mail: chennai@jaypeebrothers.com  4-2-1067/1-3, 1st Floor, Balaji Building, Ramkote Cross Road, Hyderabad 500 095, Phones: +91-40-66610020, +91-40-24758498 Rel:+91-40-32940929, Fax:+91-40-24758499 e-mail: hyderabad@jaypeebrothers.com  No. 41/3098, B & B1, Kuruvi Building, St. Vincent Road Kochi 682 018, Kerala, Phones: +91-484-4036109, +91-484-2395739 +91-484-2395740 e-mail: kochi@jaypeebrothers.com  1-A Indian Mirror Street, Wellington Square Kolkata 700 013, Phones: +91-33-22651926, +91-33-22276404 +91-33-22276415, Rel: +91-33-32901926, Fax: +91-33-22656075 e-mail: kolkata@jaypeebrothers.com  Lekhraj Market III, B-2, Sector-4, Faizabad Road, Indira Nagar Lucknow 226 016 Phones: +91-522-3040553, +91-522-3040554 e-mail: lucknow@jaypeebrothers.com  106 Amit Industrial Estate, 61 Dr SS Rao Road, Near MGM Hospital, Parel Mumbai 400 012, Phones: +91-22-24124863, +91-22-24104532, Rel: +91-22-32926896, Fax: +91-22-24160828 e-mail: mumbai@jaypeebrothers.com  “KAMALPUSHPA” 38, Reshimbag, Opp. Mohota Science College, Umred Road Nagpur 440 009 (MS), Phone: Rel: +91-712-3245220, Fax: +91-712-2704275 e-mail: nagpur@jaypeebrothers.com USA Office 1745, Pheasant Run Drive, Maryland Heights (Missouri), MO 63043, USA Ph: 001-636-6279734. e-mail: jaypee@jaypeebrothers.com, anjulav@jaypeebrothers.com Diplomate National Board © 2009 Jaypee Brothers Medical Publishers All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the authors and the publisher. This book has been published in good faith that the material provided by authors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and authors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. First Edition: 2008 Second Edition: 2009 ISBN 978-81-8448-525-7 Typeset at JPBMP typesetting unit Printed at Ajanta
  • To My Parents Mr VK Gupta and Smt. Rama Gupta
  • Preface Friends, This book is a small step towards helping the students prepare well for the DNB examination. These two papers are totally memory based papers. I was not able to collect all the questions but my friends have helped me a lot. I have been trying to make this book more standardized in the coming editions. I would also request all the students to mail me the questions and help me to bring more information. Mohit Gupta mohit_medico@yahoo.co.in
  • Acknowledgements I am grateful to: • • • My parents, who have supported me in all the hurdles of my life. My dearest friend Anju Singh, who always brings smile to my lips and helps me even before I need a help. All my friends who encouraged me whenever I felt down.
  • Contents PART I: DEC-2007 Preventive and Social Medicine ............................. 1 Surgery ....................................................................... 12 Pharmacology ............................................................ 25 Microbiology ............................................................. 42 Ophthalmology ......................................................... 55 Psychiatry .................................................................. 61 Anesthesia ................................................................. 63 Radiology ................................................................... 64 Skin ............................................................................. 66 Obstetrics and Gynecology .................................... 70 Medicine .................................................................... 79 Anatomy ..................................................................... 89 Pathology ................................................................. 100 Biochemistry ........................................................... 104 Physiology ................................................................ 106 Pediatrics ................................................................. 110 Orthopedics ............................................................. 113 ENT ........................................................................... 115 Miscellaneous ......................................................... 117
  • xii DNB DEC-2007 AND JUNE-2008 PART II: JUNE-2008 Anatomy ................................................................... 135 Microbiology ........................................................... 148 Preventive and Social Medicine ......................... 168 Dermatology ............................................................ 178 Radiology ................................................................. 182 Anesthesia ............................................................... 187 Orthopedics ............................................................. 193 Psychiatry ................................................................ 197 Surgery ..................................................................... 200 Forensic Medicine ................................................. 211 ENT ........................................................................... 214 Physiology ................................................................ 219 Biochemistry ........................................................... 224 Pathology ................................................................. 230 Pediatrics ................................................................. 238 Ophthalmology ....................................................... 246 Medicine .................................................................. 266 For all your living days And treat them all When you are the anvil When you are the hammer – – – – All the Best PREPARE ALIKE BEAR STRIKE
  • Making the Exam Easy Friends, It is a common problem faced by all those who appear for DNB examination, as to how to prepare and which book to follow. No reliable guide is available in the market till date and thus candidates get no idea about the examination pattern. This book is just to give you the previous examination papers which would enable you to know the important topics and subjects. The basic idea of examination seems to ask questions based on basic facts and concepts of important topics. About 80% of questions are directly picked up from the book we read for our MBBS examinations. It will be advisable to read some good guides and collect facts rather than wasting time in reading standard textbooks. The most important thing is to know the basic facts about many important topics rather than knowing in great detail about a few topics. Those who have less time should revise the clinical subject fast and spend more time on non- clinical area. Preparation for All India Examination is different and many people who have good ranks in All India were not able to clear DNB Dec-2007 and vice versa.
  • xiv DNB DEC-2007 AND JUNE-2008 Two months’ examination preparation is more than sufficient, so those who had been unlucky in PG Entrance for many years, should work hard and begin their new life with this golden chance. Please prepare these questions well as they might be repeated in coming examination if we are lucky.
  • References Anatomy Physiology : : BD Chaurasia William F Ganong Biochem Pathology : : Harper Robbin and Cotran Pharmacology Microbiology : : KD Tripathi Ananthanarayan Forensic PSM : : G Rao K Park Ophthalmology : Samar K Basak Parson ENT Orthopaedics PL Dhingra J Maheshwari : : Psychiatry : Anaesthesiology : Ahuja Ajay Yadav Radiology Dermatology : : B Ramgopal B Ramgopal Surgery : Bailey and Love S Das Gynaecology Obstetrics : : Shaw DC Dutta Medicine : Davidson Harrison Pediatrics : OP Ghai
  • Preventive I: DEC-2007 Medicine 1 Preventive and Social PART and Social Medicine 1 Preventive and Social Medicine 1. True about standardized normal curve is A/E: A. Standard deviation -1 B. Area under curve -1 C. Mean is not zero D. Infinite value (PSM BY K Park) Ch - 18 • X = Any value • X = Mean • σ = Standard deviation 2. Corrected effective temperature of 27-29°C is evaluated as: A. Pleasant and cool B. Comfortable and cool C. Comfortable D. Hot and uncomfortable (PSM BY K Park) Ch - 12 PSM The standard normal curve is a smooth bell shaped perfectly symmetrical curve, based on an infinitely large number of observations. • Total area under cruve is 1 • Mean is 0 • Standard deviation is 1 • Mean median and mode all coincide • Relative deviate or standard normal variate X–X • Z =
  • 2 DNB DEC-2007 PSM Comfort zones evaluated in India are as follows. Corrected effective temperature deg.C 1. Pleasant and cool 20°C 2. Comfortable and cool 20-25°C 3. Comfortable 25-27°C 4. Hot and uncomfortable 27-28°C 5. Extremely hot 28+ 6. Intolerably hot 30+ Predicted four-hour sweat rate (P4 SR) 1. Comfort zone 1-3 litres 2. Just tolerable 3-4.5 litres 3. Intolerable 4.5+ litres 3. Multipurpose worker scheme in India was introduced following the recommendation of: A. Shrivastava committee B. Bhore committee C. Kartar Singh Committee D. Mudaliar committee (AIPGMEE -2004) K Park Ch - 20 – – Kartar Singh Committee (1975) Committee on multipurpose worker under health and family planning. Shrivastava Committee (1975) • Group of medical education and support manpower • Recommended rural health scheme • Concept of village health guided was given • Recommended creation of bands of professional and semiprofessional health
  • Preventive and Social Medicine 3 3 Preventive and Social Medicine – – – workers from within the community including village health guides, multipurpose health worker and health assistant. Jungalwalla Committee (1967) Committee on integration of health services recommended elimination of private practice by government doctors Mudaliar Committee (1962) Health survey and planning committee: • PHC not to serve >40,000 • Improve quality of health care by PHC • Integration of medical and health service • Create on All India Health Service like All India Administration services Bhore Committee (1946) PSM Recommendations 1. Integration of preventive and curative services at all administration levels. 2. Short term and long term recommendations Short term: PHC to cater to a population of 40,000 Long term: PHC units to be set up with 75 bedded hospital for each 10,000 to 20,000 population 3. Major changes in medical education including 3 months training in social and preventive medicine to prepare social physicians. – Chaddah Committee (1963): Vigilance operation in respect of NMEP should be responsibility of general health service, i.e. PHC at block level – Mukherji Committee 1965: Separate staff for family planning programme, delink malaria activity from family planning – Mukherji Committee (1966) Basic health services – Bajaj Committee Health manpower planning, production and management.
  • 4 DNB DEC-2007 PSM 4. Residual chlorine in chlorination of water should be: A. 1 mg/lit after 1 hr B. 1 mg/lit after ½ hr C. 0.5 mg 1 lit after 1 hr D. 0.5 mg/lit after ½ hr K Park Ch - 12 Few points about chlorinations – It is supplement not substitute to sand filtration – No effect on spored virus like polio, viral hepatitis, (except in high doses) – Oxidizes iron, manganese and hydrogen sulphide – Destroys same taste and odour producing constituents – Controls algae and slime organisms and aids coagulation – Disinfecting action is mainly due to hypochlorous acid and hypochloride ions – Turbidity impedes efficient chlorination – Minimum recommended concentration of free chlorine is 0.5. mg/L for one hour – The sum of the chlorine demand of specific water plus the free residual chlorine of 0.5 mg/L constitutes the correct dose of chlorine to be applied. 5. Ministry of Health and Family Welfare runs which of the following programme: A. ICDS B. Vit. A prophylaxis programme C. Mid day meal programme D. Special nutrition programme K Park Ch - 10 • Prophylaxis against nutritional anaemia – Ministry of Health and Family Welfare • Vit. A prophylaxis programme – Ministry of Health and Family Welfare • Iodine deficiency disorders control programme – Ministry of Health and Family Welfare
  • Preventive and Social Medicine 5 5 Preventive and Social Medicine • ICDS – Ministry of social welfare • Special nutrition programme – Ministry of social welfare • Balwadi nutrition programme – Department of social welfare • Mid-day meal programme – Ministry of education. 6. No of children accommodated in a class should be: A. 40 B. 30 C. 35 D. 45 K Park Ch - 9 – – – – – – – – – – PSM – The school should normally be centrally situated with proper approach roads and at a fair distance from busy and noisy places Should be properly fenched and kept free from all hazards 10 acres of land for higher elementary schools 5 acres for primary schools with an additional one acre of land per 100 student Exterior wall should have a minimum thickness of 10 inches and should be heat resistant Verandhas should be attached to class rooms No class room should accommodate more than 40 students Per capita space for students in a class room should not be less than 10 Sq ft Desk should be of minus type Combined door and window area should be at least 25 percent of floor spac. Ventilators should not be less than 2% of floor area Inside colour of class room should be white and should be periodically white wasted.
  • 6 DNB DEC-2007 7. Maximum working hours per week according to factories Act 1948 should be: A. 40 B. 42 C. 48 D. 52 K Park Ch - 15 PSM The factories Act 1948 – has prescrived a maximum of 48 hr working per week not exceeding 9 hours per day with rest for at least ½ hour after 5 hours of work. For adolescents the hours of work have been reduced from 5 to 4 ½ per day. The total number of hours of work in a week including overtime shall not exceed 60. 8. A problem village has been defined as one where: A. No source of water is available within a distance of 1.6 km. B. No source of water is available within a distance of 15 metres. C. No source of water at a depth of 1.6 km. D. No guinea worm infestation is seen in available water. K Park Ch - 7 • A problem village is defined as one where no source of safe water is available within a distance of 1.6 km. • Or where water is available at a depth of more than 15 metres. • Or where water sources has excess salinity, iron, fluorides and other toxic elements or where water is exposed to the risk of cholera.
  • Preventive and Social Medicine 7 7 Preventive and Social Medicine 9. Chikungunya fever is spread by: A. Aedes only B. Aedes and mansonoides C. Aedes and culex D. Aedes culex and mansonoides. K Park Ch - 12 Type of mosquito 1. Anopheles 2. Culex 3. Aedes – – – – – Malaria, filaria (not in India) Bancroftian filariasis, Japanese encephalitis West Nile Fever, viral arthritis Yellow fever (not in India) Dengue Dengue haemorrhagic fever Chikungunya fever Chikungunya haemorrhagic fever Rift valley fever Filaria (not in India) Malayan (Brugian) filariasis, chikungunya fever 10. Denominator in perinatal mortality rate: A. Total live births B. Total births C. Total live + still births D. 1000 live births Perinatal mortality rate = Late foetal and early neonatal Deaths > 1000 gm. Still birth rate = Neonatal = Post neonatal = No. of deaths of children Infant mortality rate = K Park Ch – 3 PSM 4. Mansonoides Disease
  • 8 DNB DEC-2007 11. Positive predictive value and prevalence have: A. Positive correlation B. Negative correlation C. No relation D. Can be anything K Park Ch - 4 PSM Predictive value—diagnostic power of test Dependent upon – Sensitivity – Specificity – Prevalence The more prevalent a disease is in a given population the more accurate will be the predictive value of a positive screening test. 12. Normal adult milk requirement per day: A. 200 B. 250 C. 300 D. 400 K Park Ch - 10 Milk requirement Man Woman Adult 150 200 250 100 150 200 Sedentary Moderate work Heavy work Children 1-3 years 4-6 years 300 250 Boys 10-12 yrs 250 Girls 10-12 yrs. 250
  • Preventive and Social Medicine 9 9 Preventive and Social Medicine 13. In category II pulmonary tuberculosis sputum examination is done after: A. 1 month B. 2 months C. 3 months D. 4 months K Park Ch - 5 Pretreatment sputum Category I Category II Category III + + - Test at months 2 2 3 2 PSM 14. Dry waste in hospitals in disposed into: A. Black bag B. Yellow bag C. Blue bag D. Red bag K Park Ch - 13 Black (Plastic bag) discarded medicines Cytotoxic wastes, incineration ash General ward waste like food, papers plastic bags, etc. Yellow (Plastic bag) human anatomical; waste, animal waste, microbiology and biotechnology waste. Red Disinfected container/plastic bag Solid waste contaminated with blood and fluids Including cotton, dressings, solid plaster casts linen, beddings Blue Puncture proof container Sharp waste Tubings, catheters, intravenous sets, etc.
  • 10 DNB DEC-2007 15. Per day mean output of breast milk (ml) is maximum at: A. 4-5 months B. 5-6 months C. 6-7 months D. 7-8 months K Park Ch - 10 • 5-6 months – 730 ml (max) • 37-38 months – 345 ml (min) PSM 16. Recommended protein intake (g/day) in adult man: A. 50 B. 60 C. 70 D. 80 K Park Ch - 10 Reference adult Protein g/d Energy kcal/d Man Woman Pregnant woman Locality (0-6 m) woman 60 50 65 75 2900 2200 2500 2750 Children 1-3 yrs 4-6 yrs 7-9 yrs 13-15 yrs Boys Girls 16-18 yrs Boys Girls 21 29 40 67 62 75 60 1240 1690 1950 2450 2060 2640 2060 17. BOAA causes: A. Neurolathyrism B. Epidemic dropsy C. Endemic dropsy D. Endemic fluorosis K Park Ch - 10
  • Preventive and Social Medicine 11 Preventive and Social Medicine 11 Neurolathyrism : Lathyrus sativus Kesari dal Beta oxalyl amino alanine. Epidemic Dropsy : Argemone mexicana Sanguinarine Mustard oil ↓ed oxidation of pyruvic acid Endemic Dropsy: Junjunia Crotolaria Pyrolizidine Alkaloid (Hepatotoxicity) 18. Protein content of Buffalo milk: A. 4.3 B. 3.2 C. 3.3 D. 1.1 K Park Ch - 10 Buffallo Cow Human Fat (g) 6.5 4.1 3.4 Protein (g) 4.3 3.2 1.1 Vit C (mg) 1 2 3 Water (g) 81.0 87 88 Energy (kcal) 117 67 65 PSM Nutritive value of milk (per 100 gms)
  • 12 DNB DEC-2007 Surgery Surgery 19. De Quervain’s thyroiditis is pathologically characterised by: A. Granulomatous inflammation B. Hurthel cells C. Lyphocytic infiltration D. Malignan+ changes Bailey and Loves Ch - 44 De Quervain’s or subacute thyroiditis – Viral in origin (not autoimmune) – Usually follows upper respiratory trait infection – Progresses through 3 stages i. Hyperthyroid ii. Hypothyroid iii. Resolving stage to enthyroid state • More in women (3 times) • Painful enlarged thyroid with fever • ESR is marked by raised • FNAC – giant multinucleated cells • Self limiting • Treatment with NSAID • Steroids 20. Cystosarcoma phylloides of breast is characterised by: A. Malignant epithelial cells B. Branching leaf like pattern C. Sarcomatous changes D. Spread to adjacent structures Bailey and loves Ch - 46
  • Surgery Preventive and Social Medicine 13 13 Cystosarcoma phylloides: • It is a misnomer as it is not a sarcoma • It is a giant intracanalicular fibroadenoma Which grows rapidly and behaves clinically as sarcoma • Rapid growth • Stretched shiny skin • Red dilated veins over skin • Bosselated surface • Few cystic area • No fixity to skin or pectoralis • Lymph nodes not involved • No nipple retraction Histologically: Cells have a branching pattern, penetrating the cystic cavity (phyllus means leaf like pattern) 21. True about Varicocele is: A. More on right side B. Always present with inguinal hernia C. Always needs surgery D. May have oligospermia Bailey and Loves Ch - 68 Varicocele means varicosity of veins of the spermatic cord. • Majority of cases are idiopathic – Tall thin : Visceroptic men are prone – More common on left side – Vague and dragging discomfort is most common symptom. – May present with subfertility – Disappears when patient lies down – Feels like bag of worms – Impulse on coughing is better palpated than inspected – Treatment Surgery Treatment: Small – Excision of lump Giant– Simple mastectomy
  • 14 DNB DEC-2007 Asymptomatic – Scrotal support and reassurance Symptomatic – Excision of mass of varicocele with proper haemostasis Surgery 22. Spermatocele is most commonly present at: A. Tail of epididymis B. Head of the epididymis C. Behind and above the body of testis D. Anywhere Bailey and Loves Ch - 68 Spermatocele: • It is an acquired condition • Unilocular retention cyst in epididymis • Contains fluid like barley water containing spermatozoa • Patient presents with scrotal swelling • Looks like three testis • Swelling is present at head of epididymis above and behind the body of testis • Cyst is soft • Fluctuation test is positive • Transillumination test is negative Small – Big – – No treatment Aspiration Excision of cyst. 23. Most common site of ectopic testis: A. Perineal end and femoral end B. Superficial inguinal pouch C. Deep inguinal ring D. Pubopenile ectopia Bailey and Loves Ch - 68 Ectopic testis According to lockwood 1. Scrotal tail- main one and strongest 2. Pubic tail 3. Perineal tail 4. Inguinal tail 5. Femoral tail.
  • Surgery Preventive and Social Medicine 15 15 Positions 1. Superficial inguinal pouch : commonest type 2. Pubopenile ectopia 3. Perineal ectopia 4. Crural or femoral ectopia. 24. True about pyloric stenosis in child A/E: A. Ramstedt pyloromyotomy is treatment of choice B. Presents at 4 weeks C. Peristalsis is never seen D. USG is investigation of choice Bailey and Loves Ch - 51 25. Mesenteric cysts A/E: A. Chylolymphatic B. Urogenital remnant C. Dermoid cyst D. Calcified lesion Bailey and Loves Ch - 56 Mesenteric cysts are classified as: – Chylolymphatic cyst: Commonest variety – Enterogenous cyst – Urogenital remnant – Dermoid cyst (teratomatous cysts) – Painless abdominal swelling near umbilical Surgery Hypertrophic pyloric stenosis – Male > Female (4:1) 3 in 1000 live births – Seen in first born male child – Administration of erythromycin in early infancy might cause it – Most commonly seen at 4 weeks – Non bilious vomiting – Metabolic alkalosis with severe depletion of potassium and chloride ions – USG can diagnose 95% cases – Never a surgical emergency – Fredet Ramstedt pyloromyotomy is surgery of choice.
  • 16 – – – – – DNB DEC-2007 Fluctant swelling Moves freely in a plane at right angles to attachment of the mesentery Zone of resonance around and classically a belt of resonance across the cyst Recurrent attacks of abdominal pair with or without vomiting Acute abdominal catastrophe. Surgery 26. Percentage of cryptorchidism in children: A. 0.5% B. 0.6% C. 0.7% D. 0.8% Bailey and Loves Ch - 68 • About 30% of premature male babies have undescended testis. • For full term infants the incidence in 4% spontaneous descent occurs in most of these by 1 year of age, when the incidence of undescended testis is 0.8% • Right side – 50% • Left side– 30% • Bilateral – 20% 27. Level VI lymph nodes comprise of: A. Submental group B. Supra clavicular C. Anterior compartment D. Jugular group Level i. ii. iii. iv. v. vi. Submental and submandibular group Upper jugular group Middle jugular group Lower jugular group Posterior triangle group Anterior compartment group
  • Surgery Preventive and Social Medicine 17 17 29. Funicular hernia is present upto: A. Bottom of scrotum B. Root of scrotum C. Inguinal canal D. Whole length Bailey and Loves Ch - 62 Types of indirect hernia 1. Complete hernia – upto bottom of scrotum 2. Funicular hernia – upto root of scrotum 3. Bubonocele – upto inguinal canal only. 30. Complication of hydrocele: A. Carcinoma B. Hernia of sac C. Compression of vessels Complications of hydrocele: i. Infection ii. Atrophy of the testis Surgery 28. True about amebic liver abscess A/E: A. Mc site Rt lobe B. Mc spread to lung C. Mc by E. histolytica D. Mc by E. vogeli Bailey and Loves Ch - 52 Amoebic liver abscess: • Caused by Entamoeba histolytica • Acquired by feco-oral route • Through poral venous system • Common in Rt lobe of liver • 20-40 yrs of age • Fever, chills, anorexia, Rt. upper quadrant pain • Jaundice is rare • CT > USG • Confirmed by serological tests • Treatment by metronidazole • Complications- rupture into the peritoneum, pleural cavity or pericardium • E. vogeli causes hydatid cyst
  • 18 DNB DEC-2007 iii. iv. v. vi. Rupture Haematocele Hernia of hydrocele sac Calcification of sac 31. Precipitating factors for volvulus A/E: A. Long mesentery B. Broad attachment at the base C. Loaded colon D. Due to tumor of colon Bailey and Loves Ch - 58 Surgery Precipitating factors: 1. Long mesentery of pelvic colon 2. Narrow attachment at the base 3. Long redundant, pendulous sigmoid 4. Loaded (faecus) colon due to high residual diet 5. Diverticulitis with a band or adhesions. 32. True about instussusception A/E: A. Mc in child B. Mc type in adult in colocolic C. In adults due to polyps D. Always have periumbilical mass Bailey and Loves Ch - 58 Instussusception • Iliocolic is most common type • Caused by dietary factors, infection secondary to –diverticula, polyps, carcinoma • First born male child 6-9 months- Mc • Red current jelly stools. • Contracting, hardening mass in and around the umbilical region can be felt (sausage shaped). • Emptiness in Rt iliac fossa ‘signe De dance’ • Visible step ladder peristalsis • Digital per rectal examination-blood stained mucus. • Barium enema – claw (pincer) • Also called as meniscus sign
  • Surgery Preventive and Social Medicine 19 19 33. Treatment of choice for posterior urethral injury: A. Suprapubic cystotomy B. Urethroplasty C. Conservative D. Nephrectomy Bailey and Loves Ch - 67 • • • • • Management of urethral injury Resuscitation Urological management Suprapubic cystomy Descending urethrogram 1. If patent urethra 2. If complete obstruction 34. Treatment of choice for renal stone 5 mm in middle calyx: A. ESWL B. Conservative C. Nephrectomy D. Ureteroscopic stone extraction Bailey and Loves Ch - 64 Treatment of renal stone • < 5 mm- conservative, forced diuresis • ESWL- least invasive and most widely used 35. Treatment of choice for carcinoma penis with a small growth: A. Conservative B. Radiotherapy C. Partial amputation D. Total amputation Bailey and Loves Ch - 67 Surgery 3. If patent with extravasation Remove suprapubic catheter End to end urethroplasty at 6 weeks Repeat descending urethrogram at 2 weeks
  • 20 DNB DEC-2007 • Management of ca penis • Small noninvasive lesion – Fluorouracil cream – Nd-YAG laser – Radiotherapy Surgery Invasive penile carcinoma 1. Lesion involving the prepuce – Simple circumcision 2. Lesion of glands or distal shaft – Partial penectomy with a 2 cm margin 3. Lesion involving procimal shaft – Total penectomy with perineal – Urethrostomy 36. True about torsion testis A/E: A. Develops during sex B. Can develop during sleep also C. Always conservative approach is made D. Is a surgical emergency Bailey and Loves Ch - 68 Torsion of testis: • More in adolescents (10-25 yrs) • Sudden agonising pain • Prehn’s sign – on elevation of testis • If pain ↑ es – torsion • If pain ↓es – epididymo-orchitis • Inv. of choice – colour doppler Treatment • In 1st hr – can be treated by manipulation • If not corrected 1-4 hr = Surgery Bilateral orchipexy • > 4 hrs = Testis will be dead – Orchidectomy 37. True about Hirschsprung’s disease A/E: A. Aganglionic colon B. Presents with decreased passage of shoot
  • Surgery Preventive and Social Medicine 21 21 C. Never associated with Down’s syndrome D. Thickening of nerve seen Bailey and Loves Ch - 57 Hirschsprung’s disease Aganglionic megacolon, absence of ganglionic cells in the neural plexus accompanying with hypertrophy of nerve trunk. Mc Site is rectosigmoid • M:F 4.1 • Diagnosis by rectal biopsy Anorectal monometry – for screening Surgery • Swenson • Duhamel • Soave Congenital hernia: 1. Anteromedial hernia – Between Xiphoid and costal origins – Foramen of Morgagni – Space of larrey – More on right side 2. Posterolateral hernia – Most common type – Through pleuroperitoneal hiatus (foramen of Bochdalek) – Present on left side – Worst prognosis 3. Posterior hernia – One or both crura may be absent – Aorta and esophagus lie in the gap – There is no hearnial sac 4. Central Hernia: Rare, left sided Surgery 38. True about bochdalek hernia: A. Anterolateral B. Anteromedial C. Posterolateral D. Posteromedial Bailey and Loves Ch - 47
  • 22 DNB DEC-2007 39. True statement about inguinal canal: A. Size 1.65 cm B. Lacunar ligament is on medial side C. Transverse fascia on anterior side D. Epigastric artery lateral to deep ring Bailey and Loves Ch - 62 • Inguinal canal: Triangular slit, horizontal from deep inguinal to superficial inguinal ring – 3.75 cm (1½ inch) in adults – Anteriorly: superficial fascia Aponeurosis of external oblique – Posteriorly: conjoined tendon Surgery (Internal oblique + transverses muscles) Medial end : lacunar ligament 40. Lingual nerve block is given in: A. Upper molar B. Angle of mandible C. Base of mandible D. Neck of mandible Discussed with dental SR 41. Splenectomy is indicated in A/E: A. Hypersplenism B. Abcess C. ITP D. Trauma Bailey and Loves Ch - 53 • Splenectomy is indicated in all of above. • Not indicated in Asymptomatic hypersplenism, – Mc indication – splenic trauma – Mc indication in elective setting – Idiopathic thrombocytopenic purpura 42. Lymph flow A/E: A. Largely due to peristalsis B. Due to pressure gradient
  • Surgery Preventive and Social Medicine 23 23 C. External pressure does not stop it D. Gravity influences it 43. Edema grade II means: A. Increased interstitial pressure with no edema B. Edema + pitting + ↓on elevation C. Edema + pitting + no ↓on elevation D. Irreversible skin changes. They are in order of grading. 44. Color change in large bruise: A. From centre B. From periphery C. From middle of centre and periphery D. All together 46. Schatzki ring: A. Submucosal fibrous ring at squamocolumnar junction. B. Present in middle third C. Is malignant D. Always causes dysphagia • Is a thin submucosal curcumferential ring in the lower esophagus at the squamo columnar junction. Often associated with hiatal hernia • Pathogenesis is unclear • Mostly asymptomatic • Intermittent dysphagia may occur Treatment Esophageal dilatation 47. Ranula is: A. Retention cyst of minor salivary gland B. Retention cyst of major salivary gland Surgery 45. Smoking leads to A/E: A. Ca pancreas B. Ca gallbladder C. Urinary bldder D. Lung
  • 24 DNB DEC-2007 C. Tumour of minor salivary gland D. Tumour of major salivary gland • Due to obstruction of mucous gland on the floor of mouth • Usually unilateral • Wharton’s duct is seen running over the surface of the swelling • Plunging ranula: when it has cervical prolovgation Surgery Treatment : • Complete excision • Partial excision with marsupilisation • Plunging ranula should be excised completely.
  • Preventive andPharmacology 25 Social Medicine 25 Pharmacology 49. Which is not given in morphine poisoning: A. Methadone B. Respiratory support C. Gastric lavage D. Naloxone KD Tripathi Ch - 32 Treatment of morphine poisoning 1. Respiratory support 2. IV fluids, vasoconstrictors 3. Gastric lavage with pot permanganate [even when morphine is injected] 4. Naloxone – specific antidote 5. Nalorpine- less satisfactory alternative 50. All except one are teratogenic drugs: A. Methotrexate B. Phenytoin C. Amoxicillin D. Lithium KD Tripathi Ch - 4 Pharmacology 48. Drug cross cell membrane better when they are: A. In anionic state B. Partial ionized C. Not ionized D. Complete ionized KD Tripathi Ch - 2 • Ions being lipid insoluble do not diffuse
  • 26 DNB DEC-2007 Drug Abnormality Methotrexate Phenytoin : : Multiple defects, foetal death Hypoplastic phalange, cleft lip/palate, microcephaly Lithium : Foetal goiter, cardiac and other abnormalities Indomethalin/ : Premature closure of ductus aspirin arteriosus Antithyroid drugs : Foetal goiter Pharmacology 51. Drugs causing megaloblastic anaemia A/E: A. Trimethoprim B. Methotrexate C. Ticarcillin D. Phenytoin Drugs causing Megaloblastic Anaemia • Co- trimoxazole • Folate Antagonists (Methotrexate) • Nitrous oxide • Oral contraceptives • Phenobarbital • Phenytoin • Primidone • Triamterene • Trimethoprim 52. IV Amphotericin is used for: A. Systemic Aspergillosis B. Chromomycosis C. Dermatophytes D. All fungal infection KD Tripathi Ch – 55 Choice of drugs for systemic mycoses 1st choice 2nd choice 1. Candidiasis FLU/NYS/ ITR (Local) CLU Disseminated AMB FLU
  • Preventive andPharmacology 27 Social Medicine 27 2. Cryptococcosis 3. Histoplasmosis 4. Coccidioidomycosis 5. Blastomycosis 6. Sporotrichosis 7. Paracoccidioidomycosis 8. Aspergillosis 9. Mucormycosis 10. Chromomycosis AMB+5FC ITR/AMB AMB/FLU FLU FLU ITR/KTS ITR/AMB AMB ITR KTZ/FLU ITR AMB AMB AMB ITR ITR KTZ/5 FC AMB - Amphotericin B, 5-FC, Flycytosine KTZ - Ketoconazole, Flu - Fluconazole, ITR - Itraconazole NYS - Nystatin CLO - Clotrimazole • Latanoprost: PGF 2α derivative has shown efficacy similar to timolol • No increase in ocular inflammation increases uveo scleral outflow by increasing permeability of tissues in ciliary muscle or by an action on episcleral vessels • S. E: Occular and pain • No systemic side effects • Blurring of vision • Increased iris pigmentation 54. Drugs used in Alzheimer’s disease A/E: A. Rivastigmine B. Donepezil C. Tacrine D. Echothiophate KD Tripathi Ch - 6 Pharmacology 53. True about Latanoprost: A. PG inhibitor B. ↑ es corneal and conjuctival congestion C. ↑ es uveo scleral outglow D. Has severe systemic side effects KD Tripathi Ch - 6
  • 28 DNB DEC-2007 Pharmacology Drugs used in Alzheimer’s disease • Rivastigmine • Donepezil • Tacrine • Galantamine 55. Organophosphates poisoning shows: A. Irreversible binding B. Uncompetitive binding C. Competitive binding D. Reversible binding KD Tripathi Ch – 6 Anticholinesterases Reversible Carbamates Acridine Physostigmine (Eserine) Tacrine Neostigmine Pyridostigmine Edrophonium Rivastigmine Donepezil Irreversible Organophosphates Dyflos (DFP) Echothiophate (Baygon) Parathion Malathion Diazinon Tabun Sarin Soman Carbamates Carbaryl (Sevin) Propoxur 56. Best general Anesthetics in child: A. Sevoflurane B. Halothane C. Desflurane D. Nitrous oxide KD Tripathi Ch – 25
  • Preventive andPharmacology 29 Social Medicine 29 Agent 1. Isoflurane 2. Enflurane 3. Sevoflurane 4. Desflurane 5. Halothane 6. Nitrous Oxide Points to be known Cardioneuro surgery (Except MI) Unsafe in epilepsy and renal dysfunction Children Old age hepatic, Renal dysfunction and MI Unsafe in hepatic faliure Safe in cardiac patients and shock KD Tripathi Ch - 44 • Pantoprazole is a newer H+ K+ ATPase inhibitor similar in potency and clinical efficacy to omeprazole, but is more acid stable and less active at higher PH • It is only proton pump inhibitor available for IV administration employed in bleeding peptic ulcer and for prophylaxis of acute stress ulcers 58. True about d-tubocurarine is A/E: A. Not poisonous orally B. Causes hypertension C. Flascid paralysis D. Product of plant strychnos toxifera KD Tripathi Ch - 23 Pharmacology 57. Pantoprazole acts on: A. H+ K+ ATPase B. Na+ K+ ATPase C. H+ Na+ ATPase D. Ca2+ channel
  • 30 DNB DEC-2007 Pharmacology Skeletal muscles Relaxants : Depolarizing blockers – Sch, Dexamethonium - They depolarize muscle end – plates by opening Na+ channels and initially produce twitching and fasciculations. - Natural sources of curare are strychnos toxifera, chondrodendron tomentosum and related plants - d – Tubocurarine produces significant fall in B.P. - Non-depolarizing competitive blockers rapidly produce muscle weakness followed by flaccid paralysis 59. Shortest acting skeletal muscle relaxant: A. Mivacurium B. Pancuronium C. Vecuronium D. Rocuronium KD Tripathi Ch – 23 Drug oncet of action Pancuronium Mod (3-4 min) MOD Vecuronium Rocuronium Mivacurium Early (60 sec) Mod. Doxacurium Mod Atracurium Mod d-Tubocurare Delayed Pipecuronium Mod Rapacuronium Early Suxame- Duration of action Long (30-40 min) Intermediate (20-30 min) Intermediate (20-30 min) Small Shortest (5-10 min) Non deporalizing muscle relaxant Prolonged (60 min) Intermediate (10-15 min) Prolonged Long Small 20-30 sec 3 to 5 min thonium Shortest muscle relaxant
  • Preventive andPharmacology 31 Social Medicine 31 60. Fasciculations seen in: A. Succinylcholine B. Vecuronium C. Pancuronium D. Doxacurium KD Tripathi Ch – 23 Non-depolarizing block: These agents combine to the receptor and produce competitive blockage. They due to their large size are not able to open the Na+ channel and thus muscle fails to contract. 61. True about antipsychotic drugs A/E: A. Blood monitoring is needed B. Corneal and lens opacities C. Dystonia is due to cholinergic effect D. Act by D2 blocking KD Tripathi Ch - 30 • Major limitation of clozapine is higher incidence of agranulocytosis and other blood dyscrasias • Blue pigmentation of exposed skin, corneal and lenticular opacities, retinal degeneration • Acute muscular dystonias – central anticholinergics are given for treatment • All antipsychotics have potent dopamine D2 receptor blocking action Pharmacology Depolarizing block: They depolarize muscle end-plates by opening Na+ channels and initially produce twiching and fasciculations. Drug do not dissociate rapidly from the receptorinduce prolonged partial depolarization of the region around muscle end plate inactivation of Na+ channels- Ach released from motor nerve endings is unable to generate prolonged MAP-flaccid paralysis.
  • 32 DNB DEC-2007 62. Half life of I131 : A. 5 days B. 8 days C. 13 days D. 60 days KD Tripathi Ch - 17 I131 – 8 days – Therapeutic I123 – 13 hours – Therapeutic I125 – 60 days Pharmacology 63. Streptomycin was discovered by: A. Alexender flemming B. Louis Pauster C. Koch D. Waksman KD Tripathi Ch - 51 64. Following acts by blocking DNA synthesis: A. 5 Fu B. Acyclovir C. Penicillin D. Streptomycin KD Tripathi Ch – 56 Acyclovir is taken up by the virus infected cells. It changes to Acylovir monophosphate and then to Acylovir triphosphate. It then inhibits herper virus DNA polymerase competitively. It also gets invorporated in viral DNA and stops lengthening of DNA strand. The terminated DNA inhibits DNApolymerase irreversibly. Adverse effects: Topical-stinging and burning sensation after each application Oral-headache, nausea, malaise I.V-Rashes sweating, emesis hypotension
  • Preventive andPharmacology 33 Social Medicine 33 - Dose dependent fall in GFR Reversible neurological manifestations e.g. tremors, lethargy, disorientation hallucinations, convulsions and coma - No teratogenic potential is noted • Acyclovir inhibits herpes virus DNA polymerase competitively. 66. Essential drugs are those that: A. Satisfy priorty healthcare needs B. Available at all times C. Selected on basis of health relevance D. All the above. KD Tripathi Ch - 1 Essential drugs are those that satisfy the priority healthcare needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety and comparative cost effectiveness. Essential medicine are intended to be available within the context of functioning health systems at all times and in adequate amounts. Pharmacology 65. DOC for pneumocystis carinii infection: A. Co-trimoxazole B. Penicillin C. Streptomycin D. Methotrexate KD Tripathi Ch – 48 Cotrimoxazole: Given- Sulfamethoxazole : Trimethoprim is 5 : 1 In plasma, after more absorbtion of trimethoprim it reaches a ratio of 20:1 Sulfonamide inhibits folate synthetase Trimethoprim inhabits dihydrofolate reductase so folic acid is not formed in bacteria and a number of metabolic reactions suffer. Adverse effects: Nause, vomiting, stomatitis, headache, rashes Folate deficiency-megaloblastic anaemia blood dyscrasias. It should not be given in pregnancy
  • 34 DNB DEC-2007 67. Amount of drug eliminated in 4 half life: A. 75% B. 83% C. 94% D. 99% KD Tripathi Ch - 2 Pharmacology 1. 2. 3. 4. t 1/2 – 50% t 1/2 – 75% t 1/2 – 87.5% t 1/2 – 93.75% 68. β-blocker is contraindicated in: A. Anxiety B. Congestive cardiac failure C. Hypertension D. All the above KD Tripathi Ch – 9 Adverse effects of Beta Blockers 1. Congestive cardiac faliure 2. Bradycardia 3. Chronic obstructive lung disease 4. Prinzmetae’s angina 5. Diabetes 6. Partial and complete heart block 7. Peripheral vascular disease 8. G.I.T upset 9. Lack of drive, nightmares forgetfulness rarely hallucinations 10. Sexual distress 69. Idiosyncrasy is: A. Genetically determined abnormal reactivity to a chemical B. Immunologically mediated C. Due to drug over dose D. Tendency to cause foetal effects KD Tripathi Ch - 4
  • Preventive andPharmacology 35 Social Medicine 35 Idiosyncrasy Genetically determined abnormal reactivity to a chemical. Certain side effects of some drugs are largely restricted to individuals with a particular genotype e.g. Barbiturates cause excitement and mental confusion in some individuals. 70. Ketotifen is a: A. Mast cell stabilizer B. Bronchodilator C. Leukotriene antagonist D. Steroid KD Tripathi Ch – 15 71. NSAID with no PG inhibitory action: A. Ketorolac B. Nefopam C. Piroxicam D. Aspirin KD Tripathi Ch – 13 Pharmacology Drugs used in Asthma i. Bronchodilators a. Sympathomimetics: Adrenaline, salbutamol Terbutaline, salmeterol, formoterol b. Methylxanthines: Theophylline cnoline c. Anticholinergics: Atropine, Ipratropium bromide, Tiotropium bromide ii. Leukotriene antagonist Montelukast Zafirlukast iii. Mast cell stabilizers Sodium cromoglycate Nedocromil Ketotifen iv. Steroids: Hydrocortisone, Prednisolone Beclomethasone, Budesonide Flunisolide
  • Pharmacology 36 DNB DEC-2007 NSAID Nonselective cox inhibitors • Aspirin • Phenylbutazone • Indomethacin • Sulindac • Ibuproten • Naproxen • Ketoprofen • Mephenamic acid • Diclofenac • Piroxicam • Ketorolac Preferential Cox-2 inhibitors • Nimesulide • Meloxicam • Nabumetone Selective Cox-2 inhibitors • Celecoxib • Rofecoxib • Valdecoxib Analgesic - antipyretics with poor antiinflammatory action • Paracetamol • Metamizol Propiphenazone Nelopam 72. Psychosis is seen as a side effect of: A. Isoniazid B. Ethambutol C. Rifampicin D. Pyrazinamide KD Tripathi Ch – 53 Antitubercular drugs Side effects Isoniazid Hepatitis, peripheral neuritis hemolysis, SLE Proteinuria, Hepatitis, Flu like syndrome, Red orange urine Rifampicin Contd...
  • Preventive andPharmacology 37 Social Medicine 37 Contd... Ethambutol Retrobulbar neuritis, Red green blindness Polyarthralgia, myalgia, Hepatitis rash hyperuricemia, phototoxicity Deafness, vestibular dysfunction Nephrotoxicity Pyrazinamide Streptomycin Pharmacology 73. Optic neuritis is not caused by: A. Ehambutol B. Sulphonamide C. Penicillin D. Isoniazid • Durg causing optic neuritis • Aminosalicylic acid • Chloramphenicol • Clioquinol • Ethambutol • Isoniazid • Penicillamine • Phenothiazines • Phenylbutazone • Quinine • Streptomycin 74. Not a bacteriocidal: A. Ethambutol B. Isoniazid C. Rifampicin D. Pyrazinamide KD Tripathi Ch – 53 Antitubercular drugs Drugs Mechanism Isoniazid Inhibits mycotic acid synthesis Resistance due to Deletion in cat K gene Contd...
  • 38 DNB DEC-2007 Contd... Rifampicin Ethambutol Pharmacology Pyrazinamide Inhibits DNA dependent RNA polymerase Inhibits cell wall Synthesis Similar to INH in gene Mutation in repo B gene Alteration to drug target gene. Mutation encoding for enzyme generatio n 75. Oral contraceptive pills effects is decreased by: A. Rifampicin B. Isoniazid C. Pyrazinamide D. Ethambutol KD Tripathi Ch – 53 Interations of Rifampicin • Microsomal enzyme inducer • Enhances its own as well as other drug metabolism e.g. - Warfarin - OCP - Steroids - Sulfonylureas - Digitoxin - HIV protease inhibitors - Ketoconazole 76. Skin rashes and colour changes are seen in: A. Clofazimine B. Doxycyclin C. Streptomycin D. Dapsone KD Tripathi Ch – 54
  • Preventive andPharmacology 39 Social Medicine 39 Clofazimine • Leprostatic anti-inflammatory drug • Interferes with the template function of DNA • Active oral absorbtion Side effects: Reddish black skin • Discolouration of hair • Aceneform eruptions • Phototoxicity • Conjunctival pigmentation • Discolouration of body secretions 78. Halothane causes: A. Hepatitis B. Inflammatory Bowel syndrome C. Pancarditis D. Pancreatitis Halothane • Adverse effects - Decrease in cardiac output - Decrease in B.P. - Sensitizes heart to adrenaline - Hypercarbic and hypoxic reflexes are blunted - Patent bronchodilator Pharmacology 77. Agranulocytosis is caused by A/E: A. Antidepressants B. Anti thyroid C. Antipsychotic • Drugs causing Agranulocytosis • Captopril • Carbimazole • Cefotaxime • Chloramphenicol • Clozapine • Cotrimoxazole • Cytotoxies • Gold salts • Indomethacin • Phenothiazines • Phenylbutazone • Tricyclic antidepressants
  • 40 - DNB DEC-2007 Increase in ICT Decrease in GFR Produces moderate muscle relaxation Uterine atony and PPH Postoperative shivering Halothane hepatitis 79. Antidote of methyl alcohol: A. Ethyl alcohol B. Propanol C. Disulfiram D. Ethyleneglycol Pharmacology KD Tripathi Ch – 26 Treatment of Methyl Alcohol 1. Protect eyes from light 2. Gastric lavage with sod. Bicarbonate 3. Treat acidosis with sod. Bicarbonate i.v. 4. Treat hypokalemia with Pot.chloride 5. Ethanol 6. Hemodialysis 7. Fomepizole 8. Folate therapy 80. Use of Minoxdil: A. Alopecia B. Cardiac failure C. Anxiety D. Erectile dysfunction KD Tripathi Ch – 38 Minoxidil: - Powerful vasodilator - Directly relax arteriolar smooth muscle - It is a prodrug - Edema and CHF may occur - Palpitation may occur - Used in alopecia - Local irritation, itching and burning sensation are frequent - Headache dizziness may occur
  • Preventive andPharmacology 41 Social Medicine 41 81. Safest tetracycline in kidney disease: A. Doxycycline B. Minocycline C. Demeclocycline D. Oxytetracycline KD Tripathi Ch – 50 Comparative features of tetracyclines II III Tetracycline Oxytetracycline Low 6-10 hr Marked Demeclocycline Doxycycline Minocycline Intermediate 16-18 hr Mod High 18-24 hr least Intermediate Highest Diabetes insipidus Low High Low renal toxicity Potency T1/2 Alteration of GIT flora Diarrhoea High Photoxicity Low Specific Less tooth Discolouration 82. Prodrugs A/E: A. Enalapril B. Lisinopril C. Ramipril D. Perindopril • All ACE inhibitors are prodrugs except • Captopril • Lisinopril Pharmacology I
  • 42 DNB DEC-2007 Microbiology 83. Mc infection caused by Naegleria fowleri: A. Meningoencephalitis B. Keratitis C. Granulomatous amoebic encephalitis D. Diarrhea : Amoeba flagellates) causes primary amoebic meningoencephalitis (PAM) Acanthamoeba spp : Gronulomatous amoebic encephalitis (GAE) chronic amoebic keratitis (associated with contact lens) KD Chatterjee Ch -2 Microbiology Naegleri fowleri 84. Infection by penetration of skin is seen in A/E: A. Ancylostoma B. Necator C. Strongyloides D. Enterobius KD Chatterjee Ch – 7 Ancylostoma duodenale (Hookworm) Life cycle: – No intermediate host is required – No multiplication of worm in human body The eggs containing segmented ova with 4 blastomeres are passed out in the faeces of human host.
  • Microbiology Preventive and Social Medicine 43 43 85. Pinta is caused by: A. T carateum B. T pallidum C. T pertenue D. T. Pallidum endemicum Pinta – Caused by T. carateum extragenital papule which does not ulcerate but develop into lichenoid or psoriatic patch Yaws – By T. pertenue identical to T. pallidum extragenital papule which enlarges and ulcerates to form an ulcerating granulomia. Microbiology Rhabditiform larva moults twice on the third and fifth day and developes in filariform larva. Filariform larva casts off their sheaths and gains entrance to the body by penetrating the skin. The larval enters the lymphatics or small venules. They are carried by veins to right heart and lungs. Then they travel to pharynx and are finally swallowed. Larval settles down in small intestine and develops into adult worm. Necator americanus: American hookworm New world hookworm The life cycle, general morphology, pathogenesis, diagnosis and treatment are same as A. duodenale. Strongyloides: Also enters the human body by penetrating the skin goes to heart lung and finally intestine. Enterobius vermicularis Spreads by feco oral route. Retrograde infection (Retrofection) Eggs laid on the perianal skin immediately hatch into infective larvae and migrate back to colon through anus. Auto infection: The movement of worms at the time of egg laying causes intense itching, inducing the patient to scratch thereby carrying the eggs containing the infective larval on their fingers and later on they are ingested with food.
  • 44 DNB DEC-2007 Endemic syphilis – By T. pallidum endemicum also know as bejel, Manifestes like that of secondary syphilis R Ananthanarayan Ch - 42 86. Erythrasma is caused by: A. C. minutissimum B. C. ulcerans C. C. parvum D. Diphtheroids Microbiology R Ananthanarayan Ch - 26 Ulcerans: Transmitted by cow’s milk usually present as pharyngitis and can mimic respiratory diphtheria • C. Parvum : Used as immunomodulator • C. minutissimum : Causes Erythrasma and exhibits coral red fluorescene under wood’s light • C. Pseudotuberculosis (Preisz nocard bacillus) present as suppurative granulomatous lymphadenitis. • Diphtheroids: Normal commensals, stain more uniformly with few or no metachromatic granules eg C. Pseudodiptheriticum. 87. Mycobacteria causing lesion on foot and spreading through moist soil: A. M. kansasii B. M. marinum C. M. avium D. M. scrofulaceum R Ananthanarayan Ch - 39 • M. kansasii – Chronic pulmonary disease in old persons with pre-existing lung disease • M. marinum – Causes warty skin lesion (swimming pool granuloma.
  • Microbiology Preventive and Social Medicine 45 45 • M. avium – MAIS complex. – lymphadenopathy pulmonary lesion and disseminated disease • M. scrofulaceum – Scrofula (cervical adenitis) in children 89. Percentage of HIV infection by breastmilk: A. 1% B. 3% C. 30% D. 15% R. Ananthanarayan Ch - 62 Microbiology 88. Risus sardonicus is caused by: A. C. tetani B. C. perfrengis C. Staphylococci D. Pseudomonas R Ananthanarayan Ch - 28 Clostridium tetani: Causative agent of Teatnus. Marked tendency to swarm Strict anaerobe and form surface growth only when O2 tension is less than 2 mm Hg. Toxins 1. Tetanolysin (labile hemolysin) – no role in pathogenesis 2. Telanospasmin neurotoxin. Toxin enters brainstem (not cross BBB) it blocks release of inhibitory neurotransmitter glycine 2 GABA at presynaptic terminals. Manifestation: Mc form is generalised, teatnus. Onset after 7 days of injury First symptom- Increase in tone of masseter muscle (trismus or lock jaw) followed by nerves of head, trunk and extremities (Descending teatnus) Hands and feet are relatively spared. Short nerves are affected earlier. Mentation is unimpaired. Deep tendon reflex increases. Sympathetic stimulation occurs no person to person transmission no herd immunity.
  • Microbiology 46 DNB DEC-2007 HIV Modes of Transmission a. Sexual transmission Mc mode is heterosexual transmission Male to female is twice as female to male Anal intercourse has higher risk. b. Transmission by blood transfusion Risk by one unit of infected blood is more then 95% c. Maternal fetal transmission – Risk is 30% – Mc in perinatal period – Section decreases risk – Exclusive breastfeeding carries lower risk than mixed feeding d. Transmission by other body fluids. – HIV can be isolated from saliva but cannot be transmitted 90. Mc cause of endocarditis in IV drug users: A. Staph. aureus B. S. viridans C. Staph. epidermidis D. Staph saprophyticus R Ananthanarayan Ch - 22 Most Common Organism Native valve – Community Nosocomial Prosthetic – Early <12 m valve Late >12 m IV drug users Staph. aureus Staph. aureus Staph. epidermidis Strep. viridans Staph. aureus 91. Group ‘B’ streptococci causes: A. Wound infection B. Neonatal sepsis C. UTI D. Edocarditis R Ananthanarayan Ch - 23
  • Microbiology Preventive and Social Medicine 47 47 GroupA – S. pyogenes – URI, RF, GN B – S. agalactiae– Neonatal sepsis C – S. equisimilis – pharyngitis, endocarditis 92. Mc cause of PID: A. Gonococci B. Pneumococci C. Staphylococci D. E. Coli • • • • R Ananthanarayan Ch - 25 Mc cause of PID (world)- gonococci India – TB Septic arthritis – gonococci Mc. joint in arthritis – knee B. cereus Diarrheal types I.P. 8-16 hr. Food 1-5 hr. Cooked meal and veg. Resemble heat labile Toxin of E . coli Fever vomiting Symptoms Emetic type Rice Resemble heat stable toxin of S. aurei diarrhea 94. Diarrhea without abdominal cramps: A. V. cholera B. E. coli C. Cl. perfringens D. B. cereus R Ananthanarayan Ch – 33 Microbiology 93. Bacillus cereus emetic type is caused by: A. Rewarmed fried rice B. Cooked meat C. Vegetables D. Fruits R Ananthanarayan Ch - 27
  • Microbiology 48 DNB DEC-2007 Vibrio Cholera: – Fish in stream appearance – Darting type motility (swarm of gnads) – aerobic, grow well in alkaline media – Require 0.5 to 1% Nacl – Late lactose fermenters – Gelatin swab:funnel shaped – Painless rice water diarrhoea – Cholera toxin demonstrated by skin blueing test – Two subunits • A-A1 (Active part) activates adenyl cyclase increases cAMP • A2 joins A, and B B – Binds to GM, ganglioside receptor of jejunum. • Drug of choice • Single dose tetracyclin or Doxycycline • Alternative Erythromycin • Children < 8 yr • Furazolidone • Pregnant-Furazolidone 95. Spindle shaped sporozoites are seen in: A. P. falciparum B. P. vivax C. P. malariae D. P. ovale KD Chatterjee Ch - III Gametocytes: • P. falciparum – Crescentic/Banana • P. vivax – round, fills cell, centrally pigmented • P. malariae – Round, large coarse pigment • P. ovale- Smaller and oval, but similar to those of P. vivax 96. Cerebral malaria is caused by: A. P. falciparum B. P. vivax C. P. malariae D. P. ovale KD chatterjee Ch - III
  • Microbiology Preventive and Social Medicine 49 49 • P. Falciparum • RBC- normal size, round, maurer’s cleft • Parasite- Thread like, multiple infections double chromatin dots (Tarphozoite) • Schizonts- Absent, occasionally 8-24 merozoites in grape like pattern • Gemistocyte – Crescentic/banana shaped • IP – 12 days • Duration of erythrocytic cycle-48 days • Malignant tertian fever 97. Dimorphic fungi A/E: A. Cryptococcus B. Candida C. Blastomyces D. Histoplasma R Ananthanarayan Ch - 65 98. Nails not involved in: A. Trichophyton B. Microsporum C. Epidermophyton D. All the above R Ananthanarayan Ch - 65 • Trichophyton – Infects hair, skin and nail Colony powdery, pigmented, Microconidia abundant Microconidia – Abundant Macroconidia – Pencil or cylinderical shaped • Microsporum – Hair and skin only Colony – Cotton like pigmented Microconidia – Relatively scanty Macroconidia – Multicellular spindle or fusiform shaped • Epidermophyton – Skin and Nail only Colony- Powdery greenish-yellow Microconidia absent Macroconidia – Club shaped or pear shaped multicellular Microbiology Dimorphic fungi: Candida albicans, Blastomyces, Cocidiodes, paracoccidioides sporothrix, Penicillium.
  • 50 DNB DEC-2007 99. Rhinosporidiosis is: A. Superficial mycoses B. Cutaneous mycoses C. Subcutaneous mycoses D. Systemic R Ananthanarayan Ch - 65 Superficial mycoses: P. versicolor, Tinea nigra, white and black piedra Cutaneous mycoses: Dermatophytes Candida Subcutaneous mycoses – Mycotic mycetoma Sporotrichosis chromoblastomycosis Rhinosporidiosis Microbiology Systemic – Coccidioidomycosis, histoplasmosis Blastomycosis, paracoccidioidomycosis 100. Postexposure prophylaxis for HIV: A. Zidovudine + Lamivudine – 4 wks B. Zidovudine+ Nevirapine – 4 wks C. Zidovudine + Lamivudine + Indinavir – 4 wks D. Zidovudine + Lamivudine + Nevirapine – 4 wks Post exposure prophylaxis decreases transmission by 79% guide lines A. For routine exposure – Combination of two nucleoside analogue reverse tanscriptase inhibitor daily for 4 weeks B. For high risk or complicated exposure Combination of two nucleoside analogue reverse transcriptase inhibitor plus a protease inhibitor Most clinician give later regimen in all cases 101. Pre-exposure prophylaxis for rabies: A. 0,7,28 days B. 0,3,7 days C. 0, 7, 90 days D. 0, 28, 90 days Preexposure prophylaxis- given to laboratory staft workers with rabies virus, veterinarians etc.
  • Microbiology Preventive and Social Medicine 51 51 Cell culture vaccine on 0,7,28 days If titre of neutralizing antibody in serum taken after 1 month of 3rd dose is less than 0.5 Iu/ml than give booster untill antibodies become demonstrable. 102. Measles vaccine is given at: A. 9 months B. 10 months C. 11 months D. 12 months K. Park Ch – 3 103. Streptococci TSS is caused by: A. Enterotoxin A B. Enterotoxin B C. Enterotoxin C D. Enterotoxin F R Ananthanarayan Ch – 22 Staphylococci Toxins A. Cytolytic toxins α Hemolysin - Inactivated at 70°C and reactivated at 100°C β Hemolysin - Hot and cold phenomenon γ Hemolysin - Bi component protein δ Hemolysin - Detergent like effect on cell membrane Leucocidin panton valentine toxin synergohymenotropic toxin Microbiology National Immunization Schedule At birth – BCG and OPV-0 dose 6 wks – BCG DPT1 OPV 1 10 wks - DPT-2 OPV 2 14 wks - DPT-3 OPV-3 9 months - Measles At 16-24 months –DPT and OPV 5-6 yrs - DT 10 yrs - TT 16 yrs - TT For women early in pregnancy – TT-1 after 1 month –TT-2
  • 52 B. C. Microbiology D. DNB DEC-2007 Enterotoxin (A, B, C1-3 D, E and H) Preformed, heat stable toxin Vagal stimulation Type A toxin responsible for most cases Toxic shock syndrome toxin (TSST) TSST-1= Enterotoxin F-Pyrogenic Exotoxin C is responsible for most cases staph Enterotoxin and TSST are superantigens Exfoliative/Epidermatolytic toxin/ET Exfoliatin Causes scalded skin syndrome (SSS) severe form is Ritter’s disease and toxic epidermal necrolysis 104. Transmitting agent of mad cow disease: A. Chlamydia B. Mycoplasma C. Prion D. Virus R Ananthanarayan Ch - 60 Prion disease Human – Kuru – Iatrogenic Creutzfeldt-Jakob disease – Variant (CJD) – Familial (CJD) – Sporadic (CJD) – Fatal familial insomania – Gestmann-Sträussler-Scheinker Animal – Scrapie – Mink encephalopathy – Bovine spongiform encephalopathy (mad cow disease) 105. Human prion disease A/E: A. CJD B. Fatal familial insomania C. Gerstmann-Sträussler-Scheinker D. Mink encephalopathy R Ananthanarayan Ch - 60
  • Microbiology Preventive and Social Medicine 53 53 Prion disease Human – Kuru – Iatrogenic Creutzfeldt-Jakob disease – Variant (CJD) – Familial (CJD) – Sporadic (CJD) – Fatal familial insomania – Gestmann-Sträussler-Scheinker Animal – Scrapie – Mink encephalopathy – Bovine spongiform encephalopathy (mad cow disease) 107. Epidemic keratoconjunctivitis is caused by: A. 8,19, 37 adenovirus B. 40, 41 C. 3, 7 D. 1, 2, 5, 6 R Ananthanarayan Ch - 53 Others diarrhea – 40, 41 Respiratory disease in children – 1, 2, 5, 6 Sore throat, febrile cold, pneumonia– 3, 4, 7, 14, 21 Swimming pool conjunctivitis– 3,7 Hemorrhagic cystitis – 11, 21 Epidemic keratoconjuctivitis– 8, 19, 37 108. Tularemia is caused by: A. Gr +ve motile bacilli B. Gr –ve motile bacilli Microbiology 106. Mc cause of non-gonococcal urethritis: A. Chlamydia B. E coli C. Pseudomonas D. Staphylococci
  • 54 DNB DEC-2007 Microbiology C. Gr +ve non-motile bacilli D. Gr –ve non-motile bacilli R Ananthanarayan Ch – 35 Francisella or Pasteurella or Brucella tularensis – Capsulated – Gram negative – Non-motile – intracellular parasite – Francis blood dextrose cystine agar – Resembles mycoplasma – Causes tularemia, disease of rabbits – transmitted by ticks – In humans it present as local ulceration with lymphadenitis, typhoid like fever with glandular enlargement or influenza like respiratory infection. – Doc-streptomycin 109. Type I hypersensitivity: A. Ig E B. Ig G C. Ig D D. Ig M 110. Genetic transmission in bacteria by virus: A. Transduction B. Transformation C. Replication D. Binary fission
  • Ophthalmology Preventive and Social Medicine 55 55 Ophthalmology 111. Myopia is always: A. Overcorrected B. Undercorrected C. Perfectly corrected D. Depends on patient choice Parsons Ch – 7 112. True about laser for refractive errors A/E: A. Can be done even in thin cornea B. Both hypermetropia and myopia are corrected C. Photoablation is done D. Superficial layer is lifted Ophthalmology Treatment of refractive errors myopia: 1. Concave glasses-myopia must never be over corrected In low myopia (upto-6 D) full correction In high myopia (more than – 6 D) – Undercorrection 2. Keratorefractory surgeries – Radial Keratotomy – Keratophakia – Keratomileusis 1 Fukala’s operation 2 Minus IOL 3 Scleroplasy 4 Laser: Excimer laser Hypermetropia – Convex glasses with full cycloplegic correction Astigmatism – Cylindrical glasses are used
  • 56 DNB DEC-2007 113. Horner’s syndrome A/E: A. Proptosis B. Anhidrosis C. Miosis D. Exophthalmos Ophthalmology Parsons Ch – 4 Horner’s syndrome – Miosis – Partial ptosis – Enophthalmos – Unilateral anhydrosis – Heterochromia of iris (Congenital form) – Due to damge of sympathetic innervation of eye – Pupil reacts normally to light and accomodation but dilates poorly with cocaine drop. – If lesion is peripheral it dilates rapidly with 1 in 1000 adrenaline Treatment– Mullerectomy 114. Cornea true A/E: A. Avascular B. Long ciliary nerves C. Anterior ciliary arteries D. Keratinized squamous epithelium Parsons Ch – 1 Cornea 12 mm horizontally 11 mm vertically Refractive index–1.34 Diopteric power– +43 to +45 D Five Layers 1. Stratified squamous epithelium 2. Bowman’s layer 3. Substantia propria 4. Descemet’s membrane 5. Endothelium Cornea is a vascular but corneoscleral limbus is supplied by anterior conjuctival branch of anterior ciliary arteries.
  • Ophthalmology Preventive and Social Medicine 57 57 115. Argyll Robertson’s pupil A/E: A. Tabes dorsalis B. Absence of light reaction C. Presence of accommodation reflex D. Poor vision Parsons Ch – 4 Causes: Tabes dorsalis Diabetes Multiple solerosis Haemorrhage Tumours 116. Retinoblastoma: A. 10% bilateral B. 30% bilateral C. 50% bilateral D. Not predictable • Retinoblastoma • 30% cases are bilateral • Autosomial dominant – 6% • Sporadic – 94% Presentation–Leukocoria • Squint • Secondary glaucoma • Proptosis • Endophthalmitis • Visual difficulties • Nystagmus Parsons Ch – 23 Ophthalmology Argyll Robertson’s pupil – Bilateral abnormality – Faliure of pupil to constrict with light – Constrictions present with accomodotion – pupils are miotic, irregular eccentric and unequal – atrophic depigmented patches on iris – pupils fail to dilate with mydriatic but constrict further with eserine – Presence of good vision in both eyes Site of lesion: Internuncial neurones between pretectal nucleus and edinger westphal nucleus at the level of pretectum.
  • Ophthalmology 58 DNB DEC-2007 Treatment i. Upto 4×2 mm size No optic nerve involvement or vitero seeding – Photocoagulation Cyrotherapy ii. Upto 120×6 mm Radiotherapy–Brachy>Tele Chemo–Vincristine Etoposide Carboplatin iii. Larger, involving optin nerve Anterior chamber Viterous seeding.>1/2 of globe enucleation Also chemoradiation iv. Extraoccular involvement Radiochemotherapy Reccurance after enucleation or metastasis Chemotherapy 117. Most toxic intraocular foreign body: A. Iron B. Copper C. Gold D. Zinc Parsons Ch - 24 Minimal or no reaction– Glass plastics, gold, silver Local irritation – lead aluminium Suppurative reaction – copper, zinc mercury, nickel Specific degenerative changes – iron copper 118. KF ring is seen in: A. Superficial epithelium B. Descemet’s membrane C. Stroma D. Endothelium Parsons Ch – 15
  • Ophthalmology Preventive and Social Medicine 59 59 Pigment disorders in cornea Pigment Iron Copper Melanin Disorder Keratoconus (Fleischer’s) Old opacity (Hudson stablilive) Pterygium (Stocker’s live) Siderosis Blood stain Kayser-Fleischer’s ring Pigment dispersion syndrome (Krukenberg’s spindle) Corneal location Epithelium Epithelium Epithelium Stroma Stroma Deseemet’s Endothelium Ulcus serpens (Hypopyon corneal ulcer) – Pneumococcus – Little pain – Greyish white, disc shaped ulcer – Great tendency for early – Perforation of cornea Treatment – Excise overhanging edges – Paracentesis to evacuate pus – Antibiotics Corneal ulcer with hypopyon – Pneumococcus – Pseudomonas – Gonococcal – Staphylococcal – Streptococcal – Aspergillus – Candida Parsons Ch – 15 Ophthalmology 119. Ulcus serpens is caused by: A. Pneumococcus B. Pseudomonas C. Gonococci D. Candida
  • 60 DNB DEC-2007 Ophthalmology 120. Most powerful attachment of vitreous: A. Vessels B. Macula C. Fovea D. Optic disc margin Parsons Ch – 21 Viterous Normal attachment 1. At the base to the peripheral retina and pars plana 2. Optic disc margin – firmly attached 3. Around fovea – weak attachment Volume - 4.5 ml Consists of hyaluronic acid 121. Altitudenal hemianopia is caused by: A. Ischemic optic neuropathy B. Glaucoma C. Optic chiasma D. Optic tract Ch – 22 Visual field defects Lesion 1. Optic nerve 2. Sagittal lesion of chiasma 3. Lesion of optic tract 4. Lesion of temporal lobe 5. Lesion of optic radiations 6. Occipital lobe Defect Ipsilateral blindness Bitemporal hemianopia Homonymous hemianopia Quadrantic homonymous defect Homonymous hemianopia Homonymous hemianotria (usually sparing macula) 122. Corneal transplant needs A/E: A. Cause of death B. HLA matching C. Duration of death D. Age of graft
  • Psychiatry Preventive and Social Medicine 61 61 Psychiatry 123. True about anorexia nervosa: A. Binge eating B. Amenorrhea >3 m without loss of libido C. Wt. loss is less D. Vomiting leads to electrolyte disbalance Bulimia female vomiting common normal 50% uncommon rare hypokalemia, cardiac arrhythmias Aspiration of gastric contents 124. Suicide factor poor prognosis is: A. Female <45 yr B. Living alone or recently separated C. Self poisoning D. Lack of suicidal note 125. Mental retardation moderate: A. 20 B. 45 C. 50 D. 70 Psychiatry Anorexia nervosa Female Restriction of intake Binge eating uncommon Wt. is markedly decrease Amenorrhea 100% Other endocrine changes Skin changes usual Rare
  • 62 DNB DEC-2007 Grade Mild Mod Severe Profound IO 50-70 35-49 20-34 <20 126. Psychotherapy true A/E: A. Systemic desensitization B. Flooding C. Operant conditioning D. Depressing Neg. thoughts Psychiatry Psychotherapy • Systemic desensitization • Aversive conditioning • Flooding and implosion • Token economy • Cognitive therapy • Biofeed back.
  • Anesthesia Preventive and Social Medicine 63 63 Anesthesia 127. Epidural anesthesia: A. 0.5% lignocaine B. 2% lignocaine C. 4% lignocaine D. 5% lignocaine 129. Lingual nerve block is given in: A. Upper molar B. Angle of mandible C. Base of mandible D. Neck of mandible Anesthesia 128. Increased blood pooling is seen in: A. Spinal shock B. Septic shock C. Cardiogenic shock D. Bleeding
  • 64 DNB DEC-2007 Radiology Radiology 130. Double bubble sign in USG of fetus is seen in: A. Hydrocephalus B. Duodenal atresia C. Pyloric stenosis D. Enterocele 1. Water lily sign in lung – Hydatid disease 2. Popcorn calcification – Hamartoma 3. Meniscus sign – Aspergillus fungal ball 4. Hilar dance – ASD 5. Dock sign – Coarctation of aorta 6. Egg on side – TGA 7. Couer en sabot – TOF 8. Chain of lake – Chronic pancreatitis 9. String sign of kantor – Chron’s disease 10. Sandwich sign – Mesenteric adenopathy 131. Unit of illumination: A. Lumen B. Candella C. Lux D. Lambert Unit Roentgen Rad Gray(GY) Quantity measured Exposure Dose Dose 1Gy=100 rad
  • Radiology Preventive and Social Medicine 65 65 Rem Sievert(SV) Dose equivalence Dose equivalence 1 Sv = 100 Rem 132. Imaging of spleen is done with: A. Tc RBC B. Tc albumin C. Iodine D. Tc thallium Parathyroid – Tc thallium substraction scan Myocardial function Acute MI (Hot) – Tc albumin – Tc pyrophosphate pancreas, thyroid RBC – Selenium – Chromium Kidney – I131 orthohippurate Radiology 133. GFR is estimated by: A. DTPA B. DMSA C. Tc thallium D. Urine out put 1. 2. 3. 4. Cobra head deformity Flower vase appearance Golf hole ureter Rim sign 5. Spider leg appearance 6. Thimble bladder Ureterocele Horseshoe kidney TB urinary bladder Severe hydronephrosis Polycystic kidney TB Bladder 134. Echo – 2D is good for A/E: A. Pericardial effusion B. Bad for pericardial tamponade C. Good for valve D. Equal for both 2D Echo – Pericardial effusion and tamponade M Mode Echo – Cardiac valvular disease
  • 66 DNB DEC-2007 Skin Skin 135. Premalignant lesion A/E: A. Actinic keratosis B. Chordoma C. Bowen’s disease D. Pagets disease Premalignant lesions of skin 1. Condyloma accuminata 2. Leucoplakia 3. Erythroplakia 4. Paget’s disease 5. Bowen’s disease 6. Actinic keratosis 136. Ulcer on genitalia with intracytoplasmic telephonic handle shape is seen in: A. Donovanosis B. Chancroid C. Lymphogranuloma venereum D. Syphilis Chancroid Lymphogranuloma Venereum Agent Hemophilus Ducreyi Incubation period Primary lesion Induration Pain Lymph nodes 1-14 d Pustule Very tender Tender, unilateral unilocular Clamydia trachomatis L1 L2 L3 3d-6 wk Papule vesicle Soft Variable Tender Multicular un ilateral Donovanosis (granulomainguinale) Calymmato bacterium granulomatis 1-4 wk Papule firm firm Uncommon Psendobuboes
  • Skin Preventive and Social Medicine 67 67 Under wright Giemsa stain the bipolar condensation of chromatin gives the Donovan bodies a ‘safety ‘ pin appearance 138. Herpes simplex A/E: A. Eczema herpeticum B. Genital lesions C. Oral lesions D. Tender Lesion Herpes simplex. Incubation period – 2-7 days Primary lesion – Vesicle No. of lesion – Multiple Induration – None Pain – Tender Lymph nodes – Firm, tender often bilateral with initial episode. 139. Puritis is seen in A/E: A. Lichen planus B. Atopic dermatitis C. Urtricaria D. Pytriasis versicola Skin 137. Café-au-lait lesion are seen in: A. Neurofibroma B. Tuberous sclerosis C. Hemangioma D. Melanoma Neurofibroma– Café-au-lait macules – Axillary freckling (crowe’s sign) – Lisch nodules (iris hamortomas) – Optic glioma – Sphenoid dysplasia – thinning of long bones cortex with or without pseudoarthrosis. Tuberous sclerosis: Epiloia- Epilepsy, low Intelligence, adenoma sebacum Ash leaf hypomelanotic macules Periungual fibromas Shagreen patch – lumbosacral area Astrocytoma of optic disc.
  • 68 DNB DEC-2007 Skin Pruritus Generalised Pruritus Eczema Scabies Urticaria Xeroderma Localised pruritus Eczema Lichen planus Dermatitis Herpatiformis Pediculosis Pruritus in pregnancy – Obstetric cholestasis – Pemphigoid gestations – Polymorphic eruptions – Prurigo gestations – Pruritic folliculitis 140. Mucosa involvement is seen in A/E: A. Pemphigus vulgaris B. Bullous pemphigoid C. Phemphigus foliaceous D. Epidermolysis bullosa Oral lesions one seen in – Pemphigus vulgaris – Bullous pemphigoid – Dermatitis herpetiformis – Epidermolysis bullosa - Cicatricial pemphigoid 141. Scarring alopecia is seen in A/E: A. DLE B. T. capitis C. Alopecia areata D. Lichen planus Alopecia Non scaring alopecia 1. Telogen effluvium 2. Androgenic alopecia 3. Alopecia aerata 4. Traumatic alopecia 5. Tinea capitis
  • Skin Preventive and Social Medicine 69 69 Scaring alopecia 1. Cutaneous lupus 2. Lichen planus 3. Folliculitis decalvans 4. Linear scleroderma (Morphea) Skin
  • 70 DNB DEC-2007 Obstetrics and Gynecology Obs and Gyne 142. Risk for trophoblastic tumor: A. Full term pregnancy B. Age <35 yr C. Duration > 6 m D. HCG >4000 • • • • • • • • • • • Risk factors for trophoblastic tumors HCG >40.000 IU/ml Duration >4 m Brain and liver metastasis Prior chemotherapy failed Full term pregnancy Age >35 yr Histopath- infiltrating mole Bilateral leutin cyst > 6 cm Thyrotoxicosis Prv. H/o molar pregnancy DC Dutta Ch - 15 143. Mc ovarian tumor seen in young before pregnancy: A. Mature teratoma B. Dysgerminoma C. Mucinous cystadenoma D. Serous cystadenoma Shaw Ch - 29 Mc tumor in pregnancy is teratoma’ • Mc ovarion tumor over all –epithelial cell tumor • Meigs’ syndrome – ovarian fibroma • Pseudomeig – Brenner’s • Pseudomyxoma peritonei – mucinous tumor
  • Obstetrics and Gynecology 71 144. Increased AFP A/E: A. Acute nephrosis B. Closed abdominal wall defect C. Spina bifida D. Multiple pregnancy Williams 21st edition Page – 982 Low levels 1. Chromosomal trisomies 2. Gestational trophoblastic diseases 3. Fetal death 4. Increased maternal weight 5. Overestimated gestational age. Obs and Gyne Alpha Fetoprotein concentration Elevated levels 1. Neural tube defects 2. Pilonidal cysts 3. Esophageal and intestinal obstruction 4. Liver necrosis 5. Cystic hygroma 6. Sacrococcygeal teratoma 7. Abdominal wall defects 8. Urinary obstruction 9. Renal anomalies - Polycystic - Abscent kidneys 10. Congenital nephrosis 11. Osteogenesis imperfecta 12. Congenital skin defects 13. Cloacal exstrophy 14. Chorioangioma of placenta 15. Low birth weight 16. Oligohydramnios 17. Multifetal gestation 18. Decreased maternal weight 19. Underestimated gestational age 20. Maternal hepatoma or teratoma
  • 72 DNB DEC-2007 145. Normal menstrual cycle is for: A. 21 - 35 B. 28 - 30 C. 21 - 28 D. 28 – 35 Obs and Gyne Shaw Ch – 21 Menstrual cycle normal Menarche at 10-16 yrs Mean age – 12.5 yrs 28 + 7 days 4 to 6 days of Bleeding Irregularities • Amenorrhea—Absence of menstruation • Oligomenorrhea—at intervals of more than 35 days • Polymenorrhea—interval of less than 21 days • Menorrhagia—More than 80 ml of blood more than 5 days. • Menometrorrhagia—excessive bleeding at irregular interval • Hypomenorrhea—Scanty bleeding • Metrorrhagia—irregular timed episodes of bleeding superimposed on normal cyclical bleeding • Precocious menstruation—oncet before 10 yrs • Post coital bleeding—bleeding after sexual intercourse. 146. About semen true is: A. 8% viability B. 10% motility C. 1 ml D. 80 million/ml Shaw Ch - 17 The semen is grayish-white in color • Total volume 3 to 5 ml • Sperm count 60 -120 million per ml • 10 motile sperms/high field
  • Obstetrics and Gynecology 73 • Motility 80-90% • Morphology – 80% • Pus cells – nil PH-8 Fructose 148. Decreased sperm motility is seen in: A. Asthenospermia B. Aspermia C. Necrospermia D. Teratospermia Aspermia – no semen Azoospermia – no sperm in semen Asthenospermia – no motile sperm Or ↓ ed motility Necrospermia – Dead sperms Teratospermia – abnormal morphology Shaw Ch - 17 149. Secondary amenorrhea is: A. Absence of menstruation for > 6 m B. Absence of menstruation for >16 m C. Absence of menstruation for > 16 yr D. Absence of menstruation for more than 6yr Shaw Ch - 21 Obs and Gyne 147. Harmone increased in preovulatory surge is: A. LH B. FSH C. Oestrogen D. Progesteron Shaw Ch – 3 Harmones in Menstral cycle Pitutary-Follicle stimulating harmone-stimulates graffian follicle – produces oestrogen-inhibits FSH Stimulates LH from pitutary - LH causes GF to rupture and hence ovulation • Oestrogen reaches peak before 48 hr of ovulation • LH reaches peak before 24 hr of ovulation
  • 74 DNB DEC-2007 1° amenorrhea- >16 years no menstruation Mc – ovarian dysfunction - Mullerian agenesis 2° amenorrhea - > 6 m no menstruation Mc – Dysfunctional – HPU axis Obs and Gyne 150. MC cause of breech presentation: A. Hydrocephalous B. Malformed uterus C. Placenta previa D. Prematurity Causes: • Prematurity – MC • Twins • Oligohydramnios/Hydramnios • Congenital malformations • Short cord • Intrauterine death • Breech with extended legs • Hydrocephalous • Placenta previa • Contracted pelvis • Multiparous DC Dutta Ch - 26 151. MC site of TB perinium is: A. Ovary B. Fallopian tube C. Uterus D. Vagina TB genitalia: MC site of 1° focus – Lungs MC route of spread – Hematogenous MC site fo genital TB – Fallopian tube MC symptom – infertility MC menstrual disorder – menorrhagia MC cause of PID in virginal girl – TB Shaw Ch - 12
  • Obstetrics and Gynecology 75 In genital TB – ESR – normal – mostly Hysterosalpingography is contraindicated in proven case of genital TB 152. Treatment for CIN III in a 45-yr-old woman: A. Cone biopsy B. Cryotherapy C. Hysterectomy D. Conservative Shaw Ch – 29 153. Absolute indication of classical caesarean section: A. Carcinoma cervix B. Elderly primigravidae C. Malpresentation D. Bad obstetric history DC Dutta Ch - 36 Indication of classical caesarean section 1. Dense adhesions in lower segment 2. Severe contracted pelvis 3. Big fibroid in lower segment 4. Carcinoma cervix 5. Severe degree of placente previa 6. Postmortem section Obs and Gyne Treatment CIN CIN 1 – Mild Dysplasia – Conservative – Follow up – Persistant CIN I needs treatment CIN II to III – Cryosurgery – Laser ablation – Cold knife conization – Laser conization – Hysterectomy – Therapeutic conization
  • 76 DNB DEC-2007 154. Oligohydromnias is associated with A/E: A. Post-term B. Pre-term C. Placental insufficiency D. IUGR DC Dutta Ch – 16 Obs and Gyne Oligohydramnios • When liquor amnii is deficient up to 100 ml or may be absent • Amniotic fluid index-<5 Etiology 1. Amnion nodosum 2. Renal agenesis 3. IUGR 4. Post maturity 5. Only one sac of uniovular twin Clinical features: 1. Uterine size is much smaller 2. Less fetal movements 3. Uterus full of fetus 4. Malpresentation is common 5. IUGR Complications: 1. Abortion 2. Deformity due to adhesions due to compression 3. Fetal pulmonary hypoplasia 4. Cord compression 5. Fetal mortality is high 6. Prolonged labour 155. IUCD Cu 380 is used for: A. 10 yr B. 5 yr C. 3 yr D. 1 yr Shaw Ch - 18
  • Obstetrics and Gynecology • Cu T – 200 Cu T – 380 Multiload Cu – 250 Multiload – 375 Progestasert LNG – IUS 77 – 4 yr – 10 yr – 3 yr – 5 yr – 1 yr – 5 yr 156. IUCD Cu 380 is used for: A. 10 yr B. 5 yr C. 3 yr D. 1 yr Shaw Ch - 18 157. All are seen in RH incompetent fetus except: A. Jaundice B. Polyhydramnios C. Hemolysis D. Oligohydramnios D. C. Dutta Ch – 22 Rh incompatibility There is increased incidence of 1. Pre-eclampsia 2. Polyhydramnios 3. Big size baby hazards 4. Hypofibrinogenemia 5. Postpartum haemorrhage 6. Maternal syndrome a. Oedema b. Proteinuria c. Pruritus Obs and Gyne Question was asked in both papers Cu T – 200 – 4 yr Cu T – 380 – 10 yr Multiload Cu – 250 – 3 yr Multiload – 375 – 5 yr Progestasert – 1 yr LNG – IUS – 5 yr
  • 78 DNB DEC-2007 158. B lynch sutures is used for: A. Postpartum hemorrhage B. Cervical incompetance C. Myomectomy D. Fibroid Obs and Gyne DC Dutta Ch – 27 Discussed with senior resident treatment of PPH as in Dutta. 1. Massage the uterus 2. Explore the uterus under GA 3. Bimanual compression 4. Hot douche 5. Tight intra uterine packing 6. Hysterectomy 7. Bilateral ligation of uterine arteries 8. Angiographic arterial embolisation 159. Contraindication of internal podalic version: A. RH incompatibility B. PIH C. DM D. Multiple pregnancy DC Dutta Ch – 36 Internal Podalic Version • The only indication is transverse lie in case of second baby of twin • Contraindication-neglected obstructed labour even if the baby is living • Conditions to be fulfilled: 1. Deep anaesthesia 2. Cervix fully dilated 3. Adequate liquor amnii 4. Living fetus
  • Medicine 79 Medicine 160. Endocrine causes of hypertension A/E: A. Cushing’s syndrome B. Acromegaly C. Hyperparathyroidism D. Hyperaldosteronism 161. Primary hyperparathyroidism is seen in A/E: A. Parathyroid adenoma B. Parathyroid carcinoma C. Parathyroid hyperplasia D. Chronic renal failure CRF is a cause of secondary hyperparathyroidism 162. Urine osmolarity is decreased in A/E: A. Diabetes mellitus B. Diabetes insipidus C. Diuretic phase of renal failure D. Psychogenic polydypsia Medicine Endocrine causes of HT 1. Oral contraceptive pills 2. Cushing’s disease and syndrome 3. Primary hyperaldosteronism 4. Pheochromocytoma 5. Myxedema 6. Acromegaly
  • 80 DNB DEC-2007 Serum osmolarity DI Resolving ATN Psychogenic ↑ or N ↑ ↓ Urine osmolarity ↓ ↓ ↓ Polydypsia Medicine 163. Trigeminal neuralgia DOC: A. Carbamazepine B. Valporate C. Analgesics D. Steroids Drug of choice 1. Neonatal seizures 2. Refractory status Epilepticus 3. Partial seizures 4. West syndrome 5. Absence seizures 6. Chronic hepatitis B 7. Chronic hepatitis C 8. Wilson’s disease 9. Congenital adrenal hyperplasia 10. Duchenne’s muscular dystrophy Phenobarbitone Midazolam infusion Carbamazepine ACTH, steroids Ethosuximide Interferon+ lamivudine Interferon+ ribavarin Pencillamine Prednisolone+ fludrocortisone Prednisolone 164. Spike and Dome pattern: A. Petit mal (EEG) B. GTCS C. Partial Seizures D. Status epilectious Absence seizures (Petit mal) • Most common in 6-8 yrs age group • Not preceded by any aura • Each episode last for < 30 seconds • No loss of posture, incontinence of urine and stools during the episode • No post ictal drowsiness
  • Medicine 81 • Hyperventilation for 3 minutes often precipitates an attack • EEG pattern: 3 per second spike and slow wave pattern. • 50% develop tonic clonic fits • Doc –Ethosuximide. 165. Petit mal: A. Spike and dome pattern (EEG) B. Alpha waves C. Delta waves D. Abscent waves 166. Transient ischemic attack is seen in: A. AS B. MR C. MVPS D. MS Mitral valve Prolapse Syndrome • Barlow’s syndrome • Billowing mitral valve • Floppy valve syndrome • Most common in females • Auto somal dominant • Usually Asymptomatic • May cause non specific chest pain dyspnea, fatigue, and palpitations. Medicine Absence seizures (Petit mal) • Most common in 6-8 yrs age group • Not preceded by any aura • Each episode last for < 30 seconds • No loss of posture, incontinence of urine and stools during the episode • No post ictal drowsiness • Hyperventilation for 3 minutes often precipitates an attack • EEG pattern: 3 per second spike and slow wave pattern. • 50% develop tonic clonic fits • Doc –Ethosuximide.
  • 82 • • • • • • DNB DEC-2007 Mid systolic or late systolic non ejection click Late systotic ejection murmur Accentuation of findings by valsalva and standing Decrease by –squatting Inv of choice –ECHO ECG-mostly normal Medicine Complications: • MR • Arrhythmias • Sudden death • Transient ischemic attack • Infective endocarditis 167. Restructive lung disease true is A/E: A. Only due to thoratic cage defect Do not remember the other options but Ans is surely this one Respiratory disease A. Obstructive • Asthma • COPD • Bronchiectasis • Cystic fibrosis • Bronchiolitis B. Restrictive • Parenchymal: Sarcoidosis • Pneumoconiosis • Idiopathic pulmonary • Fibrosis • Drugs/Radiation • Extraparenchymal : Diaphragmatic palsy • GB syndrome • Muscular dystrophy • Cervical spine injury • Kyphoscoliosis • Obesity • Ankylosing spondylitis 168. Mc site hypertensive bleed: A. Internal capsule B. Basal ganglia
  • Medicine 83 C. Putamen/external capsule D. Cerebellum 169. Lateral medullary syndrome is caused by thrombosis of: A. Anterior inferior cerebral artery B. Posterior inferior cerebral artery C. Vertebral artery D. Basilar artery • Lateral medullary syndrome Wallenberg’s syndrome • Cause : Mc-Vertebral • 2nd Mc –Posterior inferior cerebellar superior, middle, inferior lateral medullary arteries • Most cases result from occlusion of ipsilateral verterbral artery. 170. Which of the following is most common location of hypertensive hemorrhage? A. Pons B. Thalamus C. Putamen/external capsule D. Subcortical white matter Medicine Intracranial Hemorrahage A. Intracerebral Hemorrhage – Parenchymal – Mc type – Mc cause is hypertension – Mc site is putamen B. Subarachnoid Hemorrhage – 2nd Mc type – Mc cause is spontaneous rupture of saccular aneurysm – Mc site is circle of willis C. Epidural Hemorrhage – Mc cause is trauma D. Subdural Hemorrhage – Mc cause is bleed from Cortical bridging vessels
  • 84 DNB DEC-2007 Medicine Intracranial Hemorrahage A. Intracerebral Hemorrhage – Parenchymal – Mc type – Mc cause is hypertension – Mc site is putamen B. Subarachnoid Hemorrhage – 2nd Mc type – Mc cause is spontaneous rupture of saccular aneurysm – Mc site is circle of willis C. Epidural Hemorrhage – Mc cause is trauma D. Subdural Hemorrhage – Mc cause is bleed from Cortical bridging vessels 171. Antinuclear Antibody raised in SLE is: A. Anti ds DNA B. Anti centromeric C. SSA RO D. Anti mitochondrial • • • • • • Anti ds DNA – SLE Anti histone – Drug induced lupus Anti SM antibody – SLE SSA Ro } Sjögren’s syndrome SSB La Antibodies of ribonucleoprotein Ag containing ULRNP – Mixed CTD. • Anti centromeric – Limited scleroderma • Histidyl t – RNA synthetase – Inflammatory myopathy • Antimitochondrial antibody – Primary biliary cirrhosis 172. Treatment for Wernike’s encephalopathy: A. Thiamine B. Steroids C. Vitamin D. Symptomatic
  • Medicine 85 Wernicke’s disease - Seen in Alcoholic - In chronic thiamine deficiency - Clinical triad • Global confusion • Ophthalmoplegia • Ataxia 173. Antiglomerular basement membrane antibody : A. Goodpasture’s syndrome B. Polyarteritis nodosa C. Crescenteric glomerulo D. Wegener’s granulomatosis nephritis The target antigen is a component of the non collagenous (NCI) domain of α3 chain of type IV collagen the α3 chain being preferentially expressed in glomerular and pulmonary alveolar basement membrane. Celiac diseaes – Antiendomysial antibody Crohn’s disease – Antisaccharomyces cervisial antibody Ulcerative colitis–Antineutrophilic cytoplasmic antibody 175. Blood pressure 165/105 is graded as: A. Normal B. Prehypertension C. Stage I D. Stage II Blood pressure Systolic Diastolic Normal < 120 < 80 Prehypertension 120-139 80-89 I 140-159 90-99 II > 160 > 100 Medicine 174. Antiendomysial: A. Tropical sprue B. Celiac disease C. Crohn’s disease D. Ulcerative colitis
  • 86 DNB DEC-2007 176. Mononeuritis multiplex is caused by: A. Leprosy B. DM C. GBS D. Syphilis Mononeuropathy multiplex Multifocal neuropathy – Simultaneous or sequential involvement of noncontiguous nerve trunks. – Might aftect only half a digit and spread gradually Medicine Common causes are – Diabetes mellitus – Leprosy – Polyarteritis nodosa – Rheumatoid arthritis 177. True about Kartagener’s syndrome: A. Azoospermia B. Situs inversus C. Ethmoidal polyp D. Ciliary dyskinesia Kartagener’s syndrome • Bronchiectasis • Sinusitis • Situs invertus • Young syndrome • Azospermia • Bronchiectasis • Yellow nail syndrome • Lymphedema • Pleural effusion • Yellow nails. • Chandra-Khetarpal syndrome • Levocardia • Sinusitis • Bronchiectasis • No ciliary dysfunction
  • Medicine 87 178. Bone marrow biopsy is indicated in: A. Idiopathic myelofibrosis B. CML C. AML D. Hodgkins 179. True about gastrinoma A/E: A. Peptic ulcer B. Islet cell tumor C. Basal acid output D. Stomatitis Gastrinoma. Zollinger-Ellison syndrome Mc site-duodenum>pancreas Mc symptom-pain 2 nd Mc -Diarrhea 3 rd – GERD – Ulcers beyond duodenal bulb – Ulcers refactory to treatment – Ulcers are recurrent – Ulcers with frank complications Provocative test – Secretin stimulation test – Calcium infusion test – Standard meal test Medicine Myelofibrosis – Bone marrow fibrosis – Extramedullary haematopoiesis – Leucoerythroblastosis – >50 yr age – Massive spleen – Tear drop poikilocytes – Giant platelets – White cell count high – Urate levels high – Aspiration is difficult – Trephine biopsy needed – Hydroxyurea is given – Splenectomy – Bone marrow transplantation
  • 88 DNB DEC-2007 Medicine 180. Investigation of choice of infectious mononucleosis: A. Paul-Bunnell test B. ESR C. Peripheral smear D. Clinically Infectious mononucleosis. Gandular fever Kissing disease – Cause by EBV – > 20% lymphocytes are atypical – Heterophil antibody – Paul-Bunnel test positive – Complication-Chronic fatigue Syndrome Myalgia encephalitis – Most common cause of death – Splenic rupture – Hypersplenism – Encephalitis 181. Figure of eight is seen in X-ray of: A. TGA B. TAPVC C. TOF D. Tricuspid atresia X. ray appearance Coren Sabot Snow man Egg on side Erosion of rib Lower morgin Rt sided aortic arch Figure of 3 appearance TOF TAPVC TGA COA Truncus arteriosus COA.
  • Anatomy 89 Anatomy 182. Boundaries of Epiploic foramen A/E: A. Inferior vena cava B. Quadrate lobe of liver C. First part of duodenum D. Free margin of lesser omentum B. D. Chaurasia Volume – 2 Ch - 18 Boundaries: Anterior - right free margin of lesser amnetum Posterior - IVC right suprarenal T12 Superior - Caudate process of liver Inferior - Peritoneum over first part of Duodenum 183. Haustra is seen in: A. Sigmoid colon B. Ileum C. Rectum D. Appendix B. D. Chaurasia Volume – 2 Ch - 20 Colon: Due to muscle tone in Teniae coli sacculations appear in colon called Haustra. Shortest part of colon is assending colon. On the surface of colon fat filled tags are scattered called Appendices epiploicae. Main function of colon is conservation of fluid. Anatomy Lesser sac communicates through epiploic foramen with the greater sac
  • 90 DNB DEC-2007 Outer longitudinal muscle layer in colon is incomplete and they are condensed into a three longitudinal bands called tenial coli. These tenial coli are most prominent on calcum and ascending colon. 184. Ejaculatory duct opens into: A. Prostatic urethra B. Membranous urethra C. Urinary bladder D. Seminal vesicles Anatomy B. D. Chaurasia Volume – 2 Ch - 30 Posterior wall of prostatic urethra • Urethral crest (verumontanum) • Colliculus seminalis • Prostatic utricle opens into the urethra • Openings of ejaculatory ducts • Openings of prostatic glands 185. Uvula vesicae is formed by: A. Median lope of prostate B. Anterior lobe C. Posterior lobe D. Lateral lobe B. D. Chaurasia Volume – 2 Ch - 30 Interior of the Bladder In an empty bladder the greater part of the mucosa shows irregular folds due to it’s loose attachments to the muscular coat the mucosa is smooth at trigone due to its firm attachment to the muscular coat The internal urethral orifice is located at the trigone. A slight elevation on the trigone immediately posterior to urethral orifice (produced by median lobs of the prostate) is called uvula vesisure The base of the trigone is formed by the interureteric ridge (bar of Mercier) produced by the continuation of the inner longitudinal muscle coats of the two ureters .
  • Anatomy 91 The ridge extends beyond the ureteric openings as the ureteric folds over the interstitial parts of ureters. 186. Muscles supplied by mandibular nerve are all except: A. Tensor tympani B. Tensor veli palatini C. Digastric D. Mylohyoid Tensor tympani — Mandibular nerve Tensor veli palatini — Mandibular nerve Digastric Anterior belly — Inferior alveolar nerve Posterior belly — Facial nerve Mylohyoid — Inferior alveolar nerve Prolapse of Rectum A. Incomplete or mucosal prolapse-due to imperfect support of rectal mucosa by the submucosa B. Complete prolapse or procidentia whole thickness of rectal wall protrudes through anus. Due to 1. laxity of pelvic floor 2. excessively deep rectovesical or rectouterine pouch 3. inadequate fixation of the rectum in it’s presacral bed. Puborectalis is a part of pelvic floor so the answer here Anatomy 187. Muscle responsible for rectal continence: A. Puborectalis B. Internal Anal sphincter C. External Anal sphincter D. Longitudnal muscle BD Chaurasia Volume – 2 Ch – 32 Supports of Rectum 1. Pelvic floor 2. Fascia of waldeyer 3. Lateral ligament of rectum 4. Rectovesical fascia of Denonvilliers 5. Pelvic peritoneum
  • 92 DNB DEC-2007 Anatomy 188. Tail of pancreas is enclosed in: A. Lienorenal ligament B. Gastrosplenic ligament C. Phrenicolic ligament D. Greater fold BD Chaurasia Volume – 2 Ch - 23 Tail of pancreas: This is the narrow left end of the pancreas. It lies in the lienorenal ligament together with the splenic vessels. It comes into contact with the lower part of the gastric surface of the spleen. The spleen is surrounded by peritoneum and is suspended by following ligaments 1. The gastrosplenic ligament-from hilum of the spleen to greater curvature of stomach contains short gastric vessels and associated lymphatics and sympathetic nerves 2. Lienorenal ligament:- from hilum of spleen to anterior surface of left kidney contains tail of pancreas, splenic vessels and associated lymph nodes, lymphatics and sympathetic nerves. 3. Phrenicolic ligament: not attached to spleen but supports the anterior end. It is horizontal fold of peritoneum extending from splenic flexure of the colon to the diaphragm opposite the 11th rib in midaxillary line. It limits the upper end of paracolic gutter. 189. Lateral cutaneous nerve of the thigh is a branch of: A. Lumbar plexus B. Sacral plexus C. Schiatic nerve D. Coccygeal plexus BD Chaurasia Volume – 2 Ch – 27 Branches of lumbar plexus A. Iliohypogastric nerve (L1) B. Ilioinguinal nerve (L1)
  • Anatomy 93 C. Genitofemoral nerve (L1, L2 ventral divisions) D. The lateral cuataneous nerve of thigh (L2, 3 dorsal divisions) E. The femoral nerve (L2,3,4 dorsal divisions) F. The obturator nerve (L2,3,4 ventral divisions) G. Lumbosacral trunk (L4,5 ventral rami) 190. Root value of inferior gluteal nerve is: A. L5, S1, S2 B. L5 S1 C. L5 S1 D L3 L4 191. Nerve which takes turn around other nerve nuclei and has the longest intracranial course: A. Abducent nerve B. Trochlear nerve C. Facial nerve D. Oculomotor nerve B. D. Chaurasia Volume – 2 Ch - 5 192. Drooping of shoulder is due to lesion of: A. Dorsal scapular nerve B. Nerve to serratus posterior C. Nerve to lattisimus dorsi D. Long thoracic nerve Anatomy Important nerves of gluteal region Inferior gluteal nerve - Gluteus maximus (L5 S, S2) Superior gluteal nerve - Gluteus medius (L5 S S1) Gluteus minimus Tensor fascial latac Ventral rami S1 S2 - Piriformis Nerve to obturator - Gemellus superior (L5 S1) obturator internus Nerve to quadrates - Gemellus inferior Femoris (L5S1) Nerve to quadrates - Quadratus femoris Femoris (L5S1) Posterior division of - obturator externus Obturator nerve (L3L4)
  • 94 DNB DEC-2007 Anatomy 193. During thyroidectomy superior thyroid artery is lied: A. As close as possible B. As far as possible C. Depends on surgeon’s choice D. Depends on different cases BD Chaurasia Volume – 3 Ch – 3 During operation the superior thyroid artery is ligated near the gland to save the external laryngeal nerve and the interior thyroid artery is ligated away from the gland to save the recurrent laryngeal nerve. Arterial Supply of thyroid gland 1. Superior thyroid artery first anterior branch of thyroid artery 2. Inferior thyroid artery Branch of of thyrocervical trank 3. Thyroidea ima artery from Brachiocephalic trunk or from arch of aorta Venous drainage of thyroid gland. 1. Superior thyroid vein ends in internal jugular vein 2. Middle thyroid vein ends in internal jugular vein 3. Inferior thyroid vein ends in brachiocephalic vein 4. Thyroid vein of kocher 194. Great cardiac vein is seen in: A. Anterior I/V groove B. Posterior I/V groove C. A/V groove on the right side D. Post surface of left atrium BD Chaurasia Volume – 1 Ch - 18 Great cardiac vein - Anterior I/V groove Middle cardiac vein - Post I/V groove Small cardiac vein - A/V groove on the right side Post vein of left ventricle - Post surface of left ventricle Oblique vein left ventricle - Post surface of left atrium
  • Anatomy 95 195. Left coronary artery supplies all except: A. SA node B. Left ventricle C. Apex of heart D. Posterior part of interventricular septum BD Chaurasia Volume – 1 Ch - 18 Area of Distribution 196. Maxillary carcinoma drains to: A. Retropharyngeal lymph nodes B. Juglo diagastric lymph nodes C. Submandibular lymph nodes D. Deep cervical lymph nodes 197. All are branches from posterior cord of Brachial plexus except: A. Ulnar nerve B. Radial nerve C. Axillary nerve D. Thoracodorsal nerve BD Chaurasia Volume – 1 Ch – 4 Anatomy Right coronary artery Left coronary artery Right atrium Left atrium Right ventricle except area Left ventricle except area adjoining anterior interadjoining post IVG ventricular groove Small part of left ventricle Area adjoining anterior adjoining post intervenIVG tricular groove Post part of interventricular Anterior part of septum septum Whole of conducting system A part of left branch of of heart except a part of left AV bundle branch of AV bundle SA node is supplied by LCA in 40 percent of cases
  • 96 DNB DEC-2007 Branches from posterior cord: Upper subscapular nerve Thoracodorsal nerve Lower subscapular nerve Axillary nerve Radial nerve Anatomy Branches from Lateral cord 1. Lateral pectoral 2. Musculocutaneous 3. Lateral root of median nerve Branches from medial cord 1. Medial pectoral 2. Medial cutaneous nerve of arm 3. Medial cutaneous nerve of forearm 4. Ulnar 5. Medial root of Median nerve. 198. Fibrous joints are all except: A. Sutures B. Syndesmosis C. Gomphosis D. Symphysis Classification of joints A. Fibrous joints a. Sutures – Skull b. Syndesmosis – Inferior tibiofibular joint c. Gomphosis – Tooth in its sockets B. Cartilaginous joints a. Primary cartilaginous (synchondrosis) – Jt between epiphysis and diaphysis – Spheno-occipital jt – 1st chondrosternal jt – Costochondral jt b. Secondary cartilaginous (symphyses) – symphysis pubis – Manubriosternal jt – intervertebral jt
  • Anatomy 97 Synovial joints a. Plane b. c. d. e. f. – Intercarpal and intertarsal articular process of vertebra Elbow Hinge – Ankle interphalangeal Pivot (Trochoid) – Sup 2 inf radioulnar jt Median altantoaxial jt Condylar – Knee jt Rt and left jaw jt Ellipsoid – Wrist jt Metacarpophalangal jt Atlanto-occipital jt Saddle (Sellar) – 1st Carpometacarpal jt Sternoclavicular jt Calcaneocuboid jt 199. Lower part of anal canal drains to: A. Superficial inguinal lymph nodes B. Deep inguinal lymph nodes C. External iliac group D. Internal iliac group BD Chaurasia Volume – 2 Ch – 33 Anal Canal Arterial Supply: Part above pectinate line – Superior rectal artery Part below pectinate line - Inferior rectal artery Venous Drainage 1. Internal rectal venous plexus (Haemorrhoidal plexus) Drain to superior rectal vein 2. External venous plexus Communicate freely with internal plexus 3. Anal veins: Communicate with internal rectal plexus and with inferior rectal vein Anatomy g. Ball and Socket – Shoulder jt (Splleroid) Hip jt Talocalcaneonavicular jt
  • 98 DNB DEC-2007 Anatomy Lymphatic Drainage Above pectinate line-Internal iliac nodes Below pectinate line-Superficial inguinal nodes 200. Touch sensations are carried by: A. Anterior spinothalamic tract B. Lateral spinothalamic tract C. Pyramidal tract D. Posterior column BD Chaurasia Volume – 1 Ch – 9 1. Anterior spinothalamic - Non discriminative Tract touch Pressure from opposite side 2 Lateral spinothalamic - Pain tract Temprature 3 Anterior spinocerebellar - Unconcious Tract proprioception and exteroception 4 Posterior spinocerebellar - Unconcious Tract - proprioception and Touch and pressure 5 Dorsal column - Concious Kinetic And static proprioception vibration sense 6 Dorso lateral - Pain and temprature Tract 201. Ulnar nerve supplies A/E: A. Plamar interossei B. Dorsal interossei C. Adductor pollicis D. Opponens pollicis Ulnar nerve supplies following muscles 1. Flexor carpi ulnaris 2. Medial half of flexor digitorum profundus. 3. Deep head of flexor pollicis brevis 4. Adductor pollicis
  • Anatomy 5. 6. 7. 8. 9. 10. 11. 99 Palmaris Brevis Abductor Digiti Minimi Flexor Digiti minimi Opponens digiti minimi Third and fourth lumbricals Palmar interossei Dorsal interossei Anatomy
  • 100 DNB DEC-2007 Pathology Pathology 202. Intrinsic and extrinsic coagulation defect are differentiated by: A. Increased PT B. Increased PTT C. D- Dimer D. Platelet count Robbin’s Ch - 4 ↑ Clotting time - both ↑ PT - Ext. coagulation defect ↑ PTT - Int coagulation defect 203. Mc organ effected in graft vs host reaction: A. Bone marrow B. Lung C. Kidney D. Heart Robbin’s Ch – 6 Graft verses host disease – Most common in allogenic bone transplant Acute GVH disease occurs within days to weeks after allogenic bone marrow transplantation – Major manifestations results from • Immune system • Epithelia of skin • Liver • Intestine
  • Pathology 101 204. Caterpillar cells are seen in: A. Acute rheumatic carditis B. Infective endocarditis C. Myocardial Infarction D. Aortics aneurysm Robbin’s Ch - 12 Acute Rheumatic Carditis Aschoff bodies = All three layers – Foci of swollen eosinophilic collagen surrounded by lymphatics (Primary T cells) plasma cells macrophages (Anitchkow, caterpillar) cells with central ovoid nuclei with ribbon like chromatin Serofibrinous pericarditis - Bread and butter appearance – Mac cullen patch - Sub endocardial thickening on post wall of left atrium 206. Fibrinoid necrosis is seen in A/E: A. HT B. DM C. Atherosclerosis D. Wegeners granulomatosis The morphologic consequences of immune complex injury are dominated by acute necrotizing vasculitis, with necrosis of the vessel wall and intense neutrophilic infiltration. The necrotic tissue and deposits of immune complexs, complement and plasma protein produce smudgy eosinophilic deposits that obscure the underlying cellular detail, an appearance called fibrinoid necrosis. 207. PAF are secreted by A/E: A. Eosinophils B. Basophils C. Monocytes D. Platelets Robbin’s Ch - 2 Pathology 205. Which of the following is not bad: A. ↑ HDL B. ↑ LDL C. ↑ Total cholesterol D. ↑ Triglycerides
  • 102 DNB DEC-2007 A variety of cell types, including platelets basophils (and mast cells) neutrophils, monocytes, macrophages and endothelial cells can elaborate PAF in both secreted and cell bound forms. 208. Deficiency of C3 and C3b causes: A. Angioneurotic edema B. Menningiococci C. Pyogenic infections D. Autoimmune disorders Robbin’s Ch - 2 Clinical syndromes associated with genetic deficiencies of complement components Pathology Group i. ii. iii. iv. v. Deficiency C1 inhibitor C1, C2, C4 C3, C3b C5 to C8 C9 Syndrome Angioneurotic edema Autoimmune disease Recurrent pyogenic infections Gram negative bacterias No particular disease 209. DAG acts by: A. Protein kinase A B. Protein kinase C C. Tyosine kinase D. Protein kinase B Gq subset of G protein ↓ Phospholipase ↓ Phosphatidylinositol 4-5 biphosphate (PIP2) ↓ ↓ ↓ Inositol 1,4,5 triphosphate Diacylglycerol (IP3) (DAG) • IP3 goes to cytosol ↓ Release of Ca2+ from cytosol intracellular stores
  • Pathology 103 ↓ Ca calmodulin mediated phosphorylation • DAG – Diffuse laterally through membrane ↓ 9 Protein kinase C • C GMP – Protein kinase G (not G protein mediated) 210. Mc cause of Dissecting Aneurysm: A. Cystic medullary necrosis. B. Fibrinoid necrosis C. Trauma D. Iatrogenic Robbin’s Ch – 12 211. Piecemeal necrosis: A. Chronic viral hepatitis B. Alcoholic hepatitis C. Drug toxicity D. Protein energy malnutrition Viral Hepatitis Acute: • Ballooning degeneration • Bridging necrosis • Kupffer cells hypertrophy hyperplasia • Interface hepatitis Chronic: Interface hepatitis Bridging fibrosis Postnecrotic cirrhosis Robbin’s Ch – 18 Pathology Dissecting Aneurysm – Typically transverse tear – Hematoma spreads along the laminar planes of aorta – Barreled aorta – False channel – Later on false channel may become endothelised Mc cause is medial degeneration – Cystic medial degeneration but neither necrosis nor cysts are present – Inflammation is absent – Frequently accompanies Marfan’s syndrome
  • 104 DNB DEC-2007 Biochemistry 212. A. B. C. D. Gluconeogenesis takes place in: Cytoplasms Mitochondria + cytoplasm Mitochondria Endoplasmic reticulum Biochemistry Cytoplasm - Mitochondria- Glycolysis HMP Shunt Protein synthesis Fatty acid synthesis Part of urea cycle Part of gluconeogenesis Cholesterol synthesis Fatty acid oxidation Krebs cycle Acetyl co-A formation Part of urea cycle Part of gluconeogenesis 213. True about glycoaminoglycans A/E: A. Contains small amount of water in them B. Bound to protein due to ionic charge C. Always carry sulphate group in them D. Present in cartilage, blood vessels and skin 214. Free radical removal in lens is by A/E: A. Vitamin A B. Vitamin B C. Vitamin C D. Catalase
  • Biochemistry 105 215. If excess protein is taken in diet: A. Urine protein excretion B. Urine amino acid excretion C. Protein increase in muscle 216. Starvation: A. Decreases blood glucose B. Increases chloride C. Increases cholesterol D. Increases protein nitrogen in blood Biochemistry
  • 106 DNB DEC-2007 Physiology Physiology 217. Semen acid phosphatase is: A. 50-100 times more than body fluid B. 50-100 times less then body fluid C. 500-1000 times more than body fluid D. 500-1000 times less than body fluid 218. Vomiting centre is present in: A. Medulla B. Pons C. Midbrain D. Cerebellum Ganong Ch – 14 Vomiting:-Starts with salivation and sensation of nausea • Glottis closes • Breath is held in mid inspiration • Vomiting center is present in reticular formation of medulla. • Chemoreceptor trigger zone is located in area postrema, a v shaped band of tissue on lateral walls of fourth ventricle near the abex 219. Hemiballismus is caused by lesion in: A. Caudate nucleus B. Patamen C. Globus pallidus D. Subthalamic nucleus
  • Physiology 107 Basal ganglion Consists of five nuclei i. Caudate nucleus Huntingtons ii. Putamen iii. Globus pallidus - Athethosis iv. Subthalamic nucleus - Hamiballism v. Substantia nigra – Parkinsonim 220. Cardiac cycle true is: A. Aortic value closes after isovolumetric relaxation B. Maximum blood flow in ventricle is due to atrial contraction C. Opening of AV value corresponds S1 Blood flow ml/min = max – liver > kidney ml/100 gm/min = max kidney > heart Oxygen consumption ml/min, max = liver > skeletal muscle ml/100 gm/min, max = heart > kidney 222. Windkessel vessels are: A. Large Arteries B. Veins C. Arterioles D. Capillaries Windkessel vessels: In distal portion of aorta and in large arteries blood velocity is much greater during systole. However the vessels are elastic and forward flow is continuous because of recoil during diastole of the vessel walls that have been stretched during systole. The recoil effect is sometimes called as windkessel effect and vessels as windkessel vessels. Physiology 221. Maximum oxygen consumption is in : A. Brain B. Kidney C. Heart D. Liver
  • 108 DNB DEC-2007 223. Isotonic exercise: A. Marked rise in diastolic blood pressure B. Marked rise in splanchnic circulation C. Tachycardia 224. True about muscle relaxation is A/E: A. Troponin Ca2+ removal B. Ca2+ goes out of sarcoplasmic reticulum C. Loosening of actin and myosin Physiology 225. Most important stimulus for instestinal secretion: A. Gastrin B. Secretin C. Tactile stimulation D. VIP Vasoactive intestinal Polypeptide • Markedly stimulates intestinal secretion of electrolytes and hence water • Relaxation of intestinal smooth muscles • Inhibition of gastric acid secretion • Also found in brain • Increases action of Ach in salivary glands • VIP omas are associated with severe diarrhea. 226. Pienal gland secretes: A. Melatonin B. Estrogen C. Gonadotrophins D. Renin The amphibian pineal gland contains melatonin Its secretion increases during dark period of day 227. Effect of pregnancy on respiration is: A.  Respiratory rate B. Tidal volume C. Respiratory volume D. Total being capacity
  • Physiology 109 228. Volume of air in inspiration and expiration in normal respiration: A. Tidal volume B. Vital capacity C. Residual volume D. Inspiratory capacity Men (L) Vital capacity IRV TV ERV RV Women (L) 3.3 0.5 1 1.2 1.9 0.5 0.7 1.1 Inspiratory capacity Functional reside Capacity Physiology
  • 110 DNB DEC-2007 Pediatrics Pediatrics 229. Alkaline phosphatase is increased in A/E: A. Osteoporosis B. Osteomalacia C. Rickets D. Vit D deficiency 230. Rubella vaccine should be given: A. At least 3 months prior to conception: B. Pregnancy C. At birth D. 6 m prior to concept Rubella Vaccine • RA27/3 • Adverse Reaction – Lymphadenopathy – Arthralgia – Transient skin rash • Contraindications – Pregnancy – Immunosuppression • Age: 12-15 months • Prepubertal girls • At least 3 months prior to pregnancy 231. Gaucher’s disease is associated with increased deposition of: A. Glucocerebrosides B. Sulfatides C. Galactocerebrosides D. Sphingomyelin
  • Pediatrics 111 Tay Sachs disease - gangliosides GM, Gangliosidosis - gangliosides and mucopolysaccharides Gaucher’s disease - glucocerebrosides Sandhoff’s disease - globoside Fabry’s disease - globosides Niemann Pick disease - sphingomyelin Farber’s disease - ceramide Krabbe’s disease - galactocerebrosides Metachromatic leukodystrophy – Sulfatides 232. Supracellular carcinoma in child: A. Craniopharyngioma B. Neuroblastoma C. Wilms tumor D. Renal cell carcinoma 233. Phenylketonuria: A. Ferric chloride test B. Guthries’s test C. Fluormetric assay D. All Above Phenylketonuria – Autosomal recessive – Deficiency of phenylalanine hydroxylase – Phenylalanine is not converted to tyrosive – Accumulates in body – Converted to phenylpyruvic acid phenyl-lactic acid and o-hydroxyphenyl acetic acid – These metabolites are excreted in urine – Irritability, tremors, convulsions hyperkinesis, muscle hypertrophy Pediatrics Mc Brain tumour in child <1 year - Supratentorial 1-10 years - infratentorial >10 yrs - Supratentorial Mc supratentorial - Gliomas (Astrocytoma) Mc infratentorial - Astrocytoma Mc Astrocytoma - Javenile pilocytic astrocytoma Mc Cerebral palsy - Spastic
  • 112 – – – – – – – – DNB DEC-2007 Blond hair, blue iris, fair skin Skin rash, eczema Musty body odor. Guthrie’s test 10% ferric chloride test 2-4 dinitrophenylhydrazine Fluorometric assay. Phenylalanine should be restricted in diet Pediatrics 234. Duschene muscular dystrophy: A. X linked recessive B. Autosomal dominant C. Autosomal recessive D. X linked dominant Duschene muscular dystrophy: – Defect in protein Dystrophin – X-linked recessive – 2-5 years – Involves pelvic girdle – Pseudohypertrophy of calf muscles – Gower’s sign positive – Intelligence is usually subnormal – Mc cause of Death-pulmonary insufficiency and respiratory infections 235. Neuroblastoma: A. Resolves spontaneously B. Arises from parasympathetic C. Adrenal medulla D. More common in adults Neuroblastoma: – Mc malignant tumor of infancy – Some cases are Autosomal Dominant – Arises from primitive neuroblast – Mc site-adrenal, sympathetic chain retroperitoneal area. Posterior mediastinum or cervical area. – Stippled calcification is quite common – Urinary catecholamines and their breakdown products VMA/HVA are increased – Amplification of N-myc oncogene is associated with poor prognosis.
  • Orthopedics 113 Orthopedics 236. Herbedens nodes are seen in: A. Osteoarthritis B. Rheumatoid arthritis C. Infective arthritis D. Reactive arthritis J Maheshwari Ch – 35 237. True about fracture clavicle is A/E: A. Mc site is outer 1/3 and middle 1/3 B. Never compound C. Commonly goes for malunion D. Shoulder splica is treatment of choice J Maheshwari Ch – 13 Orthopedics Osteoarthritis – Wear and tear of joints as one ages – Mainly in weight bearing joints – Frequently bilaterally – Knee joint is Mc involved in India – Pain is earliest symptom – Coarse crepitus may be present – Swelling is a late feature – Locking results from loose bodies and frayed menisci Radiological features – Narrowing of jt space – Subchondral sclerosis – Subchondral cysts – Osteophyte formation – Loose bodies – Deformity of joint
  • 114 DNB DEC-2007 Fracture clavicle – Clavis means key – First bone to ossify – Has two primary centres – It’s only long membranous bone – Mc bone to be fractured in children – Mc bone to be fractured in birth trauma followed by humerus Orthopedics Mechanism of injury Direct injury-91% Indirect injury-1% Mc site of fractureJunction of middle 1/3 and lateral 1/3 x ray-Lardotic view Treatment:Figure of eight bandage Sabre method Billigton yoke method 238. Tripple Arthrodesis: A. Talonavicular + Calcaneocuboidal + Talocalcaneum B. Talocuboidal + Calcaeonavicular + Talocuboidal C. Talofibula +Calcaneocuboid + Calcaneonavicular D. Talonavicular + Calcaneonavicular + Talocalcaneum J Maheshwari Ch – 27 Triple arthrode’s Given for the treatment of CTEV Fusion of – Subtalar joint – Calcaneocuboid – Talonavicular Performed after 12 yr of age of these Talonavicular jt fusion is most difficult to achieve
  • ENT 115 ENT 1. Pars tensa – Forms most of it – periphery is thickened to form a fibro cartilaginous ring called annulus tympanicus – Central part of pars tensa is tented in wards at the level of tip of malleus and is called umbo 2. Pars flaccida (Shrapnel’s membrane) Present above mallial folds Layers: 1. Outer epithelial layer 2. Inner mucosal layer 3. Middle fibrous layer ENT 239. Length of Tympanic membrane: A. 10 mm B. 9 mm C. 8 mm D. 7 mm P. L. Dhingra Ch – 1 Tympanic membrane or the Drumhead – Forms partition between the external acoustic canal and middle ear – It is obliquely set and as a result it’s posterosuperior part is more lateral than it’s antero inferior part – 10 mm tall – 8-9 mm wide – 0.1 mm thick – It has two parts
  • 116 DNB DEC-2007 240. Difference in pressure across Eustachian tube which produces symptoms: 241. Dundas grant tube is used for: A. Cold air caloric test B. Fizgeral Hallipike test C. Modified kobrak test D. Optokinetic test ENT P. L. Dhingra Ch – 8 Laboratory tests of vestibular function 1. Caloric test a. Modified kobrak test b. Fitzgerald-Hallpike test (Bithermal caloric test) Cold water induces nystagmus to opposite side, warm water to same side (cows) c. Cold air caloric test 2. Electronystagmography 3. Optokinetic test 4. Rotation test 5. Galvanic test 6. Posturography
  • Miscellaneous 117 Miscellaneous 243. Mees line is seen in: A. Lead B. Mercury C. Arsenic D. Zinc Arsenic poisoning a. Rain drop b. Riger mortic is increased c. Neuropathy d. Cholera like diarrhea e. Enhanced keratosis f. Mee’s line Miscellaneous 242. Investigation of choice for osteoid osteoma: A. CT scan B. Biopsy C. Bone scan D. X-ray J Maheshwari Ch – 30 Osteoid Osteoma: • Commenest true benign tumour of bone. • nidus of tangled array of partially mineralized osteoid trabecular surrounded by dense selerotic bone • 5-25 yrs • Mc in tibia Most of the cases are conformed on X-ray. In some cases where nidus is not seen CT scan or tomogram can be used.
  • 118 DNB DEC-2007 g. Delayed decomposition h. Red velvety stomach i. Petechial hemorrhage in the endocardium of Lt. ventricle • Odourless, tasteless substance – Used in pan – Diagnosed by ferric chloride test – Rx dimercaprol – Hemodyalises Miscellaneous 244. Non Benzodiazepine hypnotic: A. Zolpidom B. Diazepam C. Onazepam D. Clobazam KD Tripathi Ch – 26 Benzodiazepines: Hypnotic Diazepam Flurazepam Nitrazepam Flunitrazepam Temazepam Triazolam Midazolam Antianxiety Anticonvulsants Diazepam Chlordiazepoxide Oxazepam Lorzepam Alprazolam Diazepam Clonazepam Clobazam. Non Benzodiazepine hypnotics – Zolpidem – w1 subtype of BZD receptor – Zopiclone – Agonist at GABAA receptor
  • Miscellaneous 119 245. High risk carrier means: A. Hbe +ve B. Transmitted by large amount of blood C. Transmitted by even small amount of blood D. Is highly infectious. Carriers are of two categories, the highly infectious super carriers and the simple carriers. The former have high titre HBsAg, along with HBeAg, DNA polymerase and HBV in circulation and generally elevated transaminases anathanarayan. 247. Primary TB is seen in A/E: A. Lymph nodes B. Illeum C. Conjuctivitis D. Lung The primary lesion may enlarge and cause miliary, meningeal or other forms of disseminated tuberculosis. – Ananthanarayan Gastrointestinal tuberculosis Pathogenic mechanism involved are: • Direct seading by swallowing of sputum (secondary) • Spread by milk is very rare (primary) – Harrison Miscellaneous 246. Painful occular nerve paralysis is seen in: A. Cavernous sinus thrombosis B. Aneurysmal rupture C. Rhabdomyosarcoma D. Carotid covernous fistula K Basak Ch - 20 Cavernous sinus thrombosis • Violent onset • Severe pain along ophthalmic division of fifth nerve • Proptosis, congestion, edema • Lateral rectus is first muscle to get involved • Papilloedema and visual loss
  • Miscellaneous 120 DNB DEC-2007 248. All are G-Protein mediated except: A. α - adrenegic receptor B. Histamine C. Insulin D. Vasopressin G-protein mediated receptors. Hormones acting through this receptor – α-adrenergic receptor subtype – Histamine – H1 – Muscarinic – M1 M3 – 5HT2 – Vasopressin – Oxytocin – Bradykinin – B2 – Angiotensin – Prostaglandin – FP, EP, EP3 – Thromboxane–TP – Leukotriene – Cholecystokinin – Gastrin – PAF Insulin is tyrosine kinase mediated. 249. Investigation of choice for best disease: A. Electroretinogram B. B-Scan C. Direct ophthalmoscopy D. Indirect ophthalmoscopy Juvenile best disease (vitelliform dystrophy) is a rare condition which evolves gradualy through five stages. Inheritence is AD with variable penetrance and expressitivity with the gene locus on 11 q 13. Multifocal best disease is very unusual and may occur without a family history. Electroretinogram can be used to identify the problem. Effects 3–15 yrs of age. The EOG is the most diagnostic test to identify macular degeneration.
  • Miscellaneous 121 250.Keratoderma blenorrhagica is associated with: A. Reactive Arthritis B. Glucagonoma C. Behcets disease The skin lesions of keratoderma blenorrhagica is mainly associated with venereally acquired reactive arthritis. –Harrisons 252. Complete destruction of nasal septum is seen in: A. Leprosy B. Wegener’s granulomatosis C. Atrophic rhinitis D. Tuberculosis PL Dhingra Ch – 27 Pathological perforation of Nasal septum a. Septal abscess b. Nasal myiasis c. Rhinolith d. Lupus e. TB cartilaginous part f. Leprosy g. Syphilis-Bony part h. Wegener’s granuloma- total Miscellaneous 251. Ankylosing spondylitis is associated with: A. HLA B-27 B. HLA DR 4 C. HLA DR – 3 D. All of above Robbins Ch - 6 Association of HLA with disease Ankylosing spondylitis HLA B 27 Postgonococcal arthritis HLA B 27 Acute anterior uveitis HLA B 27 Rheumatoid arthritis HLA DR4 Chronic active hepatitis HLA DR3 Primary Sjogren syndrome HLA DR3 Type-1 Diabetes HLA DR 3 HLA DR 4 HLA DR 3/DR 4
  • 122 DNB DEC-2007 253. Final product of purine in non primates: A. Allantoin B. Xanthine C. Urea D. Uric acid Uric acid is converted to Allantoin in non primates. Rasbery-case–recombinant enzyme is used to oxidise uric acid to allantoin in cases of hyperuricemia. Miscellaneous 254. Alexia is inability to: A. Write B. Speak C. Remember names D. Read Inability to Write Speak Remember names Read – Harrisons – – – – Agraphia Aphasia Anomia Alexia 255. Boiled lobster syndrome is seen in: A. Boric acid B. Oxalic acid C. Sulphuric acid D. Hydrochloric acid 256. Treatment of choice for congenital hydrocele is: A. Herniotomy B. Herniorraphy C. Excision of cyst D. Conservative S Das Ch - 18 Congenital Hydrocele • Processus vaginalis remains patent so there is direct communication of the tunica vaginalis and peritoneal cavity • Present since birth
  • Miscellaneous 123 • Disappears on lying down • Not easily reducible • Treatment-Herniotomy 257. Metal fume fever is caused by: A. Zn, Hg, Ag B. Zn, Fe, Ag C. Hg, Cu, Fe D. Any metal Monday fever Zn, Mg, oxide, cadmium. Ag brazing flux 258. Gold Nernst equation is used to measure: A. Equilibrium potential 259. 5% CO2 Causes: A. ↑ Pulmonary hypertension B. Headache C. Bradycardia D. Convulsion Blood saturation of CO2 (Percentage) 0 – 2 No symptoms 4 – 5 Breathing – labored 5 – 10 Alaxia, unconsciousness 10 – 20 Slow respiration, fall on BP coma, loss of reflexes anesthesis – death due to pulmonary edema and hemorrhage Miscellaneous Symptoms: Flu like symptoms Metallic taste Burning sensation of body shock Yellow rash over skin 24-48 recovers in maximum 4 days – Self limiting Treatment – Bed rest – Symptomatic – Milk
  • 124 DNB DEC-2007 20 – 40 – 40 Interferes with total O2 supply dyspnea 80 Immediate unconsciousness, convulsion, death due to asphysia from deficiency of O2 supply to brain and tissues (carebral hypoxia). 260. Renal absorption and secretion is measured by: A. Na+ B. Urea C. Creatinine D. Uric acid Table 38-5 from Ganong Miscellaneous Reabsorbed Na+ K+ 56 Urea Creatinine Uric acid Glucose Secreted 25,850 502 460 1 49 800 – – 1 4 – 261. All can cause urinary tract infection except: A. Staphylococcus B. E. coli C. Candida D. Klebsiella Causes of UTI – E coli - MC – Klebsiella – Enterobacter – Proteus – Pseudomonas – Candida – Enterococcus 262. Multinuclear neurotrophils are not seen in: – Iron deficiency anaemia – Vit. B12 deficiency anaemia
  • Miscellaneous 125 263. Causes of Non neuronal urinary bladder paralysis: A. Myelodysplasia B. Multiple sclerosis C. Stroke D. Spinal injury Neurogenic Bladder Dysfunction: – Spinal cord paralysis – Tabes dorsalis – Multiple sclerosis – Diabetes – Other diseases – Harrisons 265. Scurvy low A/E: A. Defective collagen synthesis B. Decreased collagen production C. Decreased mineralisation of bone D. Decreased bone matrix Robbins: Primary disturbance in scurvy is in the formation of osteoid matrix. Rather than in mineralization or calcification which occurs in rickets. 266. Occular parasites are A/E: A. T. solium B. On chocerca C. Giardia D. Toxoplasma Occular parasites: Toxoplasmosis Toxocariasis Onchocerciasis Neurocysticercosis Miscellaneous 264. Urinary bladder: A. Detrusor is supplied by sympathetic innervation B. Total transsection of cervical cord causes incontenence C. External urethral spinctor contracts on bladder filling
  • 126 DNB DEC-2007 267. Bilateral tubal block with hydrosalphinic: A. Tuboplasty B. IVF C. GIFT Discussed with SR Gynae 268. Analgesia system of brain includes: A. Red nucleus B. Hippocampus C. Insular cortex Miscellaneous Pain activates cortical area S1S2 and cingulate gyrus on apposite side in addition to mediofrontal cortex, insular cortex and cerebellum cortex. Lesions of insular cortex causes analgesia – Gangong 269. Poison used for removing hair and bleeching: A. Calotropis B. Arcus precatoris C. Sulphur compounds D. Hydrochloric acid Various sites on internet. 270. Nobel prize for medicine 2007 was given for: A. Genetic therapy B. HIV treatment C. Genetic mapping D. Gene targeting in mice Various sites on internet. 271. True about Sjögren syndrome A/E: A. Keratoconjuctivitis sicca B. Xerostomia C. Xeroderma D. Enlargement of glands Sjögren syndrome (primary): Autoimmune disease Dry eye and mouth Involves both lacrimal and salivary glands
  • Miscellaneous 127 Sjögren syndrome (secondary) associated with connective tissue disorder eg-sero positive rheumatoid arthritis SLE Systemic sclerosis Polymyositis 272. Hypotonia is seen in: A. Chromosome 4 deletion B. Transient hyperamonimea C. Trisomy 13 273. Pseudorossets is seen in: A. Astrocytoma B. Oligodendroma C. Meningeoma D. Melanoma Eary development of handedness is a sign of cerebral palsy. 275. Urethral development in males is by A. Testosterone B. Oestrogen C. HCG D. LH Ganong: The testosterone metabolite dihydrotestosterone induces the formation of male external genitalia and male secondary sexual characters. 276. In gestational diabetes quick and easy test for glucose estimation: A. Fasting B. Post prandial C. Glucose tolerance D. Random glucose Miscellaneous 274. Handedness develops at: A. 18 months B. 12 months C. 24 months D. 48 months
  • 128 DNB DEC-2007 Gestational Diabetes: Screening method employed is by using 50 gm of oral glucose tolerance test without regard to time of day or last meal between 24-28 wks of pregnancy. 277. In gestational diabetes insulin is needed if fasting glucose is: A. > 120 B. > 126 C. > 105 D. > 140 Miscellaneous Human insulin should be started if fasting glucose is > 105 mg/dl and 2 hrs post prandial value is > 130 mg/dl even on diet control. 278. Swallowing and respiration in fetus develops at: A. 12 weeks of gestation B. 30 weeks C. 34 weeks D. After birth • 12 weeks – swallowing and respiration • 30 weeks – suckling • 34 weeks – synchronization 279. Perioral rash with hyperpigmented palmar crease is seen in deficiency of: A. Biotin B. Zinc C. Copper D. Cyanocobalmine 280. Child with persistant vaginal discharge: A. Ectopic ureter B. Tuberculosis C. Foreign body 281. Bovine graft: A. Xeno graft B. Allo graft C. Auto graft D. Bovi graft
  • Miscellaneous 129 282. X-ray abdomen not seen is: A. Liver B. Spleen C. Pancreas D. Kidney 283. True about Amyloid is A/E: A. Osteomyelitis B. Osteoarthritis C. AlZ disease D. Reccurent arthritis 284. Papiloma virus causing Ca. cervix: A. HPV - 18, 16 B. HPV – 6, 11 C. HPV – 1, 2 D. HPV – 3, 4 HPV virus Type 1,2,3,4 Type 6,11 Type 6,11 16,18,31,33,45 285. Fetus with pH > 7.25: A. Normal B. Acidic C. Basic The normal fetal scalp blood pH ranges between 7.25 to 7.35 286. Brown’s sign: A. Glomus tumour B. Meinear’s disease C. ASOM D. Tympanic membrane perforation PL Dhingra Ch – 18 Glomus tumour • Origin from glomus bodies • Common benign neoplasm Miscellaneous Disease Verruca vulgaris Condyloma accuminata Cervical intraepithelial neoplasia Cervical cancer
  • 130 DNB DEC-2007 • • • • Female 40-50 yrs Benign, nonencapsulated extremely vascular Slow growing Rising sun appearance – tumour arising from floor of middle ear • Brown’s sign (Pulsation sign) – tumour pulsates vigorously when pressure is raised with siegel’s speculum Miscellaneous 287. Fluctuating hearing loss: A. Meinear’s disease B. ASOM C. CSOM D. Glomus tumour Meniere’s Disease • Endolymphatic hydrops • Vertigo • Tullio’s phenomenon – noise produce vertigo • fluctuating hearing loss • Displacusis • Intolerance to loud sounds • Roaring type tinnitus • Sense of fullness PL Dhingra Ch – 16 288. Glycosylated RBC - for monitoring of glucose over: A. 2 months B. 3 months C. 6 months D. 1 year Glycated Haemoglobin – Measure of glycaemic control – Over a period of wks to months – Not for diagnosis – Rise of 1% Hb Ac corresponds to an approximate average increase of 2 mmol/l in blood glucose – Usually measured once or twice yearly to assess glycaemic control
  • Miscellaneous – – 131 Glycate serum proteins can also be measured (fructosamine) Indicate glycaemic control over 2 wks 289. B wave in Electro-occulography is due to: Davidson’s Ch - 15 290. Interstitial fluid pressure lies between: A. – 2 to + 6 B. – 10 to – 6 C. + 2 to + 6 D. + 20 to + 6 291. Hemoglobinoria is seen in A/E: A. RH immune compatibility B. Dapsone + G6PD deficiency C. Cardiac valvular disease 292. Complications of acute pancreatitis A/E: A. Pleural effusion B. Pancreatic necrosis C. Gallstone D. Hyperglycemia Complications of acute pancreatitis Local – Necrosis – Abscess – Pseudocyst – Ascites – Bowel infarction – Obstructive jaundice Systemic – Pleural effusion, atelectasis – Hypotension hypovolemia Miscellaneous The interstitial fluid pressure varies from one organ to another and there is considerable evidence that it is subatmospheric (about –2 mmHg) in subcutaneous tissue. It is positive in liver and kidney and is as high as 6 mmHg in the brain.
  • 132 – – – – – – – – DNB DEC-2007 DIC Peptic ulcer, erosive gastritis Renal failure Hyperglycemia Hypertriglyceridemia Psychosis Fat embolism Fat necrosis Miscellaneous 293. Reccurent alveolar and perialveolar abscess is seen in: A. TB mastitis B. Paget’s disease C. Lobular carcinoma D. Periductal mastitis Periductal Mastitis Known by variety of names: – Reccurent subalveolar abscess – Squamous metaplasia of lactiferous ducts – Zuska disease – May be seen in men – Painful erythematous subareolar mass – More than 90% of patients are smoker – In recurrent cases, a fistula tract often tunnels under the smooth muscle of the nipple and opens onto the skin at the edge of areola – Treatment includes removing the involved duct and fistula tract in continuity which in most cases is curative – Antibiotics are given against bacterias 294. Carcinoid tumour arises from: A. Kulchitzsky cells B. Smooth muscle cells C. Glandular cells D. All of above Carcinoid tumours (argentaffinoma) is the Mc neoplasm of appendix Arises from argentaffin tissue (Kulchitzsky cells of crypts of Lieberkühn)
  • Miscellaneous 133 Answers: C B B C A D D B A C A B A C A C A A C A A A D A A A D A D B C B D A A C A 2. 6. 10. 14. 18. 22. 26. 30. 34. 38. 42. 46. 50. 54. 58. 62. 66. 70. 74. 78. 82. 86. 90. 94. 98. 102. 106. 110. 114. 118. 122. 126. 130. 134. 138. 142. 146. D A D A A B D B B C C A C D B B D A A A B A A A B C A A D B B C B B A A D 3. 7. 11. 15. 19. 23. 27. 31. 35. 39. 43. 47. 51. 55. 59. 63. 67. 71. 75. 79. 83. 87. 91. 95. 99. 103. 107. 111. 115. 119. 123. 127. 131. 135. 139. 143. 147. C C A B A B C B B B B A C A A D C B A A A B B A C D A B D A B A C B D B A 4. 8. 12. 16. 20. 24. 28. 32. 36. 40. 44. 48. 52. 56. 60. 64. 68. 72. 76. 80. 84. 88. 92. 96. 100. 104. 108. 112. 116. 120. 124. 128. 132. 136. 140. 144. 148. C A A B B C D D C D ? C A A A B B A A A D A A A A C D A B D B A A A C B A Miscellaneous 1. 5. 9. 13. 17. 21. 25. 29. 33. 37. 41. 45. 49. 53. 57. 61. 65. 69. 73. 77. 81. 85. 89. 93. 97. 101. 105. 109. 113. 117. 121. 125. 129. 133. 137. 141. 145.
  • Miscellaneous 134 149. 153. 157. 161. 165. 169. 173. 177. 181. 185. 189. 193. 197. 201. 205. 209. 213. 217. 221. 225. 229. 233. 237. 241. 245. 249. 253. 257. 261. 265. 269. 273. 277. 281. 285. 289. 293. DNB DEC-2007 A A D D A C A D B A A A A D A B C ? D D A D B A A A A A A C C ? C A A ? D 150. 154. 158. 162. 166. 170. 174. 178. 182. 186. 190. 194. 198. 202. 206. 210. 214. 218. 222. 226. 230. 234. 238. 242. 246. 250. 254. 258. 262. 266. 270. 274. 278. 282. 286. 290. 294. D B A A C C B A B ?? A A D A C A B A A A A A A D A A D A ? C D C A C A A A 151. 155. 159. 163. 167. 171. 175. 179. 183. 187. 191. 195. 199. 203. 207. 211. 215. 219. 223. 227. 231. 235. 239. 243. 247. 251. 255. 259. 263. 267. 271. 275. 279. 283. 287. 291. B A B A A A D D A A ? D A A A A ? D ? B A C A C B A A A A A C A D D A ? 152. 156. 160. 164. 168. 172. 176. 180. 184. 188. 192. 196. 200. 204. 208. 212. 216. 220. 224. 228. 232. 236. 240. 244. 248. 252. 256. 260. 264. 268. 272. 276. 280. 284. 288. 292. C A C A C A B A A A ? ? A A C B ? ? ? A A A ? A C B A D ? C ? C C A B C
  • Anatomy PART II: JUNE-2008 135 Anatomy 1. Deltoid ligament doesn’t attach to: A. Medial Malleolus B. Navicular C. Cuboid D. Lateral Malleolus BD Chaurasia Ch-10 , Vol-2 B. Deep part - anterior tibiotalar Deltoid ligament is crossed by tendons of the tibialis posterior and flexor digitorum 2. Pain along the medial aspect of arm in carcinoma breast is through: A. Radial nerve B. Medial cutaneous nerve of arm C. Ulnar nerve D. Median nerve BD Chaurasia Ch-6, Vol-1 Cutaneous nerve supply of upper limb Arm : Medial side Upper : Intercostobrachial Lower : Medial cutaneous nerve of arm Anatomy Deltoid ligament: Very strong triangular ligament present on medial side of the ankle. A. Superficial part 1. Anterior fibres - Tibionavicular 2. Middle fibres - Tibiocalcaneal 3. Posterior fibres - Posterior tibiotalar
  • 136 DNB JUNE-2008 Lateral Anatomy Posterior Upper : Upper lateral cutaneous nerve of arm Lower : Lower lateral cutaneous nerve of arm Upper : Upper lateral cutaneous nerve of arm Lower : Posterior cutaneous nerve of arm 3. Carpal tunnel syndrome is due to involvement of: A. Ulnar nerve B. Median nerve C. Radial nerve D. Anterior interosseus nerve BD Chaurasia Ch-9, Vol-1 Carpal tunnel syndrome This syndrome consists of sensory and motor symptoms in the hand caused by compression of the median nerve in carpal tunnel. Causes : Arthritis Dislocation of the lunate Tenosynovitis Acromegaly Myxoedema Obesity Toxaemia of pregnancy – Usually in females - 40 to 70 years – Intermittant attacks of pain – Frequent attacks at night – Wasting of thenar muscles
  • Anatomy 137 4. Pudendal nerve is formed from following nerve roots: A. L1L2 B. S2S3 C. S2S3S4 D. L5S1 BD Chaurasia Ch-28, Vol-2 Pudendal Nerve S1 S2 S4 Chief nerve of the perineum and of the external ganglia. Branches: 1. The inferior rectal nerve 2. The perineal nerve 3. The dorsal nerve of the penis Muscles in superficial perineal space – Ischiocavernous – Bulbospongiosus – Superficial transverse perinei Muscles in Deep perineal space – Sphincter urethra – Deep transversus perinei 6. Wrong statement about scalenus anterior is – A. Subclavian artery lies anterior to it B. Subclavian vein lies anterior to it C. Subclavian artery lies posterior to it D. Trunks of brachial plexus lies posteriorly BD Chaurasia Ch-03, Vol-3 • Subclavian vein lies anterior to scalenus anterior • Subclavian artery lies posterior to scalenus anterior • Trunks of brachial plexus lies posteriorly Anatomy 5. Muscles in deep peroneal pouch is A. Bulbospongiosus B. Levator ani C. Sphincter urethral D. Ischiocavernous BD Chaurasia Vol-2, Ch-28
  • 138 DNB JUNE-2008 7. Pelvic Diaphragm consists of: A. Levator ani B. Sphincter urethrae C. Deep transversus perinei D. Bulbospongiosus BD Chaurasia Ch-29, Vol-2 Anatomy The pelvic floor is formed by the pelvic diaphragm which consists of the levator ani and the coccygeus. It resembles a hammock, or a gutter because it slopes from either side towards median plane where it is pierced by urethra and the anal canal and also by the vagina in the female. The pelvic diaphragm separates the perineum from pelvis. 8. Abduction of toes is by: A. Plantar interossei B. Dorsal interossei C. Abductor digiti minimi D. Extensor digitorum BD Chaurasia Ch-10, Vol-2 1. 2. 3. 4. 5. 6. 7. 8. Flexor digitorum brevis–Flexion of toes Abductor hallucis–Abducts the great toe Abductor digiti minimi–Abducts the little toe Flexor digitorum accessorius–straightens the pull of long flexor tendous • Flexes the toes through the long tendons Lumbricals–Extension of the digits at the interphalangeal joints Flexor hallucis brevis–Flexes the proximal phalanx of the big toe Adductor hallucis–Adductor of big toe-Maintains transverse arches of the foot Flexor digiti minimi brevis–Flexes the proximal phalanx of little toe
  • Anatomy 139 9. Fracture of 5th Metatarsal is displaced by pull of: A. Peroneus tertius B. Tibialis anterior C. Peroneus longus D. Peroneus brevis BD Chaurasia Ch-8, Vol-2 – – Peroneus longus-Inserts on the lateral side of the base of the first metatarsal base • The adjoining part of medial cuneiform bone Peroneus brevis –Inserts into the lateral side of the base of fifth metatarsal bone. Structures passing under cover of Extensor Retinaculum 1. The tibialis anterior 2. The extensor hallucis longus 3. The extensor digitorum longus 4. The peroneus tertius 5. Anterior tibial artery 6. Deep peroneal nerve Structure deep to flexor retinaculum 1. The tendon of tibialis posterior 2. The tendon of flexor digitorum longus 3. The posterior tibial artery 4. The tibial nerve 5. Tendons of flexor hallucis longus Anatomy 10. One of the following does not pass under Extensor Retinaculum: A. Tibial artery B. Deep peroneal nerve C. Peroneus tertius D. Tibial nerve BD Chaurasia Ch-8,9, Vol-2
  • 140 DNB JUNE-2008 11. Ophthalmic artery is a branch of: Anatomy A. B. C. D. Cervical part of Internal carotid artery Petrous part of Internal carotid artery Cerebral part of Internal carotid artery Lacrimal artery. BD Chaurasia Ch-12, 6, Vol - 3 Branches of Internal carotid artery Cervical part – No Branch Petrous part – Caroticotympanic – Pterygoid branch Cerebral part – Ophthalmic – Anterior cerebral – Middle cerebral – Posterior communicating – Anterior choroidal 12. Narrowest part of male urethra is: A. External meatus B. Membranous urethra C. Penile urethra D. Prostatic urethra BD Chaurasia Ch-30, Vol-2 Parts of Urethra 1. Prostatic part of Urethra-widest and most dilatable 2. Membranous part of Urethra-Narrow and least dilatable 3. Spongy (Penile) part of Urethra The external urethral orifice is the narrowest part of male urethra.
  • Anatomy 141 13. Sphenoid sinus opens into: A. Sphenoethmoidal recess B. Middle meatus C. Inferior meatus D. Superior meatus BD Chaurasia Ch-15, Vol-3 14. Inferior turbinate is: A. Independent bone B. Part of medial wall of maxilla C. Part of sphenoid D. None of above BD Chaurasia Ch-15, Vol-3 • The inferior concha is an independent bone – The middle concha is a projection from the medial surface of ethmoidal labyrinth • The superior concha is also a projection from the medial surface of the ethmoidal labyrinth. This is the smallest concha situated just above the posterior part of middle concha. Anatomy 1. Inferior meatus– Largest • Nasolacrimal ducts opens here • Guarded by Hasner’s valve 2. Middle meatus– Ethmoidal bulla • Hiatus semilunaris infundibulum • Opening of frontal air sinus – Maxillary air sinus – Middle ethmoidal air sinus 3. Superior meatus– • Shortest and shallowest • Receives opening of posterior ethmoidal air sinus 4. Sphinoethmoidal recess • Triangular fossa • Opening of sphenoidal air sinus
  • 142 DNB JUNE-2008 15. Lateral popliteal nerve cut at the neck of fibula results in: A. Foot drop B. Calf muscle pain C. Loss of Abduction of toes D. Loss of Adduction of toes BD Chaurasia Ch-2, Vol-2 Anatomy • The common peroneal nerve can be rolled against the neck of the fibula this nerve is commonly injured here. • Common peroneal nerve divides into superficial and deep peroneal nerve – All muscles of the anterior compartment of the leg are supplied by the deep peroneal nerve. • All these muscles are dorsiflexors of the foot. • So the answer should be foot drop 16. Quadrangular cartilage of septum is situated at: A. Anteriorly B. Posterosuperior C. Posteroinferior D. No cartilage BD Chaurasia Ch-15, Vol-3 Nasal septum Bony part• Vomer – Perpendicular plate of ethmoid Cartilaginous part – Septal Cartilage (Anteriorly) – Septal processes of the inferior nasal cartilage Cuticular part- fibrofatty tissue covered by the skin
  • Anatomy 143 17. Pudendal canal is between: A. Obturator sheath and pelvic fascia B. Obturator fascia and fascia lunata C. By splitting of obturator fascia D. Varies in individual BD Chaurasia Ch-28, Vol-2 Pudendal Canal – Fascial tunnel in lateral wall of the ischiorectal fossa – Transmits pudendal nerve and the internal pudendal vessels – The canal extends from the lesser sciatic notch to posterior border of perineal membrane – Formed by splitting of fascia lunata – Some consider it to be a space between obturater fascia and lunata fascia Inferior cerebellar peduncle Afferent tracts – Posterior Spinocerebellar – Cuneocerebellar – Olivocerebellar – Parolivocerebellar – Reticulocerebellar – Vestibulocerebellar – Anterior external arcuate fibres – Strial medullares – Trigeminocerebellar Anatomy 18. Inferior cerebellar peduncle contains afferents of all except: A. Olivo cerebellar B. Ponto cerebellar C. Cuneocerebellar D. Vestibulocerebellar BD Chaurasia Ch-27, Vol-3
  • 144 DNB JUNE-2008 Efferent tracts – Cerebellovestibular – Cerebelloolivary – Cerebelloreticular 19. Posterior limb of internal capsule does not contain: A. Optic radiation B. Corticospinal tract C. Thalamocortical tract D. Frontopontine fibres BD Chaurasia Ch-28, Vol-3 Anatomy Posterior limb of Internal capsule Descending tracts – Corticospinal tract – Corticopontine tract – Cortico rubral fibres Ascending tracts Superior thalamic radiation fibres from globus pallidus to subthalamic nucleus 20. Nucleus Ambiguous gives following cranial nerve: A. 9, 10, B. 7, 9, 10 C. 8, 9 D. 7, 9, BD Chaurasia Ch-25, Vol-3 Nucleus Ambiguous – Cranial nerve – Nucleus tractus solitarius – Inferior salivatory nucleus – Superior salivatory nucleus - 9, 10 7, 9, 10 9 7
  • Anatomy 145 21. Edinger westphal nucleus is: A. General somatic efferent B. Somatic efferent C. General visceral efferent D. Special visceral efferent BD Chaurasia Ch-25, Vol-3 General somatic efferent nuclei – C.N. 3, 4, 6, 12 Special visceral efferent – C.N. 5, 7, 9, 10 General visceral efferent – Edinger westphal nucleus – Superior and inferior salivatory nucleus – Lacrimatory nucleus. – Dorsal nuclei of vagus Special somatic afferent nuclei – Cochlear nuclei – Vestibular nuclei 22. Stylomastoid canal contains: A. Glossopharyngeal nerve B. Fascial nerve C. Hypoglossal nerve D. Mandibular nerve BDChaurasia Ch 18, Vol-3 The prominence of the facial canal runs backwards just above the fenestra vestibule to reach the lower margins of the aditus- The canal then descenals behind the posterior wall to end at the stylomastoid foramen. Facial nerve passes through this foramen. Anatomy General somatic afferent Main or superior sensory nucleus spinal nucleus of trigeminal nerve mesencephalic nucleus of 5 nerve
  • 146 DNB JUNE-2008 23. Muscles in anterior compartement of leg are all except: A. Tibialis anterior B. Extensor hallucis longus C. Peroneus longus D. Peroneus tertius BDChaurasia Ch-8, Vol-3 Muscles of leg Anterior compartment 1. Tibialis anterior 2. Extensor hallus longus 3. Extensor digitorum longus 4. Peroneus tertius Lateral side 1. Peroneus longus 2. Peroneus brevis Back of leg 1. Gastrocnemius 2. Soleus 3. Plantaris 24. Ovarian carcinoma drains into: A. Inguinal lymph nodes B. Para aortic lymph nodes C. Iliac lymph nodes D. All the above BD Chaurasia Ch-31, Vol-2 Arterial supply 1. Ovarian artery from abdominal aorta just below renal artery 2. Uterine artery Venous drainage Emerge at the hilus and form a pampiniform plexus around the artery and drain into inferior vena cava. Lymphatics The ascend along the ovarian vessel to drain into lateral aortic and preaortic nodes.
  • Anatomy 147 25. Patella is not displaced laterally due to: A. Large articular surface of patella on lateral side B. Large femoral lateral condyle C. Vastus medialis preventing it D. Both a and c BD Chaurasia Ch-31, Vol-2 • The patella has a natural tendency to dislocate outwards because of the outward angulation between the long axes of the thigh and leg. This is prevented by 1. Bony factor: The lateral edge of the patellar articular surface of the femur is deeper than the medial edge 2. Muscular factor: insertion of the vastus medialis on the medial border of the patella extends to a lower level than that of the vastus lateralis on the lateral border. 26. Following artery is present in Adductor canal: A. Popliteal artery B. Femoral artery C. Tibial artery D. Ovarian artery BD Chaurasia Ch-3, Vol-2 Contents of Adductor canal 1. Femoral artery 2. Femoral vein 3. Saphens nerve 4. Nerve to vastus medialis 5. Two divisions of obturator nerve
  • 148 DNB JUNE-2008 Microbiology 27. TSS is caused by: A. Staphylococcus aureus B. Streptococcus C. Pneumococcus D. Pseudomonas Microbiology R Ananthanarayan Ch-23 Toxins and virulence factors of streptococci – Hemolysin = Streptolysin – Pyrogenic Exotoxin = Erythrogenic = Dick = Scarlatinal toxin – Superantigen – Causes TSS – Used in Dick test – Used in Schultz Charlton Reaction – Type A is MC • Streptokinase • Deoxyribonuclease • Nicotinamide Adenine Dinucleotidase • Hyaluronidase • Serum opacity factor-Lipoproteinase 28. Mad cow disease is due to: A. Virus B. Proteinaceous particles C. Bacteria D. Fungi R Ananthanarayan Ch-60
  • Microbiology 149 Preventive and Social Medicine 149 Disease caused by prions Group A – Visna maedi (Sheep) Group B – Human – Kuru – CJD – Fatal familial insomnia – Gestmann strausster scheinker Animal – Scrapie – Mink encephalopathy – Bovine spongiform encephalopathy (Mad cow disease) Group C – • SSPE • Progressive multifocal leucoencephalopathy. K Park Ch-5 Yellow fever – Flavi virus (Group B arbovirus) – Reservoir - monkey – I.P - 3.6 days – Vaccine - 17 D vaccine (live attenuated) – Immunity - 35 yrs. or life – Spread - Aedes aegypti – Quarantine - 6 days – Validity of certificate from 10 days of vaccination to 10 years. 30. P. falciparum binds to which receptor molecule in brain vascular endothelium: A. I Cam -1 B. VCAM-1 C. PFEMP-1 D. CD 36 Harrison Ch-195, Vol-1 Microbiology 29. Yellow fever is caused by: A. Flavi virus B. Marbola virus C. Calci virus D. Adenovirus
  • 150 DNB JUNE-2008 In P. falciparum infections membrane protuberances appear on the erythrocytes surface towards the end of the first 24 h of the asexual cycle. The “knobs” extrude a high-molecular weight, antigenically variant, strain specific, adhesive protein (P1 EMP1) that mediates attachment to receptors on venular and capillary endothelium an event called cyto adherence several vascular receptors have been identified of which intercellular adhesion molecule 1 is probably the most important in the brain, chondroitin sulfate B in the placenta, and CO 36 in most other organs. Microbiology 31. SARS virus is a: A. Corona virus B. RSV virus C. Adenovirus D. Flavi virus K Park Ch-5 SARS – Severe acute respiratory syndrome – Caused by corona virus – X-ray • Unilateral patchy shadowing • Progresses over 1-2 days • Becomes bilateral and generalised – I.P 2 to 7 days – Treatment - Ribavarin + Steroids. 32. Not an RNA virus: A. Hepatitis A virus B. Hepatitis B virus C. Hepatitis C virus D. Hepatitis E virus Ananthanarayan Ch-59 HAV - Picorna virus I.P 15-45 days Acute onset Feco oral transmission
  • Microbiology 151 Preventive and Social Medicine 151 Excellent prognosis Inactivate vaccine available - Hepadna virus DNA virus I.P - 30-180 d Incidious or acute can be chronic, carrier, carcinogenic Rx – Interferon, Lamivudine, Adefovir HCV - Flavivirus 15-160 days Insidious onset Can be chronic, carrier, carcinogenic Rx - Pegylated interferon Plus ribavirin HDV - Defective virus 90-180 days Incidious acute Occasionally severe Prognosis-Acute-good chronic-poor Rx-Interferon HEV - Calcivirus Alphavirus I.P - 14-60 d. Acute onset Feco oral transmission Not chronic, carrier, carcinogenic prognosis-good. 33. True of brucellosis are all except: A. Direct Coombs test is used B. Zoonosis C. Blood culture is used for diagnosis D. Transmitted by animal product • • • • • • Characteristics of brucella Prozone phenomenon Indirect Coomb test Intracellular Casteneda method used Tbilsi phage Microbiology HBV
  • 152 • • • • DNB JUNE-2008 Undulating fever Rose Bengal test Rapid plate agglutination test Erythritol 34. Typhoid infection in first weak is diagnosed: A. WIDAL B. Blood culture C. Urine culture D. Stool culture Ananthnarayan Ch-32 Microbiology B- Blood culture A- Agglutination(WIDAL) S- Stool culture U- Urine culture - 1st wk 3rd wk 3rd wk 2nd and 3rd wk 35. Cryptococcus in CSF is assessed by: A. India ink preparation B. Periodic acid Schiff C. Latex agglutination D. All of above. Ananthanarayan Ch-63 Cryptococcus neoformans • Only yeast which is pathogenic • Capsule stained by India ink • Cell wall gram positive • Best seen in tissue by methenamine silver • Mc cause of meningitis in AIDS patients • Lesion is MC at basal ganglion • Best seen with MRI • Headache is MC symptom • Indian Ink preparation is method of choice for detection in CSF • Latex agglutination
  • Microbiology 153 Preventive and Social Medicine 153 36. Most common cause of fungal esophagitis is: A. Candida B. Aspergillous C. Histoplasma D. Cryptococcus Ananthanarayan Ch-63 Candida • Mc systemic mycosis • Normally seen in mouth, stool and vagina • Forms pseudohypahe • Reynauds Braude phenomenon [germ tubes] • Chlamydospores (thick walled spores) • Mc risk factor-Diabetes • Mc cause of esophageal fungal infection • Most common site of lesion is distal 1/3 rd. • Man is the only reservoir of infection clinical spectrum. 1. Inapparent infection 2. Abortive polio or minor illness 3. Non paralytic polio 4. Paralytic polio I.P. 7-14 days White square on vaccine bottle changes to blue if bottle is exposed to higher temperature. An epidemic is defined when 2 or more local cases caused by same virus type in any 4 wks period. Microbiology 37. True about polio: A. Man is the only reservoir B. Incubation periods is 3 months C. An epidemic is when a no. of cases occur D. Blue square is present on vaccine bottle K. Park Ch-5
  • 154 DNB JUNE-2008 38. Infant botulinism true A/E: A. Preformed toxin B. Released by bacteria in gut C. Muscle weakness D. Due to honey Ananthanarayan Ch-28 • • • • Microbiology • • • • • Mc form of botulism is infant botulism Caused by Cl. Botulinum I.P-18-36 hr Nausea, Vomiting, Abdominal pain characteristics symmetric descending paralysis Diplopia, dysphagia, ptosis, pupillary reflex decreased Severe constipation No fever, no sensory loss. Infant botulism-Toxin is produced inside GUT. Source of infection is honey. 39. Incubation period of Salmonella typhi is: A. 7-14 days B. > 30 days C. 3-21 days D. 1 days Ananthanarayan Ch-32 Salmonella • Non capsulated and non sporing • Motile with peritrichate flagella • Jet black colonies on Wilson - Blair media • Enrichment media - selenite F, Terathionate broth • needs tryptophan as growth factor • IP 14 days • Step ladder pyrexia with relative bradycardia • Rose spots on chest usually at the end of 1st wk • Treatment First line-Ciprofloxacin, ceftriaxone Second line - Azithromycin • Multi drug resistance is due to R. factor
  • Microbiology 155 Preventive and Social Medicine 155 40. Botulinum toxin is used in: A. Blepharospasm B. Myasthenia gravis C. Polio D. All of the above. Ananthanarayan Ch-28 Botulinum toxin acts on peripheral cholinergic nerve endings including neuromuscular junction, postganglionic parasympathetic nerve endings and peripheral ganglion. CNS is not involve It blocks release of acetylcholine Poisoning does not cause diarrhea 41. Virulence factors for Neisseria gonorrhoea includes all of the following except: A. Outer membrane proteins B. IgA protease C. M protein D. Pilli Ananthanarayan Ch-25 Virulence factors of N. gonorrhoea 1. Outer membrane protein – Pilli – Porin (Protein I and III) – Ig A1 Protease – Opacity associated protein (Protein II) – Lipoprotein H.8 – Transferrin and lactoferrin binding protein 2. Lipooligosaccharide (endotoxin) Microbiology Type A toxin is used for treatment of • Strabismus • Blepharospasm • Cervical dystonia
  • 156 DNB JUNE-2008 Microbiology 42. All are true about listeria except: A. Transmitted by contaminated milk B. Gram (-ve) bacteria C. Causes abortion in pregnancy D. Causes meningitis in neonates Listeria Monocytogenes – Gram positive – Catalase positive, non spore forming – Tumbling motility at 20-25°C – Grows on Muller - hinton agar – Causes abortion in 3 rd trimester – Granulomatosis infantisepticum – Most infants are symptomatic by 2nd day – Late onset disease in neonates mostly presents as meningitis – Antons test-Instillation into rabbits eye causes conjunctivitis – Bacteremia without septic focus is Mc clinical manifestation – Doc –IV. Ampicillin Alternately - cotrimoxazole 43. Drug of choice for chemoprophylaxis of cholera: A. Tetracycline B. Doxycycline C. Furazolidone D. Cotrimoxazole Ananthanarayan Ch-33 Treatment of cholera • Adult except pregnancy - Doxycycline once • Chemoprophylaxis - Tetracycline • Children - Cotrimoxazole • Pregnancy - Furazolidone
  • Microbiology 157 Preventive and Social Medicine 157 44. Regarding Brucellosis, all are true except: A. Man to man transmission B. A zoonosis C. Blood culture used in diagnosis D. Transmitted via animal products Ananthanarayan Ch-38 Acute-Standard agglutination test Chronic-Complement fixation test Rose Bengal Milk ring test • Gold standard treatment Streptomycin + Doxycycline 45. Acute HIV is diagnosed by: A. P 24 Ag capture assay B. ELISA C. Western blot D. RT-PCR Ananthanarayan Ch-62 Laboratory Diagnosis of HIV Demonstration of Antibody - ELISA (best screening method) - Western blot Demonstration of Antigen – P-24 Ag assay-earliest – Virus isolation Microbiology Brucella • Gram negative • Non motile, non capsulated, non sporing • Strict aerobic, intracellular coccobacilli • Causes caseating and non caseating granuloma • Mediterranean fever, Malta, undulating fever – Mc focal feature is musculosketal pain and physical findings in peripheral and axial skeleton • Most diagnostic is blood culture • Serological test
  • 158 – DNB JUNE-2008 Polymerase chain reaction DNA PCR RNA PCR RT PCR-most sensitive and best 46. Pralidoxime is contraindicated in: A. Organophosphate poisoning B. Carbamate poisoning C. Diazinon D. Tabun KD Tripathi Ch-6 Microbiology Acetylcholinesterase enzyme blocked by organophosphates can react rapidly with oxime to produce free enzyme. While those blocked by carbamates don’t do so. 47. Anti Ig used in asthma is: A. Omalizumab B. Rituximab C. Infliximab D. Cetuximab Omalizumab Infliximab Crohn’s diseases Adalizumab Epalizumab Rituximab Alemtuzumab - Bronchial asthma. - Rheumatoid arthritis - Daclizumab Gemtuzumab Myelodysplasia Trastuzumab Cetuximab Bevacizumab - Breast cancer - Nan small cell luy cancer - Colorectal cancer Rheumatoid arthritis Organ transplant psoriasis B.cell lymphoma CLL B cell CLL T cell lymphoma - T cell mycosis fungoides - AML
  • Microbiology 159 Preventive and Social Medicine 159 48. In amphotericin toxicity one must monitor: A. Serum K+ B. RFT C. LFT D. Hb and RBC morphology KD Tripathi Ch-55 Adverse effects of Amphotericin – Anaphylactic reaction – Nephrotoxicity – Anemia – Headache – Vomiting – Nerve palsies – Hypokalemia KD Tripathi Ch - 48 Pefloxacin - Preferred for meningitis as CSF penetration is better • Liver failure • Safe in kidney disease Levofloxacin - 100% oral absorption • Both for gram positive and negative • Single daily dose Gatifloxacin - Can cause tachycardia and prolong QT interval • Photo toxicity, CNS effects and swelling over face Sparfloxacin - Higher chances of phototoxic reactions • Prolonges Q Tc interval • Single daily dose is needed Microbiology 49. Photosensitivity is seen with: A. Pefloxacin B. Levofloxacin C. Gatifloxacin D. Sparfloxacin
  • 160 DNB JUNE-2008 50. Shortest acting anticholinesterase is: A. Neostigmine B. Physostigmine C. Edrophonium D. Pyridostigmine KD Tripathi Ch-6 Microbiology Physostigmine – Eye drops Pyridostigmine – longer acting Edrophonium – Resembles neostigmine • Brief duration of action • Suitable for diagnosis of myasthenia gravis • Postoperative decurarisation 51. Anchicholinergic action in parkinsonism is by: A. Selegeline B. Pregolide C. Procyclidine D. Tolcapone KD Tripsthi Ch-29 Antiparkinsonian drugs – Dopamine precursor – Levodopa – Peripheral decarboxylase inhibitors – Carbidopa Benserazide – Dopaminergic agonists – Bromocriptine. – Pregolide, piribedil, Ropinirole Pramipexole – MAO-B inhibitor – Selegiline – COMT inhibitor – Entacapone Tolcapone – Dopamine facilitator – Amantadine – Central anticholinergies – Trihexyphenidyl procyclidine Biperiden – Antihistaminics – Orphenadrine Promethazine 52. Drug of choice for bier’s block: A. Bupivacaine B. Lignocaine C. Ropivacaine D. Dibucaine KD Tripathi Ch-24
  • Microbiology 161 Preventive and Social Medicine 161 Dibucaine Bupivacaine Eutectic – most potent Most toxic Longest acting – Bier’s block infiltration, nerve block used in obstetrics – Lignocaine + Prilocaine lowers melting point of two solids when they are mixed 53. Drugs useful in breast ca all except: A. Methotrexate B. 5 flurouracil C. Etoposide D. Tamoxifen KD Tripathi Ch-60 Microbiology Drugs used in breast carcinoma – Tamoxifen – Methotrexate – 5-flurouracil – Estrogen – Prednisolone – Vincristine – Paclitaxel – Docetaxel – Cyclophosphamide – Mitoxantrone 54. Uterine tocolyties are all except: A. Salbutamol B. Misoprostole C. Aspirin D. Magsulph KD Tripathi Ch-12 Misoprostol (Prostaglandin) Uses of Prostaglandin 1. Abortion 2. Induction of labour
  • 162 DNB JUNE-2008 3. 4. 5. 6. 7. 8. 9. 10. Cervical ripening Post partum Haemorrhage Peptic ulcer Glaucoma To maintain potency of ducts arteriosus To avoid platelet damage Impotence Bronchial asthma Microbiology 55. Fluconazole increases concentration of A. Anti histamines B. Carbamazepine C. Isoniazide D. Valporate KD Tripathi Ch-55 Fluconazole increases levels of – Phenytoin – Astemizole – Cisapride – Cyclosporin – Warfarin – Zidovudine – Sulfonylurea 56. Side effects of sodium valporate A. Dizziness and sedation B. Hepatic necrosis C. Alopecia D. All the above KD Tripathi Ch-28 Adverse effects of valproate – Anorexia, vomiting – Drowsiness, Ataxia – Tremor – Alopecia – Curling of hair – Increase blood ammonia – Rashes
  • Microbiology 163 Preventive and Social Medicine 163 – – – – – – Thrombocytopenia Hypersensitivity Increased serum transaminase Fulminant hepatitis Pancreatitis Neural tube defects 57. Drug contraindicated in pregnancy A. Enalapril B. Valproic acid C. Phenytoin D. All the above KD Tripathi Ch-4 58. Treatment for post menopause osteoporosis A. Raloxefine B. Oestrogen C. Progesteron D. Testosteron KD Tripathi Ch – 20 Raloxifen • Estrogen partial agonist in bone and CNS • Antagonist in endomentrium and breast Microbiology Drugs contraindicated in pregnancy 1. Thalidomide – Phocomelia 2. Stilboestrol – Vaginal carcinoma 3. Tetracycline – discoloured and deformed teeth 4. Warfarin – nose, eye, hand defect 5. Phenytoin – hypoplastic phalanges cleft lip/palate 6. Carbamazepine – neural tube defect 7. Valproate – spina bifida 8. Lithium – Foetal goiter 9. Indomethacin – premature closure of ductus arteriosus 10. Isotretanoin – Craniofacial heart and CNS defects
  • 164 Microbiology • • • • • • • • DNB JUNE-2008 Prevents bone loss in post menopausal women Reduces LDL Increases HDL Has antiatherogenic potential Reduces risk of Breast ca. No risk of endometrial ca Hot flushes are not relieved Increases risk of embolism. 59. Drug used for hepatitis B virus are all except: A. Adefovir B. Lamivudine C. Ribavarin D. Interferon Adefovir : Inhibits HDV DNA polymerase used in chronic HBV infection Lamivudine resistant HBV infection Nephrotoxic. Lamivudine : Inhibits HBV DNA polymerase used in chronic HBV infection. Ribavarine Inhibits viral replication Used in chronic HCV infection Causes rash wheeze and conjunctival irritation. Interferon : Protein synthesis inhibitor used in chronic HBV HCV causes acute influenza like syndrome. 60. Side effects of Levodopa are all except: A. Hepatitis B. Behavioral disorders C. Postural hypotension D. Angina KD Tripathi Ch-29 Adverse effects of Levodopa 1. Nausea vomiting 2. Postural hypotension 3. Cardiac arrhythmias 4. Exacerbation of angina 5. Alteration in taste sensation
  • Microbiology 165 Preventive and Social Medicine 165 6. Abnormal movements 7. Behavioral effects 8. Fluctuation in motor performance 61. Neuroleptics are used for A. Schizophrenia B. Gille de la Tourelle’s syndrome C. Huntigton’s disease D. All the above KD Tripathi Ch-30 62. Following can be used as CNS stimulants A. Cocaine B. Caffeine C. Bicuculline D. All the above KD Tripathi Ch-33 CNS stimulants 1. Convulsants Strychnine Picrotoxin Bicuculline Pentylenetetrazol 2. Analeptics Doxapram Prethcamide Microbiology Uses of Neuroleptics 1. Schizophrenia 2. Mania 3. Organic brain syndrome 4. Anxiety 5.. Antiemetic 6. Intractable hiccough 7. Tetanus 8. Huntigton’s disease 9. Gilles da la Tourette’s syndrome 10. Alcoholic hallucinations
  • 166 DNB JUNE-2008 3. Psycho stimulants Amphetamines Methylphenidate Pemoline Cocaine Caffeine Microbiology 63. Follwing are anticoagulants except: A. Heparin B. Acenocoumarol C. Fibrinogen D. Phenindione KD Tripathi Ch-42 Anticoagulants I. Used in vitro Heparin Sodium citrate Sodium oxalate Sodium edetate II. Used in vivo Heparin Low molecular weight heparin Danaparoid Lepirudin Ancrod Warfarin Acenocoumarol Phenindione 64. Side effects of clofazamine are all except: A. Discolouration of skin B. Pigmentation of conjunctiva C. Pigmentation of cornea D. Vomiting KD Tripathi Ch-54 Adverse effects of clofazamine • Reddish black discolouration of skin • Discolouration of hair and body secretion
  • Microbiology 167 Preventive and Social Medicine 167 • • • • • • Acneform eruption Photo toxicity Conjunctival pigmentation Enteritis Weight loss Clofazamine crystals in intestinal mucosa 65. Drug of choice for Burkitt’s lymphoma A. Cyclophosphamide B. Methotrexate C. Melphalan D. Actinomycin KD Tripathi Ch-60 Drug of choice Multiple myeloma Ewing’s sarcoma Microbiology - Melphalan - Doxorubicin, vincristine Actinomycin D Wilm’s tumour - Actinomycin D Vincristine Prostate carcinoma - Oestrogen Breast carcinoma - Tamoxifen Carcinoma endometrium - Progestin Choriocarcinoma - Methotrexate Burkitt’s lymphoma - Cyclophosphamide
  • 168 DNB JUNE-2008 Preventive and Social Medicine PSM 66. Neonatal tetanus is considered eliminated when its incidence is: A. < 0.1/1000 LB B. < 1/1000 LB C. > 1/1000 LB D. > 1/100 LB. KD Tripathi Ch-5 Neonatal tetanus elimination NT high risk Rate > 1/1000 LB Or TT2 coverage < 70% Or Attended deliveries <50% NT control Rate < 1/1000 LB and TT2 coverage >70% and Attended deliveries > 50% NT elimination Rate < 0.1 /1000 LB and TT2 coverage >90 % and Attended deliveries >75% 67. Natural mosquito control agent is A. Pyrethrum B. BHC C. DDT D. Propoxur KD Tripathi Ch-12 Pyrethrum : : : : Is an extract from pyrethrum flowers Use as space spray Nerve poison No residual action
  • Preventive and Social Medicine 169 Preventive and Social Medicine 169 Other natural agents Rotenone Derris Nicotine Mineral oil 68. Sulvian index is for A. Life free of disability B. Time of life with disability C. Premature death D. Number of years in full health KD Tripathi Ch-2 Sullivaris index - Life free of disability HALE - Health Adjusted life expediency number of years in full health DALY - Disability Adjusted life year lost year of healthy life Serial interval: Time gap between onset of primary case and secondary case. Generation time: Interval of time between receipt of infection by a host and maximal infectivity of that host. Communicable period: The time during which an infectious agent may be transferred directly or indirectly from an infected person to another person. Latent period: Period from disease initiation to disease detection. Incubation period: The time interval between invasion by an agent and appearance of the first sign and symptom. PSM 69. Time from entry of pathogen to maximum infectivity is A. Serial interval B. Incubation period C. Generation time D. Latent period
  • 170 DNB JUNE-2008 70. Rat flea transmits: A. Endemic typhus B. Epidemic typhus C. Chagas disease D. Sleeping sickness K Park Ch-12 - Black fly Reduviid bug Tsetse fly Louse PSM Rat flea - Hard tick - Bubonic plague Endemic typhus Chiggerosis Hymenolepsis diminuta. Onchocerciasis Chagas disease Sleeping sickness Epidemic typhus Relapsing fever Trench fever Pediculosis Tick typhus Viral encephalitis Tularemia, KFD Tick paralysis Human babesiosis 71. Not transmitted by mosquito: A. Malaria B. Dengue C. Yellow fever D. Kala azar K Park Ch-12 Disease by mosquito Anopheles: - Malaria, filarial (not in India) Culex - Bancroftian filariasis Japanese encephalitis West Nile fever Viral arthritis
  • Preventive and Social Medicine 171 Preventive and Social Medicine 171 Aedes - Yellow fever Dengue Chikungunya fever Rift valley fever Filaria (not in India) Mansonoides- Filaria Chikungunya Kala azar is by sand fly 72. Chandler’s index is for: A. Ascariasis B. Ankylostoma C. Sistosomiasis D. Taeniasis K Park Ch - 5 73. Antigenic shift is seen in: A. Plague B. Influenza C. Rabies D. HIV K Park Ch-5 Influenza Shift - Sudden complete or major change in antigenic composition Drift - Gradual, over a period of time IP - 18 to 72 hrs. PSM Chandler’s index Average number of hookworm per gram of faces. Below 200 - Not of much significance 200 - 250 - Potential danger 250 – 300 - Minor public health problem >300 - Important public health problem
  • 172 DNB JUNE-2008 74. Dracunculiasis is transmitted by: A. Contaminated milk B. Water C. Eggs in soil D. Insects K Park Ch-5 PSM Guinea worm disease (Dracunculiasis) Agent : Dracunculus medinensis man acquires infection by drinking water containing infected Cyclops. Reservoir : An infected person harboring the gravid female. 75. Shortest incubation period in food poisoning is seen with: A. C. botulinum B. Bacillus C. E. coli D. Staph aureus K Park Ch-5 Food poisoning Salmonella Staphylococcal Botulism C. perfringens B. cereus –emetic diarrhoeal I.P 12-24 hrs 1-6 hrs 12-36 hrs 6-24 hrs 1-6 hrs 12-24 hrs 76. Follow up in multi bacillary leprosy is for: A. 2 years B. 5 years C. 1 years D. 3 years K Park Ch-5
  • Preventive and Social Medicine 173 Preventive and Social Medicine 173 Treatment of Leprosy Paucibacillary: Rifampicin 600 mg – once a month Dapsone 100 mg – daily for 6 month Follow up for 2 years. Multi bacillary: Rifampicin - 600 mg - once a month Dapsone - 100 mg – daily Clofazimine - 300 mg – once a month For 12 month Follow up for 5 years Employees state insurance Act 1948 Contribution Employer - 4.75% Employee - 1.75% Govt. share - 1/8 ESI share - 7/8 Benefits Medical benefit Sickness benefit Maternity benefit Disablement benefit Dependant’s benefit Funeral expenses Rehabilitation allowance PSM 77. Contribution of employees (centre/ state) in employee state insurance scheme is A. 3.75% B. 4.75% C. 5.75% D. 1.75% K Park Ch-15
  • 174 DNB JUNE-2008 78. Criteria for chlorination of water is A. 15 min contact period B. Clear water C. Chlorine concentration- 1 mg/dl D. All of above K Park Ch - 12 PSM Principles of chlorination • Water should be clear and free from turbidity • Chlorine demand should be estimated • Contact period - 60 min. • Free chlorine-0.5 mg/l • Correct dose of chlorine – Chlorine demant + free residual chlorine 79. Most common cause of blindness in India is: A. Cataract B. Trachoma C. Vit A deficiency D. Glaucoma K Park Ch- 6 Cause of Blindness in India Cataract Refractive error Glaucoma Posterior segment pathology Corneal opacity Other causes - 62.6% 19.7% 5.8% 4.7% 0.9% 6.2% 80. Triage is used for: A. Sorting of cases in disaster B. Trying a new drug C. Disaster preparedness D. Normal basis in hospitals K Park Ch-14 Triage consists of rapidly classifying the injured on the basis of the severity of their injuries and the
  • Preventive and Social Medicine 175 Preventive and Social Medicine 175 likelihood of their survival with prompt medical intervention. Red - High priority treatment Yellow - medium priority Green - ambulatory patients Black - dead or moribund 81. Socratic method is for all except: A. Group discussion B. Symposium C. Panel discussion D. Demonstration K Park Ch - 19 82. Epidemiological test for Kala azar is: A. ELISA B. Mantoux test C. Aldehyde test D. Parasitological diagnosis K Park Ch-5 Lab test for kala azar 1. Parasitological diagnosis– • Demonstration of parasite in tissue • Diagnostic 2. Aldehyde test-(Napier) Formalin + serum from infected person Jellification – positive test good for surveillance not diagnostic 3. Serological – ELISA, IFAT Both for diagnosis and epidemiological purpose PSM Group approach in communication 1. Lecture- one way (didactic method) 2. Demonstration- two way (Socratic method) 3. Group discussion-two way 4. Panel discussion-two way 5. Symposium-one way 6. workshop-two way
  • 176 DNB JUNE-2008 4. Hematological findings: eg. Anemia, leucopenia 5. Leishmanin (Montenegro) test:Intradermal injection 0.1 ml Read after 48-72 hrs Indurations of 5 mm or more is positive PSM 83. Different populations are best compared by using: A. Age standardized death rate B. Survival rate C. Specific death rate D. Case fatality rate If we want to compare the death rates of two population with different age-composition the crude death rate is not a yard stick. We use age adjusted or age standardized death rate. 84. Street dog licked on abraded skin and ran away A. No need to do anything B. Give vaccines and immunoglobulin both C. Start vaccination immediately D. Start treatment if dog dies K Park Ch-5 Class I Class II : Licks on healthy unbroken skin Consumption of unboiled milk of suspected animal Scratches without oozing of blood - No treatment needed if reliable history is available : Licks on fresh cuts Scratches with oozing of blood All bites except those on head, neck face, palms and fingers Minor wounds < 5 in number - Administer, vaccine immediately
  • Preventive and Social Medicine 177 Preventive and Social Medicine 177 Class III : All bites with oozing of blood on neck head face palms and fingers Lacerated wound on any part Multiple wounds >5 in number Bites from wild animals - Rabies immunoglobulin and vaccine 85. Dietary source of vit D with maximum content is A. Shark liver oil B. Butter C. Egg D. Halibut liver oil K Park Ch-10 0.5 - 1.5 1.25 - 1.5 0.1 5 - 30 30 - 100 200 - 750 500 - 10,000 PSM Vit D (mg / 100 gm.) Butter Eggs Milk Fish fat Shark liver oil Cod liver oil Halibut liver oil
  • 178 DNB JUNE-2008 Dermatology Dermatology 86. Auspitz sign is seen in: A. Dermatitis B. Fungal infection C. Common wart D. Psoriasis Signs in psoriasis Auspitz sign : When scales are forcefully removed pinpoint bleeding from dilated superficial capillaries occurs Grattage sign : On scratching the lesions mica like scales appear Woronoff’s sign : Whitish halo around the lesion Kobner’s : Traumatized area often develop phenomenon lesions of psoriasis 87. True about pityriasis rosea is all except: A. More in women B. Christmas tree appearance seen C. Spares palms and soles D. Herald patch seen Pityriasis rosea - Most common in 10-35 yrs. women - Herald mother patch seen over trunk - Cigarette paper scale seen - Christmas tree distribution of lesions - Involvement of palms and soles occur - Self limiting
  • Dermatology 179 Preventive and Social Medicine 179 88. Scarring alopecia is seen in all except: A. Cutaneous lupus B. Lichen palnus C. Sarcoidosis D. HIV Infection Scarring alopecia is seen in Cutaneous lupus Lichen planus Folliculitis Decalvans Linear Scleroderma (Morphea) Lupus erythematosus Sarcoidosis Cutaneous metastasis Herpes zoster Acne vulgaris- More in adolescents (90% are affected) - Caused by propionobacterium acne StagesI - Comedon II - Comedon + papule III - Pustule IV - Cystic lesions Treatment - Retinoic acid- most important Tetracycline Isotretinoin - in nodulocystic type 90. True about Dermatomyositis is: A. Heliotrope’s rash B. Mechanics hands C. Shawl’s sign D. All of the above Dermatomyosistis Heliotrope rash - Mc manifestation Gottrons papule Dermatology 89. Treatment of choice for acne vulgaris is: A. Antibiotic B. Frequent face wash C. Avoidance to dirt D. Retinoic acid
  • 180 DNB JUNE-2008 Dowling’s lines Poikiloderma Shawl sign Non scarring alopecia Mechanic’s hands Dermatology 91. All are seen in Diabetes except: A. Necrobiosis lipoidica diabeticorum B. Granuloma annulare C. Xanthoma D. Acanthosis nigricans Skin manifestations of Diabetes mellitus 1. Necrobiosis lipoidica diabeticorum 2. Granuloma annulare 3. Diabetic dermatopathy 4. Neuropathic ulcerations 5. Xanthoma 6. Skin thickening 7. Yellow skin 8. Yellow nails 9. Diabetic bullae 92. True about Roseola infantum is all except: A. Called as sixth disease B. Due to HHV-6 C. Involves face D. Rose pink rash Roseola Infantum - Exanthem subitum - Sixth disease - Caused by HHV-6 B - Mc in children < 3 yrs - Rash appears after fever subsides - Rose pink maculopapular rash - Sparing of face - Resolves in 2 days
  • Dermatology 181 Preventive and Social Medicine 181 93. Coral red appearance in wood’s lamp examination is seen in A. Vitiligo B. Erythrasma C. Tinea versicolor D. Tuberous sclerosis Wood’s lamp examination -360 nm ultraviolet light Erythrasma - Coral red Tinea capitis - Brilliant green Pseudomonas - Pale blue /green Vitiligo - Totally white Tinea versicolor - Dull yellow Tuberous sclerosis - Blue white Porphyria cutanea tarda - pinkish red Incubation period in STD Syphilis - 9-90 days Herpes 2-7 days Chancroid 1-14 days LGV 3 days 6 wks Donovaniosis 1-4 wk Dermatology 94. Incubation period of LGV is A. 3 - 4 wk B. 1 - 4 wk C. 9 - 90 days D. 1 wk
  • 182 DNB JUNE-2008 Radiology Radiology 95. Small Heart in chest X ray is seen in all except: A. Normally B. Emphysema C. Ebsteins anomaly D. Addison’s disease • • • • • Cardiac enlargement Multiple valvular disease Pericardial effusion Atrial septal defect Ebsitein’s anomaly • • • • • • Small heart Normal variant Addison’s disease Dehydration Malnutrition Constrictive Pericarditis 96. Radiotherapy affects A. Liver B. Kidney C. Bone marrow D. All the above Adverse effects of Radiation therapy Acute radiation sickness – Nausea vomiting – Hematopoietic syndrome-Bone marrow – CNS-CVS-Altered sensorium Respiratory distress
  • Radiology 183 Preventive and Social Medicine 183 Long Term: CNS : Infarction, necrosis, transverse myelitis, leukoencephalopathy Skin : Erythema, hyperpigmentation Heart : Asymptomatic pericardial effusion Lungs : Pneumonitis Digestive tracts : Enteropathy, Diarrhoea perforation Bladder : Mucosal desquamation, ulceration testis and ovaries : Type B spermatogonia amenorrhoea and sterility 98. Following is a radio protective agent: A. Oxygen B. Cytochlor C. Amifostive D. Paclitaxel Radio sensitizing agents Oxygen Cisplatin 5. Fu Paclitaxel Radiology 97. Half life of cobalt- 60 is A. 30 years B. 5.2 years C. 8 days D. 28 days Half life of isotopes Calcium 137 - 30 years Cobalt 60 - 5.26 years Gold 198 - 2.7 years Iridium 192 - 74 days Radium 226 - 1640 days Radon 222 - 3.8 days Strontium 90 - 28 years Tantalum 182 - 11.5 years Yttrium 90 - 64 hrs
  • 184 DNB JUNE-2008 Metronidazole Misonidazole SR 25 08 Gemcitabine Cytochlor Radio protective agents Amifostine Etramustine Pentoxyphylline Zinc oxide Radiology 99. Spider leg appearance on IVP is seen in: A. Polycystic kidney B. Horse shoe kidney C. T.B. urinary bladder D. Posterior urethral valve Cobra head Deformity Flower vase appearance Golf hole ureter Rim sign Thimble bladder - Ureterocele Horse shoe kidney T.B urinary bladder Severe hydronephrosis T B urinary bladder 100. Chain of lake appearance is seen in A. Carcinoma pancreas B. Chronic pancreatitis C. Sigmoid volvulus D. Hydatid cyst Chain of lake appearance – Coffee bean sign Apple core appearance Corkscrew esophagus Double bubble sign Floating membrane Saw tooth appearance Rose thorrning String sign of kantor Thumb printing Triple bubble - Chronic pancreatitis Sigmoid volvulus carcinoma colon Diffuse spasm Duodenal atresia Hydatid disease Diverticulosis Ca head of pancreas Chrons disease Ischaemic colitis Jejunal atresia
  • Radiology 185 Preventive and Social Medicine 185 101. Agent used in myelography is A. Metrizoate B. Ioxaglate C. Diatrizoate D. Iohexol 102. Air Bronchogram is seen in A. Respiratory distress syndrome B. Pneumonic consolidation C. Pulmonary edema D. All the above Air bronchogram - Respiratory distress syndrome Pneumonic consolidation Pulmonary edema Pop corn calcification - Hamartoma Shrinking lung syndrome - SLE Steeple sign - Group Thumb sign - Acute epiglottitis Water lily sign - Hydatid disease Radiology Ionic dyes can not be used in myelography Contrast media Ionic - Iothalamate Diatrizoate Metrizoate Ioxaglate Non ionic - Iohexol Iopamidol Ioversol Iopromide Ioxilan Metrizamide Iodixanol
  • 186 DNB JUNE-2008 103. Radiological sign of scurvy are A. Wimberger’s line B. White line of frenkel C. Pelkan spur D. All the above Radiology Radiological sign of scurvy 1. Whiteline of frenkel 2. Whimberger’s line 3. Trummerfeld zone 4. Pelkan spur 5. Ground glass appearance of shaft of diaphysis 6. Periosteal reaction due to haematoma subperiosteal 7. Osteoporosis 104. Cod fish vertebra is seen in A. Osteoporosis B. Osteomalacia C. Sickle cell disease D. All the above Cod fish vertebra Osteoporosis Osteomalacia Sickle cell disease Rugger jersy spine - Renal osteodystrophy Ostopetrosis Ivory vertebra - Lymphoma Infection Metastasis Paget’s disease
  • Anesthesia 187 Preventive and Social Medicine 187 Anesthesia 105. Drug of choice for local anaesthesia in severe hepatitis A. Procaine B. Lignocaine C. Bupivacaine D. Prilocaine Ajay Yadav Ch-16 Anesthesia Local Anaesthetics Amino esters - Procaine Chloroprocaine Tetracaine Benzocaine Cocaine • Esters are metabolized by pseudocholinesterase (except cocaine which is metabolized by liver) • High incidence of allergic reactions • Solutions are not stable Aminoamides - Lignocaine Mepivacaine Prilocaine Bupivacaine Etidocaine Ropivacaine
  • 188 DNB JUNE-2008 Anesthesia 106. All are seen in total spinal anaesthesia except: A. Hypotension B. Tachycardia C. Unconciousness D. Respiratory distress Ajay Yadav Ch-18 Complication of spinal Anaesthesia • Hypotension • Bradycardia • Respiratory arrest • Nausea and vomiting • Difficulty in phonation • Restlessness, anxiety • Anaphylaxis • Cardiac arrest • Bloody tap • Total spinal anaesthesia – Severe bradycardia – Hypotension – Respiratory distress 107. All are seen in epidural anaesthesia in lumbar region except: A. Backache B. Altered sensorium C. Menimgitis D. Headache Ajay Yadav Ch-18 Complications of Epidural Anaesthesia 1. Inadequate block 2. Hypotension 3. Apnea 4. Total spinal 5. Dural puncture 6. Subdural block 7. Anaphylaxis
  • Anesthesia 189 Preventive and Social Medicine 189 8. 9. 10. 11. 12. 13. Horner’s syndrome Epidural hematoma Epidural Abscess Anterior spinal artery syndrome Backache Meningitis 108. Factors effecting MAC are A. Age B. Temperature C. Anemia D. All the above 109. Not true about Halothane A. Potent anaesthetic B. Increase ICT C. Good analgesia D. Hypotension Halothane: • Inhalational agent • Excellent for induction in child • Stored in amber coloured bottles • Non inflammable non explosive • Induction is very smooth • Potent - anaesthetic • Not a good analgesic • Muscle relaxation is moderate • Causes Hepatitis • Sensitizes heart to adrenaline • B.P is decreased Anesthesia Factors effecting MAC 1. Age 2. Temperature 3. Barometric pressure 4. Anemia 5. Hypoxia 6. Alcohol 7. Pregnancy 8. Thyroid disease Ajay Yadav Ch-10
  • 190 • • • • DNB JUNE-2008 Blunts baroreceptor reflexes Potent bronchodilator Increases ICT Causes uterine atony 110. True about propofol is: A. Causes analgesia B. Injection is painful C. Causes hypertension D. Cerebro protective Anesthesia Ajay Yadav Ch-12 Propofol • Consists of phenol ring • Injection is painful • Rapid recovery • No analgesic property • Metabolised in liver • Hypotension occurs • Causes respiratory depression • Produces muscle twitchings • Causes myoclonic activity • Anti emetic • Agent of choice for day care • Used in TIVA 111. Following Pin Index is used for Entonox: A. 7 B. 3.5 C. 2.5 D. 1.4 Ajay Yadav Ch-6 Pin index Oxygen Nitrous oxide Cyclopropane Air Nitrogen Entonox 2, 5 3, 5 3, 6 1, 5 1, 4 7
  • Anesthesia 191 Preventive and Social Medicine 191 Carbon dioxide (<7.5 %) 2, 6 Carbon dioxide (>7.5 %) 1, 6 112. Colour of gas cylinder of carbon dioxide: A. Brown B. Grey C. Blue D. Orange Ajay Yadav Ch-6 113. Complication of Laryngoscopy are: A. Dental Injury B. Bleeding C. Aspiration D. All the above Ajay Yadav Ch-6 Complications of laryngoscopy 1. Dental injury 2. Damage to soft tissue and nerves 3. Injury to cervical spinal cord 4. Haemodynamic alterations 5. Breakage and aspiration of bulb 114. True about laryngeal mask is all except: A. Easy to insert B. Prevents aspiration C. Used in cervical injuries D. Causes bronchospasm Ajay Yadav Ch-6 Anesthesia Colour coding for various gases Oxygen - Black with white shoulders Nitrous oxide - Blue Air - Grey body with black and white shoulders Carbon dioxide - Grey Cyclopropane - Orange Helium - Brown Entonox - Blue body with blue and white shoulders
  • 192 DNB JUNE-2008 Laryngeal mask Airways Advantages 1. Easy to insert 2. Does not need laryngoscope 3. Does not need specific position of cervical spine. Disadvantages 1 Does not prevent aspiration. 2 More laryngo and bronchospasm. Anesthesia 115. Premedications in anaesthesia are used to A. Relieve anxiety B. Provide analgesia C. Control infection D. All the above Ajay Yadav Ch-7 Goals of Premedications • To relieve anxiety. • To produce haemodynamic stability • To induce sedation • To provide analgesia and amnesia • To decrease chances of aspiration • To control oral and respiratory secretions • To prevent post operative nausea • To control infections
  • Orthopedics 193 Preventive and Social Medicine 193 Orthopedics 116. Most common indication of amputation is: A. Trauma B. Peripheral vascular disease C. Infection D. Tumour J Maheshwari Ch - 40 117. Onion peel appearance is seen in: A. Osteosarcoma B. Osteoclastoma C. Ewing’s sarcoma D. Chondrosarcoma Osteoid osteoma Adamantinoma Hemangioma Chondroblastoma Osteoclastoma - Radiolucent nidus - Honeycomb appearance - Loss of horizontal striations and prominent vertical strations - Mottled calcification - Soap bubble appearance Orthopedics Indications for amputation 1. Injury 2. Peripheral vascular disease 3. Infections e.g. gas gangrene 4. Tumours 5. Nerve injuries 6. Congenital anomalies Over all, injury is the commonest cause of amputation in developing courtnies.
  • 194 DNB JUNE-2008 Osteosarcoma - Codman’s triangle sun ray appearance Ewing’s sarcoma - Onion peel appearance Multiple myeloma - Punched out lesions Reticulum cell sarcoma- Moth eaten appearance 118. Card test is used for paralysis of A. Ulnar nerve B. Median nerve C. Radial nerve D. Musculoskeletal nerve J Maheshwari Ch-10 Orthopedics Pen test Egawa test Card test Book test (froment’s sign) - Median nerve Ulnar nerve Ulnar nerve Ulnar nerve 119. Bone involved in stress fracture is A. 2nd metatarsal B. 5th metatarsal C. Talus D. Calcaneum J Maheshwari Ch-21 March fracture: • Fatigue fracture • Resulting from long continued and repeated stress • More in army marching • Heals- spontaneously • Treatment is purely symptomatic Fracture of base of 5th metatarsal Jones fracture 120. Avascular necrosis is commonly seen in A. Head of humerus B. Intracapsular fracture of neck of femur C. Capitulum D. Talus
  • Orthopedics 195 Preventive and Social Medicine 195 Avascular necrosis Site in order of occurrence 1. Femoral head 2. Femoral condyle 3. Head of humerus 4. Capitulum 5. Scaphoid 6. Lunate 7. Talus • Investigation X-ray – Increased bone density • Earliest - Tc 99 Bone scan • Best Inv. MRI (decreased signal) 121. True about myositis ossificans is all except: A. More in children B. Stiffness of joint C. Mobilisation of joint is advised D. Surgery is treatment of choice 122. Test done for anterior cruciate ligament tear is all except: A. Pivot test B. Lachmann test C. Anterior drawer test D. Posterior drawer test Pivot – Anterior cruciate ligament Lachmann’s – Anterior cruciate ligament Anterior drawer – Anterior cruciate ligament Orthopedics Myositis ossificans – Due to ossification of hematoma – especially in severe injury where periosteum is stripped off – more in children – stiffness of joint seen Treatment – – Immobilization – Disphosphonate (calcitonin) – NSAID – Physiotherapy. (Active not passive) – Manipulation under anaesthesia surgery is treatment of choice.
  • 196 DNB JUNE-2008 Posterior drawer - Posterior cruciate ligament Mc Murray - Meniscus Appley’s grinding. Meniscus 123. Most common site of spondylolisthesis is: A. C7 over T1 B. L3 over L4 C. L4 over L5 D. L5 over S1 Orthopedics Most common site Spondylolisthesis – L5 over S1 Disc prolapse lumbar – L4 over L5 Cervical – C5 over C6 124. Most common site of fracture non union is: A. Lateral condyle of humerous B. Talus C. Scaphoid D. Collis fracture Non union Scaphoid Fracture neck of femur Lateral condyle of humerus Lower 1/3 of ulna Lower 1/3 of tibia Talus Mal union Colli’s fracture Supracondylar fracture Intertrochanteric fracture
  • Psychiatry 197 Radiology Psychiatry 125. Pathological buying is: A. Kleptomania B. Omniomania C. Teichotelomania D. None – – – – Impulse to steal things Repetitive fire setting Impulse to buy things Irresistable urge to pull out their hair Pathological gambling – Overwhelming need to gamble 126. Most common psychiatric illness is A. Dementia B. Depression C. Delusion D. Mania Neeraj Ahuja Ch-6 The life time risk of depression in males is 8-12% and female 20-26% though the life time risk of major depression or depressive episode is about 8%. The life time risk of manic episode is 0.8 -1% Incidence of schizophrenia is currently about 0.5 -1% Psychiatry Kleptomania Pyromania Omniomania Trichotillomania
  • 198 DNB JUNE-2008 127. Cataplexy is: A. Paralysis of lower limbs B. Paralysis of one half C. Sudden onset attack of paralysis D. Normal physiological phenomenon Neeraj Ahuja Ch-11 Sleep attacks Cataplexy Psychiatry Hypnogogic hallucinations Hypnopompic hallucination – due to short REM latency – Sudden onset physical collapse because of loss of all muscle tone after a strong emotional stimulus – which occur just as the patient falls asleep – occur just as the patient wakes up. 128. Psychosis is: A. Delusion B. Illusion C. Obsession D. Depression Neeraj Ahuja Ch-7 The term psychosis is defined as 1. Gross impairment in reality testing 2. Marked disturbance in personality with impairment in social, interpersonal and occupational functioning 3. Market impairment in judgment and absent understanding of the current symptoms and behavior (loss of insight) 4. Presence of the characteristic symptoms like delusions and hallucination.
  • Psychiatry 199 129. Bipolar disorder is treated by: A. Mood stabilizers B. Antidepressant C. Antipsychotic D. Psychotherapy Neeraj Ahuja Ch-6 Treatment of Bipolar disorder 1. Mainstay of treatment is mood stabilizers (lithium) 2. Anticonvulsants like carbamazepine and valproic acid are also used 130. Dementia has all except: A. Hallucination B. Forget fullness C. Unconsciousness D. Altered sensorium Psychiatry Cardinal features: Dementia 1. Global deterioration of higher mental functions 2. Impaired recent memory (in early stages) and remote (in later stages) 3. Deterioration of personality 4. Impaired judgment and reasoning 5. Syntax errors, aphasia, mutism 6. No insight 7. Thinking is slow and muddled, delusion perseveration 8. Illusion, hallucination (Mc. Visual) 9. All above features interfere with daily living skills.
  • 200 DNB JUNE-2008 Radiology Surgery Surgery 131. Epulis is a swelling arising from: A. Lip B. Jaw C. Neck D. Tonsil Epulis means upon the gum can originate from the bone the periosteum or mucous membrane. It is of five types 1. Fibrous – most common 2. Granulomatous 3. Myeloid 4. Sarcomatous 5. Carcinomatous 132. Tumour with no lymphatic spread: A. Squamous cell carcinoma B. Melanoma C. Basal cell carcinoma D. Lymphosarcoma Basal cell carcinoma: • Locally invasive carcinoma of the basal layers of the epidermis. • It is of low grade malignancy • Lymph nodes are not enlarged • Blood spread is also rare • Most common site - face • Above the line drawn from the angle of mouth to lobule of the ear • Also called as tear cancer.
  • Surgery 201 Types 1. Deeply eroding ulcer- Mc 2. Nodular 3. Cystic 4. Pigmented nodule 5. Geographical 6. Morphoric type Treatment: Radiotherapy cures over 90% of all basal cell carcinoma. 133. Hyoid bone is related to: A. Thyroglossal cyst B. Branchial cyst C. Cystic fibroma D. Laryngocele Treatment: Excision with a segment of the bone from midline. 134. Furuncle is caused by: A. Streptococcus B. Pseudomonas C. Gonococci D. Staphylococci Disease by staphylococci 1. Boil 2. Carbuncle 3. Furuncle Surgery Thyroglossal cyst: • Cystic swelling developing from remnant of the thyroglossal tract. • It descends either in front of the hyoid bone or through the hyoid bone • May appear at any age • More in women • Painless swelling • Mc site subhyoid • Cystic consistency • Moves with deglutition.
  • 202 DNB JUNE-2008 4. Parotitis 5. Breast abscess 6. Osteomyelitis Erysipelas: • Streptococcus pyogens • Acute infection of skin and subcuticular tissue associated with severe lymphangitis. Surgery 135. Middle age male with palpable loin lump on both sides with renal failure: A. Adult polycystic kidney disease B. Wilms tumour C. Neuroblastoma D. Renal cell carcinoma • Wilm’s tumour and neuroblastoma are seen in children. • RCC is unilateral (generally) does not cause renal failure. • Answer is obvious polycystic kidney. 136. Risk factor for breast carcinoma in 40 year female: A. Previous contralateral breast carcinoma B. Mother having carcinoma breast C. Early menarche D. All the above Risk factors for Breast carcinoma: 1. Age most important risk factor increases with age 2. Gender: F : M = 150 : 1 3. More common in western countries 4. Family history is associated with increased risk 5. Family history of ovarian cancer is also associated 6. Previous cancer of contralateral breast ovarian cancer Endometrial cancer 7. Early menarche 8. Late menopause 9. Nulliparity 10. Obesity
  • Surgery 203 137. Risk factor for breast carcinoma are all except: A. Early menarche B. Late first pregnancy C. Breast feeding D. Nulliparity Risk factors continued 1. Age most important risk factor increases with age 2. Gender: F : M = 150 : 1 3. More common in western countries 4. Family history is associated with increased risk 5. Family history of ovarian cancer is also associated 6. Previous cancer of contralateral breast ovarian cancer Hereditary non polyposis Colorectal cancer – MSH 2 MLH 1 138. Female who underwent mantle radiotherapy in her teens carcinoma now likely of: A. Thyroid B. Ovary C. Lung D. Breast Surgery Endometrial cancer 7. Early menarche 8. Late menopause 9. Nulliparity 10. Obesity 11. Late first pregnancy 12. Alcohol 13. High fat diet 14. Previous benign breast disease 15. High socioeconomic status 16. Harmonal replacement therapy 17. Syndromes Li Fraumeni – P53 Cowden’s – PTEN Peutz-Jeghers – LKB1
  • 204 DNB JUNE-2008 Surgery Facts about Thyroid carcinoma Least malignant Most malignant Mc type after irradiation Associated with MEN synd Associated with Amyloidosis Associated with dystrophic calcification Psammoma bodies Orphan Annie- eyed nucleus Long standing multinodular goiter Derived from C cells Papillary ca Anaplastic ca Papillary ca. Medullary ca Medullary ca Papillary ca Papillary ca Papillary ca Papillary ca Medullary ca 139. Treatment for Harmone receptor breast carcinoma: A. Radiotherapy B. Surgery C. Conservative D. Harmone therapy Adjuvant chemotherapy • All node positive cases • Node negative with > 1 cm size • Node negative with >0.5 cm with adverse factors • Tamoxifen is added to all those with estrogen / progesterone receptor positive. 140. Most common cause of intestinal obstruction in a neonate is: A. Hirschsprung disease B. Meconium ileus C. Intussuception D. Chron’s disease Intussusceptions • Telescoping of one portion of the intestine into the other • Most common cause of intestinal obstruction in 3 months- 6 years • Vomiting
  • Surgery 205 • Red currant jelly stools • Sausage shaped mass • Sign of dance- emptiness of RIF Diagnosis 1. Barium enema Claw sign Coiled spring sign 2. Ultrasound– Target sign Pseudo kidney sign 3. Hydrostatic reduction by contrast agent or air enema. Contraindicated in peritonitis or hemodynamic instability. Repair Cleft palate Cleft lip – – 6 to 18 months Rule of Ten After 10 wks of age Weight >10 lb Hemoglobin >10 g/de. 142. Most common benign tumour is: A. Neurofibroma B. Lipoma C. Dermoid D. Hemangioma Lipoma: – Most common – Most benign – Universal tumour- can occur anywhere. Types 1. Encapsulated – Most common 2. Diffuse Surgery 141. Cleft palate is ideally repaired at: A. 5 months of age B. 1 year of age C. Before going to school D. 6-8 years of age
  • 206 DNB JUNE-2008 3. Multiple Dercum’s disease Adiposis dolorosa. Complications • Myxomatous degeneration • Saponification • Calcification • Malignant changes Treatment • A lipoma should always be excised. Surgery 143. Following is seen in Anterior mediastinum: A. Pheochromocytoma B. Neurogenic tumours C. Thymoma D. Vascular masses. Anterior mediastinum • Thymoma- Mc • Lymphoma • Germ cell tumour • Mesenchymal tumours • Thyroid and parathyroid masses Middle Mediastinum • Bronchogenic cyst • Neuroenteric cyst • Vascular masses • Lymph node enlargement • Mesenchymal tumours • Pheochromocytoma Posterior mediastinum • Neurogenic tumours MC • Meningoceles • Gastroenteric cysts • Mesenchymal tumour • Pheochromocytoma • Lymphoma.
  • Surgery 207 144. Clinical features of fracture of zygomatic bone include all of the following except: A. Diplopia B. Trismus C. Bleeding D. CSF rhinorrhea. 145. Most common tumour of parotid gland is: A. Squamous cell carcinoma B. Pleomorphic adenoma C. Warthin’s tumour D. Adenolymphoma Mc tumour of parotid – IInd Mc tumour of parotid – Mc malignant tumour – Tumour spreading through Neural sheath – Best diagnostic modality – Mc tumour children – Pleomorphic adenoma Warthin’s Mucoepidermoid Ca. Adenoid cystic Ca. FNAC Hemangioma Surgery Zygomatic bone fracture • Second most commonly fractured bone of face after nasal bone • Tripod fracture – Zygomaticofrontal fracture – Zygomaticotemporal fracture – Infraorbital fracture • Flattening of malar prominence • Step deformity of infraorbital margin • Epistaxis • Anaesthesia in distribution of infraorbital nerve • Trismus • Restricted ocular movements due to involvement of inferior rectus muscle • Diagnosis – X ray water’s view CT scan is best • Treatment – Only displaced fracture require • Treatment – Open reduction and internal fixation.
  • 208 DNB JUNE-2008 146. Pancreatic pseudocyst occurs most commonly after: A. Trauma B. Pancreatitis C. Pancreatic surgery D. Pancreatic malignancy Surgery Pancreatic pseudocyst – Mc cause Pancreatitis > Trauma Indications of Surgery • More than 6 wks • More than 6 cm • Evidence of secondary infection • Development of other complications – e.g.Haemorrhage Perforation GIT obstruction • Internal drainage – Cystojejunostomy – Cystogastrostomy – Cystoduodenostomy • External drainage – Gross infection – Immature pseudocyst – Unstable patients 147. Commonest hypospadias is A. Penile B. Glandular C. Scrotal D. Coronal Hypospadias: A condition where urethral meatus opens on the underside of penis (ie) ventral side of penis. Types Glandular Coronal Penile Peno scrotal Perineal – Glans penis opening (Mc) – Coronal sulcus – – – Most severe type
  • Surgery 209 Hypospadias is Mc congenital anomaly of urethra Treatment - not required in glandular type in other types plastic surgery for bringing meatus to normal position Circumcision is contraindicated. 148. Most common tumour of appendix is: A. Lymphoma B. Adenocarcinoma C. Leiomyosarcoma D. Argentaffinoma Carcinoid tumour (Argentaffinoma) – Mc neoplasm of appendix – Arises from kulchitzsky cells of crypts of lieberkuhn – Mc seen in distal third. – Rarely gives rise to metastasis • Appendicectomy is treatment of choice • Rx, Hemicolectomy if – Tumour > 2 cm in size – Caecal wall is involved – Lymph nodes is involved • Carcinoid of small intestine • Carcinoid < 1 cm – segmental bowel resection – > 1 cm or multiple – wide excision • Carcinoid of terminal ileum – Rt Hemicolectomy 149. The treatment of choice for inguinal hernia in infants: A. Herniotomy B. Herniorrhapy C. Truss D. Hernioplasty • Mc type of hernia in men • Mc type in female • Femoral hernia – Indirect inguinal hernia – Indirect inguinal hernia – More in female Surgery Treatment
  • 210 DNB JUNE-2008 Indirect inguinal hernia – Mc of all forms – Mc in young – Mc on right side Direct inguinal hernia Protrude through the posterior wall of inguinal canal medial to inferior epigastric vessel (Hesselback’s triangle). 150. Most common site of hypertrophic keloid is: A. Face B. Leg C. Presternal area D. Arm Surgery Keloids: Scar which shows extreme overgrowth so that scar tissue grows beyond the limits of original wound. Central chests – Mc site • Hypertrophic scar regresses over time keloid does not • HTS develops with in 4 wks of trauma keloid occurs over 3 m to years • Keloid grows beyond the margins of trauma while HTS does not • Both may cause burning sensation, itching of pain.
  • Forensic Medicine 211 Radiology Forensic Medicine 151. Acrodynia is seen in: A. Lead poisoning B. Copper poisoning C. Iron poisoning D. Mercury poisoning NG Rao Ch-20 152. Instead of penincillamine following can be used in copper poisoning: A. BAL B. EDTA C. Desferroxamine D. Vitamin D NG Rao Ch-20 Copper Poisoning • Copper sulfate (blue viriol) • Copper sub-acetate (Virdigris) • Are poisonous. FM Features of Mercury poisoning Acute – Nephrotoxic Chronic – Mercuria lentis Blue black lines on gums Hotter’s shake Glass- blower shake Erythrism Acrodynia
  • 212 DNB JUNE-2008 Signs and symptoms • Metallic taste • Salivation, thrust • Discoloration of oral mucosa • Vomitus and stool are blue in colour • Urine output is less and contains casts and albumin • Muscular spasms FM Treatment • Stomach wash with warm water • Egg albumin • Potassium ferrocyanide • BAL • Penicillamine 153. Boiled lobster appearance is seen in: A. Oxalic acid poisoning B. Boric acid poisoning C. HNO3 poisoning D. Phenol 154. Chilotic line is seen in: A. Hips for sex determination B. Hips for race C. Femur for sex determination D. Femur for race Chilotic line index • For sex differentiation • Present on hip bone • Chilotic line India • = Sacral part of chilotic line × 100 • Pelvic part of chilotic line 155. Poisonous acid in tomato, spinach rhubarb is: A. Oxalic acid B. Citric acid C. Phenol D. Methanol
  • Forensic Medicine 213 Various poisons are found on various internet sites – Arsenic – Paraaminobenzoic acid – Oxalic acid 156. Colour of dead body in carbon monoxide poisoning is: A. Pink B. Cherry red C. Red D. Black NG Rao Ch-5 – – – – – – – – Pink Cherry Red Chocolate brown Bluish green Black Dark brown Red brown Deep blue FM Hypostasis Cyanide Carbon monoxide Chlorate Hydrogen sulphite Opiates Phosphorus Aniline Nitrates 157. IPC for death in dowry is: A. 300 B. 302 C. 304 B D. 304 A NG Rao Ch-2 IPC Murder Punishment for murder Criminal negligence Dowry death Suicide Defines perjury Punishment for perjury – – – – – – – 300 302 304 A 304 B 306 191 192
  • 214 DNB JUNE-2008 ENT ENT 158. Following form bed of tonsil except: A. Fascial nerve B. Styloglossus C. Glossopharyngeal nerve D. Buccopharyngeal fascia PL Dhingra Ch-52 Bed of tonsil 1. Loose areolar tissue 2. Paratonsillar vein 3. Superior constrictor muscle 4. Styloglossus 5. Glossopharyngeal nerve 6. Facial artery 7. Medial pterygoid muscle 8. Angle of mandible 9. Submandibular salivary gland 10. Pharyngo-basilar fascia 11. Buccopharyngeal fascia 159. Most common cause of Epistaxis is: A. Malignancy B. Deviated nasal septum C. Foreign bodies D. Trauma PL Dhingra Ch-34 Causes of Epistaxis 1. Trauma- Finger nail 2. Infections
  • ENT 3. 4. 5. 6. 215 Foreign bodies Neoplasm Atmospheric changes (Caisson’s ds) Deviated nasal septum General causes • Hypertension • Mitral stenosis • Pregnancy • Bleeding dyscrasias • Hepatic cirrhosis • Chronic nephritis • Salicylates • Mediastinal tumours • Vicarious menstruation Cad well luc operation Indications • Chronic maxillary sinusitis – Removal of foreign bodies – Dental cysts – Oroantral fistula – Reccurant antrochoanal polyp – Fracture of maxilla – Vidian neurectomy – Approach to ethmoids and Pterygopalative fossa Complications • Postoperative bleeding • Anaesthesia of check • Injury to nasolacrimal duct • Sublabial fistula • Osteomyelitis of maxilla ENT 160. Cad wells operation is for: A. Maxillary sinus B. Frontal sinus C. Ethmoidal sinus D. Sphenoidal sinus
  • 216 DNB JUNE-2008 161. All the sinus are seen in which view? A. Waters view B. Cald wells view C. A P view skull D. Lateral view PL Dhingra Ch - 91 Water’s view • Maxillary (Best) • Frontal • Sphenoidal ENT Cad well view • Frontal (Best) • Ethmoidal • Maxillary Lateral view • Sphenoidal • Maxillary • Frontal • Ethmoidal Submentovertical (Basal) view • Sphenoidal • Ethmoidal • Maxillary 162. Antrochoanal polyp is usually: A. Multiple in number B. Single C. Operation is difficult D. Appear at posterior choana PL Dhingra Ch-33
  • ENT 217 Differences between antrochoanal and Ethmoidal polyps ACP Age Cause Number Laterality Origin Growth Children Infection Single Unilateral Maxillary sinus Backwards to Choana Size and shape Trilobed Recurrence Uncommon Treatment Polypectomy Cod well-Luc Endoscopic removal EP Adult Allergy Multiple Bilateral Ethmoidal sinus Grows auteriorly Grape like common Endoscopy Ethmoidectomy Kiesselbach’s plexus or littles area • Vascular area in the anterior-inferior part of nasal septum • Just above the vestibule • Anastomosis of – Anterior ethmoidal – Spheno palatine – Greater palatine – Septal branch of labial arteries – Corresponding veins • Mc site of epistaxis • Site of origin of hemangioma ENT 163. Keisselbach’s plexus is: A. Littles area B. Plexus of veins in posterior aspect of nose C. Present in throat D. Present in lateral wall of nose PL Dhingra Ch-27
  • 218 DNB JUNE-2008 164. Drainage of nasal mucosa is caused by: A. Sneezing B. Ciliary movements C. Negative pressure of posterior choana D. Inspiration and aspiration PL Dhingra Ch-25 ENT In mammals cilia beats 10-20 times per second at room temperature. They have a rapid “effective stroke” and a slow “recovery stroke” In immotile cilia syndrome cilia are defective and can not beat effectively, leading to stagnation of mucus in nose and sinuses and bronchi causing chronic rhinosinusitis and bronchiectasis. Mucous blanket consists of a superficial mucus layer and a deeper serous layer, floating on the top of cilia which are constantly beating to carry it like a conveyer belt. 165. Aspirin induced asthma is associated with: A. Nasal polyps B. Otitis media C. Nasal allergy D. Atrophic rhinitis PL Dhingra Ch-33 Causes of nasal polyp 1. Chronic rhinosinusitis 2. Asthma 3. Aspirin intolerance 4. Cystic fibrosis 5. Allergic fungal sinusitis 6. Kartagener’s syndrome 7. Young’s syndrome 8. Chrug- Strauss syndrome 9. Nasal mastocytosis
  • Physiology 219 Physiology 166. Circadian rhythm is controlled by: A. Arcuate nucleus B. Suprachiasmatic nucleus C. Optic chiasma D. Globus pallidus W Ganong Ch – 14 167. Most important buffer in blood is: A. HCO3 B. Hb C. ClD. Proteins W. Ganong Ch – 39 Buffers in Blood 1. Carbonic acid bicarbonate system most important because CO2 produced is excreted out by lungs 2. Plasma proteins: 3. HemoglobinRelatively little buffering capacity Physiology In mammals, including humans most of the cells in the body have circadian rhythms. In the liver these are influenced by the pattern of food intake, but in almost all other cells the rhythm are entrained by the paired suprachiasmatic nuclei, on either side above optic chiasma. These nuclei receive information about the light dark cyclevia a special neural pathway. The retinohypothalamic fibers that pass from the optic chiasm to the suprachiasmatic nucleus
  • 220 168. DNB JUNE-2008 True about capillaries is: A. large surface area in total B. Maximum velocity C. Maximum blood D. Large surface area per capillary W. Ganong Ch – 27 Types of blood vessels Physiology Vessel Cross sectional Area (cm2) Percentage of blood Artery Artery Arteriole Capillary Venule Vein Vena cava 4.5 20 400 4500 4000 40 18 2 8 1 5 T 54 1 169. Interstitial fluid has maximum: A. Na+ B. K+ C. CL D. HCO3– WF Ganong Ch – 7 Concentration of Ions. (m mol/l) Ion Inside the cell Outside the cell Equilibrium potential Na+ K+ Cl– 15 150 9 150 5.5 125 +60 -90 -70 Resting membrane potentional is -70 mv
  • Physiology 221 170. Ganglionic sympathetic and parasympathetic fibers secrete: A. Nor adrenaline B. Acetylcholine C. Acetylcholinesterase D. Dopamine K Tripathi Ch - 5 • Acetycholine is secreted at a. Skeletal muscle neuromuscular junction b. Preganglionic parasympathetic c. Preganglionic sympathetic Nor adrenaline is secreted at post ganglionic sympathetic with a few exceptions 172. Arterial PO2 decreases in: A. C O poisoning B. Cyanide poisoning C. Anaemia D. None W. F. Ganong Ch - 34 The amount of dissolved oxygen in anemia and carbon monoxide poisoning is generally normal even though the combine O2 in the blood is markedly decreased. Physiology 171. Diffusion of a molecule is directly proportional to: A. Temperature B. Water solubility C. Thickness of membrane D. Molecular weight WF Gaanong Ch - 1 Diffusion of a molecule is directly proportional to a. Temperature b. Lipid solubility c. Thin membrane d. Low molecular weight
  • 222 DNB JUNE-2008 The chemoreceptors are stimulated when arterial PO2 is low ie. hypoxic hypoxia or stasis of blood. Powerful stimulation of receptors is also produced by drugs such as cyanide which prevents O 2 utilization at the tissue level (Histotoxic hypoxia) 173. Vit B12 is absorbed in: A. Ileum B. Duodenum C. Jejunum D. Stomach Physiology U. Satyanarayan Ch - 7 Vitamin B12 is present in diet bound to proteins. It is liberated in stomach in free form. Dietary source of B12 is called as Extrinsic factor of castle. Stomach secretes a special protein called intrinoic factor (1F) The cobalmin 1F complex travels down to ileum and binds to specific receptors and enters into mucosal cells It is converted to methylcobalamin and is transported in circulation by transcobalmin 174. Glossitis is seen in deficiency of: A. Vitamin A B. Vitamin C C. Vitamin B2 D. Vitamin B6 U. Satyanarayan Ch - 7 Riboflavin-B2 vitamin • Riboflavin deficiency symptoms Cheilosis - fissures at corner of mouth Glossitis - smooth and purple tongue dermatitis Chronic alcoholics are susceptible to B2 deficiency • Assay of enzyme glutathione reductase in erythrocytes is useful in assessing the riboflavin deficiency
  • Physiology 223 175. PH sensing receptors are present in all except: A. Medulla B. Aortic body C. Carotid body D. Juglar bulb WF Ganong Ch - 34 Chemoreceptors: 1. Carotid bodies • At the bifurcation of common carotid artery • Afferent fibers via Hering’s nerve of XI CN to the dorsal respiratory area of the medulla 2. Aortic bodies : Located in arch of aorta Afferent via X CN to dorsal respiratory area of medulla Telomers are present in chromosal end and confer stability In humans it consists of many arrays of TTAGGG repeats They are formed by a special reverse transcriptase TELOMERASE They get shortened during senescence. The enzyme is active in cells, normal or malignant with high proliferative rate Physiology 176. Telomerase is: A. DNA dependent DNA polymerase B. DNA dependent RNA polymerase C. RNA dependent DNA polymerase D. RNA dependent RNA polymerase Harper’s Ch - 62
  • 224 DNB JUNE-2008 Biochemistry Biochemistry 177. HGPRT is involved in metabolism of: A Hypoxanthine and guanine B. Pyrimidine C. Purine D. Xanthine U Satyanarayan Ch - 17 Hypoxanthine-guanine phosphoribosyltransferase converts Guanine to guanine monophosphate and hypoxanthine to Inosine monophosphate This pathway is more important in certain tissue such as erythrocytes and brain where de novo synthesis of purine is not operative. A defect in enzyme HGPRT causes Lesch-Nyhan syndrome. 178. Degeneracy of genetic code means: A. Same codon for some amino acid B. There may be more than one codon for each amino acid C. Read from a fixed position D. Codes for a specific amino acid U. Satyanarayan Ch - 18 Genetic codons • Stop codons – UAA, UAG, UGA Ochre, amber, opal respectively • Initiating codons- AUG and sometimes GUG
  • Biochemistry Universality Specificity Non-overlapping Degeneracy 225 - Same codon for same amino acid in all species - A particular codon codes for a particular a.a. - Read from a fixed point as a continuous base sequence - One codon can code for more than one a.a. 179. Iron is present in all except: A. Transferrin B. Ferritin C. Ceruloplasmin D. Myoglobin U Satyanarayan Ch - 9 180. Phsensing receptors are present in all except: A. Medulla B. Aortic body C. Carotid body D. Juglar bulb Chemoreceptors: 1. Carotid body – At the bifurcation of common carotid body Afferent fibres via Herring nerve of 11 cranial nerve to the dorsal respiratory area of medulla 2. Aortic body Located at arch of aorta Afferent via 10 cranial nerve to dorsal respiratory area of Medulla WF Ganong Ch - 34 Biochemistry Ceruloplasmin • Blue coloured – Copper Containing – Binds to almost 90% of plasma copper – Does not readily release it to tissue – Has oxidase activity – Associated with Wilson’s disease Albumin binds to 10% of plasma copper
  • 226 DNB JUNE-2008 181. Best parameter in analysis of body iron store is: A. S. ferritin B. S. Iron C. TIBC D. S. transferring U. Satyanarayan Ch - 19 Biochemistry Sr. ferritin is best for estimation of iron body store. Transferrin or siderophilin For transport of iron Each molecule can bind to 2 atoms Ferritin . To store in liver, spleen and bone marrow • Temporary storage in mucosal cells Hemosiderin - Iron storage protein • Supplies iron in excess demand 182. Myoglobin is present in. A. Slow fibers B. Fast fibers C. White fibers D. All the above Myoglobin: • Monomeric oxygen, binding – Hemoprotein in heart and skeletal muscles – Reservoir of oxygen – Promotes transport to oxygen to rapidly respiring muscle – Structurally resembles Hb 183. PH of blood is: A. 7.35-7.45 B. 7.25-7.35 C. 7.30-7.40 D. 7.40-7.50 WF Ganong Ch - 39
  • Biochemistry PH of various acids Gastric Hcl Maximal urine acidity Plasma Extreme acidosis Normal Extreme alkalosis Pancreatic juice - 227 0.8 4.5 7.0 7.4 7.5 8.0 185. Brown fat is present in all sites except: A. Cheeks B. Nape of neck C. Thigh’s D. Anterior abdominal wall U Satyanarayan Ch - 14 Brown adipose tissue: – Store less fat – Metabolically more active – Has more mitochondria – Has more cytochrome – Produces less ATP – Responsible for diet induced thermogenesis – Oxidation and phosphorylation is not coupled Biochemistry 184. In allosteric inhibition: A. Inhibitor binds to same site as substrate B. Binds to different site C. Binds covalently D. None U Satyanarayan Ch - 6 Types of Enzyme Inhibition 1. Reversible Inhibition a. Competitive: Inhibitor resembles the substrate b. Non-competitive: Inhibitor binds to site other than active site c. Uncompetitive—Inhibitor binds to enzyme substrate complex and not to the enzyme 2. Irreversible inhibition Inhibitor binds covalently with the enzyme 3. Allosteric Inhibition: Substance binds to the allosteric site on enzyme
  • 228 – – – – – DNB JUNE-2008 Produces more heat and less ATP Thermogenin is present in inner mitochondrial membrane Present in newborns Present in check, nape of neck and thoracic region Absent in obese Biochemistry 186. Glucocorticoid secretion is increased in all except: A. Surgery B. Hemorrhage C. High potassium intake D. Trauma Glucocorticoids secretion Increased • Surgery • Anxiety • Trauma • Hemorrhage Unaffected • High potassium intake • Low sodium intake • Constriction of NC in thorax • Standing • Secondary hyperaldosteronism 187. Categorical cortex is better than working cortex in: A. Language B. standing speech C. Reading D. All the above W. F. Ganong Ch - 16 The primary brain areas concerned with language are arrayed along and near the sylvian fissure of the categorical hemisphere. A region at the posterior end of the superior temporal gyrus called wernicke’s area is concerned with comprehension of auditory and visual information
  • Biochemistry 229 188. Nerve regeneration is: A. 10 mm/day B. 5 mm/day C. 1 mm/ day D. 7 mm/day The average rate of growth of sensory nerve fibres was 5mm a day and that of motor nerves is 1.7 mm a day 190. Antioxidants are all except: A. Vit A B. Vit C C. Vit E D. Vit D Antioxidants Vitamin A Vitamin E Vitamin C Selenium Zinc Manganese Copper Riboflavin Pyridoxine Biochemistry 189. Haptoglobulin is all except: A. Plasma glycoprotein B. Acute phase reactant C. Increases in hemolytic anemia D. Increases in inflammatory conditions U. Satyanarayan Ch - 9 Haptoglobulin: • Plasma glycoprotein • Acute phase protein • Increase in inflammation • Binds with free hemoglobin • Hemolytic anemia is associated with decreased plasma Concentration of haptoglobin.
  • 230 DNB JUNE-2008 Pathology 191. Programmed cell death is: A. Apoptosis B. Necrosis C. Inflammation D. Aging Pathology Robbins Ch - 1 Difference between Apoptosis and Necrosis Feature Cell size Nucleus Necrosis Enlarged Pyknosis - Karyorrhexis - Karyolysis Plasma membrane Disrupted Cellular contents Enzymatic digestion Adjacent Frequent inflammation Invariably Causes Pathologic Apoptosis Reduced Fragmentation into nucleasomes Intact Intact No often physiologic 192. Apoptosis true is: A. It is pathological B. Self mediated C. Apoptotic body is basophilic D. It is inflammatory Robbins Ch - 1 Apoptosis is a pathway of cell death that is induced by a tightly regulated intracellular program in which
  • Pathology 231 cells destined to die activate enzymes that degrade the cells own nuclear DNA and nuclear and cytoplasmic proteins Morphology: – Cell shrinkage Chromatic condensation (most characteristic) • Cytoplasmic blebs and apoptotic bodies • Phagocytosis of apoptotic cells or cell bodies usually by macrophages The apoptotic cell appears as a round or oval mass of intensely eosinophilic cytoplasm with dense nuclear chromatin fragments 193. Barr body was first detected in: A. Mucosal cells B. Brain C. Skin D. Nerve • Lyon outline the x-inactivation commonly called Lyon hypothesis • The inactive X can be seen in the interphase nucleus as a darkly stained small mass in contact with nuclear membrane called Barr body or X chromatin • It involves a unique gene called xist, whose product is a non-coding RNA that is retained in the nucleus where it coats the inactive X chromosome and initiates a gene- silencing process by chromatin modification and DNA methylation • The xist allele is turned off in inactive X • At least some of the genes that are expressed from both X chromosome are important for normal growth and development • Regardless of the number of X chromosome the presence of a single Y determines the male sex • Male specific Y or MSY region is present on Y chromosome • Barr and Bertram first described Barr body in the nucleus of nerve cell of a female cat and named it as Barr body Pathology Robbins Ch - 5
  • 232 DNB JUNE-2008 194. HMB 45 is a tumour marker of: A. Angioma B. Melanoma C. Prostate cancer D. Pheochromocytoma Robbins Ch - 7 Tumour markers Calcitonin Catecholamine X-Fetoprotein – Medullary carcinoma of thyroid – Pheochromcytoma – Liver cell carcinoma Pathology Carcinoembryonic antigen – Carcinoma of colon pancreas, lung, stomach and heart Prostatic acid phosphatase – Prostate cancer Neuron- specific enolase – small cell cancer of lung neuroblastoma HMB 45 Melanoma CA 125 Ovarian cancer CA 19-9 Colon cancer, pancreatic cancer CA 15-3 Breast cancer Immunoglobulins Prostate specific antigen Multiple myeloma Prostate cancer 195. Prostrate specific antigen is: A. Lipoprotein B. Useful for differentiation between benign and malignant prostate enlargement C. Measured by immunoassay D. Normal value is 40 mg/ml Robbins Ch - 21 Prostrate specific antigen • Product of prostate epithelium • Normally present in semen • It is a serine protease • Cleaves and liquefies seminal coagulum • Normal serum level-4 mg/ml • Organ specific
  • Pathology 233 • Not cancer specific • Increased in benign and malignant prostate prostatitis, infract, instrumentation • PSA density: Ratio of PSA value and volume of prostate • Upper normal value = 0.15 • PSA velocity Rate of change of PSA • Best way to distinguish cancer from normal • PSA is assessed by antibody test 197. Flame cells are seen in following tumour: A. Multiple myelome B. Pheochromocytoma C. Angioma D. Squamous cell carcinoma Robbins Ch - 14 Pathology 196. Good prognostic factors for neuroblastoma are all except: A. Less than one year age B. Stage IV s C. Decreased CD 44 D. Trk A gene expression Robbins Ch - 7 Prognostic factors Neuroblastoma Good Poor <1yr age >1yr age I II IV stage III IV stage Hyperdiploidy Diploid Triploidy Deletion of short Arm of ch 1, 14 Trk A gene n myc (most important) Decreased mitosis Increased mitosis Increased intramural Decreased intramural Calcification Calcification Decreased Telomerase Increased Decreased MRP Increased Increased CD 44 Decreased Decreased ferritin Increased Increased CD 44 Decreased Decreased LDH Increased
  • 234 DNB JUNE-2008 Pathology Multiple myeloma Histology Flame cells Firy red cytoplasm Mott’s cells Grape like cytoplasm Deposits 1. Eosinophilic nuclear Ducher bodies 2. Cytoplasmic Russel bodies 198. Nodular glomerural sclerosis is seen in: A. Hypertension B. Diabetes C. Amyloidosis D. Cryoglobulinemia Robbins Ch - 20 Features of glomerular changes in various diseases Diabetes - Diffuse glomerulosclerosis nodular glomerulosclerosis Amyloidosis - Nodular eosinophilic - Large masses Cryoglobulinemia - Diffuse mesangial proliferative - Membrano proliferative glomerulonephritis Hypertension - Decreased size kidney (Benign) Gross Grain leather appearance Microscopic - Hyaline arteriosclerosis - Fibroclastic hyperplasia (Malignant) Gross Decreased size Increased size in acute malignant hypertension flea bitten appearance Microscopic - Hyperplastic arteriolitis necrotizing arteriolitis
  • Pathology 235 199. Poor prognosis in Hodgkin’s disease is seen in all except: A. Males B. Age > 45 years C. WBC > 30,000 D. Hemoglobin < 10.5 gm % Robbins Ch - 14 Worse prognosis Hodgkins lymphoma. Male gender Age > 45 yr Stage IV Hb < 10.5 gm/dl WBC > 15,000 Lymphocytes < 8% Albumin < 4 gm/dl Pathology 200. Following are seen in paraneoplastic syndrome except: A. Hypernatremia B. Hypercalcemia C. Hypocalcemia D. Hyponatremia Robbins Ch - 7 Harmones in paraneoplastic syndrome ADH - Hypernatremia ACTH - Cushing’s syndrome PTH like harmone - Hypercalcemia Calcitonin - Hypocalcemia Peptides - Hypophosphatemia Serotonin - Carcinoid syndrome 201. Desmin is tumour marker of: A. Carcinoma B. Rhabelomyosarcoma C. Neuronal tumour D. Glial tumour Robbins Ch - 7
  • 236 DNB JUNE-2008 Tumour markers 1. Cytokeratin - 2. Desmin 3. Viamentin - 4. Glial fibrillary acid protein 5. Neuro filaments - Carcinoma Mesothelioma Rhabdomyosarcoma Non-specific mesenchymal tumours Glial tumour - Neural tumour Pathology 202. True about Ageing is: A. Increased mitochondria B. Increased uptake of nutrients C. Telomere shortening D. Decreased lipofuschin Ageing Telomer shortening Decreased oxidative phosphorylation Decreased mitochondria Decreased DNA and RNA synthesis Accumulation of lipofuschin Abnormally lobed nuclei Decreased uptake of nutrients Decreased repair of chromosome 203. Antigen presenting cells are: A. Macrophages B. B cells C. Dendritic cells D. All of the above Robbins Ch - 6 Antigen presenting cells Macrophages Dendritic cells B cells Largerhans’ cells
  • Pathology 237 205. Cadmium is a risk factor for following carcinoma: A. Liver B. Prostate C. Lung D. GIT Robbins Ch - 7 Metals as risk factor for various cancers Arsenic - Lung, skin, hemangiosarcoma Benzene - Leukemia, Hodgkin’s lymphoma Berrylium - Pneumoconiosis Asbestos - Lung mesothelium GIT Chromium - Lung Radon - Lung Ethylene oxide - Leukemia Cadmium - Prostate Nickel - Nose lung Vinyl chloride - Angiosarcoma liver Pathology 204. Major protein in amyloidosis in chronic renal failure is: A. AL B. AA C. AB2 m D. ATTR Robbins Ch - 6 Amyloidosis Multiple mycloma - AL Monoclonal B - cell proliferation AL Chronic inflammatory condition - AA Chronic renal failure - AB2 m Systemic senile amyloidosis - ATTR Familial amyloidotic neuropathies - ATTR AlZheimer’s disease - AB Type II diabetes - AIAPP Prion disease - Misfolded prion proteins
  • 238 DNB JUNE-2008 Pediatrics Pediatrics 206. Most common cause of neonatal meningitis: A. Group A streptococci B. Group B streptococci C. Pneumococci D. E. coli OP Ghai Ch - 17 Causes of Meningitis Neonatal Meningitis – E coli (Mc) Strep. Pneumoniae Listeria Staph. aureus Step. fecalis 3 months – 3 years H. influenza S. pneumoniae Meningococci >3 years S. pneumoniae N- meningitis 207. Citrate is added to ORS to: A. Decrease acidosis B. Increase absorption C. Decrease secretion D. To make it stable OP Ghai Ch – 12 The base (bicarbonate, citrate, lactate) is added to correct acidosis due to alkali loss in stool.
  • Pediatrics Composition of WHO ORS Sodium Chloride Tri sodium citrate dehydrate Potassium chloride Glucose Water Na+ Kr -Cl Citrate Glucose 239 3.5 gm/l 2.9 gm/l 1.5 gm/l 20 gm/l 1 lit. 90 m mol/L 20 m mol/L 80 m mol/L 10 m mol/L 111 m mol/L 209. Ratio of chest compression to breath in neonatal reoussitation is: 13. 3:1 14. 2:1 15. 5:1 16. 15:2 OP Ghai Ch - 7 Pediatrics 208. One-year-old baby with diarrhea flushing , fullness in flanks, diagnosis is: A. Wilms’ tumour B. Neuroblastoma C. Polycystic kidney disease D. Hydornephrosis OP Ghai Ch - 21 Neuroblastoma – Mc malignancy of infant – Autosomal dominant – Mc site adrenal medulla – Encapsulated tumour – Orbital proptosis, fever, bony pain – Diarrhea, flushing , tachycardia headache, sweating – X-ray = Stippled calcification – Increased urinary catecholamine – Increased VMA /HVA
  • 240 DNB JUNE-2008 Chest compression in Neonates • Thumb technique – Two thumbs are used to depress the sternum • Two finger technique – Tip of middle finger and either index or ring finger are used. Compression is applied to lower third of sternum No pressure applied to xiphoid Sternum is depressed to ½ to ¾ inch Rate: compression to breath ration should be 3:1 Heart rate is checked after 30 seconds HR below 80 – continue Above 80 – discontinue Pediatrics 210. Fore milk contains all except: A. Glucose B. Fat C. Na+ D. Ca2+ O. P. Ghai Ch - 7 Varying composition of breast milk Colostrum : During first three days Transitional milk : During the following 2 wk Mature milk : Follows 2 wk Preterm milk : Mother who delivers preterm baby Fore milk : Secreted at the start of a feed watery, rich in proteins, sugar vitamins minerals and water satisfies babies thrust Hind milk : Comes late towards the end of feed Richer in fat content and provides more energy and satisfies baby’s hunger 211. Fetal hemoglobin is: A. Zeta 2 Epsilon 2 B. Alpha 2 beta 2 C. Alpha 2 gamma 2 D. Alpha 2 delta 2 OP Ghai Ch - 6
  • Pediatrics Types of Haemoglobin in Human Embryonic Gower 1 - Zeta 2 Gower 2 - Alpha 2 Partland - Zeta 2 Fetal Alpha 2 Gamma 2 Adult HbA1 - Alpha 2 HbA2 - Alpha 2 241 Epsilon 2 Epsilon 2 Gamma 2 Beta2 Delta 2 4-6 wks Gower 1.2 is predominant after 8 wk Hbf 12 wk 16-20 wk 20 wks At birth By 6 months 12 months - Embryonic Hb diappeares Adult Hb appears 90% of Hb - Hbf 70% of HbF and 30% HbA Normal level of HbA1 Normal level of HbA2 is attained. 213. Brain to liver ration in malnourished is: A. 1:2 B. 2:1 C. 3:1 D. 5:1 Pediatrics 212. True about Thalasemia major facies are all except: A. Depressed nasal bridge B. Frontal bossing C. Anti-mongoloid slant D. Maxillary prominence OP Ghai Ch - 6 Thalasemia major facies Mongoloid facies Bossing of skull Prominent frontal eminences Prominent parietal eminences Flattened vault Straight forehead Hypertrophy of maxilla Prominent molar eminences Depressed bridge of nose Puffy eyes
  • 242 DNB JUNE-2008 Pediatrics Journal of clinical pathology Dysmature infants of body weight less than 1 SD below the mean body weight for gestation age are characterized by brain liver weight ratio of 4-5 or more 214. Most common malignancy in child is: A. Brain tumour B. Neuro blastoma C. Blood cancer D. Rhabdomyosarcoma OP Ghai Ch - 21 Pediatric malignancy 1. Mc intra-abdominal - Neuroblastoma solid malignancy 2. Mc malignancy - Leukemia 3. Mc cause of - Multi cystic Abdominal Mass kidney 4. Mc solid tumour - Brain tumour 5. Mc Brain tumour - Supratentorial 6. Mc Supratentorial - Astrocytoma tumour 7. Mc infratentorial - Glioma tumour 8. Mc astrocytoma - Juvenile pilocytic astrocytoma 9. Mc cerebral palsy - Spastic 10. Mc cause of death - Respiratory infection in DMD 215. Most common cause of bronchiolitis is: A. Parainfluenza B. Rhinovirus C. RSV D. H.influenza OP Ghai Ch - 15 Acute coryza - Rhinovirus Bronchiolities - RSV ALTB - Parainfluenza Epiglotitis - H inf B Empyema < 2y - Staphylococci
  • Pediatrics 243 Bronchiolitis – Seen between 1-6 months – Main stay of treatment is 02 – No role of antibiotic – Ribavorin is used in CHD Chronic lung disease Immunodeficiency 216. Following strain is used in measles vaccine: A. Edmonston Zagreb B. Jeryll lynn C. Danish 1331 D. Park Williams 8 OP Ghai Ch - 8 - Danish 1331 Lansing, Leon and Brunhilde Edmonston Zagreb Jeryll lynn Ty 21 a OKa Pitt moore strain 17 D HM 175 RA 27/3 Park William 8 217. Following are X linked dominant disorders except: A. Hypophospatemic rickets B. Orofacial digital syndrome C. Dent disease D. Alports syndrome OP Ghai Ch - 22 X linked Dominant disorders 1. Hypophospatemic rickets 2. Orofacial digital syndrome 3. Alports syndrome 4. Incontinenta pigment Pediatrics BCG Polio Measles Mumps Typhoral Chicken pox Rabies Yellow fever Hepatitis A Rubella Diptheria
  • Pediatrics 244 DNB JUNE-2008 218. Gene product associated with Marfan’s syndrome is: A. Merlin B. Dystrophin C. Laminin D. Fibrillin OP Ghai Ch - 22 Gene products and disease Firbillin - Marfan Tuberin, Hamartin - Tuberous sclerosis Neurofibromin - NF1 Merlin - NF I Drystrophin - DMD Spectrin, Ankyrin - Hereditary spherocytosis SMN - Survival motor neuron NAIP - Neuronal apoptosis inhibitor gene FMR 1 gene - Fragile X syndrome Nephrin - Congenital nephrotic syndrome Aquaporin - Nephrogenic diabetes insipid us. 219. Most common cause of coryza in children is: A. Parainfluenza type I B. Allergic C. Rhinovirus D. Bacteria O. P. Ghai Ch - 15 Mc cause of acute epiglotitis H inf. Type I Mc cause of bronchiolitis RSV Mc cause of coryza Rhino virus Mc cause of ALTB Parainfluenza I Mc cause of status epilepticus Febrile status Mc type of childhood seizures GTCS Mc cause of neonatal seizures Hypoxic Ischemic Encephalopathy
  • Pediatrics Mc casue of conductive deafness Mc cause of sensorineural deafness Mc cause of stridor at birth Mc cause of upper GI bleed 245 - OMC effusion - Meningitis - Laryngomalacia - Esophgeal varices 220. Following is seen normally in newborn: A. Peeling of skin B. Vaginal bleed C. Breast enlargement D. All of the above Pediatrics Normal findings in a newborn Milia Mongolian spots Strok bites Breast enlargement Epsteins pearl Pre deciduous teeth Vaginal mucoid discharge Hymenal tags Physiological phimosis Cephalohematoma Caput succedaneum Vaginal bleeding Erythema toxicum Sub-conjuctinal Haemorrhage Peeling of skin
  • 246 DNB JUNE-2008 Ophthalmology Ophthalmology 221. Drugs contraindicated in corneal ulcer: A. Corticosteroids B. Antibiotics C. Pilocarpines D. Atropine Kanski page 259 Mydriatics are used to prevent the formation posterior synechiae and to reduce pain from ciliary spam Topical steroids They should not be introduced untill the sensitivity of the isolate to antibiotics has been demonstrated and fungal infections excluded They can potentiate coexisting fungal infection and may make elimination of acanthamoeba infection more difficult They reduce inflammationand can rapidly make the eye more comfortable. However, their use probably does not affect the amount of scar formation or the final visual outcome They may help to prevent rejection following infection of a corneal graft. 222. Intermittent proptosis is seen in: A. Orbital cellulitis B. Orbital varices C. Graves disease D. Retrobulbar tumour Journal of neurosurgery
  • Ophthalmology 247 Two cases of intermittent exophthalmos are reported in both of them cerebral angiography and orbital venography failed to outline the lesions which was clearly demonstrated with the aid of computerized tomography. An orbital varix was seen to be the cause of proptosis in one surgically verified case, whereas in the other this same diagnosis was suspected on the basic of clinicoradiological 223. Reese Ellsworth classification is for: A. Trachoma B. Retinoblastoma C. Hodgkins D. Sympathetic ophthalmitis 224. Papilloedema is seen in: A. Trauma B. Congenital C. lukaemia D. All of the above Ophthalmology Classification of Retinoblastoma Reese Ellsworth Group I Very favourable a. Solitary tumour less than 4 disc diameter in size at or behind the equator b. Multiple tumour < 4 disc diameter all at or behind the equator Group II Favourable a. Solitary tumour 4 to 10 DD at or behind the equator b. Multiple tumour. 4-10 DD, behind the equator Group III Doubtful a. A lesion anterior to the equator b. Solitary tumors larger than 10 DD behind equator Group IV Unfavorable a. Multiple tumor, some larger than 10 DD b. Any lesion extending anterior to ora serrata Group V Very unfavourable a. Massive tumors involving over half the equator b. Vitreous seeding
  • Ophthalmology 248 DNB JUNE-2008 Papilloedema: Headache vomiting Usually Bilateral Pupil is normally reacting More than + 3D disc elevation Haemorrhage and exudates may be seen Enlargement of blind spot Recovery of vision is not complete Due to increased intracranial tension Due to intracranial space occupying lesions Causes: Aqueductal stenosis, cranio synostosis Intracranial space occupying lesion Head injury Meningitis encephalitis Sub-arachnoid haemorrhage Malignant hypertension Lukaemia, polycythemia Saroidosis, serum sickness Pseudo tumour cerebri 225. True about ARMD are all except: A. Usually bilateral B. Exudative type is more common C. Argon laser photocoagulation is done D. Retinal pigmentary epithelial atrophy is seen Age Related Macular Degeneration – Bilateral – Sub-retinal neovascular membranes at macula a. Non exudative: Mc type Slow and progressive atrophy of retinal pigmentary epithelium Sharp circumscribed areas of RDE atrophy with varying degrees of loss of chorio capillaries In late stage the larger choroidal vessels become visible within the atrophic area Treatment: No effective treatment except The provision for low visual aids b. Exudative: Neovascular or wet ARMD Detachment of RPE and choroidal neovascularisation
  • Ophthalmology 249 Undertectable in early stage but later they appear as grey green elevated lesion in macular region Treatment: Argon (blue green) laser photo coagulation may be effective in obliterating extra-foveal SRNVMs outside the FAZ. 226. All are seen in Retinitis Pigmentosa except: A. Night blindness B. Constricted visual field C. Atrophy of optic disc D. Venular attenuation 227. A child with white papillary reflex can be suffering from: A. Congenital cataract B. Retinal dysplasia C. Coat’s disease D. All of the above Cause of Leukocoria (Amaurotic cat’s eye reflex) – Congenital cataract Ophthalmology Retinitis Pigmentosa: – Night blindness – Constricted visual field – Bilateral symmetrical diffuse retinal dystrophy predominantly affecting the rod Autosomal recessive – MC X-linked dominant – Most severe Degeneration of rods and cones Migration of pigments into retina Degenerated ganglion cells Attenuation of blood vessels Atrophy of optic disc Triad of: Bony spicule pigmentation Arteriolar attenuation Waxy pallor of optic disc – Cystoid macular edema – Cellophane maculopathy – Atrophic maculopathy Treatment: No treatment is satisfactory
  • 250 – – – – – – – DNB JUNE-2008 Retinoblastoma Retinopathy of prematurity Toxocara endophthalmitis Persistent hyperplastic primary vitreous Retinal dysplasia Coat’s disease Choroidal coloboma 228. Epiphora in bell’s palsy is due to: A. Increased tear production B. Lagophthalmus C. Lacrimal pump failure D. All of the above Ophthalmology Epiphora: Defective drainage of tears due to fault in the lacrimal passage Causes 1. Mechanical obstruction – Congenital absence or occlusion of puncta – Canaliculitis – Congenital dacryocystitis – Chronic or acute dacryocystitis – Neoplasms of the lacrimal sac – Nasal polyps 2. Lacrimal pump failure – Lower lid laxity – Weakness of orbicularis oculi in bell’s palsy – Ectropion 229. Persitant: Hyperplastic primary vitreous is associated with. A. Microophthalmos B. Cataract C. Glaucoma D. All of the above Persistent hyperplastic primary vitreous Failure of hyaloid artery to regress combined with the hyperplasia of the posterior portion of vascular meshwork produces PHPV – Unilateral condition – Eye fails to develop and is smaller than yellow eye – A white papillary reflex is noticed
  • Ophthalmology – – – 251 Associated with cataract glaucoma intraocular haemorrhage Anterior chamber is shallow and retrolental tissue contracts to pull the ciliary process in wards Visual prognosis is poor 230. Meibomianitis is mostly due to: A. Staphylococci B. Streptococci C. Pseudomonas D. E. coli 231. Trichiasis is: A. Misdirected eye lashes B. Inward turning of lid margin C. Outward turning of lid margin D. Extrafold of skin over lower lid Ankyloblepharon—Adhesion between upper and lower lid margins Ablepharon—Absence of eyelids Coloboma—Absence of some occular tissue Ophthalmology Meibomianitis: Chronic infection of meibomian gland Mostly due to staphylococcal infection Symptoms: Watering Frothy discharge Foreign body sensation Sign: White frothy secretion on lid margin and at the canthi Associated features of blepharitis or chalazion may be seen Vertically yellowish streaks shining through conjuctiva are seen Treatment: Tarsal massage and removal of secretion with a moistcotton applicator Steroid antibiotic ointment is applied by rubbing on the lid margins 2-4 times daily
  • 252 DNB JUNE-2008 Distichiasis—Accessory row of eye lashes Ectropion—Outward turning of lid margin Entropion —Inward turning of lid margin Epiblepharon—Extra fold of skin of lower lid Lagophthalmos—Inability to close eye Symblepharon—Adhesion between palpebral and bulbar conjuctiva Trichiasis—Misdirected eye lashes Ophthalmology 232. Munson’s sign is seen in. A. Buphthalmos B. Microcornea C. Microophthalmos D. Keratoconus Keratoconus Bilateral conical projection of central part of cornea with thinning of its central and inferior paracentral areas Starts at around puberty Bilateral usually asymmetrical Impaired vision Irregular retinoscopic reflex Placido’s disc Vogt’s lines : vertical fold at the level of deep stroma Prominent corneal nerves Munson’s sign-bulging of lower lid when patient looks down Flischer’s ring-Epithelial iron deposition at the base of cone 233. Central serous Retinopathy is seen in: A. Young adult male B. Young adult female C. Old male D. Old female Central Serous Retinopathy – Edema of macular area – Unknown cause – Young adult male – Localised retinal detachment
  • Ophthalmology – – – – – – 253 Sudden onset blurring of vision Black fixed spot Metamorphopsia Macula appears as an oval or circular dark swelling about the size of the optic disc which is surrounded by glistening ring reflex 90% patients undergo spontaneous regression 40% develop recurrent attack. 234. Subluxation of lens is: A. A portion of lens remains in papillary area B. Lens completely lost C. Aphakia D. Congenital condition Subluxation: – When a portion of supporting zonules is absent – The lens remains in papillary area Dislocation: Lens is completely unsupported by Zonular fibres so that the lens is completely displaced from papillary area (patellar fossa) 235. Shortest pelvic diameter is of. A. Transverse diameter B. Inter spinous diameter C. Obstetric conjugate D. True conjugate DC Dutta Ch 9 Diameter of maternal pelvis Inlet 1. Anteroposterior – 11cm 2. Obstetric conjugate -10 cm 3. Diagonal conjugate – 12 cm 4. Transverse diameter – 13 cm 5. Oblique diameter-12 cm Ophthalmology Ectopia lentis Congenital Bilateral Subluxation or dislocation
  • 254 DNB JUNE-2008 Cavity 1. Anteroposterior – 12 cm 2. Transverse – 12 cm Outlet 1. Transverse -10.5 cm 2. Anteroposterior – 11cm 3. Posteriorsagital – 5 cm Ophthalmology Anatornical outlet 1. Anteroposterior – 13 cm 2. Transverse- 11cm 3. Posterior sagittal diameter – 8.5 cm 236. Steroid secreted by fetus is A. Cortisol B. Pregnenolone C. Progesterone D. Dihydroepiandrosterone D.C.Dutta Ch-4 Fetal Harmones: 10 wk - Growth harmone ACTH Prolactin Gonadotropin 11wk - Thyroxine 12 wk - Insulin Fetal adrenal show hypertrophy of reticular zone which is the site of synthesis of oestriol precursor, dehydroepiandrosterone This zone is absent in anencephaly 237. Features of Preeclampsia are all except: A. Edema B. Hypertension C. Convulsion D. Proteinuria DC Dutta Ch-17
  • Ophthalmology 255 Diagnosis of pregnancy induced hypertension 1. Hypertenion: At least 140/90 mm Hg Or a rise of systolic by 30 mm Hg Or a rise of diastolic by 15 mm Hg At least at 2 occasions 4 hrs apart 2. Edema: Pitting edema over ankles after 12 hr of bedrest or rapid gain of weight by 1b a week or more than 5 1b a month 3. Proteinuria: More than 0.3 gm/l in 24 hr collection More than 1 gm/l in 2 or more midstream samples Cervical changes in pregnancy 1. Hypertrophy and hyperplasia of elastic and connective tissue 2. Fluid accumulation between fibres 3. Increase in vascularity 4. Hypertrophy and hyperplasia of glands 5. Marked proliferation of endocervical mucosa 6. Physiological leucorrhoea 239. Complication of oxytocin is: A. Hypertension B. Hypotension C. Diuresis D. Hyperpituitarism Complictions of Oxytocin Maternal: 1. Uterine rupture 2. Hypotension 3. Antidiuresis 4. Pituitary shock DC Dutta Ch - 33 Ophthalmology 238. Cervical changes in Pregnancy are all except: A. Increased collagen B. Increased glands C. Atrophy of endocervical mucosa D. Fluid accumulation DC Dutta Ch - 5
  • 256 DNB JUNE-2008 Ophthalmology Fetal: 1. Asphyxia 2. Neonatal jaundice 240. Drug of choice of Antihypertensive in pregnancy: A. Enalapril B. Methyldopa C. Propranolol D. Diazoxide DC Dutta Ch - 33 Antihypertensive therapy in pregnancy 1. Methyldopa- Doc 2. Reserpine 3. Labetalol 4. Propanolol 5. Hydralazine 6. Nifedipine 7. Diazoxide 8. Sodium nitroprusside 241. Amniotic fluid contains: A. Fructose B. Mannose C. Glucose D. Galactose DC Dutta Ch - 3 Composition of Amniotic fluid A. Organic 1. Protein 2. Glucose 3. Urea 4. NPN 5. Uric acid 6. Creatinine 7. Total lipids 8. Harmones (Prolactin, insulin and rennin) B. Inorganic 1. Sodium 2. Chloride 3. Potassium
  • Ophthalmology 257 C. Suspended particles 1. Lanugo 2. Exfoliated squamous epithelial 3. Vernix caseosa 4. Cells from urinary bladder respiratory tract and vagina of the fetus. 243. Advantages of condom are all except: A. No side effects B. Protection against STD C. Good sexual pleasure D. Simple to use DC Dutta Ch - 35 Condom Advantages 1. Cheaper 2. No contraindication 3. No side effect 4. Simple to use Ophthalmology 242. True about median episiotomy are all except: A. Muscles are not cut B. Early recovery C. Suitable in all cases D. Wound disruption is rare DC Dutta Ch - 36 Median episiotomy Merits: 1. The muscles are not cut 2. Blood loss is least 3. Repair is easy 4. Postoperative comfort is maximum 5. Healing is superior 6. Wound disruption is rare 7. Dyspareunia is rare Demerits: 1. May involve rectum 2. Not suitable for manipulative delivery 3. Not suitable for abnormal presentation or position
  • 258 5. 6. 7. 8. DNB JUNE-2008 Disposable Protection against STD Protection against PID Protection against cervical cell abnormalities Ophthalmology Disadvantages 1. Accidentally break or slip off 2. In adequate sexual pleasure 3. To discard after one coital act 244. Implantation of fertilised ovum occurs at: A. 72 hr B. 96 hr C. 6th day D. 9th day DC Dutta Ch - 2 Events following fertilization Fertilization - 0 hr 2 cell stage (Blastomere) - 30 hr 4 cell stage - 40-50 hr 12 cell stage - 72 hr 16 cell stage - 96 hr Blastocyst - 5th day Implantation - 6-7th day Lacunar period - 9th day Implantation completed - 10-11th day Primary villi - 13th day Secondary villi - 21st day Fetal heart - 21-22 day 245. Immediate complication in puerperium is: A. Inversion of uterus B. Breast engargement C. Psychosis D. Sepsis DC Dutta Ch - 29 Puerperal Emergencies Immediate: 1. Postpartum haemorrhage 2. Shock 3. Postpartum eclampsia
  • Ophthalmology 259 4. Pulmonary embolism 5. Inversion Early 1. Acute retention of urine 2. Urinary tract infection 3. Puerperal sepsis 4. Breast engorgement 5. Mastitis and breast abscess 6. Anuria Delayed 1. Secondary postpartum haemorrhage 2. Thromboembolism 3. Psychosis 4. Postpartum cardiomyopathy 5. postpartum haemolytic uraemia Shaw Ch - 2 Inhibin: – Non-steroidal water-soluble protein – Secreted by graffian follicle – Mc Cullagh identified it – Also called it folliculostatin – Suppress pituitary FSH – Oestrogen is responsible for secretion of inhibin – It suppresses FSH – Stimulates LH secretion – Causes agglutination of sperms – Prevents cervical mucus penetration – Interferes with egg interaction 247. Estradiol is secreted by: A. Theca cell B. Granulosa cell C. Corpus luteum D. All of the above Shaw Ch - 2 Ophthalmology 246. Inhibin causes stimulation of: A. FSH B. Oestrogen C. LH D. All of the above
  • 260 DNB JUNE-2008 Oestrogen Sources: Theca cell Granulosa cell Corpus luteum Adrenal cortex Secreted as oestradiol Ophthalmology Bound to • Albumin (30%) • Sex harmone binding globulin 69% • Only 1% is biologically active • Inactivated in liver and excreted in urine • Peak level in blood are seen - 2 days before ovulation - 24 hr before LH peak 248. Causes of delayed puberty are all except: A. Turner’s syndrome B. Hyperthyroidism C. Hypopituitarism D. Hypothyroidism Shaw Ch - 4 Causes of delayed puberty Pituitary in sufficiency Hypothalamic insufficiency Turner syndrome Resistant ovary Autoimmune disease Polycystic ovarian disease Testicular feminizing syndrome Malnutrition Anorexia nervosa Hypothyroidism 249. Latzko operation is done for: A. Ureteric fistula B. Vesico vaginal fistula C. Vesico uterine fistula D. Urethrovaginal fistula Shaw Ch - 16
  • Ophthalmology 261 Repair of Vesicovaginal Fistula • Spontaneous healing • Latzko procedure • Chassar Moir technique • Omental graft Martius graft Gracilis muscle graft Implantation of ureters into the sigmoid colon Creating an ideal loop bladder Rectal bladder 251. Adenomyosis usually present as: A. Menorrhagia B. Dysmenorrhoea C. Asymptomatic D. Pain Adenomyosis – Uterine endometriosis – Islands of endometrium in uterine – Seen in elderly women – Mc – asymptomatic – Co exists with endometrial carcinoma – Symmetrically enlarged uterus Shaw Ch - 35 Ophthalmology 250. Early features of Menapause are all except: A. Hot flushes B. Insomnia C. Cancer phobia D. Osteoporosis Shaw Ch - 5 Early Features of Menapouse 1. Hot flushes 2. Sweating 3. Insomnia 4. Headache 5. Psychological 6. Cancer phobia 7. Pseudocyesis 8. Irritability, depression 9. Lack of concentration
  • 262 – – – – – – – DNB JUNE-2008 Localized nodular enlargement on cut section Islands of endometrial glands surrounded by stroma Menorrhagia Dysmenorrhoea Pain Localized excision Hysterectomy 252. Discharge seen in trichomoniaisis is: A. Greenish yellow B. Curdy white C. Frothy D. Watery Ophthalmology Shaw Ch - 11 Trichomoniasis – Trichomonas vaginalis – Greenish yellow discharge – Associated with pruritis vulvae and dysuria – Strawberry coloured dots – Marked erythema – Oedema – Wet mount of vaginal secretion – Feinberg-Whittington medium 253. Most common method of minilap sterilization in female is: A. Pomeroy method B. Madlener method C. Irving method D. Uchida method Shaw Ch - 18 Minilaprotomy sterelisation 1. Pomeroy method – Mc 2. Madlener operation 3. Irving method 4. Aldridge method 5. Cornual resection 6. Uchida method 7. Fimbriectomy
  • Ophthalmology 263 254. Cause of amenorrhoea are: A. Lactation B. Anorexia nervosa C. Pregnancy D. All of the above Shaw Cause of Amenorrhoea Physiological amenorrhoea – Puberty – During pregnancy – Lactaton – After menopause Ch 21 Ophthalmology Pathological – Genetic factors – Endocrinopathies – Gynatresia – Nutritional factors – Drug usage – Psychological factors 255. Treatment given for Menorrhagia are: A. Mafenamic acid B. Oral contraceptive pills C. Hysterectomy shaw D. All of the above Management of Menorrhagia 1. NSAID 2. OCP 3. Electrocautery 4. Laser vaporization 5. Hsyterectomy Ch - 22 256. Most important cause of genital prolapse: A. Menopause B. Birth trauma C. Nerve injury D. Increased intra-abdominal pressure Cause of Genital prolapse 1. Atonicity (Menopause) Most important 2. Birth injury
  • 264 3. 4. 5. 6. 7. DNB JUNE-2008 Peripheral nerve injury Rapid succession of pregnancy Delivery of big baby Raised intraabdominal pressure Abdominoperineal excision of rectum Shaw Ch 25 257. Procidentia is: A. Descent of cervix into vagina B. Descent of cervix upto introitus C. Descent of cervix outside introitus D. All the uterus outside the introitus Ophthalmology Shaw Ch - 25 Classification of Prolapse Anterior vaginal wall Upper two third - Cystocele Lower two third - Urethrocele Posterior vaginal wall Upper one third - Enterocele (pouch of Danglas) Lower two third – Rectocele Uterine descent 1°- descent of cervix into the vagina 2°- descent of cervix upto introitus 3°- descent of cervix outside introitus Procidentia- all of the uterus outside the introitus 258. True about Ulcer due to prolapse is all except: A. Decubitus ulcer B. Due to friction C. Has clean edges D. Does not heal on repositioning Shaw Ch - 25 Decubitus ulcer of prolapse – Caused by friction, congestion and circulatory changes in dependent part of prolapse – The reduction of prolapse into vagina and daily packing heals the ulcer in a week or two – It shows a clean edge which differentiates it from a carcinoma
  • Ophthalmology 265 259. Least common complication of fibroma: A. Atrophy B. Torsion C. Sarcomatous changes D. Infertility Ophthalmology Complications of fibroma 1. Atrophy 2. Calcareous degeneration 3. Red degeneration 4. Sarcomatous change (extremely rare) 5. Torsion 6. Inversion 7. Capsular haemorrhage 8. Infection 9. Asociated endometrial carcinoma 10. Menstrual disorders 11. Infertility Shaw Ch - 27 260. Pseudo Meigs’ syndrome consists of: A. Brenner’s tumour B. Ascites C. Hydrothorax D. All of the above Shaw Ch - 28 Brenner’s Tumour – Uncommon – Fibroepithelial tumour – 1-2 % of all ovarian neoplasm – Resembles fibroma – Cut surface appears gritty and yellowish grey – Generally unilateral – Small to moderate size – Essentially benign – Having no endocrine function
  • 266 DNB JUNE-2008 Medicine Medicine 261. Porto caval anastomosis is present in all except: A. Upper anal canal B. Lower anal canal C. Lower end of esophagus D. Bare area of Liver Davidson Ch - 17 Major site of collateral flows are: 1. Esophagogastric varices 2. Rectum (haemorrhoids) 3. Retroperitoneal space 4. Falciform ligament of liver 262. Requirement of Iron in Anaemia: A. 4.4 × body wt × Hb deficit B. 2.21 × body wt × Hb deficit C. 5 × Body wt × Hb deficit D. 7 × Body wt × Hb deficit Fe needed in mg= @ (hb – pt’s Hb) × wt in kg × 2.21 +1000 @ Hb in – 14 mg/dl -12 mg/dl change according to type matter Addition of 1000 is to correct deficit and replenish body stores 263. Perforation is typhoid is usually seen in: A. 3rd week B. 4th week C. 1st week D. 2nd week
  • Medicine 267 Events in Typhoid 4-5 days – Constipation Prominent Diarrhoea, vomiting in children Bradycardia 7 days – Onset of rash – Rose spot on Abdomen and back, cough epistaxis, septicemia 10 days – Splenomegaly Distension of stomach, bronchitis Delirium 2 wk – Profound illness 3 wk – Toxaemia, coma Intestinal hemorrhage, perforation Diagnostic tests used for H. Pylori Invasive: 1. Endoscopy based biopsy urease test most convenient, quick, simple 2. Histology- Accurate but time consuming 3. Culture- Accurate, also tests antibiotic susception time consuming Non-invasive 1. Urea breath test Simple, safe and cheaper 2. Serological (serum IgG) ebidemiological tool Can not differentiate between active and remote infection 3. Stool Antigen test: Less accurate Used for follow up. Medicine 264. Most rapid test for H. pylori detection. A. C14 breath test B. Urease test C. Biopsy D. Histology Harrison’s Ch - 135
  • Medicine 268 DNB JUNE-2008 265. Paised IVP Pedal edema, tender hepatomegaly and bilateral basal crepitations are seen in: A. Rt. heart failure B. Lt heart failure C. Biventricular failure D. Constructive Pericarditis Davidson Ch - 12 Heart Failure Clinical features: 1. Low cardiac output - Fatigue Cold peripheries Low BP 2. Poor renal perfusion - Oliguria Uraemia 3. Pulmonary oedema - Breathlessness Orthopnoea paroxysmal nocturnal Dyspnoea 4. Rt. heart failure High JVP, hepatic congestion Peripheral oedema 5. Othersmarked - Impaired absorption in wt loss git - Increased level of cytokine, tumour necrosis factors 266. Watermelon stomach is seen in: A. Ca. stomach B. Scleroderma C. SLE D. Peptic ulcer When systemic scleroderma affects the stomach it can cause watermelon stomach which is the popular term for Gastric Antral Vascular Ectasia (CAVE) The primary symptom is shortness of breath, which is often severe No treatment at present
  • Medicine 269 267. Rheumatoid arthritis affects: A. Cervical spine B. Lumbar spine C. Thorasic spine D. Sacrum Harrison’s Page - 1971 268. Amount of blood in clot of size of a clenched fist: A. 200 ml B. 300 ml C. 500 ml D. 600 ml For each hand of fist measurement assume a cumulative loss of about 5-10% of circulative blood volume. So it should be 500 ml 269. Most common valve affected in RHD is: A. Mitral B. Tricuspid C. Aortic D. Pulmonary Harrison’s Page – 1978 The most serious complication of Rheumatic fever is valvular stenosis regurgitation, the mitral valve is most frequently involved. Followed by Aortic valve. Medicine Rheumatoid Arthritis Mostly causes symmetric arthritis with characteristic involvement of certain specific joints like proximal interphalangeal and metacarpophalangeal joints. Distal interphalangeal joint are rarely involved Axial involvement is usually limited to upper cervical spine. Involvement of lumbar is never seen and lower back pain can not be attributed to R.A synovitis of wrist joint is a feature of R.A synovitis of elbow joint leads to flexion contracture. Knee joint is commonly involved with synovial hypertrophy chronic effusion and ligamentous laxity.
  • 270 DNB JUNE-2008 However isolated aortic valve disease is rare. Although Rheumatic pericarditis can cause serous effusion, fibrin deposits pericardial effusion it does not cause constrictive pericarditis Carditis of RHD Pancarditis Characterized by : Sinus tachycardia murmur of mitral regurgitation S3 gallop pericardial friction rub and cardiomegaly Prolonged PR interval. 270. Nada’s criteria is used for: A. Heart disease B. Lung disease C. Kidney disease D. Protein energy malnutrition Medicine Davidson Ch - 12 Nada’s Criteria Major 1. Systolic murmur grade III or more specially with thrill 2. Diastolic murmur 3. Cyanosis 4. Congestive heart failure Minor 1. Systolic murmur grade less than III 2. Abnormal S2 3. Abnormal ECG 4. Abnormal X-ray 5. Abnormal BP 271. Drug induced lupus is due to: A. Anti-histone Antibodies B. Anti Sm Antibodies C. Anticentromere Antibodies D. Antiribosomal P Harrison’s Table 3001 Page - 1961
  • Medicine 271 Auto Ab of SLE Antinuclear Antibodies – Best scneening test Anti ds DNA Anti – Sm, Specific for SLE Anti RNP Anti Ro – Not specific Associated with Sicca syndrome, subacute Cutaneous lupus, neonatal lupus Congenital heart block Anti histone – Drug induced lupus Anti ribosomal P – positive test in serum Correlates with depression, psychosis CNS lupus Study in 111 patients 1. The amount of nodal cells in SAN was found to be invariably Propotional to the age of patients 2. Normal sinus rhythm was present in some cases with severe fibrosis of SAN 3. No relation with atrial fibrillation 4. The auriculartachycardia- bradycardia syndrome was associated in most cases So probably answer is ‘B’ 273. Sinus bradycardia is: A. <60 /min B. <50 /min C. <40 /min D. <70 /min Harrison’s Page - 1335 Sinus Bradycardia - when sinus rate <60 beats / min Sinus Tachycardia - when sinus rate >100 beats/min Medicine 272. ECG findings in sinoatrial disease A. Sinus arrhythmia B. Atrial ectopics C. Ventricular ectopics D. Sinus arrest
  • 272 DNB JUNE-2008 In adults normal sinus rate under basal condition is 60-100 beats/min Etiology Sinus Bradycardia is associated with Hypothyroidism, advansed liver disease typhoid, brucellosis, vasovagal syncope, severe hypoxia, hypercapnia academia and acute hypertension Medicine 274. Most common cause of Infective Endocarditis: A. Streptococcus viridans B. Staphylococcus aureus C. HACEK D. Candida Davidson Page - 62 The vindias group of streptococci (Strep Mitis, Strep. Sange are commensals in upper Respiratory tracts that may enter blood stream on chewing, tooth-brushing or dental treatment and are common cause of SABE. Others are Enterococcus faicalis E. faecium and Strep. bovis Remember Staph. aureus Coagulase - It is common cause of SABE originating from skin infection abscess or vascular access sites (IV and central lines) intravenous drugs misuse - ve Staphylococcus (Staph. epidermidis) Mc org. for Postoperative endocarditis after cardiac surg. (Associated with prosthetic valve) 275. Osler’s nodes are seen in: A. Infective endocarditis B. Leibmann sach’s endocarditis C. Rheumatic carditis D. Thromboembolism
  • Medicine 273 Infective Endocarditis 1. Osler’s nodes : Tender raised lesion on 2. Roth’s spots - Finger or toe pads Round white spots on retina surrounded by hemorrhage 3. Janeway’s lesion - Small erythematous Lesion on palm or sole 4. Splinter haemorrhage Acute Bacterial Endocarditis - Staphylococcus aureus Subacute Bacterial Endocarditis - Streptococcus viridians Blood culture is crucial investigation because it may identify the infection and guide Antibiotic therapy. It is the major criteria in modified Duke’s criteria Positive blood cultureTypical organism from 2 Cultures Persistent +ve blood culture taken >12 hrs apart 3 or > 3 culture taken over more than 1 hr Modified Duke Criteria Major 1. Positive Blood culture 2. Endocardial involvement Minor 1. predisposing valvular or cardiac abnormality 2. Intravenous drug misuse 3. Pyrexia > 38 °C 4. Embolic phenomenon 5. Vasculitic phenomenon 6. Blood culture suggestive organism grown but not achieving major criteria 7 Suggestion echocardiographic findings Definitive diagnosis 2 major (or) 1 major and 3 minor (or) 5 minor Medicine 276. Diagnostic test in infective endocarditis. A. Blood culture B. Echocardiography C. Serum CRP D. ECG Davidson Page – 63
  • 274 DNB JUNE-2008 277. Anemic in CRF is due to: A. Erythropoietin deficiency B. Iron deficiency C. Folate deficiency D. Hemoglobinopathies Harrison’s Page – 658-659 Medicine Normocytic, normochromic Anemia in CRD is observed beginning at stage 3 CRD and is almost universal at stage 4. The Primary cause of anemia is due to insufficient production of EPO by diseased kidneys Treatment : Darbopoetin alfa – (hyperglycosylated Management analogue of recombinant human EPO Erythropoietin Starting done – 50-150 units / kg per wk IV/sc Target Hb 11-12 g/dl Optimal rate of correction Aero Hb by 1-2 g / dl over 4 wks Darbepoetin alfa Starting dosage- 0.45 ug/kg single IV/sc oncel weekly Target Hb - < 12 g/dl Optimal rate of correction: increase Hb by 1-2 gm/dl over 4 wks 278. Duration of angina is usually: A. 1-5 min B. 5-10 min C. 15 min D. 30 min Harrison’s Page – 1435 Angina is usually crescendo descrescendo in nature typically last for 2-5 min and can radiate to left shoulder and to both arms, especially to ulnar surface of forcarm and hand Radiates also to back inters cap or region, root of neck, jaw , teeth, epigastrium Angina is rarely localized below umbilicus or mandible.
  • Medicine 275 280. Refractory Hypertension is due to: A. Renovascular B. Pheochromocytoma C. Drug induced D. Poor compliance MC cause of Refractory Hypertension – Renal Artery stenosis 2 MC cause of Refractory hypertension – coarctation of aorta Osler’s sign- Palpable brachial or radial artery when cuff is inflated above systolic pressure: 281. Exogenous Insulin can be differtiated from endogenous insulin by estimation of: A. C peptide B. Insulin C. Glucose D. Serological ‘C’ peptide is liberated in synthesis of Insulin in body level of ‘C’ peptide can be used to assess insulin synthesis in body. Medicine 279. ECG findings in hypokalemia are all except: A. Tall tented T waves B. U waves C. ST depression D. Q T prolongation (ST segment) Harrison’s Page - 1319 Hypokalemia Prolongs ventricular repolarization Prominent U waves Prolongation of Q.T interval Some imp features: J point – Osborn wave – Hypothermia incQT interval – Hypocalcemia inc QT interval – Hypercalcemia inc QT interval – Digitalised Scooping of ST- T wave complex: Digitalis effect CVAT – wave pattern In subarachnoid hemorrhage (QT prolonged, dup wide T wave inversion)
  • 276 DNB JUNE-2008 282. Sequence in Raynauds phenomenon is: A. Pallor – cyanosis – Rubour B. Cyanosis – Pallor – Rubour C. Rubour – Cyanosis – Pallor D. Pallor – Rubour – Cyanosis Patient Exposed to cold – Blanching or Pallor due to vasospasm (Ischemic phase) – Cyanosis as capillaries and venules dilate cyanosis due to deoxynated blood. – Rubor due to rewarming vasospasm resolve blood flow into dilated arterioles/capillaries is increased – Reactive hyperemia Medicine 283. Curling’s ulcer is seen in: A. Burns B. Surgery C. Head injury D. Any trauma Curling’s ulcer – burn Cushing’s ulcer – Head injury 284. Barrett’s esophagus is: A. Metaplasia B. Anaplasia C. Dysplasia D. All of the above Barrett’s esophagus Metaplasia of esophageal squamous epithelium to columnar epithelium occurs during healing of erosive esophagitis with continued acid flux as columns epithelium is more resistant to acid- pepsin damage than is squamous epithelium 285. Alcoholism there is an increased level of: A. AST B. ALT C. ALP D. GGT AST level – twice that of ALT – specific for alcoholic liver disease
  • Medicine 277 ALT>AST – in nonalcoholic fatty liver disease Isolated AST inc – Codiac disease Both AST and ALT increased – Hepatocellular necrosis inflammation ALT is present in cytoplasm AST in both cytoplasm and mitochondria ALT elevated: Paget’s bone disease Rickets Hyperparathyroidism Metastatic bone tumour 3rd trimester of pregnancy Cirrhosis GGT is increased in biliary obstruction The diagnosis must be confirmed by histopathology and biopsy is the diagnostic Diagnosis of Leprosy 1. Skin Smears 2. Nasal smears 3. Nasal scrapings 4. Foot pad culture 5. Histamine test 6. Lepromin test 7. FLA – ABS test. 287. In typhoid, chronic carriers are those: A. Urinary carriers with anomaly B. Urinary carriers without anomaly C. Blood carriers with anomaly D. Blood carriers without anomaly As anomaly allow prolonged colonization, Urinary carriers with anomaly are chronic carriers (who shed S. typhi in either urine/stool >1 yr) Medicine 286. Definitive diagnosis of leprosy is by: A. Skin biopsy B. Skin smear C. Clinically D. Serological
  • 278 DNB JUNE-2008 288. All cause painless Haematuria except: A. Acute cystitis B. Glomerulonephritis C. Infection endocarditis D. Schiotomiasis Medicine Causes of painless Haematuria Kidney 1. Glomerulonephritis 2. Infectious endocarditis 3. Benign familial Haematuria 4. IgA nephropathy 5. Acute pyelonephritis 6. Papillary necrosis in DM 7. Renal cell carcinoma Ureter – Tumour Bladder 1. Tumour 2. Trauma 3. Schistosomiasis Postrate 1. Prostatitis 2. Neoplasm Urethra – Trauma 289. Cheynes-Stokes breathing is seen in: A. Metabolic alkalosis B. Metabollic acidosis C. Heart failure D. Respiratory alkalosis Davidson Ch - 12 Kussmal’s Respiration is seen in metabolic acidosis Cheynes-Stokes RespirationCyclic Pattern of respiration Due to reduced sensitivity of respiratory centre to carbon dioxide May occur in left ventricular failure Slowly diminishing respiration leading to apnoea,
  • Medicine 279 followed by progressively increasing respiration and hyperventilation May be accompanied by sensation of breathlessness and panic during the period of hyperventilation It’s length is a function of circulation time Can occur in more diffuse cerebral atherosclerosis, stroke or head injury and may be exaggerated by sleep, barbiturates and narcotics 290. Granulomatous condition with hypercalcemia is: A. Sarcoidosis B. SLE C. Forresties’s disease D. Systemic and cirrhosis 291. Loud P2 is seen in: A. Pulmonary Hypertension B. Shock C. CHF D. WPW syndrome Loud S1 - MS, TS Sinus tachycaridia Hyperdynamic status Medicine SLE Features found: 1. Interstitial lung disease - Necrotizing sarcoidal granulomatosis 2. Lymphadenopathy 3. Erythema 4. Uveitis 5. Nasal stuffiness 6. Anaemia, Neutropenia, esosinophilia. Throbocytopenia 7. Hypercalcemia 8. Hypercalciuria 9. 7th nerve palsy (mostly unilateral) 10. Cardiac dysfunction 11. Diabetes incipidus 12. Parotid enlargement
  • 280 DNB JUNE-2008 Medicine PDA, VSD, ASD Short PR interval Soft S1 - VSD, MR Calcified MS Pericardial fluid S2 - Single S2 AS, PS Pulmonary atresia Fallot’s tetralogy - Wide and fixed split – ASD - Wide variable split – RBBS PS Pulmonary embolism Reverse split LBBB AS LVF Loud P2 Pulmonary hypertension 292. Disease causing orchitis is: A. Mumps B. Measles C. Leprosy D. Gonococci Mumps Paramyxovious Droplet infection I.P – 15-20 days Clinical features: Prodromal symptoms Malaise Anorexia Fever Tenderness at angle of jaw Parotitis (B/L) in 2/3 case) Difficulty in eating swallowing and talk Complications 1. Orchitis, oophoritis 2. Pancreatitis 3. Encephalitis, Meningitis 4. Myocarditis 5. Thrombocytopenic purpura
  • Medicine 281 293. Lesion of basal ganglion causes: A. Pin rolling tremor B. Head noding C. Mania D. Intentional tremor 1 Hemiballis mera = tremor= chorn- Sanolia Lesion of Basal ganglion a. Hemiballismus b. Huntington’s chorea c. Parkinson’s disease (Pin rolling tremor) d. Athetosis 294. Least common site to be involved in osteoarthritis is: A. Hip joint B. Knee joint C. Carpometacarpal it of thumb D. Metacarpophalangeal joint 295. ASD all except: A. Rt.ventricular enlargement and Rt axis deviation B. Rt abium and ventricular enlargement C. Oligemic lung fields D. Hyperdynamic precordium Findings in ASD. Right Atrium and Right ventricular enlargement Hyperdynamic precordium Ejection systolic murmur Increased blood flow across pulmonary valve Systolic thrill in pulmonary area Wide and fixed splitting of S3 Medicine Osteoarthritis Involves: P1P, DIP and first carpometacarpal joint Spares: MCP and wrist Rheumatoid arthritis: Involves: PIP, MCP wrist Spares DIP Psoriatic arthritis Involves: PIP, DIP, MCP and wrist Spares : May not spare any joint
  • 282 DNB JUNE-2008 296. Viral meningitis are except: A. Increased chloride B. Low protein C. Normal sugar D. Lymphocytosis CSF finding in viral yeningatis Clear, ICP Protein Sugar Cell cound (lymphocytosis) N CSF TBM Bacterial Viral Medicine Colour Clear Color/cobweb Turbid Clear Transp Press 60-150mm >180 Protein 20-40% (>45) Sugar 90-70 mg (<40) (2/3 of RBS) lymphoCells 0-5 (lympo- (lympho(Neutro- cytes Chlorides cytes) cytes) philia) 720-750 297. Heart impulse shifted down and out in: A. Left ventricular hyportrophy B. Rt ventricular hypertrophy C. Rt Abium enlargement D. Lt Atrium enlargement LVH- impulse shifted laterally and down RVH- Sustained systolic lift at lower lt para sternal area 298. Heart sound that occur in systole is: A. S3 B. Pericardial Knock C. Opening snap D. Ejection and click Systolic ejection murmur- occurs when blood in ejected across aortic or pulmonic outflow tract Dastolic sounds 1. Opening snap 2. S3 3. S4 Systolic sound 1. Ejection sound 2. Non-ejection click or mid systolic click
  • Medicine 283 299. Most common bronchogenic carcinoma A. Small cell carcinoma B. Squamous cell carcinoma C. Mixed cell carcinoma D. Adenocarcinoma Medicine MC bronchiogenic Ca in India - Squamous cell Ca In world – Adenocarcinoma • Mc type in smokers – sq. cell • Mc type in non smokers – Adeno Ca. • Mc type in females – Adeno ca. • Mc site for metaotasis – liver • Mc gland to be involved – Adrenals • Mc type which metastasite to opposite lung – Adeno Ca. • Mc tumour to metastasise to heart- Ca lung • Pancost tumour – squamous cell. • Mc type which causes paraneoplastic syndrome – small cell
  • 284 DNB JUNE-2008 Medicine Answers: 1. 5. 9. 13. 17. 21. 25. 29. 33. 37. 41. 45. 49. 53. 57. 61. 65. 69. 73. 77. 81. 85. 89. 93. 97. 101. 105. 109. 113. 117. 121. 125. 129. 133. 137. 141. 145. 149. 153. D C D A B A A&C A A A C A D C D D A C B D B D D B B D A C D C C B A A C B B A B 2. 6. 10. 14. 18. 22. 26. 30. 34. 38. 42. 46. 50. 54. 58. 62. 66. 70. 74. 78. 82. 86. 90. 94. 98. 102. 106. 110. 114. 118. 122. 126. 130. 134. 138. 142. 146. 150. 154. B A D A B B B A B A B B C B A D A A B B A D D B C D B B B A D B C D A B B C A 3. 7. 11. 15. 19. 23. 27. 31. 35. 39. 43. 47. 51. 55. 59. 63. 67. 71. 75. 79. 83. 87. 91. 95. 99. 103. 107. 111. 115. 119. 123. 127. 131. 135. 139. 143. 147. 151. 155. B A C A B C B A A A A A C A C C A D D A A C D C A D D A D A D C B A D C B D A 4. 8. 12. 16. 20. 24. 28. 32. 36. 40. 44. 48. 52. 56. 60. 64. 68. 72. 76. 80. 84. 88. 92. 96. 100. 104. 108. 112. 116. 120. 124. 128. 132. 136. 140. 144. 148. 152. 156. C C A A A B B B A A A A&B A D A C A B B A C D C D B D D B A B C A C D C D D A B
  • Medicine C D A A D C D C B B C D C B C A D D C D D B C B A A D B C B A A A A A B 158. 162. 166. 169. 173. 177. 181. 185. 189. 193. 197. 201. 205. 209. 213. 217. 221. 225. 229. 233. 237. 241. 245. 249. 253. 257. 261. 265. 269. 273. 277. 281. 285. 289. 293. 297. A B B A A C C C C D A B D A D C A B D A C C A B A D B C A A A A A A A A 159. 163. 167. 170. 174. 178. 182. 186. 190. 194. 198. 202. 206. 210. 214. 218. 222. 226. 230. 234. 238. 242. 246. 250. 254. 258. 262. 266. 270. 274. 278. 282. 286. 290. 294. 298. C A A A C B B C D B B C D B C D B D A A C C C D D D B B A A A A A A D D 160. 164. 167. 171. 175. 179. 183. 187. 191. 195. 199. 203. 207. 211. 215. 219. 223. 227. 231. 235. 239. 243. 247. 251. 255. 259. 263. 267. 271. 275. 279. 283. 287. 291. 295. 299. A B A A D C A D A C C D A C C C B D A C B C D C D C A A A A A A A A C D Medicine 157. 161. 165. 168. 172. 176. 180. 184. 188. 192. 196. 200. 204. 208. 212. 216. 220. 224. 228. 232. 236. 240. 244. 248. 252. 256. 260. 264. 268. 272. 276. 280. 284. 288. 292. 296. 285