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DAMS CBT 2016 SET - 1 Q-1 Renal fascia is also known as? a. Scarpa’s fascia b. Gerota’s fascia c. Denonvillier’s fascia d. Buck’s fascia Ans-1: (b) Gerota’s fascia Ref.:Read the text below Sol : Buck’s fascia Colles’s fascia Denonvillier’s fascia Gerota’s fascia Scarpa’s fascia Zuckerkandl’s fascia The penile fascial sheath Continuation of scarpa’s layer of abdominal fascia. Fascia separating the prostate from the rectum The renal fascia; encapsulates the perinephric fat. The fibrous layer of the superficial fascia of the lower abdomen The retrorenal fascia. Q-2 Inferior mesenteric artery does not supply? a. Rectum b. Descending colon c. Right flexure of transverse colon d. Upper part of the anal canal Ans-2: (c) Right flexure of transverse colon Ref.:Read the text below Sol : Right flexure of transverse colon is supplied by superior mesenteric artery not inferior mesenteric artery Part Part in adult Gives rise to Arterial Supply Foregut Esophagus to first Esophagus, Stomach, Celiac trunk nd 2 sections of the Duodenum first and 2 parts), duodenum Liver, Gallbladder, Pancreas, spleen, Superior portion of pancreas Midgut Lower duodenum, to Lower duodenum, jejunum, Branches of the the first two-thirds of ileum, cecum, appendix, superior the transverse colon ascending colon, and first two mesenteric artery thirds of the transverse colon Hindgut Last third of the Last third of the transverse Branches of the transverse colon, to colon, descending colon, inferior mesenteric the upper part of the rectum, and upper part of the artery anal canal anal canal www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-3 Regarding meningeal blood supply and innervations,incorrect statement is: a. The main blood supply to the meninges is from the middle meningeal artery. b. The accessory meningeal artery may arise from the maxillary or middle meningeal artery. c. The middle meningeal artery is subdural in location. d. Innervation of the dura is primarily from the trigeminal nerve. Ans 3: (c) The middle meningeal artery is subdural in location. Reference – Read the text below Sol: The main blood supply to the meninges is from the middle meningeal artery however, there are contributions from the cavernous, carotid,ophthalmic and vertebral arteries. The accessory meningeal artery enters the skull through the foramen ovale and supplies the meninges. The middle meningeal artery is extradural and along with the meningeal veins grooves the inner table of the skull. Innervation of the dura is primarily from the trigeminal nerve and also from the lower cranial nerves and the first three cervical segments. This may be the reason for cervical pain in cranial subarachnoid haemorrhage. Q-4 Regarding the normal development of the brain: a. The neural tube expands to form the three primary vesicles during the fourth week of intrauterine development. b. Hypodense white matter in a pre-term infant’s CT brain usually signifies ischaemia. c. Vascular supply of the embryonic brain is similar to that of the adult. d. MRI is insensitive to assess the progress of myelination. Ans 4: (a) The neural tube expands to form the three primary vesicles during the fourth week of intrauterine development. Reference – Read the text below Sol: Due to the relatively high water content, white matter of the normal preterm infant appears hypodense and should not be mistaken for ischaemia. The embryonic brain is exclusively supplied by the internal carotid artery, which may persist in the adult when one of the two posterior cerebral arteries is supplied only through the ipsilateral posterior communicating artery. MRI is used to assess the progress of myelination. T1-weighted inversion recovery images are particularly sensitive to myelination in the first 6 months. Thereafter T2 weighted images are used. Q-5 Lateral cutaneous nerve of thigh is a branch of? a. Lumbar plexus b. Femoral nerve c. Obturator nerve d. Sciatic nerve www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ans-5: (a) Lumbar plexus Ref.:Read the text below Sol : Lateral cutaneous nerve of thigh is a purely sensory branch of lumbar plexus L2 L3 as it passes through the opening between inguinal ligament and its attachment 1-2 cm medial to the anterior superior iliac spine. Entrapment of lateral cutaneous nerve of thigh causes Meralgia paresthetica. Numbness is the earliest and most common symptom Pain, paresthesia, Hyposthesia over the anteriolateral aspect of thigh. Particularly common in obese and in abdominal distension. Q-6 Bochdalek hernia is? a. Anterolateral hiatus hernia b. Posterolateral hiatus hernia c. Central hiatus hernia d. Anterior hiatus hernia Ans-6: (b) Posterolateral hiatus hernia Ref.:Read the text below Sol : The classic appearance of a hiatus hernia, with a fluid level superimposed on the cardiac shadow on the PA film, is well known. A bochdalek hernia arise posterolaterally through the pleuroperitoneal canal and is usually congenital, presenting at birth as respiratory distress. Ninety percent are left sided. The hernia may contain omentum, fat, spleen, kidney and bowel, in which case a gas shadow is seen within the mass. The ipsilateral lung is invariably hypoplastic with deviation of the mediastinum away from the side of the hernia. Q-7 Which of the following best describes the landmark known as lambda? a. Point on calvaria at junction of sagittal and lambdoid sutures b. Point on calvaria at junction of sagittal and coronal sutures c. Junction of the greater wing of the sphenoid, squamous temporal, frontal, and parietal bones d. Star-shaped landmark at junction of parietomastoid,occipitomastoid, and lambdoid sutures Ans 7: (a) Point on calvaria at junction of sagittal and lambdoid sutures Ref– Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Lambda is the point on the calvaria at the junction of the sagittal and lambdoid sutures Q-8 Which of the following transmits a nerve branch to the meninges? a. Foramen spinosum b. Mastoid foramen c. Jugular foramen d. Foramen magnum Ans 8: (a) Foramen spinosum Ref– Read the text below Sol: The foramen spinosum transmits the meningeal branch of the mandibular division of the trigeminal nerve Q-9 Theforamen magnum transmits all of the following except a. Medulla and meninges b. Vertebral arteries c. Spinal roots of the accessory nerve d. Internal carotid artery Ans 9: (d) Internal carotid artery Ref– Read the text below Sol: The foramen magnum transmits the medulla and meninges, vertebral arteries, spinal roots of the accessory nerve, dural veins, and the anterior and posterior spinal arteries www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-10 All are supplied by mandibular nerve except: a. Anterior belly of digastrics b. Omohyoid c. Tensor tympani d. Tensor veli palatine Ans-10: (b) Omohyoid Ref.:Read the text below Sol : The superior belly of omohyoid is innervated by branches from the superior ramus of the ansa cervicalis (C1). The inferior belly is innervated from the ansa cervicalis itself (C1, 2 and 3) The anterior belly of digastric is supplied by the mylohyoid branch of the inferior alveolar nerve (post division of mandibular), and the posterior belly is supplied by the facial nerve. Q-11 Pleural reflection on left mid axillary line is upto which intercostals space? a. 5 b. 6 c. 8 d. 10 Ans-11: (d) 10 Ref.:Read the text below Sol : The inferior border is thin and sharp where it separates the base from the costal surface and extends into the costo diaphragmatic recess. It is more rounded medially where it divides the base from the mediastinal surface. The lower border of the pleura on both sides follows a curved line, which crosses the 8 th rib in midclavicular line, and the 10th rib in midaxillary line, and reaches the 12 th rib adjacent to the vertebral column, that is at the lateral border of erector spinae muscle Note : Lower margins of lungs crosses the 6th , 8th and 10 ribs at the midclavicular lines, and axillary lines and sides of the vertebral column respectively. The distance between the lower border of lungs and plura corresponds the costodiaphrangmatic recess. Q-12 A patient is unable to prevent anterior displacement of the femur on the tibia when the knee is flexed. Which of the following ligaments is most likely damaged? a. Anterior cruciate b. Fibular collateral c. Patellar d. Posterior cruciate Ans 12: (d) Posterior cruciate www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Reference – Read the text below Sol: The posterior cruciate ligament is important because it prevents forward displacement of the femur on the tibia when the knee is flexed. The anterior cruciate ligament prevents backward displacement of the femur on the tibia. Q-13 To avoid damaging the sciatic nerve during an injection, the needle should be inserted into which of the following areas? a. Over the sacrospinous ligament b. Midway between the ischial tuberosity and the lesser trochanter c. Midpoint of the gemelli muscles d. Upper lateral quadrant of the gluteal region Ans 13: (d) Upper lateral quadrant of the gluteal region Reference – Read the text below Sol: To avoid damaging the sciatic nerve during an intramuscular injection, the clinician should insert the needle in the upper lateral quadrant of the gluteal region. The inserted needle in the lower medial quadrant may damage the pudendal and sciatic nerves. The inserted needle midway between the ischial tuberosity and the lesser trochanter may damage the sciatic and posterior femoral cutaneous nerves on the quadratus femoris. The inserted needle over the sacrospinous ligament may damage the pudendal nerve and vessels. Q-14 A 20-year-old patient cannot flex and medially rotate the thigh while running and climbing. Which of the following muscles is most likely damaged? a. Semimembranosus b. Rectus femoris c. Vastus intermedius d. Tensor fasciae latae Ans 14: (d) Tensor fasciae latae Reference – Read the text below Sol: The tensor fasciae latae can flex and medially rotate the thigh, so this is the muscle most likely damaged. The hamstring muscles (semitendinosus, semimembranosus, and biceps femoris) can extend the thigh and flex the leg. The sartorius can flex the thigh and leg. The rectus femoris can flex the thigh and extend the leg. The vastus intermedius can extend the leg. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-15 A 22-year-old patient is unable to unlock the knee joint to permit flexion of the leg. Which of the following muscles is most likely damaged? a. Rectus femoris b. Semimembranosus c. Popliteus d. Gastrocnemius Ans 15: (c) Popliteus Reference – Read the text below Sol: The popliteus muscle rotates the femur laterally (unlocks the knee) or rotates the tibia medially, depending on which bone is fixed. This action results in unlocking of the knee joint to initiate flexion of the leg at the joint. The rectus femoris flexes the thigh and extends the knee. The gastrocnemius flexes the knee and plantar flexes the foot. The semimembranosus extends the thigh and flexes and rotates the leg medially. The biceps femoris extends the thigh and flexes and rotates the leg laterally. Q-16 Planning and programming of movements is done by which part of brain? a. Vestibulocerebellum b. Motor cortex c. Spinocerebellum d. Basal ganglia Ans-16: (d) Basal ganglia Ref.: Read the text below Sol : Planning and programming of movements are done by both cerebrocerebellum and basal ganglia. Studies have made it clear that neurons in the basal ganglia, like those in the lateral portions of the cerebellar hemispheres, discharge before movements begin. These observations, plus careful analysis of the effects of diseases of the basal ganglion in humans and the effects of drugs that destroy dopaminergic neurons in animals, have led to the concept that the basal ganglia are involved in the planning and programming of movement or, more broadly, in the processes by which an abstract thought is converted into voluntary action. Q-17 Duration of second heart sound is? a. 0.12 sec b. 0.1 sec c. 0.15 Sec d. 02. Sec Ans-17: (a) 0.12 sec Ref.:Read the text below Sol : Heart Duration Pitch or Character www.damsdelhi.com Cause Timing Email: [email protected] DAMS CBT 2016 SET - 1 sound 1st 0.15 sec frequency 25 to 45 Hz High pitched 2nd 0.12 sec 50 Hz Higher than S1 3rd 0.1 sec -- Soft 4th -- <20 Hz Soft Sudden closure of mitral and tricuspid valves Closure of aortic or pulmonary valves Rapid ventricular filling due to blood inrushing from atria Filling of ventricles due to aortic contraction Start of ventricular systole Just after end of ventricular systole Beginning of middle third of diastole Just Before 1st sound Q-18 The term “Mileu interior” was given by? a. Knut schmidt-nielsen b. George Bartholomew c. Claude Bernard d. Walter Cannon Ans-18: (c) Claude Bernard Ref.:Read the text below Sol : Milieu intérieur or interior milieu, from the French, milieu intérieur (the environment within), is a phrase coined by Claude Bernard to refer to the extra-cellular fluid environment, and its physiological capacity to ensure protective stability for the tissues and organs of multicellularliving organisms. Q-19 Avoiding response is due to which of the following lesion in the brain. a. Ipsilateral frontal lobe lesions b. Contralateral frontal lobe lesions c. Ipsilateral parietal lobe lesions d. Contralateral parietal lobe lesions Ans-19: (d) Contralateral parietal lobe lesions Ref.:Read the text below Sol : www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 In the demented patient and in other organic confusional states, certain reflexes, released from the control of higher center, may be elicited. Some may also be found in patients with large focal lesions ; for example, the grasp reflex is characteristically released in patients with contra lateral frontal lobe disease. In infancy the presence or absence of these reflexes is used as part of the development assessment. The most important of these higher level reflexes are the grasping and avoiding responses the palmomental reflex, the glabellar tap reflex released oral responses such as the snout response and tactilely and visually evoked sucking reflexes. The avoiding response consists of a tendency for the patient’s hand to move away from palmar or dorsal contact. It is usually evoked by stimuli on the ulnar side of the hand. It is released in patients with contralateral parietal lobe disease, or lesions in is connections. Q-20 SODIUM Na+ Reabsorption in association with secretion of K+in a normal male when GFR = 125 mL/min ,Plasma HCO3- = 27 meq/L; Plasma Na+ =145 meq/L is : a. 5 ueq b. 50 ueq c. 500 ueq d. 1000 ueq Ans-20: (b) 50 ueq Ref.:Read the text below Sol : Quantitative aspects of Na reabsorption in a Normal man GFR = 125 mL/min; Plasma HCO = 27 meq/L; Plasma Na = 145 meq/L Na+ filtered per minute 18,125 ueq. Reabsorbed with CI14,585 ueq. Reabsorbed while reabsorbing 3375 ueq of HCO3 3,375 ueq. Reabsorbed in association with formation of filterable 50 ueq. acidity and ammonia Reabsorbed in association with secretion of K+ 50 ueq. Total Na+ reabsorbed per minute 18,060 ueq. Q-21 In gametogenesis, meiosis differs significantly from mitosis. All of the following are characteristics of meiosis except : a. Crossing over occurs between sister chromatids during prophase I b. Daughter cells enter a second M phase of the cell cycle after division I without passing through the GI phase and S phase c. Independent assortment of maternal and paternal genetic material occurs in division I d. The result of division I is a chromosomal reduction to the haploid number. Ans-21: (d) The result of division I is a chromosomal reduction to the haploid number. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ref.:Read the text below Sol : Gametogenesis uses meiosis to admix the parental genetic material and to produce a haploid gamete. There is pairing of homologous chromosomes and chromosomal duplication during prophase I. The paired homologues align in the metaphase and crossing over occurs between sister chromatids. Also at this stage the independent assortment of maternal and paternal genetic material occurs. Because the chromosomal replication results in a tetraploid chromosomal number, division I produces cells with the diploid number. After division I the daughter cells enter a second M phase of the cell cycle without passing through the GI phase and S phase. Thus, the result of division. It is a chromosomal reduction to the haploid number. Q-22 Which non proteinous substance has highest normal blood level? a. Urea b. Creatinine c. Uric acid d. Ammonia Ans-22: (a) Urea Ref.:Read the text below Sol : Substance Normal Level Urea 20-40 mg/dl Creatinine 05.-0.9 mg/dL (female), 0.6-1.2 mg/dL (male) Uric acid 2.5-5.6 mg/dL (female), 3.1 – 7.0 mg/dL (male) Ammonia 19-60 ug/dL Q-23 Plasma volume is best evaluated by using? a. Evan blue b. Inulin c. Mannitol d. Radiolabelled water Ans-23: (a) EVAN'S BLUE Ref.:Read the text below Sol : T-1824 or Evans Blue, often incorrectly rendered as Evan's Blue, is an azo dye which has a very high affinity for serum albumin. Because of this, it can be useful in physiology in estimating the proportion of body water contained in blood plasma Q-24 Golgi tendons and muscle fibre ratio is? www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 a. 1:1 b. 1 : 3-25 c. 1 : 40 d. 1 : 50 Ans-24: (b) 1 : 3-25 Ref.:Read the text below Sol : This organ consists of a net-like collection of knobby nerve endings among the fascicles of a tendon. There are 3-25 muscle fibers per tendon organ. The fibers from the Golgi tendon organs make up the Ib group of myelinated, rapidly conducting sensory nerve fibers. Q-25 Blood pressure changes by ____ above or below heart level? a. 0.55 mm of Hg/cm b. 0.50 mm of Hg/cm c. 0.60 mm of Hg/cm d. 0.77 mm of Hg/cm Ans-25: (d) 0.77 mm of Hg/m Ref.:Read the text below Sol : The blood pressure increases or decreases by 0.77 mm of Hg/cm for every centimeter below or above the level of heart. Q-26 Hematocrit in veins is higher than arteries because? a. Increased number of particles b. Slow flow c. Lymphatic absorption d. Larger amount of blood Ans-26: (a) Increased number of particles Ref.:Read the text below Sol : Veins have higher hematocrit compared to arteries because due to addition of chloride ions, bicarbonate ions and CO2 which makes blood osmolarity in veins to increase and therefore red cells take in water and hematocrit in veins increase. This is major reason, minor reason is formation of tissue fluid in capillaries & absorption of some fluid as lymphatics. Q-27 Action of pineal gland is? a. Circadian rhythm b. Secretion of TSH c. Control of the impulses d. Central control of autonomic nervous system. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ans-27: (a) Circadian rhythm Ref.:Read the text below Sol : Some pineal indoleamines, including melatonin and enzymes for their biosynthesis (e.g. serotonin N-acetyltransferase) show circadian rhythms in concentration. The level rises during darkness, and falls during the day, when secretion may be inhibited by sympathetic activity. It is thought that the intrinsic rhythmicity of an endogenous circadian oscillator in the suprachiasmatic nucleus of the hypothalamus governs cyclical pineal behavior. Q-28 All the following are characteristics of the plasma membrane except: a. It serves as a selective filtration barrier through the facilitation of both active and passive transport b. It possesses a thickness of 1 to 2/nm c. It is involved in the generation of ionic gradients between the cytoplasm and the external environment d. It serves as a sensor of signals from the extra-cellular environment Ans-28: (b) It possesses a thickness of 1 to 2 nm Ref.:Read the text below Sol : Cell membranes range in thickness from 7 to 10nm. A cell membrane surrounds all eukaryotic cells and sub serves a number of essential functions. The plasma membrane forms a boundary to the external environment and contains a large variety of receptors that function as ligands for hormones, growth factors, cytokines, and other extra – cellular factors. It’s a selective barrier that controls the entry and exit of substances to and from the cell. The plasma membrane is involved in both energy – dependent (active) and energy independent (passive) transport and the generation of ionic gradients between inside and outside of the cell. The plasma membrane and the internal membranes of the cell such as those surrounding organelles like the nucleus and mitochondria – are similar in their morphologic appearance under electron microscopy. The organelles membranes are usually thinner and differ in overall biochemical composition from that of the plasma membrane. Q-29 Closure of the aortic valve occurs at the onset of which phase of the cardiac cycle? a. Isovolumetric contraction b. Rapid ejection c. Protodiastole d. Isovolumetric relaxation Ans-29: (d) Isovolumetric relaxation Ref.:Read the text below www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Sol : Closure of the semilunar valves (aortic and pulmonic valves) marks the beginning of the isovolumetric relaxation phase of the cardiac cycle. During this brief period (approximately 0.06s), the ventricles are closed and myocardial relaxation, which began during protodiastole, continues. Intraventricular pressure falls rapidly, although ventricular volume changes little. When intraventricular pressure falls below atrial pressure, the mitral and tricuspic valves open and rapid filling of the ventricles begins. Q-30 An increase in plasma PTH level would lead to an increase in which of the following? a. Renal synthesis of calcitriol b. Renal proximal tubular reabsorption of Ca+2 c. The number of active osteoblasts d. Plasma inorganic phosphate concentration Ans-30: (a) Renal synthesis of calcitriol Ref.:Read the text below Sol : The major renal effect of parathyroid hormone (PTH) is stimulation of proximal tubular 1 –hydroxylase, an enzyme that converts calcidiol to calcitriol. PTH affects renal Ca+2 reabsorption in two ways: it reduces Ca+2 reabsorptionin the proximal tubule and increases Ca+2 reabsorption in the distal tubule. The net effect is an increase in tubular Ca+2 reabsorption. This renal effect of PTH can be lessened by PTH’s effect on bone. PTH increases plasma [Ca+2] by promoting bone resorption, which causes an increase in the renal filtered load of Ca+2 and, thus, hypercalciuria. Also, PTH inhibits the proximal reabsorption of phosphate, thereby favoring phosphate excretion. PTH acts on bone by dissolving the non readily exchangeable calcium phosphate “pool” known as stable bone. PTH activates the osteoclast cells that cause osteolysis by their high content of lysosomal enzymes. PTH also stimulates osteocytes, which are bone – bound osteoblasts that mediate osteocytic osteolysis. Q-31 Which of these are not a gluconeogenic substrate : a. Oxaloacetate b. Pyruvate c. Acetyl-CoA d. Lactate Ans-31: (c) Acetyl-CoA Ref: Harper : illustrated biochemistry 30/e p185 Sol: Acetyl Co A can not form glucose, rest all other substrates given in other options are capable of gluconeogenesis. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Following are gluconeogenic substrates Glycerol Fumarate Propionic acid Glucogenic amino acid Pyruvate Lactate Q-32 All of the following are required in PCR except? a. Deoxyribonucleotides b. Thermostable enzyme c. Dideoxyribonucleotides d. DNA Template Ans-32: (c) Dideoxyribonucleotides Ref: Read the text below Sol: A basic PCR set up requires several components and reagents. These components include: DNA template that contains the DNA region (target) to be amplified. Two primers that are complementary to the 3' (three prime) ends of each of thesense and anti-sense strand of the DNA target. Taq polymerase or another DNA polymerase with a temperature optimum at around 70 °C. Deoxynucleoside triphosphates (dNTPs, sometimes called "deoxynucleotide triphosphates"; nucleotides containing triphosphate groups), the building-blocks from which the DNA polymerase synthesizes a new DNA strand. Buffer solution, providing a suitable chemical environment for optimum activity and stability of the DNA polymerase. 2+ 2+ Divalent cations, magnesium or manganese ions; generally Mg is used, but Mn can be utilized for PCR-mediated DNA mutagenesis, as higher Mn2+concentration increases the error rate during DNA synthesis Monovalent cation potassium ions. Q-33 Second messenger for smooth muscle relaxation mediated by NO is : a. cGMP b. cAMP c. Ca2+ d. Magnesium Ans-33: (a) cGMP Ref: Harper: Illustrated biochemistry 30/e p660 Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 NO is paracrine in action as after getting produced in endothelial cell from arginine,it is diffused in underlying smooth muscle where it is activating guanylyl cyclase which converts GTP to cGMP. This cGMP phosphorylates muscle protein which undergo relaxation. Q-34 Which of these amino acid does not enter the krebs cycle by forming Acetyl-CoA via pyruvate : a. Tyrosine b. Hydroxyproline c. Glycine d. Alanine Ans-34: (a) Tyrosine Ref: Harper: Illustrated biochemistery 30/e p165 Sol: List of amino acid which,can form acetyl co A Hydroxyproline Cysteine Glycine Serine Threonine Alanine will form pyruvate Tyrosine and phenylalanine will form fumarate Valine, isoleucine, methionine will form Succinyl co A Q-35 Aminoacyl –tRNA synthetases must be capable of recognizing which of the following? a. A specific tRNA and a specific amino acid b. A specific rRNA and a specific amino acid c. A specific tRNA and the 40S ribosomal subunit d. A specific amino acid and the 40S ribosomal subunit Ans-35: (a) A specific tRNA and a specific amino acid Ref: Read the text below Sol: There are 20 isoenzymes for aminoacyl tRNA Synthetase enzyme. The respective isoenzyme for charging of tRNA is selected by D arm. Q-36 The lactose operon is negatively controlled by the lactose repressor and positively controlled by which of the following? a. Increase concentration of glucose and cyclic AMP b. Decrease concentration of glucose and cAMP c. Increase concentration of glucose, decrease concentration of cAMP www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 d. Decrease concentration of glucose, Increase concentration of cAMP Ans-36: (d) Decrease concentration of glucose, Increase concentration of cAMP Ref: Read the text below Sol: The lactose operon is negatively controlled by the lactose repressor and positively controlled by decreasing concentration of glucose and increase concentration of cAMP Q-37 The metabolic adaptation in alcoholic is all of the following except? a. Lactic acidosis b. High NAD+ level c. Accumulation of fat in the liver d. Decreased uric acid excretion Ans-37: (b) High NAD+ level Ref: Read the text below Sol: Oxidation of ethanol by alcohol dehydrogenase leads to excess production of NADH. The increased (NADH/NAD+) ratio also causes increased (lactate/pyruvate) , resulting in hyperlacticacidemia, which decreases excretion of uric acid, aggravating gout. Increased NADH/NAD ratio will prevent fatty acid oxidation and hence fatty acid will tend to deposit in hepatocyte leading to fatty liver. Q-38 In the synthesis of collagen, the hydroxylation of proline and lysine occurs in which of the following? a. Golgi apparatus b. Secretory vesicles c. Rough endoplasmic reticulum d. Smooth endoplasmic reticulum Ans-38: (c) Rough endoplasmic reticulum Ref: Alberts, pp 1098–1100. Junqueira, pp 106–110 Sol: Prolyl and lysyl hydroxylase are the two enzymes that carry out hydroxylation of proline and lysine. The process is both co- and posttranslational and, therefore, occurs during, or more often after, the amino acids are inserted into nascent collagen polypeptide chains in the RER. Hydroxyproline, which constitutes 10% of collagen, is often used to determine the collagen content of various tissues. Hydroxylation of proline stabilizes the triple helix through interchain hydrogen bonds, and hydroxylation of lysine is critical for the cross-linking stage of collagen assembly. Q-39 A child to emergency with accidental ingestion of Cyanide . It blocks citric acid cycle by blocking : a. Acetyl-CoA Production www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 b. Aconitase c. NAD+ d. Citrate Ans-39: (c) NAD+ Ref: Illustrated Biochemistry 30/ep132 Sol: Cyanide inhibits electron transport chain and hence stops ATP synthesis, depleting NAD. In lack of NAD , TCA cycle does not run as NAD is important coenzyme for three dehydrogenases in this cycle. 1. Isocitrate dehydrogenase 2. Alpha keto glutarate dehydrogenase 3. Malate dehydrogenase Q-40 Calcium absorption is increased in the GUT by : a. 1,25 dihydroxycholecalciferol b. Intrinsic factor c. Calcitonin d. PTH Ans-40: (a) 1,25 dihydroxycholecalciferol Ref: Read the text below Sol: In liver, Vitamin – D is hydroxylated at the 25th position, and in kidney further hydroxylation is affected at the 1st position to produce dihydroxy-cholecalciferol or calcitriol. The calcitriol induces a carrier protein in the intestinal mucosa, which increases the absorption of calcium. Hence blood calcium level tends to be elevated. Vitamin D is acting independently on bone. Vitamin D increases the number and activity of osteoblasts, the bone forming cells. Secretion of alkaline phosphatase by osteoblasts is increased by vitamin D Q-41 LDL lipoprotein is associated with : a. Apoprotein A2 b. Apoprotein B100 c. Apoprotein C1 d. Apoprotein E Ans-41: (b) Apoprotein B100 Ref: Read the text below Sol: Low-density lipoprotein (LDL) is one of the five major groups of lipoproteins, which in order of size, largest to smallest, are chylomicrons, VLDL, IDL, LDL, and HDL, that enable transport of various lipid in plasma. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Each native LDL particle contains a single apolipoprotein B-100 molecule (Apo B-100, a protein that has 4536 amino acid residues and a mass of 514 kDa. Q-42 Which among the following is a feature of non competitive inhibition? a. Increased Vmax b. Decreased Vmax c. Increased Km d. Decreased Km Ans-42: (b) Decreased Vmax Ref: Read the text below Sol: A non competitive inhibitor has no effect on Km. but decrease Vmax Vmax : maximum velocity Km : the substrate concentration at which the enzyme attains half of the Vmax Acting on Structure of inhibitor Inhibition is Excess substrate Km Vmax Significance Competitive inhibition Active site Substrate analogue Reversible Inhibition relieved Increased No change Drug action Non competitive inhibition May or may not Unrelated Generally irreversible No effect No change Decreased Toxicological Q-43 Insulin Dependent glucose Transport occurs in all except a. Skeletal muscle b. Heart c. Liver d. Adipocyte Ans-43: (c) Liver Ref: Read the text below Sol: GLUT 4 is the transporter of glucose which is dependent on insulin for its action. This type of GLUT is distributed at skeletal muscle, heart muscle and adipose cell. Q-44 Selenocysteine is derived from a. Serine b. Cysteine c. Anethionine d. Alanine Ans-44: (a) Serine Ref: Read the text below www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Sol: Serine is hydroxyl group containing amino acid. Its oxygen is replaced by selenium as to give rise to selenocysteine. Q-45 Proximal Histidine is a. E7 b. E8 c. F7 d. F8 Ans-45: (d) F8 Ref: Read the text below Sol: F8 is proximal histidine and E7 is distal histidine. Q-46 A 10 year old boy, Pappu, died of acute rheumatic fever. All the following can be expected at autopsy except. a. Ashoff nodules b. Rupture of chordate tendinae c. Mc Callum patch d. Fibrinous pericarditis Ans-46: (b) Rupture of chordate tendinae Ref.:Robbin’s - 566 Sol : Pathological features of Rheumatic carditis Acute Rheumatic carditis There is diffuse inflammation and aschoff bodies in any of the three layers of heart Pericardium – Fibrinous or serofibrinous pericarditis also known as “bread & butter” pericarditis. Pericarditis generally resolve without sequelae. Myocardium – Diffuse non-specific myocarditis with Aschoff bodies. Endocardium – Small warty projection, i.e. verucae along the line of closure on the valvular leaflets (especially on left side mitral valve.) Q-47 Characteristic feature of Rheumatic carditis is a. Pericarditis b. Endocarditis c. Myocarditis d. Pancarditis Ans-47: (d) Pancarditis Ref.:Robbin’s - 566 Sol : During Acute Rheumatic fever, diffuse inflammation and Aschoff bodies may be found in any of the three layers of heart-pericardium, myocardium or endocardium- Pancarditis. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-48 The commonest mode of inheritance of von willebrand’s diasease – a. Codominant b. Autosomal recessive c. Autosomal dominant d. X linked recessive Ans-48: (c) Autosomal dominant Ref.:Robbin’s - 671 Sol : Von willebrand disease is of following types Type I (most common 70%) – Autosomal dominant, with reduced quantity of vWF. Type II (25%) – Autosomal dominant, with qualitative defect of vWF. Type III – Autosomal recessive, with reduced quantity of vWf. Q-49 The presence of small sized platelets on the peripheral smear is characteristic ofa. Idiopathic thrombocytopenic purpura. b. Bernard soulier syndrome c. Disseminated intravascular coagulation d. Wiskott Aldrich syndrome Ans-49: (d) Wiskott Aldrich syndrome Ref.:Robbin’s 8th/e p. 263 Sol : Characteristics of Wiskott Aldrich syndrome Severe eczema Thrombocytopenia Recurrent infections The platelets are not only reduced in number but more characteristically are small. Other characteristic abnormality seen in Wiskott Aldrich syndrome is that peripheral T cells appear bald and devoid of microvilli. Q-50 A female patient nandini presents with upper respiratory tract infection. Two days after. She develops hematuria. Probable diagnosis is – a. IgA nephropathy b. Wegner’s granulomatosis c. Henoch sholein purpura d. Post streptococcal glomerulonephritis Ans-50: (a) IgA nephropathy Ref.:Robbin’s - 931 Sol : DIFFERENTIATING FEATURES B/W IGA NEPHROPATHY AND POSTSTREPTOCOCCAL G.N. IgA nephropathy Poststreptococcal glomerulonephritis Onset of hematuria 2-4 days after URTI Onset of hematuria 7-21 days following Serum complement C3 normal URTI and skin infection www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Recurrence common No elevation of antibody titre Serum complement C3 decreased Recurrence rate, one attack confers life long immunity Elevation of antistreptococcal antibody titre Q-51 Which component or HBV causes glomerulonephritis– a. Hbe Ag. b. HBc Ag. c. HBs Ag. d. Anti HBs Ag antibody Ans-51: (a) Hbe Ag. Ref.:Harrison - 1938 Sol : Immune complex mediated tissue damage is the cause of glomerulonephritis in the host. Immune complex consistsHbs Ag and antiHBs. Hbs Ag is a structural compent HBV, while Anti Hbs Ag is formed by the host So, Hbs Ag is the component of HBV that is responsible for glomerulonephritis. Q-52 All of the following are associated with low complement levels except– a. Lupus nephritis b. Mesanogio capillary glomerulonephritis c. Diarrhea associated hemolytic uremic syndrome d. Glomerulonephritis related to bacterial endocarditis Ans-52: (c) Diarrhea associated hemolytic uremic syndrome Ref.:Read the text below Sol : Lupus Nephritis, post streptococcal glomerulonephritis and membrano proliferative glomerulonephritis are all associated with low complement levels Q-53 The Electron Microscopy is virtually diagnostic in renal biopsy study of a. Goodpasture’s syndrome b. Churg-Strauss Syndrome c. Alport syndrome d. Wegner’s granulomatosis Ans-53: (c) Alport syndrome Ref.:Robbin’s - 932 Sol : Alport’s syndrome presents with characteristic histological features on electron microscopy. Such changes may present in other diseases, but are most pronounced and widespread in Alport’s syndrome. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Features of Alport’s syndrome on electron microscopy : Alport’s patients early in their disease typically have diffuse thining of the basement membrane which thickens over time into multilamellous surrounding lucent areas that often contain granules of varying density. The characteristic electron electron microscopic finding of fully developed disease is that glomerular basement membrane shows irregular foci of thickening alternating with attenuation (thinning) with pronounced splitting and lamination of lamina densa often with distinctive basket weave appearance. Q-54 Renal papillary necrosis is almost always associated with one of the following conditions – a. Diabetes – mellitus b. Analgesic – nephropathy c. Chronic pyelonephritis d. Post streptococcal GN Ans-54: (a) Diabetes – mellitus Ref.:Dorlands Illustrated Medical Dictonary 28th / e.p. 1104 Sol : ‘Renal papillary necrosis, an accompaniment of acute pyelonephritis is most often seen in diabetics and is characterized by necrosis of renal papillae of one or both kidneys with shaped demarcation between necrotic and living tissue’ . Q-55 All are features of hemolytic uremic syndrome, except a. Hyperkalemia b. Anaemia c. Renal microthrombi d. Neuro psychiatric disturbances Ans-55: (d) Neuro psychiatric disturbances Ref.:Robbin’s - 669 Sol : Hyperkalemia is seen in hemolytic urenic syndrome as a result of renal failure. About neuropsychiatric manifestations Neurological manifestations are used to distinguish between Hemolytic uremic syndrome and Thrombotic Thrombocytopenic Purpura. H.U.S. is distinguished from T.T.P by the absence of neurological symptoms and the prominence of acute renal failure. Q-56 The following carcinomas are associated with DIC except a. Stomach b. Pancreas c. Prostate d. Breast Ans-56: (d) Breast www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ref.:Robbin’s - 673 Sol : Cancers associated with DIC Ca pancreas – Ca lung - Acute promyelocytic leukemia Ca protstate - Ca Stomach Note : Breast Ca. can also cause DIC, but amongst the given options, it is least frequently associated with DIC. Q-57 Although more than 400 blood groups have been identified, the ABO blood group system remains the most important in clinical medicine because a. It was the first blood group system to be discovered b. It has four different blood groups A, B, AB, O (H) c. ABO(H) antigens are present in most body tissues and fluids d. ABO(H) antibodies are invariably present in plasma when persons RBC lacks the corresponding antigen. Ans-57: (d) ABO(H) antibodies are invariably present in plasma when persons RBC lacks the corresponding antigen. Ref.:Robbin’s -263 Sol : The basic difference between ABO blood group system and other blood group systems (such as Rh, Kell, Duffy, MNSs blood groups), which makes the ABO group so important is that. Preformed ABO antibodies (agglutinins) are present in persons serum when his RBCs lack the corresponding antigen (ie. Anti B antibody would be present in a person of person of type A and type O blood groups. These two blood groups do not have the ‘B’ antigen on the RBCs) This is not the case with other blood groups. Preformed antibodies are not present. They are formed only after an exposure to the antigen, for example Rh negative person do not have anti- Rh antibodies, these antibodies are formed only after an exposure to Rh positive blood (by a blood transfusion, i.e. this makes the first blood transfusion safe even if mismatched. Q-58 Most common type of hodgkin’s lymphoma in India isa. Nodular sclerosing b. Lymphocyte predominance c. Mixed cellularity d. Lymphocyte depletion Ans-58 (c) Mixed cellularity Ref.:Robbin’s 8th/e p. 928 Sol : While nodular sclerosis is the most common subtype in the most common subtype in the developed countries, the mixed cellularity type is most common in developing countries. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-59 Histologic examination of the lesion in stomach reveal fat-laden cells, likely causes is a. Lymphoma b. Postgastrectomy c. Signet-cell carcinoma stomach d. Atrophic gastritis Ans-59 : (b) Postgastrectomy Ref.:Read the text below Sol : Lipid – laden macrophages (foam cells) are seen in xanthomatosis of stomach. Xanthomatosis of stomach It is characterized by collection of lipid laden macrophages (foam cells) forming plaques or nodules. Gastric xanthomatasis is more common in patients with : Gastritis Gastric ulcer Deudenogastric reflux ofter gastric surgery. Q-60 The gene involved in GIST – a. C-KIT b. BRAC-1 c. p53 d. BRAC-2 Ans-60: (a) C-KIT Ref.:Robbin’s - 789 Sol : Pathogenesis of GISTs Approximately 75% to 80% of all GISTs have oncogenic, gain-of-function mutations of gene encoding the gyrosine kinase c-KIT. Approximately 8% of GISTs have mutations that activate a related tyrosine kinase, platelet derived growth factor receptor (PDGFRA). Consitutively active c-KIT or PDGRA receptor tyrosine kinases activate RAS and P13K/AKT pathways and thereby promote tumor cell proliferation. Q-61 In a patient with acute leukemia, immunophenotype pattern is CD 19+ve, CD 10+ve, CD33+ve, CD 13+ve, He may probably have – a. Biphenotypic leukemia b. ALL c. AML – M2 d. AML- M0 Ans-61: (a) Biphenotypic leukemia Ref.:Robbin’s - 263 Sol : www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 These type of acute leukemia with immunophenotypic features of more than one cell lineage are referred to as acute leukemias of ambiguous lineage in new classification system proposed by world health organization Biphenotypic leukemia is a subtype of leukemia of ambiguous lineage in which the malignant cells population express markers of two different lineage- most commonly myeloid and either B or T lymphoid lineage. Q-62 Which of the following is not compatible with a diagnosis of juvenile myelomonocytic leukemia – a. Peripheral blood monocytosis, more than 1 x 109/L b. Increased hemoglobin F levels for age c. Presence of ber/abl fusion gene d. GM-CSF hypersensitivity of myeloid progenitors in vitro Ans-62: (c) Presence of ber/abl fusion gene Ref.:Robbin’s - 1968 Sol : Juvenile myelomonocytic leukemia is a clonal proliferation of hematopoietic stem cells that typically affects children younger than 2 years of age. Patients with this disease do not experess bcr/abl fusion gene and the also do not have Philadelphia chromosome which is seen in 90% of cases of adult CML. Q-63 Lymphoepithelial lesions in GIT are seen in all except: a. IPSD (Immune proliferative small instestinal Disease) b. MALTOMA c. Celiac disease d. Adenocarcinoma intestine Ans-63: (d) Adenocarcinoma intestine Ref.:Robbin’s - 795 Sol : Lymphoepithelial lesions are seen in lymphomas of GIT When extreme numbers of atypical lymphoid cells populate the superficial or glandular epithelium , it is called lymphoepithelial lesions. Various intestinal lymphomas are. MALT lymphoma (MALTOMA) Immunoproliferative small intestinal disease (IPSID) also referred to as Mediterranean lymphoma. Intestinal T cell lymphoma Predisposing factors to lymphoma are : Chronic gastritis caused by H. Pylori Organ transplantation with immunosuppression. Celiac disease. Congenital immunodeficiency. Q-64 All of the following conditions may show Mallory Hyaline changes www.damsdelhi.com except Email: [email protected] DAMS CBT 2016 SET - 1 a. Wilson disease b. Indian childhood cirrhosis c. Primary biliary cirrhosis d. Hepatitis E Ans-64: (d) Hepatitis E Ref.:Robbin’s - 858 Sol : Mallory hyaline (Mallory bodies) Mallory bodies are eosinophilic intracytoplasmic inclusion bodies which are composed predominantly of keratin intermediate filaments. They are also known as alcoholic hyaline. These inclusions are characteristic but not specific feature of alcoholic liver disease, as they are also seen in other conditions. Q-65 Raised iron content is not found in which organ in Hemochromatosis a. Heart b. Skin c. Testis d. Pituitary Ans-65 : (c) Testis Ref.:Robbin’s - 862 Sol : In hemochromatosis hypogonadism is caused by impairment of hypothalamic pituitary function and not due to deposition of Iron in the Testis. Q-66 Kerley B lines are seen in which part of chest X-ray: a. Upper portion b. Mid portion c. Peripheral lower zone d. Upper peripheral zone Ans-66: (d) Peripheral lower zone Ref: Sutton 7th/e Pg 289 Sol: Kerley B lines seen in the peripheral part of the base of the lung (lower zone) are diagnostic of pulmonary venous hypertension. These are seen as horizontal lines at the lung base. Q-67 A 25 years old young male presents with sudden onset dyspnea and chest pain. His chest is hyper resonant to percussion on the left side. The X ray picture is shown below www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 The diagnosis is: a. Consolidation b. Pneumothorax c. Flailchest d. Pleural effusion Ans67: (b) Pneumothorax Ref: Sutton 5th ed ; Grainger and Allison 5th ed chapter 13 Sol: Sudden onsetdyspnoea and chest pain along with a hyperresonantnot( due to air) to percussion on the left side is suggestive of a diagnoses of Pneumothorax amongst the given options. Also the X-ray picture depicting a raised hemidiaphragm on the left side and a deepsulcus sign(increasedlucent area over the costophrenicrecess) goes in favour of a diagnosis of Pneumothorax. Q-68 A 50 years old male presented with fatigue, recurrent upper respiratory tract infections and headache. On investigating he was found to have anemia, hypercalcemia and elevated urine protein. The image of his skull X ray is given in www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 What is the diagnosis: a. Chronic fatigue syndrome b. Multiple myeloma c. Hemolytic anemia d. Brain metastasis Ans-68: (b) Multiple myeloma Ref: Sutton 7thed; Grainger and Allison 5thed chapter 74 Sol: The clinical picture suggests a diagnosis of Multiple myeloma and the characteristic skull X-ray picture depicting punched out lytic lesions also favours a diagnosis of Multiple myeloma. Note: Skull X ray picture depicting lytic lesions with bevelled edges is seen in patients with Eosinophillic granuloma. Q-69 The most sensitive imaging modality for diagnosis of ureteric stones in a patient with acute colic is a. X-ray b. USG www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 c. NCCT Abdomen d. CECT Abdomen Ans-69: (c) NCCT Abdomen Ref: Grainger and Allison’s Diagnostic Radiology 5th/e, Radiology in surgical practice 1st/e Pg 220 Sol: Best investigation for the diagnosis of renal and ureteric stones is NCCT(Non Contrast Spiral CT) Abdomen. Q-70 Rigler’s sign is seen in a. Hydatid cyst b. Pneumoperitoneum c. Intussusception d. Crohn’s disease Ans-70: (b) Pneumoperitoneum Ref: Sutton’s Radiology, 7th ed., p. 676 Sol: Rigler’s sign is seen in pneumoperitoneum. Visualization of the outer as well as inner wall of a loop of bowel is seen in pneumoperitoneum and this is called Rigler’s sign. Q-71 Comb sign is seen in: a. Crohn disease b. Ulcerative colitis c. Pseudomyxoma peritonei d. Typhoid fever Ans-71: (a) Crohn disease Ref: Read the text below Sol: "Comb sign is seen in Crohn disease. It refers to the hypervascular appearance of the mesentry in active Crohn disease. Fibro-fatty proliferation and peri-vascular inflammatory infiltrates are seen outlining the intestinal border. It can be seen in both CT and MRI but is not pathognomic of Crohn disease." Q-72 Step ladder pattern on X-ray is seen in: a. Perforation peritonitis b. Ulcerative colitis c. Intestinal obstruction d. Meckel’s diverticulum Ans-72: (c) Intestinal obstruction Ref: Read the text below www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Sol: "Step ladder pattern on X-ray is seen in intestinal obstruction. It occurs due to multiple air-fluid level. This occurs because beyond the obstruction there is no gas and only fluid with distension of the intestines. Other sign seen in intestinal obstruction is string of beads sign." Sutton’s Radiology, 7th ed, –p. 1539 Q-73 The trefoil which is used in international radiation warning symbol has three blades and the angle between each blade should be a. 45 b. 50 c. 60 d. 70 Ans-73: (c) 60 Ref: Read the text below Sol: The international radiation symbol (also known as trefoil) first appeared in 1946, at the University of California, Berkeley Radiation Laboratory. At the time, it was rendered as magenta, and was set on a blue background. The modern version used in the US is magenta against a yellow background, and it is drawn with a central circle of radius R, an internal radius of 1.5R and an external radius of 5R for the blades, which are separated from each other by 60°. The trefoil is black in the international version, which is also acceptable in the US. Q-74 Linear acceleratoris for a. Electrons and xrays b. Gamma and protons c. Electrons and protons d. Neutrons and xray Ans-74: (a) Electrons and xrays Ref: Read the text below Sol: LINAC produces both xrays and electrons. A linear accelerator (LINAC) is the device most commonly used for external beam radiation treatments for patients with cancer. It delivers high-energy x-rays to the region of the patient's tumor. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-75 Bear claw sign on CT1 a. HCC b. Hepatic laceration c. RCC d. Pancreatic laceration Ans-75: (b) Hepatic laceration Ref: Read the text below Sol: Q-76 According to ICD 10 classification by WHO 2016 version how many chapters are there in ICD X? a. 20 b. 21 c. 22 d. 23 Ans-76: (c) 22 Ref: Read the text below Sol: International Classification of disease is produced by WHO for national and international use It has been revised over years and the latest revision ICD 10, came into effect on January 1, 1993 is arranged in 21 chapters. The 2016 modification has made it into 22 chapters. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 I Certain infectious and parasitic diseases II Neoplasms III Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism IV Endocrine, nutritional and metabolic diseases V Mental and behavioural disorders VI Diseases of the nervous system VII Diseases of the eye and adnexa VIII Diseases of the ear and mastoid process IX Diseases of the circulatory system X Diseases of the respiratory system XI Diseases of the digestive system XII Diseases of the skin and subcutaneous tissue XIII Diseases of the musculoskeletal system and connective tissue XIV Diseases of the genitourinary system XV Pregnancy, childbirth and the puerperium XVI Certain conditions originating in the perinatal period XVII Congenital malformations, deformations and chromosomal abnormalities XVIII Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified XIX Injury, poisoning and certain other consequences of external causes XX External causes of morbidity and mortality XXI Factors influencing health status and contact with health services XXII Codes for special purposes www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q77 As per ESI rules 2016, dependant gets: a. A job b. 100% wage c. 90% wage d. 80% wage Ans-77: (c) 90% wage Ref: Read the text below Sol: New ESI Guidelines 2016 Heads Benefit Facility Medical Full medical care Sickness 50% of daily wage is payable for 91 days Extended sickness Temporary disablement 80% of daily wage payable for 2 years (730 days) for a set of 34 diseases Full daily wage up to 7 days for vasectomy and up to 14 days for tubectomy Full daily wages • up to 12 weeks for confinement • up to 6 weeks for miscarriage or MTP • up to 4 weeks for sickness arising out of pregnancy, confinement, premature birth 90% of daily wage till recovery Permanent disablement 90% of daily wage Dependant Pension at 90% of wages Funeral expenses Cash amounting to 10000/- Enhanced sickness Maternity Rehabilitation Q-78 WHO definition for impairment is? a. Difficulty to carry out activities that is considered normal for the age b. Any loss or abnormality of psychological, physiological or anatomical structure or function c. Deviation from normal anatomy d. Any disability that prevents the fulfillment of a role that is normal www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ans-78: (b) Any loss or abnormality of psychological, physiological or anatomical structure or function Ref: Read the text below Sol: Any loss or abnormality of psychological, physiological or anatomical structure or function is impairment Disability - Any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being is disability Handicap - A disadvantage for a given individual resulting from an impairment or a disability that limits or prevents the fulfillment of a role that is normal (depending on age, sex and social and cultural factors) for that individual Q-79 Which is the correct formula to calculate specific death rates due to TB for males among the following? a. No. of deaths in males during a calendar year x 1000 / No. of TB deaths b. No. of deaths due to TB among males during a calendar year x 1000 / No. of death among malesduring the calendar year c. No. of deaths due to TB among males during a calendar year x 1000 / Mid year population of males d. No. of deaths due to TB among males during a calendar year x 1000 / No. of diagnosed cases of TB during the calendar year Ans-79: (c) No. of deaths due to TB among males during a calendar year x 1000 / Mid year population of males Ref: Read the text below Sol: Specific death rate = No of deaths due to the disease during a calendar year x 1000 / Midyear population Q-80 Identify the picture used for health promotion: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 a. Flip chart b. Flannel chart c. Pictogram d. Flash cards Ans-80: (a) Flip chart Ref: Read the text below Sol: Q-81 Which of the following is true regarding Attack rate? a. An incidence rate used only when population is exposed to risk for a limited period of time b. Indicates the number of exposed persons develops disease within the incubation period c. No. of all current cases of suspected disease at a a specific period of time d. Average number of spells of disease in each calendar year Ans-81: (a) An incidence rate used only when population is exposed to risk for a limited period of time Ref: Read the text below Sol: An incidence rate used only when population is exposed to risk for a limited period of time such as during an epidemic Usually expressed in % It reflects the extent of epidemic Attack rate = No. of new cases of a specified disease during a specified time interval x 100 / Total population at risk during the same interval Q-82 following www.damsdelhi.com To calculate Incidence rate during the year the cases to be considered are? Email: [email protected] DAMS CBT 2016 SET - 1 a. 1, 2, 3, 4,6,7,8 b. 2,3,4,7 c. Case 8 only d. Case 2 & Case 4 Ans-82: (b) 2,3,4,7 Ref: Read the text below Sol: Incidence rate is defined as the nmber of new cases occurring in a defined population during a specified period of time It is not influenced by duration of the disese Q-83 In case of disaster epidemiology mitigation means? a. Lowering the impact b. Preventing the impact c. Early warning d. Triage Ans-83: (a) Lowering the impact Ref: Read the text below Sol: Mitigation is the effort to reduce loss of life and property by lessening the impact of disasters. In order for mitigation to be effective we need to take action now—before the next disaster—to reduce human and financial consequences later (analyzing risk, reducing risk, and insuring against risk). It is important to know that disasters can happen at any time and any place and if we are not prepared, consequences can be fatal. Effective mitigation requires that we all understand local risks, address the hard choices, and invest in long-term community well-being. Without mitigation actions, we jeopardize our safety, financial security and self-reliance. Disasters can happen at anytime and anyplace; their human and financial consequences are hard to predict. The number of disasters each year is increasing but only 50% of events trigger Federal assistance. FEMA's mitigation programs help reduce the impact of events—and our dependence on taxpayers and the Treasury for disaster relief. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-84 If cut off for a screening test in serum cholesterol level is increased, what will happen to the number of False positives: a. Increase b. Decrease c. Increase exponentially d. No change Ans-84: (b) Decrease Ref: Read the text below Sol: The following terms are fundamental to understanding the utility of clinical tests: 1. True positive: the patient has the disease and the test is positive. 2. False positive: the patient does not have the disease but the test is positive. 3. True negative: the patient does not have the disease and the test is negative 4. False negative: the patient has the disease but the test is negative. If the cut-off point is raised, there are fewer false positives but more false negatives—the test is highly specific but not very sensitive. Similarly, if the cut-off point is low, there are fewer false negatives but more false positives—the test is highly sensitive but not very specific. Q-85 The number of diseases eradicated till date are: a. 0 b. 1 c. 2 d. 3 Ans-85: (b) 1 Ref: Read the text below Sol: So far only one disease, smallpox, has been eradicated by vaccines, saving approximately 5 million lives annually. Polio could be next. Over 80% of the world's children are now being immunized against the polio virus, and the annual number of cases has been cut from 400,000 in 1980 to 90,000 in the mid-1990s Q-86 Current Tobacco pack warnings by MOHFW, GoI are: a. 40% on one side b. 85% on both sides c. Plain packaging d. Any of the above will do Ans-86: (b) 85% on both sides Ref: Read the text below Sol: On October 15, 2014, India’s Ministry of Health and Family Welfare (MOHFW) announced new rules called the Cigarettes and Other Tobacco Products (Packaging and www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Labelling) Amendment Rules, 20146 to amend the previous 2008 Packaging and Labelling Rules7 . These new rules increased the size of PHWs on smoked and smokeless tobacco packages, effective April 1, 2015. The new warnings would cover 85% of the principal display areas (both sides at the top edge) of tobacco packages, of which 60% would consist of specified pictorial warnings and 25% would consist of the text warning. This represents a substantial increase from the current size of PHWs, which cover 40% of the principal display area of the front panel of the packages Q-87 Which of the following is an experimental study? a. Ecological b. Cross-sectional c. Case control d. Randomized control trial Ans-87: (d) Randomized control trial Ref: Read the text below Sol: Epidemiological Methods Experimental / Intervention Studies Observational Studies Descriptive Studies Ecological / Correlational Analytical Studies Cross sectional / Prevalence Randomized Controlled Trials Case control / Case Reference Field Trials Community Trials Cohort Q-88 The primary role of ophthalmic examination in PHC is entrusted to? a. Medical officer b. Ophthalmologist c. Optometrist d. Any one of these Ans-88: (c) Optometrist www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ref: Read the text below Sol: Under NPCB optometrist is posted at level of PHC Q-89 Which of the following is a live attenuated vaccine? a. Plague b. Pertussis c. Varicella d. Rabies Ans-89: (c) Varicella Ref: Read the text below Sol: Plague Pertussis and Rabies are killed whole organism Important vaccines currently in use include Live Killed Toxoid / Polysacharide Glycoconjugate attenuate whole Protein d organis m BCG Typhoid Diphtheri Pneumococcus Hib Pneumococcus OPV Cholera a Meningococcu MeningococcusACW Measles Plague Tetanus s Y Mumps Pertussis anthrax Hib Rubella IPV Typhoid Yellow Rabies fever JE Typhoid TBE Varicella HAV Rotavirus Recombinan t HBV HPV Lyme disease Q-90 Brand name of condoms available under the national program is: a. Nirodh b. ASHA c. ASHOK d. Chatri Ans-90: (b) ASHA Ref: Read the text below Sol: Recently the brand name of condoms available under the national program has been changed from Nirodh to ASHA Q-91 MALA D contains a. Levonorgestral 0.15 mg and ethinyl estradiol 0.03 mg b. Norgestral 0.15 mg and ethinyl estradiol 0.03mg www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 c. Levonorgestral 0.25 mg and ethinyl estradiol 0.15 mg d. Norgestral 0.25 mg and ethinyl estradiol 0.15 mg Ans-91: (a) Levonorgestral 0.15 mg and ethinyl estradiol 0.03 mg Ref: Read the text below Sol: MALA N and MALA D are the low dose oral pill made available by Government of India. MALA N and MALA D contains Levonorgestral 0.15 mg and ethinyl estradiol 0.03 mg MALA N is supplied free of cost through all PHCs, Urban family welfare centrs etc Q-92 An oriya boy married a haryanvi girl. This will lead to: a. Mores b. Acculturation c. Folkways d. Nothing will happen Ans-92: (b) Acculturation Ref: Read the text below Sol: Acculturation refers to the processes that occur when different individuals or groups of people meet and exchange aspects of their culture. Due to advances in transportation, communication, and technology, there has been a significant increase in the interactions among different cultures. As a result, understanding acculturation, and learning how to accomplish it effectively, has become vital to the future of the world. Q-93 Infant mortality rate (per thousand live births) in of India as per the recent SRS is: a. 40 b. 39 c. 38 d. 37 Ans-93: (a) 39 Ref: Read the text below Sol: Q-94 As per WHO classification mild MR is a. IQ 50 – 70 b. IQ 55 – 75 c. IQ 50 – 65 d. IQ 45 – 35 Ans-94: (a) IQ 50 – 70 Ref: Read the text below Sol: Mild MR – IQ 50 – 70 www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Moderate MR – IQ 35 – 49 Severe MR – IQ 20 – 34 Profound MR – IQ under 20 Q-95 Cut off for CD 4 count for treatment of HIV and TB confected currently in India is: a. 200 b. 350 c. 500 d. Treat the moment either is diagnosed Ans-95: (c) 500 Ref: Read the text below Sol: WHO guidelines4 recommend that, among HIV-positive individuals, ART should be initiated for: anyone age five years or older with a CD4 count of ≤500 cells/mm3 all children over age five regardless of CD4 count if they are in WHO clinical stage 3 or 4 or have active TB disease all children under five years old, including infants all pregnant and all breastfeeding women all serodiscordant couples all people coinfected with TB all people coinfected with hepatitis B who present with chronic liver disease. Q-96 Rajesh, a 7-month-old child, presents with failure of gaining weight and noisy breathing which becomes worse when the child cries. Laryngoscopy shows a reddish mass in subglottis. Which of the following is not a part of treatment modality in this patient? a. Radiation b. Steroids c. Tracheostomy d. Carbon dioxide laser treatment Ans-96: (a) Radiation Ref.:Read the text below Sol : The diagnosis is subglottic hemangioma. Radiotherapy is not a treatment option for the same while CO2 laser, intraregional steroids and tracheostomy are tried. Q97 A 38-year-old gentleman reports of right sided deafness for the past 2 years; on testing with a 512 Hz tuning fork, the Rinne test without masking is negative on the right side and positive on the left side. On doing weber, the tone is perceived louder on the left ear. The patient most likely has : a. Right Conductive deafness b. Right Sensorineural deafness c. Left Sensorineural deafness www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 d. Left conductive deafness Ans-97: (b) Right Sensorineural deafness Ref.: Read the text below Sol : For right sided deafness, if Weber is lateralized to left that indicates sensorineural hearing loss. Due to transcranial transmission to the opposite normal cochlea in severe sensorineural deafness, namely false negative Rinne on the right as explained above. Patient has a severe sensorineural deafness on the right side. Q98 Which is the correct statement regarding facial nerve injury in temporal bone fractures? a. Commoner in transverse fractures b. Commoner in longitudinal fractures c. Facial palsy is of immediate onset d. It is always associated with CSF otorrhea Ans-98: (a) Commoner in transverse fractures Ref.:Read the text below Sol : Facial palsy is commoner with transverse fractures (in>50%). It may be of immediate onset in transverse fractures since the fracture line may run across the facial canal leading to trans-section. But facial palsy is rare (<20%) in longitudinal fractures since the fracture line usually runs above the external and middle ear and parallel to the facial canal. When present, it is delayed in longitudinal fractures since it is usually due to edema of the nerve. CSF otorrhea need not manifest in transverse fractures since the tympanic membrane is intact while it is a usually accompaniment of longitudinal fractures. Q99 Sade classification is related with retraction of pars tensa,Grade 2 includes a. Mild retraction b. Retracted TM touching incus or stapes c. TM touching promontory but moves on seigelisation d. TM touching promontory, does not move Ans-99: (b) Retracted TM touching incus or stapes Ref:Read the text below Sol: Sade classification of retraction of pars tensa • Grade 1 – mild retraction • Grade 2—severe retraction—retracted TM touching incus or stapes • Grade 3—Atelectatic TM—TM touching promontory but moves on seigelisation • Grade 4---Adhesive TM--TM touching promontory, does not move on seigelisationos classification of pars flaccida Toss classification of pars flaccida • Stage I: Pars flaccida is dimpled and is more retracted than normal. It is not adherent to www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 the malleus. • Stage II: In this stage the retraction pocket is adherent to the handle of malleus. The full extent of the retraction pocket can be clearly seen. • Stage III: In this stage part of the retraction pocket may be hidden. There may also be associated erosion of the outer attic wall (scutum). • Stage IV: In this stage there is definite severe erosion of the outer attic wall. The extent of the retraction pocket cannot be clearly seen as most of it are hidden from the view. Q-100 In Otosclerosis, carhart’s notch dips at : a. 1000 Hz in air conduction b. 1000 Hz in bone conduction c. 2000 Hz in air conduction d. 2000 Hz in bone conduction Ans-100: (d) 2000 Hz in bone conduction Ref.:Read the text below Sol : The dip in audiogram occurs for bone conduction curve in otosclerosis and is maximum of about 15 dB at 2000 Hz. It may involve other frequenceies from 500 Hz to 4000 Hz to a lesser extent (5-10 dB). The Carhart’s notch though demonstrable in bone conduction curve does not signify sensorineural hearing loss and disappears after a successful stapedectomy. Q-101 A 55-year-old female presents with tinnitus, dizziness, and h/o progressive deafness. Which of the following is not a differential diagnosis for this? a. Acoustic neuroma b. Endolymphatic hydrops c. Meningioma d. Histiocytosis X Ans-101: (d) Histiocytosis X Ref.:Read the text below Sol : All except histiocytosis present with triad of vertigo, tinnitus, and deafness. Histiocytosis X belong to the group of disorders collectively termed inflammatory reticuloendotheliosis characterized by multiple osteolytic lesions involving skull, temporal bone, long bones, ribs, and vertebrae. There is generalized lymphadenopathy, hepatosplenomegaly, and in severe cases involvement of the bone marrow. Involvement of temporal bone leads to features mimicking complicated CSOM like otorrhea, mastoiditis, facial palsy, and labyrinthitis. Q-102 Inverted papilloma is characterized by all except : a. Also called as schneiderian papilloma b. Seen more often in females www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 c. Presents with epistaxis and nasal obstruction d. Originates from lateral wall of nose Ans-102: (b) Seen more often in females Ref: Dhingra– 216 Sol : Inverted papilloma is a transitional cell papilloma also called Schineiderian papilloma/Ringertz Tumor. It is the most common benign neoplasm of the nose and paranasal sinuses. It presents in the middle age (40-70 yrs.) as soft friable mass resembling polyp. More common in males (male : female = 5 : 1). Arises almost exclusively from the lateral wall of the nose and only occasionally from the septum. It is always unilateral. Patients mainly complain of nasal obstruction, rhinorrhea & unilateral epistaxis, There is coincidental malignancy else where in the upper respiratory tract in about 4% of the cases and malignant transformation of the tumor occurs in about 8% cases. Treatment is adequate local excision. If it arises in maxillary sinus, then a radical antrostomy is carried out. If it arises in the ethmoidal sinus, an external ethmodiectomy is done. If it arises from nose, treatment is wide surgical excision by lateral rhinotomy Has a tendency to recur even after removal. Q-103 About nasal syphilis which of the following is untrue : a. Perforation occurs in septum b. Saddle nose deformity may occur c. In new born, it presents as snuffles d. Secondary syphilis is the common association Ans-103: (d) Secondary syphilis is the common association Ref: Dhingra– 173 Sol : Nasal syphilis may be : Acquired : — Primary e.g. chancre in vestibule Secondary e.g. simple rhinitis, crusting and fissuring Tertiary e.g. Gumma Congenital : Early (first 3 months) : Presenting as snuffles, purulent nasal discharge, fissuring excoriation. Late (around puberty) : Gumma in septum and other stigmatas. Saddle nose deformity occurs due to collapse of nasal bridge. Atrophic rhinitis is a complication. Teritary syphilis is a common association : primary and secondary is rare association in nasal syphilitic. Septal perforation occurs in bony part in case of syphilis. Q-104 Which of the following is not typical feature of Meniere’s disease? www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 a. Sensorineural deafness b. Pulsatile tinnitus c. Vertigo d. Fluctuating deafness Ans-104: (b) Pulsatile tinnitus Ref.:Read the text below Sol : Episodic vertigo and fluctuant sensorineural hearing loss are features of Meniere’s disease. It is associated with tinnitus, which is usually a low pitched roaring or hissing sound. Pulsatile tinnitus is not a feature of Meniere’s disease and occurs with conditions like arteriovenous malformations of the temporal bone, glomus tumor, etc. Q-105 Tympanoplasty is most commonly performed for tympanic membrane perforations greater than: a. 10 – 20% of the size of the entire tympanic membrane b. 20 – 30% of the size of the entire tympanic membrane c. 30 – 40% of the size of the entire tympanic membrane d. 40 – 50% of the size of the entire tympanic membrane Ans-105: (a) 10 – 20% of the size of the entire tympanic membr Ref:Read the text below Sol: Tympanoplasty is most commonly performed for tympanic membrane perforations greater than 10 – 20% of the size of the entire tympanic membrane. Tympanoplasty alone or type 1 tympanoplasty denotes that the surgery is confined to the eardrum alone, and no manipulation of the middle ear bones (ossicles) occurs. Tympanoplasty that includes manipulation of the ossicles is defined as tympanoplasty with ossicular reconstruction, or tympanoossiculoplasty. Overall, there is approximately 95 – 98% success rate in closing tympanic membrane perforations with tympanoplasty. There are three ways to approach the tympanic membrane Transcanal Approach(Most Common) The transcanal (meaning, through the ear canal) approach is performed exclusively through the ear canal except for a small incision behind the ear, which is used to obtain the graft material. Postauricular Approach Endaural approach Q-106 A 27 year old female presents with tender subcutaneous nodules on lower legs. Which of the following is least likely to be the etiology? www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Use of oral contraceptives a. Streptococcal infection b. Sarcoidosis c. Giant cell arteritis Ans-106: (d) Giant cell arteritis Ref: Read the text below Sol: The diagnosis is Erythema nodosum. It can occur as a result of Infections(eg:Streptococcal,Fungal,Mycobacterial,Yersinial) Drugs(eg:Sulfadrugs,Penicillins,Oral contraceptives) Sarcoidosis. Q-107 Shagreen patch is aa. Neurofibroma b. Neuroma c. Collagenoma d. Angiofibroma Ans-107: (c) Collagenoma Ref: Read the text below Sol: The shagreen patch is most commonly found on the back or flank area; it is an irregularly shaped, slightly raised, or textured skin lesion. The lesion is found in 20 to 30% of patients with tuberous sclerosis complex. Hypomelanotic macules (ash leaf spots) are found in over 90% of patients with tuberous sclerosis complex. They are usually present at birth but are often difficult to see in the newborn without an ultraviolet light. Adenoma Sebaceum (Facial angiofibromas) occur in about three fourths of patients but often appear several years after the diagnosis has been established by other means. These lesions typically become apparent during the preschool years as a few small red papules on www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 the malar region; they gradually become larger and more numerous, sometimes extending down the nasolabial folds or onto the chin. Angiofibromas contain both vascular and connective tissue elements. Although facial angiofibromas are a strong indication of tuberous sclerosis complex when found with other manifestations, these lesions also occur in individuals with multiple endocrine neoplasia type I and thus are not pathognomonic for either condition Ungual fibromas are nodular or fleshy lesions that arise adjacent to or from underneath the nails. Ungual fibromas are seen in about 20% of unselected patients with tuberous sclerosis complex and are more likely to be found in adolescents or adults than in younger children. Q-108 Slit skin smear is positive if a. >104 bacilli /gm of tissue b. >103 bacilli /gm of tissue c. >102 bacilli /gm of tissue d. >105 bacilli /gm of tissue Ans-108: (a) >104 bacilli /gm of tissue Ref: Read the text below Sol: Slit skin smear is positive if >104 bacilli /gm of tissue Q-109 A suspected case of pemphigus vulgaris is best investigated with a. DIF of a fresh blister b. DIF of a perilesional sample c. Light microscopy of an old blister d. Electron microscopy Ans-109: (b) DIF of a perilesional sample Ref: Read the text below Sol: Immuno bullous diseases are best diagnosed by demonstrating the antibodies bound in the skin sample by direct immunofluorescence (DIF). For DIF samples are best taken from perilesional skin. Q-110 A child had a scratch on its cheek, who complained of fever the next day.Within days the infection spread to ear.Most probable diagnosis is: a. Cellulitis b. Erysipelas c. Ecthyma d. Erythrasma Ans-110: (b) Erysipelas Ref: Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Milan’s ear sign: ear is involved in erysipelas and not in cellulitis as it does not have deep dermis. Q-111 The histopathology image shown below points to a diagnosis of ? a. Pemphigus vulgaris b. Pemphigus foliaceus c. Psoriasis d. Lichen planus Ans-111: (d) Lichen planus Ref: Read the text below Sol: The characteristic histological changes seen in Lichen planus are; i)Basal epidermal cell degeneration causing saw tooth appearance of rete pegs and eosinophiliccytoid bodies(Civatte bodies) ii)Epidermal thickening,especially of granular cell layer iii)Sub-epidermal lichenoid band due to deposition of lymphocytes and histiocytes. iv)Max Joseph spaces or small areas of artifactual separation between the epidermis and the dermis Q-112 A 3 months old male infant developed otitis media for which he was given a course of Co-trimoxazole. A few days later, he developed extensive peeling of the skin , there were no mucosal lesions and the baby was not toxic,Diagnosis: a. Toxic epidermal necrolysis b. Staphylococcal scalded skin syndrome c. Steven Johnson syndrome d. Infantile pemphigus Ans-112: (b) Staphylococcal scalded skin syndrome www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ref: Read the text below Sol: Staphylococcal scalded skin syndrome. It is caused by Staphylococcus aureus of phage group II (here otitis dermatitis) which produce epidermolytic toxins. These toxins cleave desmoglein 1 and produce widespread peeling of stratum corneum. Since desmoglein 1 is not expressed in mucosae, there is no mucosal involvement. Steven Johnson syndrome and Toxic epidermal necrolysis are drug reactions with purpuric lesions, severe mucosal involvement and deeper level of split with full thickness peeling of epidermis. In SSSS patient is generally well but in SJS and TEN patient is quite ill. Q-113 According to new research, which is most strongly associated with pathogenesis of psoriasis a. Th1 b. Th2 c. Th17 d. Th18 Ans-113: (c) Th17 Ref: Read the text below Sol: Psoriasis earlier believed to be mediated by predominantly TH1 cells (CD 8+); but now TH17 appears to be most important pathogenic subset of T- cells induced by IL-23 from psoriatic plaques. IL-8 may be important for attracting neutrophils in the plaques (esp in pustular psoriasis). Q-114 “Islands of sparing” (“nappes claires”) are a classical feature of a. Pityriasis versicolor b. Pityriasis rosea c. Pityriasis rubra pilaris d. Pityriasis alba Ans-114: (c) Pityriasis rubra pilaris Ref: Read the text below Sol: Palmoplantar keratoderma (orange-red, waxy, hyperkeratosis of palms and soles known as PRP sandal) Red (salmon colored ) scaly plaques with “islands of sparing” (“nappes claires”) i.e normal skin within erythematous plaques Perifollicular, hyperkeratotic, rough, horny papules over trunk and especially over digits simulating a “nutmeg grater” appearance and feel. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-115 Which of the following is not associated with atopic dermatitis a. Posterior subcapsular cataract b. Anterior subcapsular cataract c. Keratoconus d. Hertoghe’s sign Ans-115: (a) Posterior subcapsular cataract Ref: Read the text below Sol: Many eye/periorbital changes are associated with atopic dermatitis including: Anteriorsubcapsular cataract Keratoconus, periorbital pallor (headlight sign) Periorbital darkness (allergic shiners) Lateral madarosis (Hertoghe’s sign) Accessory and deep infraorbital lines (Dennies’ lines/ Dennie Morgan folds). Q-116 What is the most common presentation of Ashermans syndrome a. Infertility b. Menstrual irregularities c. Pain d. Abortions Ans-116: (b) Menstrual irregularities Ref: Read the text below Sol : The most common presentation is menstrual irregularities while the single most common complaint is infertility Among menstrual irregularities the most common is amenorrhoea followed by hypomenorrhoea Q-117 A primigravida comes for first antenatal visit at 12 weeks she is B negative and her husband blood group is B positive and ICT is negative which of the following g is the best step in her management a. Give her 300mcg Inj Anti D b. Give her 50 mcg of Inj Anti D c. Repeat her ICT at 28 weeks d. Nothing needs to be done as this is her first pregnancy Ans-117: (c) Repeat her ICT at 28 weeks Ref: Read the text below Sol : She needs a repeat ICT at 28 weeks and if that is also negative then we will give her 300mcg of anti D www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-118 All are used as post coital contraceptives except a. High dose estrogens b. Cu T c. LNG d. Ulipristal Ans-118: (a) High dose estrogens Ref: Read the text below Sol : Estrogen alone are not used as emergency contraceptives although OCP are used as emergency contraception Ulipristal is the most effective hormonal EC While LNG tab is the most commonly used CuT is the most effective among all Q-119 A lady G2P1L1 comes to you at 20 weeks POG with a history of first child suffering from downs which if the following is the management for her a. Nothing to be done as she is beyond 20 weeks b. CVS c. Amniocentesis d. Cordocentesis Ans-119: (c) Amniocentesis Ref: Read the text below Sol : Amniocentesis is the safest procedure to obtain sample for karyotyping and it can be done anytime after 15 weeks. The cells used for karyotyping are amniocytes and fibroblast. Early amniocentesis before 15 weeks is no longer done Q-120 Which of the following dose of Misoprostol is incorrectly matched a. Prophylaxis of PPH 600mcg b. MTP 800mcg c. Labor induction at term 25mcg d. Treatment of PPH 800mcg Ans-120: (b) MTP 800mcg Ref: Read the text below Sol : The dose of Misoprostol used for out patient medical abortion upto 7 weeks is 400 mcg The other drug used with it is mifepristone in a dose of 200mg Q-121 Congenital diaphragmatic hernia can be diagnosed by USG as early as : a. 11 weeks www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 b. 15 weeks c. 24 weeks d. 30 weeks Ans-121: (a) 11 weeks Ref: Read the text below Sol : The CDH can be diagnosed as early as 11 weeks although most commonly it is diagnosed at around 15 weeks The anomaly that can be earliest diagnosed on USG is anencephaly as early as 10 weeks Q-122 All are true about thyroid physiology in pregnancy except a. Increase in TBG b. Increase in free T4 T3 c. Goitre d. Decrease in TSH Ans-122: (c) Goitre Ref: Read the text below Sol : Goitre is never physiological it is pathological finding in pregnancy Because of stimulation of the thyroid gland by HCG both total and free t4 and t3 increase. Q-123 A pregnant mother presents with history of delivery of a previous child with CongenitalAdrenal Hyperplasia (CAH). The best management protocol for the current pregnancy is : a. To start prednisolone after establishing whether fetus is affected by Chorionic Villous Sampling b. To start dexamethasone as soon as pregnancy is confirmed c. To start dexamethasone after determining sex of the fetus by Karyotyping d. To start prednisolone after determining sex of the fetus with USG Ans-123: (b) To start dexamethasone as soon as pregnancy is confirmed Ref: Read the text below Sol : "The best management protocol for the current pregnancy in a pregnant mother presents with history of delivery of a previous child with Congenital Adrenal Hyperplasiais is to start dexamethasone as soon as pregnancy is confirmed. To achieve best results treatment must be started as soon as pregnancy is recognized and no later than 9 weeks. Dexamethasone (20mg /kg) is the agent of choice for fetal adrenal suppression. The diagnosis of CAH in a sibling places the fetus of current pregnancy at risk of CAH." www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-124 Which of the following dietary supplements is recommended for a pregnant lady on Heparin: a. Folic acid b. Copper c. Zinc d. Calcium Ans-124: (d) Calcium Ref: Read the text below Sol : Calcium dietry supplements is recommended for a pregnant lady on Heparin. Heparin does not cross blood brain barrier or placenta and it is the anticoagulant of choice in pregnancy. However use of heparin may be associated with transient hypocalcemia and hence calcium supplementation during pregnancy may be advised Q-125 Risk factors for Placenta Accreta include all of the following except: a. Previous LSCS scar b. Previous curettage c. Previous myomectomy d. Previous placenta praevia Ans-125: (d) Previous placenta praevia Ref: Read the text below Sol : Placenta Praevia in the present pregnancy (not previous placenta previa) constitutes a risk factor for placenta Accreta. Note: Risk Factors for placenta Accreta include placenta previa (Present pregnancy), Previous curettage, Multiparity, previous cesarean section, previous myomectomy and advanced maternal age ( 35 years) Q-126 Which of the following conditions is not diagnosed by Chorionic Villous Biopsy? a. Neural tube defects b. Down’s syndrome c. Phenylketonuria d. Sickle cell anemia Ans-126: (a) Neural tube defects Ref: Read the text below Sol : "Neural tube defects are not associated with any of the above and are not detected by chronic villous biopsy. Chorionic villous sampling may be used to detect disorders with cytogenetic, biochemical (genetic) or molecular disorder." www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-127 What is the ideal treatment for a 55 yr female with Simple Hyperplasia of endometrium with Atypia? a. Simple hysterectomy b. Medroxy progesterone Acetate (MPA) c. Levonorgesterol (LNG) d. Mirena Ans-127: (a) Simple hysterectomy Ref: Read the text below Sol : The ideal treatment for a 55 yr female with Simple Hyperplasia of endometrium with Atypia is simple hysterectomy. Endometrial hyperplasia is regarded as a precursor for endometrial carcinoma. Presence of cytological atypia and post menopausal age (55 years) suggest increased risk of progression to carcinoma, and hence this patient should be treated with hysterectomy." Q-128 Salpingitis /Endosalpingitisis best confirmed by: a. Endometrial biopsy b. Laparoscopy + hysteroscopy c. Hysterosalpingography d. Sonosalpingography Ans-128: (b) Laparoscopy + hysteroscopy Ref: Read the text below Sol : "Salpingitis /Endosalpingitis is best confirmed by by Hysteroscopy + Laparoscopy. The diagnosis of salpingitis is best confirmed by Laparoscopy. Hysterectomy may also provide confirmatory evidence of salpingitis. Hence Hysteroscopy + Laparoscopy is the single best answer of choice." Q-129 The first sign of puberty in girls is: a. Breast budding b. Peak height velocity c. Menarche d. Pubic and axillary hair growth Ans-129: (a) Breast budding Ref: Read the text below Sol : First sign of puberty in females is growth spurt while the first visible sign of puberty is Thelarche which is appearance of breast buds. Growth spurt is beginning of skeletal growth which is not synonymous to peak height velocity www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-130 In a case of complete Müllerian duct Aplasia all the following are likely to be absent except : a. Uterus b. Fallopian tubes c. Vagina d. Ovaries Ans-130: (d) Ovaries Ref: Read the text below Sol : Ovaries are gonads and they develop from genital ridge and not from Müllerian ducts while all other structures in the question are derived from Müllerian ducts. Also the karyotype of the patient will be normal 46 XX. Q-131 Vaginal Delivery may be recommended in: a. Monochorionic Monoamniotic Twins b. First twin vertex, second twin breech c. First twin extended breech, second twin vertex d. First twin me to posterior , and second twin breech Ans-131: (b) First twin vertex, second twin breech Ref: Read the text below Sol : The outcome of twin pregnancy depends on lie of first twin, if the first twin is longitudinal vaginal delivery can be done. While if the first twin is non longitudinal then CS is done. If the first twin is breech and second vertex again CS is preferred because of risk of twin entrapment Monism optic twins have a risk of cord entanglement and they are delivered by CS Q-132 Minimum duration between onset of symptoms and death is seen in: a. APH b. SEPTECEMIA c. PPH d. Obstructed labor Ans-132: (c) PPH Ref: Read the text below Sol : The most common cause of death in obstetric patient is PPH and the progression is also rapid. The most common cause of shock after delivery is PPH Q-133 The most effective contraceptive method recommended in lactating mothers is www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 a. Barrier method b. Progesterone only pill c. Oral contraceptive Pills d. Lactational Amenorrhea Ans-133: (b) Progesterone only pill Ref: Read the text below Sol : Progesterone only pills (POP’s) are the most effective contraceptives during lactation amongst the options provided. POPs are more effective than Barrier methods and lactational amenorrhea (alone). Q-134 Which of the following is true about obstructive azoospermia a. Increase FSH and increaseLH b. increase FSH and Normal LH c. Increase LH, Normal FSH d. Normal FSH, Normal LH Ans-134: (d) Normal FSH, Normal LH Ref: Read the text below Sol : The hormone levels including Lh FSH and testosterone are normal in a patient with obstructive azoospermia. While in non obstructive the testosterone level is low and LH bad FSH are high. The single most important hormone for evaluation is serum testosterone Q-135 Which method of contraception is shown? www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 A) Falope ring B) Hysteroscopic C) Modified pomeroy D) Laparoscopic Ans-135: (b) Hysteroscopic Q-136 Which of the following is not true about physiological changes in pregnancy? a. Renal blood flow and GFR decreases by 50% b. Plasma volume increases by 40 % c. Plasma protein concentration is decreased by 10% d. Respiratory rate and Vital capacity remains unchanged. Ans-136: (a) Renal blood flow and GFR decreases by 50% Ref: Read the text below Sol : Renal blood flow and GFR increases by about 50% during pregnancy as a result of which serum creatinine levels decrease and excretion of glucose increases during pregnancy. Glucosuria is a normal physiological finding seen in pregnancy. Q-137 Ideal time for termination of pregnancy in cases with Intrahepatic cholestasis is: a. 32 weeks b. 34 weeks c. 36 weeks www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 d. 38 weeks Ans-137: (d) 38 weeks Ref: Read the text below Sol : Ideal time for termination of pregnancy in cases with intrahepatic cholestasis is 37 weeks. Most common clinical manifestation of intrahepatic cholestasis in pregnancy is Pruritis. Drug of choice for Intrahepatic cholestasis of pregnancy is Ursodeoxycholic acid. Q-138 Minimum hCG level at which gestational sac can be detected by tranvaginal songoraphy is a. 1500 b. 1000 c. 2000 d. 2500 Ans-138: (b) 1000 Ref: Read the text below Sol : Express critical Titer of hcg for TVS is 1500IU/l but the minimum value at which it can pick up sac may be 1000Iu/l The critical Titer for transabdominal ultrasound is 6500 Iu/l Q-139 The most common chromosomal anomaly to be associated with abortions is a. Trisomy 16 b. Trisomy 21 c. Monosomy X d. Trisomy 18 Ans-139: (c) Monosomy X Ref: Read the text below Sol : The single most common cause of abortions is monosomy X followed by trisomy 16 Q-140 Embryo reduction of multiple pregnancyis done at a. 8-10 weeks b. 11-13 weeks c. 13-15 weeks d. 16-18 weeks Ans-140: (b) 11-13 weeks Ref: Read the text below www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Sol : Embryo reduction of multiple pregnancy ( i.e. converting a triplet or quadruplet pregnancy to twin pregnancy ) is done at 11-13 weeks period of gestation Embryo reduction is done using injection potassium chloride in the fetal heart under USG guidance. Q-141 All of the following are true about pancreatic pseudocyst except? a. It is a collection of amylase rich fluid b. Develops within 2 weeks after the onset of acute pancreatitis. c. Pseudocyst fluid has a low CEA level d. It may resolve spontaneously Ans-141: (b) Develops within 2 weeks after the onset of acute pancreatitis. Ref: Read the text below Sol: Pseudocyst of pancreas Pseudocyst of pancreas is a collection of amylase-rich fluid enclosed in a wall of fibrous or granulation tissue. It typically arise following an attack of acute pancreatitis, but can develop in chronic pancreatitis or after pancreatic trauma. Formation of a pseudocyst requires 4 weeks or more from the onset of acute pancreatitis. Fluid from a pseudocyst typically has a low CEA level, and levels above 400 ng/mL are suggestive of a mucinous neoplasm. Pseudocysts will resolve spontaneously in most instances. Therapeutic interventions are advised only if the pseudocyst causes symptoms, if complications develop or a distinction has to be made between a pseudocyst and a tumour. Q-142 Which of the following is not an intramural cause of intestinal obstruction? a. Stricture b. Hernia c. Intususseption d. Volvulus Ans-142: (b) Hernia Ref: Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-143 Which one of the following plastic surgeon won the noble prize for his work? a. Harold Gillies b. T.P.Kilner c. Paul Tessier d. Joseph Murray Ans-143: (d) Joseph Murray Ref: Read the text below Sol: It was Joseph Murray who performed the first successful renal transplant in identical twins in 1955, for which he was conferred the Noble prize. The other options are of leaders and icons of plastic surgery based on their individual contributions to the specialty. Q-144 The TRAM (transverse rectus abdominis musculocutaneous) flap has revolutionized breast reconstruction. All of the following can be considered advantages and indications of the free TRAM flap over pedicled TRAM except which one of the following? a. Reduced abdominal dissection and muscle sacrifice. b. History of heavy cigarette use (10 packs/ years smoking) c. High incidence of flap failure d. Avoidance of disturbance of medial inframammary fold Ans-144: (c) High incidence of flap failure Ref: Read the text below Sol: Both the pedicled and free TRAM procedures may be indicated for patients desiring breast reconstruction. Patients in high-risk categories,such as those with a history of heavy cigarette use(>10 pack/years smoking) and those who are overweight or obese, are more suitable for free than for pedicle TRAM reconstruction. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Advocates for the free TRAM cite its advantages of reduced abdominal dissection and muscle sacrifice , enhanced flap vascularity , ease of flap inset, and avoidance of disturbance of the medical inframammary fold. Requirement of microvasular skills and significantly higher risk of total flap failure are disadvantages of the free TRAM flap technique. Q-145 The deformity “crow’s feet “ is located at which one of the following region? a. Feet of the crow b. Perioral region c. Perineal region d. Periobicular region Ans-145: (d) Periobicular region Ref: Read the text below Sol: Crow’s feet are lateral periorbital wrinkles due to muscle hyperactivity combined with senile degeneration of the overlying skin. They can be treated temporarily using Botox injection therapy but definitive treatment may require suborbicularis midfacial elevation. The rest of the options are incorrect. Q-146 Which of the following nerve is not in relation to submandibular gland? a. Lingual nerve b. Hypoglossal nerve c. Marginal mandibular branch of facial nerve d. Vagus nerve Ans-146: (d) Vagus nerve Ref: Read the text below Sol: Important anatomical relationships of the submandibular glands Lingual nerve Hypoglossal nerve Anterior facial vein Facial artery Marginal mandibular branch of the facial nerve Q-147 Trauma and injury severity score (TRISS) includes a. GCS + BP +BR b. Revised trauma score+ injury severity score + age c. Revised trauma score + injury severity score + GCS d. Revised trauma score+ GCS+BP Ans-147: (b) Revised trauma score+ injury severity score + age Ref: Read the text below www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Sol: Trauma and injury severity score (TRISS) combines the revised Trauma score (RTS) and injury severity score (ISS) with the ‘Age’ of patient together with the method of injury (Blunt or penetrating). Trauma and injury severity score (TRISS) The TRISS is a combined scoring system used to predict the outcome following major trauma It combines the anatomic derangements (ISS) and physiological derangements (RTS) together with patients Age and Mechanism of Injury (Blunt or penetrating) to predict survival after trauma. .. TRISS (Trauma and injury Severity Score). Injury severity Score (ISS) Revised Trauma Score (RTS) Age Mechanism of injury (Blunt/penetrating) . The TRISS scoring system provides a rough predicator medicating whether morality in a given patient is expected to be greater or less than 50 percent. Q-148 Which of the following is not an extra intestinal manifestation of acute colitis? a. Arthritis b. Cirrhosis c. Pleural effusion d. Uveitis Ans-148: (c) Pleural effusion Ref: Read the text below Sol: Extraintestinal manifestations of ulcerative colitis. Arthritis occurs in around 15 per cent of patients. Sacroiliitis and ankylosing spondylitis are 20 times more common in patients with UC. Sclerosing cholangitis is associated with UC and can progress to cirrhosis and hepatocellular failure. Cholangiocarcinoma is rare association and its frequency is not influenced by colectomy. The skin lesions include erythema nodosum and pyoderma gangrenosum. The eyes can also be affected with uveitis and episcleritis. Q-149 Which of the following feature is more common in Ulcerative colitis than Chron’s disease? a. Perianal disease b. Fistula formation c. Stricture d. Crypt abscess Ans-149: (d) Crypt abscess www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ref: Read the text below Sol: Q-150 All of the following can cause paralytic ileus except? a. Hypokalaemia b. Hypocalcaemia c. Salmonella typhi infection d. Diffuse peritonitis Ans-150: (b) Hypocalcaemia Ref: Read the text below Sol: Common causes of paralytic ileus include Post operative Infection – Intra peritoneal sepsis , Salmonella typhi infection Reflex ileus - # of Ribs or spine,Retroperitoneal hemorrhage Metabolic – Uremia, Hypokalemia Q-151 The sac contains only a portion of the circumference of the intestine is called a. Richter’s Hernia b. Littre’s hernia c. Spigelian hernia d. Lumber hernia Ans-151: (a) Richter’s Hernia Ref: Read the text below www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Sol: (1) Richter’s Hernia – is a hernia in which the sac contains only a portion of the circumference of the intestine (usually small intestine). It usually complicates femoral and rarely obturator hernias. (2) Littre’s hernia – A Mechel’s diverticulum (3) Spigelian hernia – This is a variety of interparietal hernia occurring at the level of the accurate line. (4) Lumber hernia- Most primary lumber hernia occurs through the inferior lumber triangle of Petit. Bounded below by the crest of the ilium, laterally by the external oblique and medially by the latissmus dorsi. Q-152 Millidgan-Morgan operation is indicated in a. Rectal prolapsed b. Haemorrhoides c. Anal fissure d. Fistula in Ano Ans-152: (b) Haemorrhoides Ref: Read the text below Sol: Indication of Haemorrhoidectomy Third degree haemorrhoids Second degree haemorrhoids which have not been cured by non operative treatments Fibrosed haemorrhoids Unteri – external haemorrhoids when the external haemorrhoids is well defined Haemorrhoidectomy can be performed using an open or closed technique-open technique is most commonly used in the UK and is known as the Milligan-Morgan operation. In the open technique the anal mucosa and skin are left open to heal by secondary intension, and in the closed technique the wound is sutured. Delorme’s operation used in rectal prolapsed Q-153 “Seat belt syndrome” is a. Fracture ilium with rupture of urethra b. Sudden deceleration can result in a torn mesentery c. Frature shaft of the femur with testicular swelling d. Non-specific ; mesenteric adenitis Ans-153: (b) Sudden deceleration can result in a torn mesentery Ref: Read the text below Sol: SEAT- BELT SYNDROME If a car accident occurs when a seat belt is worn, sudden deceleration can result in a torn mesentery. This possibility should be borne in mind, particularly as multiple injuries may distract attention from this injury. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 If there is any bruishing of the abdominal wall or even marks of clothing impressed into the skin, laparotomy may be indicated. Diagnostic peritoneal lavage may be helpful in this situation. Q-154 Pneumatosis cystoids intestunalis is a. Gas filled cysts in the subserosa or submucosa of the small intenstine b. Gas filled cysts in the subserosa or submucosa of the duofenum c. An external fistula communicating with the caecum following operation of gangrenous appendicitis d. Fibrotic thickening of the intestinal wall with narrow lumen. Ans-154: (a) Gas filled cysts in the subserosa or submucosa of the small intenstine Ref: Read the text below Sol: Gas filled cysts in the subserosa or submucosa of the small intenstine Pneumatosis cystoids intestinalis- in which gas- filled cysts are found in the subserosa or submucosa of the intestine or colon. Majority of cases are associated with COPD or the immunocompromised state (eg. AIDS , post transplantation; in association with leukemia, lymphoma, vasculitis, or collagen vascular disease, and in those patients taking chemotherapy or corticosteroids) other associated conditions include inflammatory , obstructive or infectious conditions of the intestine: iatrogenic conditions as such endoscopy and jejunstomy placement; ischemia and extra-intestinal disease such as diabetes. Q-155 Most common site of intra peritoneal abscess is: a. Left superior intraperitoneal space b. Left inferior intraperitoneal space c. Right superior intraperitoneal space d. Right inferior intraperitoneal space Ans-155: (d) Right inferior intraperitoneal space Ref: Read the text below Sol: Right inferior (posterior) intra peritoneal (“right subhepatic")space: This lies transversely beneath the right lobe of the liver in the Rutherford Morison’s pouch It is the deepest space of the four and the commonest site of a subphenic abscess which usually arise from appendicitis, cholescystitis, a perforated duodenal ulcer or following upper abdominal surgery. The complicated arrangement of the peritoneum results in the formation of four intraperitoneal and three extra peritoneal space in which pus may collect. Q-156 Risk of permanent hypoparathyroidism after total thyroidectomy is about? a. 1% b. 2% www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 c. 5% d. 10% Ans-156: (c) 5% Ref: Read the text below Sol: Risk of permanent hypoparathyroidism after total thyroidectomy is about 5% In subtotal thyroidectomy it is 1% Q-157 Positive predictive value of triple assessment of breast symptoms is about? a. 85% b. 95% c. 65% d. 99.9% Ans-157: (d) 99.9% Ref: Read the text below Sol: Q-158 All of the following statements about Phylloides tumour are true except? a. Commonly seen after the age of 40. b. Usually becomes large massive tumour. c. Ulceration of overlying skin is common. d. Can metastasis via lymphatics. Ans-158: (d) Can metastasis via lymphatics. Ref: Read the text below Sol: Phyllodes Tumour Benign Also known as serocystic disease of Brodie or cystosarcoma phyllodes Usually occur in women over the age of 40 years Present as a large, sometimes massive tumour www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ulceration of overlying skin occurs because of pressure necrosis. Mobile on the chest wall rarely cystic Very rarely develop features of a sarcomatous tumour May metastasise via the bloodstream. Treatment for the benign type is enucleation or wide local excision. Massive tumours, recurrent tumours and those of the malignant type will require mastectomy Q-159 Which of the following is ANDI? a. Galactocoele b. Duct ectasia c. Puerperal abscess d. Cyclical mastalgia Ans-159: (d) Cyclical mastalgia Ref: Read the text below Sol: ANDI (aberations of normal differentiation and involution) includes Cyclical nodularity and mastalgia Cysts Fibroadenoma Q-160 After Pateys mastectomy the resected specimen does not contain? a. Whole breast b. Skin over the breast along with nipple areola complex c. All lymphnodes in axilla d. Pectoralis minor Ans-160: (d) Pectoralis minor Ref: Read the text below Sol: Patey mastectomy The breast and associated structures are dissected en bloc and the excised mass is composed of: o the whole breast; o a large portion of skin, the centre of which overlies the tumour but which always includes the nipple; o all of the fat, fascia and lymph nodes of the axilla. The pectoralis minor muscle is either divided or retracted The axillary vein and nerves to the serratus anterior and latissimus dorsi (the thoracodorsal trunk) should be preserved. The intercostal brachial nerves are usually divided Early mobilisation of the arm is encouraged www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-161 In CEAP classification lipodermatosclerosis is classified as? a. C3 b. C4a c. C4b d. C5 Ans-161: (c) C4b Ref: Read the text below Sol: The CEAP (clinical – etiology – anatomy – pathophysiology) classifi cation Clinical classifi cation • C0: no signs of venous disease • C1: telangectasia or reticular veins • C2: varicose veins • C3: oedema • C4a: pigmentation or eczema • C4b: lipodermatosclerosis or atrophie blanche • C5: healed venous ulcer • C6: active venous ulce Etiologic classifi cation • Ec: congenital • Ep: primary • Es: secondary (post-thrombotic) • En: no venous cause identifi ed Anatomical classifi cation • As: superfi cial veins • Ap: perforator veins • Ad: deep veins • An: no venous location identifi ed Pathophysiological classifi cation • Pr: refl ux • Po: obstruction • Pr,o: refl ux and obstruction • Pn: no venous pathophysiology identifi able Q-162 Base of the skull fracture presents with involvement of the petrous temporal bone, which of the following important sign: a. Subconjunctive haematoma b. CSF rhinorrhoea c. Raccon eyes d. Battle sign Ans-162: (d) Battle sign Ref: Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Base of Skull Fractures Anterior fossa fracture- May open into the frontal or ethmoid air sinuses or run across the cribriform plate. Presents with sub conjunctival hematoma,anosmia, epistaxis, nasal tip anaesthesia, CSFrhinorrhea and occasionally carotico-cavernous fistua. Periobital haematoma or “raccoon eye” indicate subgaleal haemorrhage. Middle fossa fracture involving petrous temporal bone presents with CSF otorrhea, haemotympanum, occicular disruption, Battle sign or VII and VIII cranial nerve palsies. Battle sign – bruising behind the ear appearing 36 hours after a head injury with a petrous temporal base of skull fracture. Q-163 Wolfe grafts is : a. Full thickness skin grafts b. Partial thickness grafts c. Split –skin grafts d. Pedicled flap Ans-163: (a) Full thickness skin grafts Ref: Read the text below Sol: Split-skin grafts (THIERSCH – GRAFTS) Donor site factors Large area available Donor site heals spontaneously Donor site reusable Recipient factors Poor color match Easily abraded Inferior cosmetic resistant More reliable take Shiny texture, inelastic FULL thickness grafts (WOLFF-GRAFTS) - Small area - Donor site must be closed - Donor site scars Good colour match Abrasion resistant Good cosmetic resistant Less reliable take Normal texture elastic Q-164 “Crumbled egg appearance” in liver seen in : a. Hepatic adenoma b. Chronic amobic liver abscess c. Hydatid liver of disease d. Haemagioma Ans-164: (c) Hydatid liver of disease Ref: Read the text below Sol: Cysts due to echinococcus (hydatid) disease may be single or multiple , a few show, calcified walls. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Hydatid liver cyst- Active hydatid disease usually produces a non-calcified liver cyst and within the cysts-floating layers of the germinal membrance can be seen. Q-165 The best investigation to assess complex incisional hernia is? a. Xray b. USG c. CT Scan d. MRI Scan Ans-165: (c) CT Scan Ref: Read the text below Sol: Computed tomography scanning is helpful in complex incisional hernia, determining the number and size of muscle defects, identifying the content, giving some indication of presence of adhesions and excluding other intra-abdominal pathology such as ascites, occult malignancy, portal hypertension, etc. Q-166 Chilotic line is? a. Line on hip bone for sex determination b. Line on femur for sex determination c. Line on hip bone for race determination d. Line in femur bone for race determination Ans-166: (a) Line on hip bone for sex determination Ref.:Read the text below Sol : Chilotic line is a line on hip bone for sex determination. A line is extended back from the iliopectineal eminence to the nearest point on the anterior auricular margin and thence to the iliac crest. The auricular point divides this chilotic line into anterior (pelvic) and posterior (sacral) segments, each expressed as a percentage of the other. Chilotic indices display reciprocal values in the sexes : the pelvic part of the chilotic line is predominant in females (63 mm in males, 67.3 mm in females), and the sacral part in males (65.5 in males, 55.6 in females). Q-167 Takayama reagent is used in detection of? a. Semen b. Blood c. Gun powder d. Old tattoos Ans-167: (b) Blood Ref.:Read the text below Sol : TESTS USED FOR DETECTION OF BLOOD Test Comments www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Takayama’s Haemochromagen crystal test Kastle-Mayer-phenolphthalein test Teichmann’s Hemin crystal test Benzidine test (gicial acetic acid + H2O2) Spectroscopic test Thin layer chromatography Electrophoresis Salmon pink colour haemochromagen crystals are obtained Less sensitive but more specific for blood Brown rhombic hemin crystals are seen Greenish blue colour obtained Positive even with blood subjected to heat or cold Negative reaction rules out presence of blood Best preliminary test (detects blood in 1:3 lakh dilution) Most specific Q-168 The word subpoena is synonymous with : a. Res ipsa loquitur b. Res judicata c. Summons d. Solemn affirmation Ans 168: (c) Summons Ref:Read the text below Sol: A subpoena is a writ issued by a government agency that has authority to compel testimony by a witness or production of evidence, the agency most often acourt, under a penalty for failure. Q-169 Guainacum test gives which color in the presence of blood a. Pink b. Deep blue c. Bright green d. Yellowish brown Ans 169: (b) Deep blue Ref:Read the text below Sol: Six color tests have been traditionally used by forensic scientists to detect blood stains. All these tests use the peroxidase like activity of heme to knock a nascent oxygen atom off hydrogen peroxide. This nascent oxygen atom brings about a color change in various reagents. These color changes have often been asked in examinations. Various screening tests for blood and the colors they give S.No. Reagent Color change 1. Benzidime Intense Blue 2. Ortho-tolidine blue green 3. Tetramenthylbenzidine green or blue green (TMB) www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 4. 5. 6. Phenolphthalein (Kastle – Meyer test) Leucomalachite green Guaicum Pink Bright green Deep blue Q-170 Skull of a male differs from that of a female by all of the following except. a. Capacity is greater than 1500 cc in males b. Muscular markings over occiput are less marked in males. c. Orbits are square in males. d. Frontal eminence is smaller in males Ans 170: (b) Muscular markings over occiput are less marked in males. Ref:Read the text below Sol: Skull difference between Male and Female The male cranial mass is more blocky and massive compared to the females which more rounder and tapers at the top. Capacity is greater than 1500 cc in males Muscular markings over occiput are more marked in males. Orbits are square in males. Frontal eminence is smaller in males The females Supraorbital margin is sharper while the males is rather round and dull. The Zygomatic bone is more pronounced on the male skull. The Mandible of a female is more rounded while the male's is squared. Males have a deeper cranial mass The supercilary arch is large and pronounced in the male. Q-171 Mechanical obstruction of the flow of air from the environment into the mouth and/or nostril is ? a. Smothering. b. Guillotine c. Garroting d. Burking Ans 171: (a)Smothering. Ref:Read the text below Sol: Smothering is the mechanical obstruction of the flow of air from the environment into the mouth and/or nostrils, for instance, by covering the mouth and nose with a hand, pillow, or a plastic bag. In homicidal cases, the term burking is often ascribed to a killing method that involves simultaneous smothering and compression of the torso. They killed the usually-intoxicated victims by sitting on their chests and suffocating them by putting a hand over their nose and mouth, while using the other hand to push the victim's jaw up. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-172 A dumb witness : a. Is not allowed to testify in a court of law b. Can testify by signs in an open court. c. By producing a previously written statement. d. By writing in an open court. Ans 172: (b) Can testify by signs in an open court. Ref:Read the text below Sol: DUMB WITNESSES ( S. 119 IEA ) A witness who is unable to speak may give his evidence in any other manner in which he can make it intelligible, as by writing or by signs; but such writing must be written and the signs made in open Court. Evidence so given shall be deemed to be oral evidence. Q-173 All of the following are related to medical negligence except : a. Section 304A I.P.C. b. Section 37 I.P.C. c. Section 34I I.P.C. d. Section 312 I.P.C. Ans 173: (b) Section 37 I.P.C. Ref:Read the text below Sol: SECTION 37 I.P.C. Co-operation by doing one of several acts constituting an offence When an offence is committed by means of several acts, whoever intentionally cooperates in the commission of that offence by doing any one of those acts, either singly or jointly with any other person commits that offence. Q-174 Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both is: a. Section 304A I.P.C. b. Section 37 I.P.C. c. Section 34I I.P.C. d. Section 312 I.P.C. Ans 174: (a) Section 304A I.P.C. Ref:Read the text below Sol: Whoever causes the death of any person by doing any rash or negligent act not amounting to culpable homicide, shall be punished with imprisonment of either description for a term which may extend to two years, or with fine, or with both www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-175 Testing for the presence of air in the middle ear is a. Fodere’s test b. Ploucquet’s test c. Breslau’s second life test d. Wreden’s test Ans 175: (d) Wreden’s test Ref:Read the text below Sol: During embryonic life, the middle ear contains gelationous tissue. During afforts of breathing, some air enters the middle ear through the Eustachian tube. Thus if the air is found in the middle ear, it is quite reasonable to suppose that the child had been born alive. Q-176 Maximum analgesic action is seen with: a. Catecholamine b. Propofol c. Ketamine d. Thiopentone Ans 176: (c) Ketamine Ref– Read the text below Sol: Ketamine produces profound analgesia. It produces a state where one feels “dissociated” from his own body. It does not produce unconsciousness. Propofol and thiopentone are the induction agaents causing unconsciousness quickly. They are poor analgesics. Catecholamines e.g. Adrenaline, Noradrenaline do not produce analgesia. Q-177 Anesthetic agent of choice in renal failure is: a. Methoxyflurane b. Isoflurane c. Enflurane d. None of the above Ans 177: (b) Isoflurane Ref– Read the text below Sol: Methoxyflurane and enflurane are metabolized in the body producing inorganic fluoride which is quite toxic to the renal tubules and can cause high-output renal failure;hence contra-indicated in renal failure. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Because of this problem, they are practically out of use nowadays. Since isoflurane is sufficiently lipid insoluble; it is exhaled back through respiration before any significant metabolism occurs. Q-178 Which one of the following statements regarding desflurane is correct? a. It causes severe myocardial depression b. It is a structural analogue of isoflurane c. It has a very high blood and tissue-gas partition coefficients d. It is metabolically unstable Ans-178: (b) It is a structural analogue of isoflurane Ref:Morgan’s Anesthesia -144 Sol : Desflurane’s structure is very similar to Isoflurane; It is highly volatile; Very low solubility in blood & tissues i.e, very low B/G partition coefficient, thus induction & recovery are very fast. It causes minimal cardiac depression & undergoes minimal metabolism Q-179 All of the following statements are incorrect regarding treatment of prolonged suxamethonium apnea due to plasma cholinesterase deficiency (after a single dose of suxamethonium) except a. Reversal with incremental doses of neostigmine b. Continue anesthesia & mechanical ventilation till recovery c. Transfusion of fresh frozen plasma d. Plasmapheresis Ans-179: (a) Reversal with incremental doses of neostigmine Ref:Lee’s Anesthesia -.223] Sol : The best management in this case is to provide mechanical ventilation, maintain anesthesia and continue monitoring till muscle function returns to normal. Transfusion of fresh frozen plasma is beneficial (It will provide pseudocholinesterase) Q-180 Differential sensory blockade is seen with a.Lignocaine b. Ropivacaine c. Prilocaine d. Tetracaine Ans-180: (b) Ropivacaine Ref:Read the text below Sol : Differential blockade occur with bupivacaine and ropivacaine. At lower concentration only sensory blockade while at higher concentration both motor and sensory www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-181 Most common artery used for invasive monitoring is a.Ulnar artery b. Dorsalis pedis artery c. Femoral artery d. Radial artery Ans-181: (d) Radial artery Ref:Read the text below Sol : Radial artery is used for invasive monitoring. Allens test is used to confirm collateral circulation Q-182 A rapid fall in ETCO2 is a indicator for a.Malignant hyperthermia b. Accidental extubation c. Venous air embolism d. Disconnection in circuit Ans-182: (c) Venous air embolism Ref:Read the text below Sol : Rapid fall in ETCO2 is indicative of venous air embolism which occurs most commonly in posterior fossa surgery in sitting position. Q-183 Choice of induction agent for LMA insertion is :a.Thiopentone b. Propofol c. Halothane d. Althesin Ans-183: (b) Propofol Ref:Read the text below Sol : Propofol Causes Maximum Depression Of Upper Airway Reflexes So Choice For Lma Insertion Q-184 Propofol infusion syndrome consist of all except a.Nephropathy b. Acute cardiomyopathy c. Metabolic acidosis d. Skeletal myopathy Ans-184: (a) Nephropathy Ref:Read the text below Sol : www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Propofol infusion syndrome consists of metabolic acidosis, skeletal myopathy and acute cardiomyopathy. It occurs in children on prolonged infusion due to failure of metabolism of free fatty acids. Q-185 Ideal muscle relaxant for use of continuous infusion is a.Rocuronium b. Mivacurium c. Pancuronium d. Vecuronium Ans-185: (b) Mivacurium Ref:Read the text below Sol : The ideal muscle relaxant for continous infusion is mivacurium as it has got ultra short duration of action. It has a slow onset. Q-186 All of the following are true except : a. Osteomyelitis of the bone can spread through human and animal bites b. In a suspected osteomyelitis , first step is to withdraw the blood and fluid samples rather than to start broad spectrum intravenous antibiotics c. The most common complication of acute osteomyelitis is chronic osteomyelitis d. Development of malignancy is a very common complication of acute osteomyelitis Ans 186: (d) Development of malignancy is a very common complication of acute osteomyelitis Ref: Read the text below Sol: Go through the most common causes of osteomyelitis in different clinical scenarios. Sinus tract malignancy is a common complication of chronic osteo myelitis and not acute osteomyelitis Q-187 All of the following are the components of terrible triad of Hotchkiss except : a. Fracture radial head b. Posterior dislocation of elbow c. Fracture of the coronoid process d. Fracture of the olecranon process Ans 187: (d) Fracture of the olecranon process Ref: Read the text below Sol: Fracture of olecranon process is not a part of terrible triad of Hotchkiss. Terrible triad of Hotchkiss except : a. Fracture radial head www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 b. Posterior dislocation of elbow c. Fracture of the coronoid process Q-188 This X ray given along represents which of the following terms a. Arthrodesis b. Arthroplasty c. Arthrotomy d. Ankylosis Ans 188: (a) Arthrodesis Ref: Read the text below Sol: Ankylosis : pathological fusion of a joint Arthrodesis: surgical fusion of a joint Q-189 A 55-year-old right-handed woman has left elbow pain laterally. X-ray findings are negative. There is tenderness and slight swelling over the lateral epicondyle of the humerus. Anatomically, this condition can be explained by which of the following? a. Sprain of the lateral collateral elbow ligament b. Rupture of the triceps muscle c. Tendinitis of the wrist extensors d. Synovitis of the left elbow joint Ans 189: (c) Tendinitis of the wrist extensors Reference: Read the text below Sol: The act of wringing rags results in repeated and forceful wrist dorsiflexion, causing increased pressure on the wrist extensor muscles, which have their tendinous origins from the lateral humeral epicondyle. This results in an inflammatory condition at the bone tendon junction, lateral epicondylitis, or “tennis elbow.” Although this condition is common in tennis players, it occurs more frequently in the general population. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-190 An86-year-old woman experiences left hip pain after a fall at home. She cannot ambulate,her hip area is swollen and painful, and her left lower extremity is shortened and externallyrotated. Before the fall, she was ambulatory and had no complaint of hip, pelvic, or kneepain. In addition to the fracture of the proximal portion of the left femur, the x-ray would show which of the following? a. Arthritis of the left hip b. Calcific bursitis of the left hip c. Osteoporosis d. Fracture of the pelvis Ans 190: (c) Osteoporosis Reference: Read the text below Sol: Postmenopausal osteoporosis is the common denominator in all fractures involving elderly women. In this particular fracture, it is the twisting effect on an osteoporotic femur that causes the fracture rather than the impact of the fall itself. Q-191 Which of the following is osteoinductive : a. Cancellous allograft b. Cancellous autograft c. Hydroxyapatite d. Collagen based matrix Ans 191: (b) Cancellous autograft Ref: Read the text below Sol: An ideal bone-graft substitute must provide scaffolding for osteoconduction as well as progenitor cells and growth factors for osteoinduction. Furthermore, the bone graft must be able to integrate with the host. Autogenous bone graft contains osteoblasts, endosteal osteoprogenitor cells capable of synthesizing new bone, and a structural matrix that acts as a scaffold, making it the gold standard for bone grafting. BMP-2 is a commonly utilized adjunct for grafting, and is inherently osteoinductive. The referenced article by Buckwalter et al is a review on the biology of bone grafting which nicely defines the various osteoinductive and osteoconductive properties of the various bone graft options. Q-192 Most important technical consideration at the time of doing a below Knee Amputation is : a. Stump should be kept too long b. Stump should be kept too short c. Anterior flap should be kept longer than the posterior flap d. Posterior flap should be kept longer than the anterior flap Ans 192: (d) Posterior flap should be kept longer than the anterior flap www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ref: Read the text below Sol: Techniques to follow amputation : - Flap is longer on the posterior side than anterior side - nerve and vessels should be doubly ligated - suture line should be obtained anterior to the midline in coronal plane - level of amputation must be planned earlier Q-193 Most common nerve injured in Supracondylar fracture of Humerus : a. Anterior Interosseous Nerve b. Median Nerve c. Radial Nerve d. Ulnar Nerve Ans 193: (a) Anterior Interosseous Nerve Ref: Read the text below Sol: Anterior Interosseous nerve a branch of median nerve is most commonly injured nerve in supracondylar fracture humerus while tardy ulnar nerve palsy is most commony seen in fracture lateral condyle humerus Circumflex branch of axillary nerve is most commonly injured in fracture proximal humerus. Q-194 Which is the most common carpal bone to get dislocated : a. Scaphoid b. Lunate c. Pisiform d. Hamate Ans 194: (b) Lunate Ref: Read the text below Sol: Scaphoid is the most commonly injured bone among carpal bones and lunate is the most commonly dislocated. Scaphoid has so many exceptions and one important one is Retrograde blood flow which leads to avascular non union Q-195 Which is the first reflex to recover after a period of Spinal Shock : a. Abdominal reflex b. Ankle jerk c. Cremasteric reflex d. Bulbocavernous reflex Ans 195: (d) Bulbocavernous reflex Ref: Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Bulbocavernous reflex is the first reflex to recover after spinal shock though not very clearly appreciable. Q-196 The vector shown below transmits which of the following diseases? a. Malaria b. Filaria c. Yellow fever d. Kala-azar Ans-196: (d) Kala-azar Ref.:Read the text below Sol : Sandfly (Phlebotomus) is the vector of Kala-azar The average life of a sandfly is about 2 weeks. Diseases transmitted by Sandfly SPECIES Phlebotomusargentipes Phlebotomuspapatasii Phlebotomussergenti DISEASES TRANSMITTED Kala-azar Sandfly fever Oriental sore Oriental sore Q-197 A patient presents with lower gastrointestinal bleed. Sigmoidoscopy shows ulcers in the sigmoid. Biopsy from this area shows flask-shaped ulcers. Which of the following is the most appropriate treatment? a. Intravenous ceftriaxone b. Intravenous metronidazole c. Intravenous steroids and sulphasalazine d. Hydrocortisone enemas Ans-197: (b) Intravenous metronidazole Ref.:Read the text below www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Sol : It is case of intestinal amoebiasis in the form of amoebic dysentery Drug Therapy for Amebiasis Asymptomatic carrier Acute Colitis Amebic liver abscess (Luminal agents) Lodoquinol Metronidazole plus Metronidazole or Paromomycin Luminal agent Tinidazole or tinidazole or ornidazole plus Luminal agent Q-198 The following is characteristic feature of staphylococcus food poisoning except: a. Optimum temperature for toxin production is 37°C b. Intradietic toxin are responsible for intestinal symptoms c. Toxin can be destroyed by boiling for 30 minutes d. Incubation period is 1-6 hours. Ans-198: (c) Toxin can be destroyed by boiling for 30 minutes Ref.:Read the text below Sol : Staphylococcal food poisoning : Staphylococcal food poisoning is due to heat stable preformed toxin mostly after consuming milk products. Toxin is produced optimally at 35°C to 37°C IP- 1.-6 hours. Mechanism – Acts by stimulating vagus nerve and vomiting center of brain Q-199 Which of the following infestations leads to malabsorption? a. Giardia lamblia b. Ascaris lumbricoides c. Necator Americana d. Ancylostoma duodenale Ans-199: (a) Giardia lamblia Ref.:Read the text below Sol : Giardia lamblia Symptoms of infection include (in order of frequency) diarrhea, malaise, excessive gas (often flatulence or a foul or sulphuric-tasting belch, which has been known to be so nauseating in taste that it can cause the infected person to vomit), steatorrhoea (pale, foul smelling, greasy stools), epigastric pain, bloating, nausea, diminished interest in food, possible (but rare) vomiting which is often violent, and weight loss People with recurring Giardia infections, particularly those with a lack of the immunoglobulin A antibody, may develop chronic disease. Lactase deficiency may develop in an infection with Giardia, but this usually does not persist for more than a few weeks, and a full recovery is the norm. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Some studies have shown giardiasis should be considered as a cause of vitamin B12 deficiency as result of the problems caused within the intestinal absorption system Ascaris lumbricoides in small intestine usually cause no symptoms. In children it may cause pain and intestinal obstruction sometimes complicated by perforation, intussusceptions or volvulus. Migration to aberrant site can cause biliary colic, cholecystitis, cholangitis, pancreatitis or rarely intrahepatic abscess. Intestinal phase of A. duodenale cause epigastric pain, inflammatory diarrhea and iron deficiency anemia. Q-200 Disinfectant used as a standard of measurement of killing power. a. Alcohol b. Phenol c. Cresol d. Formaldehyde Ans-200: (b) Phenol Ref.: Read the text below Sol : Chemical disinfectants vary greatly in their ability to kill microorganisms. A quantitative measure of this variation is expressed as the phenol coefficient, which is the ratio of the concentration of phenol to the concentration of the agent required to cause the same amount of killing under the standard conditions of the test. Q-201 Which of the following is most resistant to antiseptics? a. Spore b. Prion c. Cyst d. Fungus Ans-201: (b) Prion Ref.:Read the text below Sol : Resistance of organism to antiseptics in decreasing order is as follows : Prions Coccidia Spores Mycobacteria Cysts Small non-enveloped virus Trophozoites Gram-negative bacteria Fungi Large non-enveloped virus www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Gram-positive bacteria Lipid enveloped/medium size virus (HIV, HBV) Q-202 Which of the following statement is true: a. Solid media are enrichment media b. Nutrient broth is basal media c. Agar adds nutrient to media d. Chocolate agar is selective media. Ans-202: (b) Nutrient broth is basal media Ref.:Read the text below Sol : Media Simple media Complex media Synthetic or defined (Basal media) media Nutrient broth Added ingredient Prepared from chemicals with defined composition e.g., simple peptone water medium Special media Enriched media Enrichment media Selective media Indicator media Sugar media Transport media Q-203 In all of the following diseases chronic carriers are found except : a. Measles b. Typhoid c. Hepatitis B d. Gonorrhea Ans-203: (a) Measles Ref.:Read the text below Sol : In measles and whooping cough only cases are found with no carriers. Chronic carriers seen in : Typhoid Dysentery Hepatitis B Malaria Cerebrospinal meningitis Gonorrhea Q-204 A woman with infertility receives an ovary transplant from her sister who is an identical twin. What type of graft is it? a. Xenograft b. Autograft www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 c. Allograft d. Isograft Ans-204: (d) Isograft Ref.:Read the text below Sol : Terminology of grafts Donor Self Different individual, genetically identical with recipient. Identical twin or member of same inbred strain. Genetically unrelated member of same species Different species Term Autograft Isograft Synonyms Autogenous or autogenic graft Autogenous or autogenic graft Allograft Xenograft Isologous or syngeneic graft or syngraft Xenogeneic. Formerly called heterograft Q-205 Rabies virus persists in the saliva for how many days: a. 3-6 b. 7-10 c. 1-3 d. Upto 6 years Ans-205: (a) 3-6 Ref.:Read the text below Sol : SOURCE OF RABIES INFECTION The source of infection to man is the saliva of rabid animals. In dogs and cats, the virus may be present in the saliva for 3-4 days (occasionally 5-6 days) before the onset of clinical symptoms and during the course of illness till death. However, it may be stated that not all rabid animals have virus in saliva and even if present, the quantity is variable. The variability of the virus in saliva explains the fact why only about 50% of bites by proven rabid animals will result in rabies. Q-206 Tubercle bacilli was discovered by: a. Robert Koch b. Hansen c. Edward Jenner d. Virchow Ans-206: (a) Robert Koch Ref.:Read the text below Sol : On March 24, 1882, Robert Koch announced to the Berlin Physiological Society that he had discovered the cause of tuberculosis. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Three weeks later, on April 10, he published an article entitled "The Etiology of Tuberculosis" In 1884, in a second paper with the same title, he first expounded "Koch's postulates," which have since become basic to studies of all infectious diseases. He had observed the bacillus in association with all cases of the disease, had grown the organism outside the body of the host, and had reproduced the disease in a susceptible host inoculated with a pure culture of the isolated organism. Q-207 Which one of the following Gram positive organism is most common cause of UTI among sexually active women: a. Staphylococcus epidermidis b. Staphylococcus aureus c. Staphylococcus saprophyticus d. Enterococcus Ans-207: (c) Staphylococcus saprophyticus Ref.:Read the text below Sol : S. saprophyticus cause UTI in young women due to its enhanced capacity to adhere to uroepithelial cells. A 160 KDa hemagglutinin adhesions may contribute to this affinity. S. Saprophyticus is novobiocin resistant. Q-208 In autoclaving, which of the following spore used to confirm effectiveness: a. Bacillus anthrax b. Bacillus stearothermophilus c. Clostridia spores d. Bacillus cerius Ans-208: (b) Bacillus stearothermophilus Ref.:Read the text below Sol : STERILIZATION CONTROL : For determining the efficacy of moist-heat sterilization, spores of Bacillus stearothermophilus are used as the test organism. The is a thermophilic organism with an optimum growth temperature of 55°-60°C and its spores require an exposure of 12 minutes at 121°C to be killed. Paper strips impregnated with 106 spores are dried at room temperature and placed in paper envelopes. These envelopes are inserted in different parts of a load and after being sterilized; the strips are inoculated into a suitable recovering medium and incubated for sterility test at 55°C for five days. Chemical indicators, autoclave tapes and thermocouples are also used instead. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-209 Which of the following cannot bereliably used for hand washing : a. Chlorh exidine b. Isopropyl alcohol c. Lysol d. Cresol Ans-209: (c) Lysol Ref.:Read the text below Sol : Skin disinfectants are : Chlorhexidine (Savlon) Alcohols (as spirit) – Isopropyl alcohol (preferred), ethyl alcohol Iodine Cresol Chloroxylenol Hexachlorophene Tincture iodine Q-210 Which component of streptococcal pyogenes has cross reactivity with synovium of human? a. Capsular hyaluronic acid b. Cell proteins c. Group A carbohydrate antigens d. Peptidoglycan Ans-210: (a) Capsular hyaluronic acid Ref.:Read the text below Sol : Gross Reactivity of streptococcal antigen Bacterial antigen Cross reacting human component Capsular hyaluronic acid Human synovial fluid Group A carbohydrate antigen Cardiac valves Cytoplasmic membrane antigen Vascular intima Cell wall protein Myocardium Peptidoglycan Skin antigen Membrane antigens Sarcolemma of smooth and cardiac muscle, dermal fibroblasts And neurons of caudate nucleus Q-211 An HIV positive female has an indurated ulcer over cornmeal agar at 20 degrees, microscopy showing hyphae and growth inhuman serum at 37 degrees show budding yeasts. The probable cause is: a. Candida albicans b. Histoplasmosis c. Blastomycosis www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 d. Coccidiodomycosis Ans-211: (a) Candida albicans Ref.:Read the text below Sol : This is a case of oral thrush secondary to candidiasis C. albicans is a dimorphic fungi which occur both as yeast and moulds (with hyphae) In HIV oral thrush occurs when CD4 < 50/ul. Q-212 Regarding HIV which of the following is not true? a. It is a DNA retrovirus b. Contains Reverse transcriptase c. May infect host CD 4 cells other than T lymphoctyes d. Causes a reduction in host CD 4 cells at late stage of disease Ans-212: (a) It is a DNA retrovirus Ref.:Read the text below Sol : HIV is RNA retrovirus (not DNA virus) It primarily infect CD 4 + T cells but can infect other cells also which bear CD4 receptor on their surface These include circulating dendritic cells; epidermal langerhans’ cells; monocytes. Q-213 Which toxin of streptococcus causes hemolysis a. Streptolysin O b. Streptolysin S c. Streptokinase d. Streptodornase Ans-213: (b) Streptolysin S Ref.:Read the text below Sol : Streptococci Produce two hemolysin Streptolysin O Streptolysin S (Serum soluble) Oxygen labile Oxygen stable Activity only on pour plate not on Responsible for hemolysis seen around surface streptococcal colonies on surface Antigenic protein Non antigenic protein elaborated in presence of serum Q-214 A patient admitted to an ICU is on central venous line for the last one week. He is on ceftazidime and amikacin. After 7 days of antibiotics he develops a spike of fever and his blood cultyure is positive for gram positive cocci in chains which are catalase-negative. Following this vancomycin was started but the culture remained positive for same organism even after 2 weeks of therapy. The most likely organism causing infection is : a. Staphylococci aureus www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 b. Viridans streptococci c. Enterococcus faecalis d. Coagulase negative staphylococcus Ans-214: (c) Enterococcus faecalis Ref.:Read the text below Sol : Enterococci are catalase negative and grow in chains and above all resistant to cephalosporins. Enterococci is a frequent cause of nosocomial bacteremias and many of these enterococci are resistant to vancomycin. Enterococcal bacteremias is characteristically seen in ICU in patient taking cephalosporin as antibiotic. Q-215 Which infection is not common in HIV patients? a. Cryptosporidiosis b. Atypical mycobacterial infection c. Aspergillosis d. Candidiasis Ans-215: (c) Aspergillosis Ref.:Read the text below Sol : All of the following organism can cause opportunistic infection in AIDS patient. But invasive aspergillosis is generally not seen in patient with AIDS in the absence of neutropenla or administration of glucocorticoids. Aspergillosis also given in list of opportunistic infection but is not much common, hence is best option. Q-216 All of the following are causes of night blindness except : a. Oguchi's disease b. Gyrate atrophy c. Choroideremia d. Devics disease Ans-216: (d) Devics disease Ref: Read the text below Sol: Neuromyelitis optica (NMO), also known as Devic's disease or Devic's syndrome, is an heterogeneous condition consisting of recurrent and simultaneous inflammation and demyelination of the optic nerve (optic neuritis) and the spinal cord (myelitis). The main symptoms of Devic's disease are loss of vision and spinal cord function. Optic neuritis may manifest as visual impairment with decreased visual acuity, although visual field defects, or loss of color vision may occur in isolation or prior to formal loss of acuity. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-217 The diagnosis is : a. Anterior lenticonus b. Posterior lenticonus c. Anterior lentiglobus d. Posterior lentiglobus Ans-217: (a) Anterior lenticonus Ref: Read the text below Sol: This is view through slit lamp in retro illumination showing oil globule reflex , typical of anterior lenticonus . Q-218 Most common intracranial tumor encroaching the orbit is : a. Astrocytoma b. Glioblastoma multiforme c. Sphenoid wing meningioma d. Medulloblastoma Ans-218: (c) Sphenoid wing meningioma Ref: Read the text below Sol: Meningioma is a benign brain tumour arising from the arachnoid. It is more common in females after the age of 50yrs. 20% of meningiomas are sphenoid wing meningiomas. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-219 Schaffer’s sign is seen in: a. Glaucoma b. Uveitisv c. Retinal detachment d. Keratitis Ans-219: (c) Retinal detachment Ref: Read the text below Sol: It is pigment dispersion from RPE in anterior vitreous due to retinal break. It is also called tobacco dust. Q-220 Treatment of mooren’s ulcer is : a. Corneal graft b. Immunosuppressives c. Topical steroids d. All of the above Ans-220: (d) All of the above Ref: Read the text below Sol: Mooren's ulcer is a rare peripheral ulcerative keratitis caused by ischemic necrosis resulting from vasculitis of limbal vessels. Apart from the above modality of treatment , we can also do conjunctival excision 3 mm from limbus parallel to the ulcer. This is affective as conjunctiva adjacent to the ulcer has been found to secrete collagenase and proteoglyconase. Q-221 Sclera is thinnest at ? a. Limbus b. Insertion of rectus muscle c. Equator d. Posterior pole Ans-221: (b) Insertion of rectus muscle Ref: Read the text below Sol: Sclera is thinnest at lamina cribosa and then posterior to the attachment of the muscles. Q-222 Uveoparotitis is seen in : a. Sarcoidosis b. SLE c. Scleroderma d. Mumps www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ans-222: (a) Sarcoidosis Ref: Read the text below Sol: Sarcoidosis causes granulomatous panuveitis with inflammation of parotid glands. A rare manifestation of sarcoidosis is Heerfordts syndrome in which there is uveitis with parotid inflammation , fever and sometimes associated with facial nerve palsy. Q-223 Multifocal ERG is useful to assess the function of a. Assessing rods b. Assessing macular cones c. Function of ganglion layer. d. RPE Ans-223: (b) Assessing macular cones Ref: Read the text below Sol: Multifocal ERG allows the local ERG responses to be recorded from many regions of the retina . An abnormal Multifocal ERG indicates that the foveal cones or bipolar cells are dysfunctional and a source of vision loss . It also indicates precise distribution of retinal dysfunction and can be correlated with field testing . It is particularly useful in Unknown visual loss with normal appearing retina Distinguishing between optic nerve and retinal disease Diagnosis of focal cone dystrophy where mf ERG is the only diagnostic test . Q-224 Antiglaucoma drug contraindicated in infants : a. Brimonidine b. Latanoprost c. Bimatoprost d. Timolol Ans-224: (a) Brimonidine Ref: Read the text below Sol: Brimonidine causes serious lethargy,hypotonia and CNS depression . Q-225 Cupulliform cataract starts from : a. Centre anteriorly b. Centre posteriorly c. Peripheral anteriorly d. Peripheral posteriorly Ans-225: (b) Centre posteriorly Ref: Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Cupulliform cataract is posterior subcapsular cataract and starts from centre posteriorly Q-226 Blood sugar estimation is relevant in all the following except: a. Rh incompatibility b. Birth asphyxia c. SFD babies d. Baby of hypothyroid mother Ans-226: (d) Baby of hypothyroid mother Ref: Read the text below Sol : High risk situations where screening for hypoglycemia is recommended: 1. Low birth weight infants (<2000 grams) 2. Preterm infants (≤35 weeks) 3. Small for gestational age infants (SGA) : birth weight <10th percentile 4. Infant of diabetic mothers (IDM) - insulin dependent and gestational diabetes 5. Large for gestational age (LGA) infants: birth weight >90th percentile* 6. Infants with Rh-hemolytic disease 7.Infants born to mothers receiving therapy with terbutaline/propranolol /labetolol/oral hypoglycemic agents 8 Infants with IUGR 9. Any sick neonate such as those with perinatal asphyxia, polycythemia, sepsis, shock etc, 10. Infants on total parenteral nutrition Q-227 The following may present as haemolytic disease of the newborn: a. Hereditary spherocytosis b. Sickle cell trait c. Thalassaemia d. None Ans 227: (a) Hereditary spherocytosis Reference: Read the text below Sol: HAEMOLYTIC DISEASE OF THE NEWBORN • Immune: (Rh, ABO, other) • Membrane defects: Spherocytosis, elliptocytosis • Enzyme defects: G6PD, PK, hexokinase • Sepsis • Polycythaemia: IDM, fetal transfusion. Sickle cell and thalassaemia do not present in the neonatal period (HbF present). Q-228 The following features are characteristic of William's Syndrome: a. Short stature b. Transient neonatal hypocalcaemia c. Normal facies www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 d. Severe learning difficulties Ans 228: (a) Short stature Reference: Read the text below Sol: Recognized clinical features of William's Syndrome include: 1. Short stature 2. Characteristic facies "elfin" (full face with high rounded cheeks, broad forehead, flattened bridge of the nose and long upper lip), 3. Idiopathic hypercalcaemia 4. Supravalvular aortic stenosis 5. Mild to moderate learning difficulties. Q-229 Concerningblood flow in the fetus: a. Blood flows fromleft to right through the foramen ovale. b. The ductus arteriosus is closed. c. Pulmonary pressure equals systemic pressure. d. The haemoglobin may be 20g/dl. Ans 229: (d) The haemoglobin may be 20g/dl. Reference: Read the text below Sol: Persistence of the fetal circulatory pattern of right-to-left shunting through the patent ductus arteriosus and foramen ovale after birth is due to an excessively highpulmonary vascular resistance. Fetal pulmonary vascular resistance is usually elevated relative to fetal systemic or postnatal pulmonary pressure. This fetal state permits shunting of oxygenated umbilical venous blood to the left atrium (and brain) through the foramen ovale and bypasses the lungs through the ductus arteriosus to the descending aorta. After birth, pulmonary vascular resistance normally declines rapidly as a consequence of vasodilatation due to gas filling the lungs, a rise in postnatal PaO2, a reduction in PCO2, increased pH, and release of vasoactive substances. Normal haemoglobin range in the first 1-3 days of life is between 14.5-22.5 g/dl. Q-230 Sodium valproate is the one of the anticonvulsant medication for a 12-yr-old boy with epilepsy.Which of the following factors markedly increases the risk of fatal liver necrosis ? a. Male gender b. Age younger than 2 yr c. Down syndrome d. Family history of epilepsy Ans 230: (b) Age younger than 2 yr Reference: Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Young age is a risk factor for hepatic and perhaps pancreatic complications of valproic acid. It is much safer in 12-yr-old children than those younger than 2 yr. Q-231 A 10-yr-old girl is being evaluated for new onset of school problems, obsessivecompulsive behavior, and occasional uncontrolled movements of the hands. She has been healthy and has not taken any medications. Further evaluation is most likely to reveal: a. Brain tumor in the posterior fossa b. Partial complex epilepsy c. Evidence of streptococcal infection d. Hydrocephalus Ans 231: (c) Evidence of streptococcal infection Reference: Read the text below Sol: Poststreptococcal obsessive-compulsive disorder is a well-recognized clinical entity. Q-232 All are causes of IUGR excepta. Anemia b. PIH c. GDM d. Maternal heart disease Ans-232: (c) GDM Ref: Read the text below Sol : Gestational DM causes MACROSOMIA; not IUGR Q-233 Placenta is not as efficient as lungs. The umbilical venous pO2 is a. 20-25 mm Hg b. 25-28 mm Hg c. 30-32 mm Hg d. 40-45 mm Hg Ans-233: (c) 30-32 mm Hg Ref: Read the text below Sol : The placenta is not as efficient an oxygen exchange organ as the lungs, so that umbilical venous Po2 (the highest level of oxygen provided to the fetus) is only about 30-35 mm Hg. Approximately 50% of the umbilical venous blood enters the hepatic circulation, whereas the rest bypasses the liver and joins the inferior vena cava via the ductus venosus, where it partially mixes with poorly oxygenated inferior vena cava blood derived from the lower part of the fetal body. This combined lower body plus umbilical venous blood flow (Po2 of ≈26-28 mm Hg) enters the right atrium and is preferentially directed by a flap of tissue at the right atrial– www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 inferior vena caval junction, the eustachian valve, across the foramen ovale to the left atrium. This is the major source of left ventricular blood flow, since pulmonary venous return is minimal. Left ventricular blood is then ejected into the ascending aorta where it supplies predominantly the fetal upper body and brain. Q-234 The newborn cardiac output is a. 200 ml/kg/min b. 250 ml/kg/min c. 300 ml/kg/min d. 350 mL/kg/min Ans-234 : (d) 350 mL/kg/min Ref: Read the text below Sol : The newborn cardiac output (about 350 mL/kg/min) falls in the 1st 2 mo of life to about 150 mL/kg/min and then more gradually to the normal adult cardiac output of about 75 mL/kg/min Q-235 New born baby are prone to hypoglycemia because ? a. Low body glycogen reserve b. Impaired glucose metabolism c. Prematurity d. All of the above Ans-235: (a) Low body glycogen reserve Ref: Read the text below Sol : New born babies are more prone to hypoglycemia because they have poor glycogen stores. The other options are causes of hypoglycemia in a new born and not why they can normally be predisposed to it. Q-236 Most common cause of neonatal meningitis is due to ? a. Streptococcus group A b. Streptococcus group B c. Streptococcus group C d. Streptococcus group D Ans-236: (b) Streptococcus group B Ref: Read the text below Sol : Group B Streptococcus is the most common cause of neonatal meningitis. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Second most common cause is E. coli. Q-237 Most common bacterial cause of diarrhoea in children is? a. E. coli b. Salmonella c. Staphylococcus d. Shigella Ans-237 : (a) E. coli Ref: Read the text below Sol : Most common bacterial cause of diarrhea is ETEC (Enterotoxic E. coli). Other causes : Salmonella is most common cause of inflammatory diarrhea in children Shigella, Cholera, Campylobacter are other common bacteria involved Q-238 Best method of diagnosis of childhood HIV ? a. CD4 cell counts b. P24 antigen c. HIV PCR d. Anti HIVA antibody Ans-238: (c) HIV PCR Ref: Read the text below Sol : HIV DNA PCR is the preferred virologic assay in developed countries. Almost 40% of infected newborns have positive test results in the 1st 2 days of life, with >90% testing positive by 2 wk of age. Plasma HIV RNA assays, which detect viral replication, may be more sensitive than DNA PCR for early diagnosis, but data are limited. The p24 antigen assay is also highly specific and essay to perform, but it is less sensitive than the other virologic tests. It is not recommended for diagnosis of infection infants <1 months of age. Q-239 Perioral rash & pigmentation of palmar area, diagnosis is? a. Zn deficiency b. Cu deficiency c. Mg deficiency d. Iron Deficiency Ans-239: (a) Zn deficiency Ref: Read the text below Sol : Perioral rash is very typical of zinc deficiency . www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Although it’s association with palmar erythema couldn’t be found, but the clinical picture given most likely indicates zinc deficiency. Q-240 Hyaline membrane is seen in all of the following conditions, except : a. Radiation pneumonitis b. Viral pneumonitis c. Uremic pneumonitis d. Staphylococcal bronchopneumonia Ans-240: (d) Staphylococcal bronchopneumonia Ref: Read the text below Sol : Hyaline membranes are seen in ARDS or ACUTE lung injury Hyaline membrane disease Cyanotic congenital heart disease (TAPVC) Early onset sepsis Pneumonia Maternal group B streptococcal infection Meconium aspiration syndrome Cystic adenomatoid malformation Uremic pneumonitis Radiation pneumonitis Viral pneumonia Q-241 Vertical transmission of Toxoplasmosis causes more severe disease in? a. During labour b. 1st trimester c. 2nd trimester d. 3rd trimester Ans-241 : (b) 1st trimester Ref: Read the text below Sol : When a mother acquires infection during gestation, organisms may disseminate hematogenously to the placenta. Infection may be transmitted to the fetus transplacentally or during vaginal delivery. Of untreated maternal infections acquired in the 1st trimester, approximately 17% of fetuses are infected, usually with severe disease. Of untreated maternal infection acquired in the 3rd trimester, approximately 65% of fetuses are infected, usually with disease that is mild or inapparent at birth These different rates of transmission and outcomes are most likely related to placental blood flow, virulence, inoculum of T. gondii, and immunologic capacity of the mother to limit parasitemia. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-242 Which should be measured in a newborn who presents with hyperbilirubinemia? a. Total and direct bilirubin b. Total bilirubin only c. Direct bilirubin only d. Conjugated bilirubin only Ans-242: (b) Total bilirubin only Ref: Read the text below Sol : A child with Neonatal jaundice is evaluated and managed on the basis of Total serum bilirubin only Q-243 A baby presents with limb hypoplasia with scarring. What is the intra uterine infection which can manifest in this way? a. Varicella b. Rubella c. CMV d. Toxoplasmosis Ans-243: (a) Varicella Ref: Read the text below Sol : Congenital Varicella classically presents with IUGR, Cicatrical(scarring) skin lesions in a characteristic dermatomal distribution & limb hypoplasia Q-244 Complete head control, without any head lag when pulled to sit, disappearance of hand regard, bidextrous grasp able to sit with support all occur at about – a. 12 weeks b. 16 weeks c. 20 weeks d. 24 weeks s Ans-244 : (c) 20 weeks Ref: Read the text below Sol : DEVELOPMENT MILESTONES (QUICK REVIEW): Gross Motor: 3 months Head holding 5 months Sitting with support 6 months Prone to supine, supine to prone 8 months Sitting without support 9 months Crawling 10 months Creeping 1 year Walking few steps independently 2 yr walk up stairs with two feet at each step www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 3 yr 4 yrs 5 yr Fine motor 12 weeks 4 months 5 months 7 months 9 months 13 months 15 months 18 months 24 months 3 yrs 4 yrs 5 yrs Social 2 months 3 months 6-7 months 9 months 15 months 18 months 2 yrs 3 yrs Language 1 month 3 months 6 months 9 months 1 yr 18 months 2 yrs 3 yrs 4 yrs 5 yrs Up stairs with one foot at each step, rides tricycle Hops on one foot Skips on two feet Grasp reflex disappears goes for object bidextrous grasp Transfer object, palmar grasp Pincer grasp Casting Self feed with a spoon Self feed with a cup tower of 4 cubes turns pages of a book one at time 6-7 cubes makes circle, tower of 10 cubes Square, + sign Triangle x sign Social smile recognizes mother smiles at mirror image waves bye-bye Stranger anxiety Peek a boo hugs parents kisses parents Dry by day dry by night Dress/undress himself head turns to sound cooing mono syllabus (ma,ba) Bisyllabus (ma-ma, baba) 2 words with meaning vocabulary of ten words simple sentences with 2 words tells age and sex, uses pronouns,handedness tells story knows colors www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-245 Which among the following is not the major criteriain jones criteria for rhematic fevera. Carditis b. Chorea c. Arthritis d. Increased E.S.R. Ans-245: (d) Increased E.S.R. Ref: Read the text below Sol : Revised Jones criteria for diagnosis of Acute Rheumatic fever Major criteria Minor criteria * Carditis * Migratory polyarthritis * Erythema marginatum * Fever * Arthralgia * Elevated acute phase reactants ( ESR, CRP ) * Prolonged PR interval * Chorea * Subcutaneous nodules Essential criteria: Evidence of a preceding group A streptococcal infection ( culture, rapid antigen, antibody rise/ elevation ) Q-246 A diabetic female on INH and rifampin for TB suffers DVT: She is started on warfarin: PT is not raised; next step should be: a. Long term heparin therapy b. Replace warfarin with acecoumarin c. Switch ethambutol for rifampin d. Use LMW heparin. Ans-246: (c) Switch ethambutol for rifampin Ref:Read the text below Sol: Rifampin is a microsomal enzyme inducer – enhances its own metabolism as well as that of many drugs including warfarin, oral contraceptives, corticosteroids sulfonylureas, digitoxin, HIV protease inhibitors, ketoconazole etc. Q-247 Secukinumab is a new drug that is used to treat Ankylosing Spondylitis.which of the following cytokines is inhibited by this drug? a. Interleukin 1 b. TNF alpha c. Interleukin 17 A d. Interleukin 6 Ans-247: (c) Interleukin 17 A Ref: Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Secukinumab is a monoclonal antibody that binds to Interleukin 17 A The drug was first approved for the treatment of chronic plaque Psoriasis. The drug is now approved for the treatment of Psoriatic arthritis and Ankylosing spondylitis also. Q-248 The Bruton Tyrosine Kinase inhibitor, Ibrutinib is used to treat which of the following hematological malignancy? a. Chronic myelogenous leukemia b. Acute myeloid leukemia c. Chronic Lymphocytic Leukemia d. Multiple Myeloma Ans-248: (c) Chronic Lymphocytic Leukemia Ref: Read the text below Sol: Ibrutininb is an orally administered covalent inhibitor of Bruton Tyrosine Kinase.It has been approved for the treatment of Chronic lymphocytic leukemia,mantle cell lymphoma and Waldenstrom’s macroglobulinemia. Newer molecules for treatment of CLL: Ibrutinib : Bruton Tyrosine Kinase inhibitor Idelalisib: Phosphoinositide 3-kinase delta inhibitor Ofatumumab,Obinutuzumab : Anti CD20 monoclonal antibodies Q-249 All of the following drugs are recommended for treatment of beta blocker induced excessive bradycardia and/or decrease in cardiac output except :a. Dopamine b. Dobutamine c. Glucagon d. Phentolamine Ans-249: (d) Phentolamine Ref:Read the text below Sol: Drugs useful in b blocker toxicity/Bradycardia: – Atropine – Isproterenol – Glucagon – Dopamine & Dobutamine – Epinephrine/norepinephrine Q-250 A patient has completed a course of cancer chemotherapy and now has severe anemia, neutropenia, and thrombocytopenia. If only one intervention is possible, which of the following is the most appropriate therapy? a. Epoetin www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 b. Filgrastim c. Growth hormone d. Sargramostim Ans-250: (d) Sargramostim Ref:Read the text below Sol: Apatient who is anemic, neutropenic, and thrombocytopenic requires stimulation of all three major cell lines in the bone marrow. The only drug currently available that accomplishes this broad-spectrum stimulant effect is sargramostim (granulocyte–macrophage colony stimulating factor [GM-CSF]). Epoetin is a more selective stimulant of erythrocyte production and is useful in simple anemia. Filgrastim is a somewhat selective stimulant of leukocyte production and has much less effect on erythrocytes and platelet production than sargramostim Growth hormone and testosterone have both been tried in the treatment of anemia with negligible success. Q-251 Which of the following is the agent of choice for chronic treatment of simple hypothyroidism (myxedema)? a. Desiccated thyroid b. Levothyroxine (T4) c. Liothyronine (T3) d. Potassium iodide Ans-251: (b) Levothyroxine (T4) Ref:Read the text below Sol: The agent of choice in treating simple hypothyroidism is levothyroxine (T4). Administered thyroxine is bound in plasma in the same way and metabolized to triiodothyronine in the same manner as native thyroxine. Although liothyronine (tri-iodothyronine [T3]) ismore active than T4 as an agonist at thyroid hormone receptors, its shorter half-life of 1 day as compared with the 6–7-day halflife of T4 means that thyroxine has a longer duration of action and provides smoother control. Q-252 Which of the following correctly describes the mechanism of action of streptokinase? a. Combines with plasminogen to form an enzymatically active complex b. Competitively Blocks Binding Of Plasminogen To Fibrin c. Converts plasmin to plasminogen d. Inhibits platelet cyclooxygenase (COX) activity Ans-252: (a) Combines with plasminogen to form an enzymatically active complex Ref:Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Streptokinase has no intrinsic enzymatic activity, but instead forms a stable complex with the patient’s plasminogen, making it enzymatically active in cleaving free plasminogen to plasmin. The streptokinase– plasminogen complex is not inhibited by antiplasmin. The other thrombolytic agents—t-PA, reteplase, tenecteplase, and urokinase— activate plasminogen directly. Q-253 A17-year-old patient suffers from tonic–clonic seizures. This condition has been well controlled with a regimen of phenytoin. Which of the following signs or symptoms indicates phenytoin toxicity? a. Diplopia and abnormal gait b. Hyperprolactinemia c. Polydipsia and polyuria d. Postural hypotension Ans-253: (a) Diplopia and abnormal gait Ref:Read the text below Sol: Diplopia, abnormal gait, and other signs of cerebellar dysfunction are important symptoms of phenytoin toxicity. Other manifestations of toxicity include gingival hyperplasia, nystagmus,and vertigo. Hyperprolactinemia is an adverse effect of antipsychotic dopamine antagonists such as the phenothiazines; dopamine inhibits prolactin secretion by the anterior pituitary. Polydipsia and polyuria are symptoms of diabetes insipidus. These symptoms may be produced by lithium toxicity during treatment of bipolar depression, and are not associated with phenytoin toxicity. Postural hypotension is not an adverse effect of phenytoin but often occurs with levodopa treatment of Parkinson’s disease. Q-254 Which of the following substances contains the highest concentration of molecules with estrogenic effects? a. Ginseng b. Grapefruit juice c. Saw palmetto d. Tomatoes Ans-254: (c) Saw palmetto Ref:Read the text below Sol: Saw palmetto is promoted by purveyors of herbs and “alternative medicines” as therapy for prostatic hyperplasia and does have weak estrogenic activity. Grapefruit juice and tomatoes are used therapeutically in a treatment regimen referred to as “raw juice therapy.” www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-255 Selective serotonin Reuptake Inhibitor (SSRI) are all except: a. Fluphenazine b. Fluoxetine c. Fluvoxamine d. Sertraline Ans-255: (a) Fluphenazine Ref: CMDT’ Pg. 1091 Sol : Selective serotonin reuptake inhibitors are : Fluoxetine Fluvoxamine Paroxetine Duloxetine Sertraline Citalopram Fluphenazine and fluphenthixol are antipsychotics. Q-256 Megaloblastic anemia is caused by all except a. Aspirin b. Primidone c. Methotrexate d. Triamterene Ans-256: (a) Aspirin Ref: Harrison’s - 433 Sol : Megaloblastic anemia is caused by certain drugs such as Co-trimoxazole - Folate antagonists (Mtx) N 2O - OCP Phenobarbital - Phenytoin Primidone - Triamterene Aspirin causes hemolytic anemia in G6PD deficiency. Chloramphenicol causes aplastic anemia by causing BM suppression. Q-257 Thromboprophylactic agent is a. Dextran b. Gelatin c. Haemacil d. Diethyl starch Ans-257: (a) Dextran Ref: KDT - 584 Sol : Dextran 40 has been tried in stroke and for prophylaxis of deep vein thrombosis (i.e. thromboprophylactic) and pulmonary infarction. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-258 Exenatide is a newer drug proposed to be used in the treatment of a. Osteoporosis b. Diabetes mellitus c. Hyperparathyroidism d. Anovulatory infertility Ans-258: (b) Diabetes mellitus Ref: Read the text below Sol : Exenatide is a glucagon like peptide analogue which is proposed to be used in the treatment of post prandial hyperglycemia. Exenatide is believed to facilitate glucose control in at least five ways: 1. Exenatide augments pancreas response (i.e. increases insulin secretion) in response to eating meals; the result is the release of a higher, more appropriate amount of insulin that helps lower the rise in blood sugar from eating. Once blood sugar levels decrease closer to normal values, the pancreas response to produce insulin is reduced; however, other drugs (like injectable insulin) are effective at lowering blood sugar, but can "overshoot" their target and cause blood sugar to become too low, resulting in the dangerous condition of hypoglycemia. 2. Exenatide also suppresses pancreatic release of glucagon in response to eating, which helps stop the liver from overproducing sugar when it is unneeded, which prevents hyperglycemia (high blood sugar levels). 3. Exenatide helps slow down gastric emptying and thus decreases the rate at which meal-derived glucose appears in the bloodstream. 4. Exenatide has a subtle yet prolonged effect to reduce appetite, promote satiety via hypothalamic receptors (different receptors than for amylin). Most people using exenatide slowly lose weight, and generally the greatest weight loss is achieved by people who are the most overweight at the beginning of exenatide therapy. Clinical trials have demonstrated the weight reducing effect continues at the same rate through 2.25 years of continued use. When separated into weight loss quartiles, the highest 25% experience substantial weight loss, and the lowest 25% experience no loss or small weight gain. 5. Exenatide reduces liver fat content. Fat accumulation in the liver or nonalcoholic fatty liver disease (NAFLD) is strongly related with several metabolic disorders, in particular low HDL cholesterol and high triglycerides, present in patients with type 2 diabetes. It became apparent that exenatide reduced liver fat in miceand more recently in man. Q-259 A drug ‘X’ belongs to the anticholinergic drug group. It is primarily used in pre anesthetic medication and also during surgery. Which of the following can be ‘X’ ? a. Glycopyrrolate b. Pipenzolate methyl bromide c. Isopropamide d. Dicyclomine Ans-259: (a) Glycopyrrolate Ref: Read the text below Sol : www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Glycopyrrolate is used to reduce the secretions (to prevent reflex bronchospasm) during anaesthesia. In anesthesia, glycopyrrolate injection can be used as a preoperative medication in order to reduce salivary, tracheobronchial, and pharyngeal secretions, as well as decreasing the acidity of gastric secretion. It is also used in conjunction with neostigmine, a neuromuscular blocking reversal agent, to prevent neostigmine's muscarinic effects such as bradycardia. Q-260 All of the following mydriatics produce cycloplegia except a. Phenylephrine b. Tropicamide c. Cyclopentolate d. Homatropine Ans-260: (a) Phenylephrine Ref: KDT’s - 113, 114 Sol : Anticholinergic agents produce both cycloplegia as well as mydriasis whereas sympathomimetics cause mydriasis without inducing cycloplegia. Q-261 Which of the following drugs shows the phenomenon of vasomotor reversal of Dale after administration of an α adrenergic blocker ? a. Adrenaline b. Noradrenaline c. Isoprenaline d. All of the above Ans-261: (a) Adrenaline Ref: KDT’s - 123 Sol : Vasomotor reversal of dale is seen with adrenaline. When this drug is infused quickly, initially there is rise in blood pressure (due to sitmulation of α α receptors) followed by prolonged fall (β2 action). α–blocking drugs inhibit the initial rise and only fall in blood pressure is recorded. This is known as vasomotor reversal. Nor adrenaline has no β2 activity and isoprenaline lacks α activity, therefore cannot demonstrate this phenomenon. Q-262 A female patient suffering from psychosis is taking phenothiazines. She now complains of sudden onset of high-grade fever, muscle rigidity and altered sensorium. The most likely diagnosis is a. Malignant hyperthermia b. Neuroleptic malignant syndrome c. Tardive dyskinesia d. Akathesia Ans-262: (b) Neuroleptic malignant syndrome Ref: Read the text below www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Sol : Neuroleptic malignant syndrome has developed in this patient. It may occur with high doses of phenothiazines. It lasts 5 – 10 days after drug withdrawal and may be fatal. The neuroleptic must be stopped promptly and symptomatic treatment should be given. Dantrolene and bromocriptine in large doses have been found to be useful. Antiparkinsonian anticholinergics are of no help in this situation. Q-263 The major difference between typical and atypical antipsychotics is that : a. The latter cause minimal or no increase in prolactin b. The former cause tardive dyskinesia c. The former are available as parenteral preparations d. The latter cause substantial sedation Ans-263: (b) The former cause tardive dyskinesia Ref: Read the text below Sol : The most important reason to classify the antipsychotics in typical and atypical agents is the occurrence of extrapyramidal symptoms. Typical antipsychotics have significant extrapyramidal symptoms such as parkinsonism, acute muscle dystonia and tardive dyskinesia. These side-effects are negligible or minimal with atypical agents like clozapine, olanzapine and risperidone. Q-264 Antipyschotic drug-induced Parkinsonism is treated by : a. Anticholinergics b. Levodopa c. Selegiline d. Amantadine Ans-264: (a) Anticholinergics Ref: Read the text below Sol : For antipsychotic drug induced parkinsonism, anticholinergics are the drug of choice e.g. Trihexphenidyl. Drugs facilitating dopaminergic system (e.g. Levodopa, selegiline and Amantadine) are not much effective as the dopamine receptors are already blocked by antipsychotics (antidopaminergic) in the drug induced vomiting. Q-265 In a log dose response curve, which of the following is a false statement about drug efficacy and potency a. Efficacy of drug is more important than potency b. ED50 denotes efficacy c. Higher peak mean higher efficacy d. Two drugs having same efficacy can have different pharmacological profile Ans-265: (b) ED50 denotes efficacy www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Ref: Read the text below Sol : ED50 is the dose of a drug producing 50% of the maximal effect. So, it indicates potency of the drug. Higher upper limit of log dose response curve (log DRC) means higher efficacy. Efficacy of a drug is more important factor than potency in making choice of the drug. Two drugs can have same efficacy e.g. analgesic efficacy but may have different pharmacological effects and side effects. Q-266 Which among the following agents is the most common cause of Prosthetic valve endocarditis arising within one year of surgery? a. Staphylococcus aureus b. Streptococcus viridans c. Coagulase negative staphylococcus d. Streptococcus bovis Ans-266: (c) Coagulase negative staphylococcus Ref: Read the text below Sol: In the first one year the most common cause of Prosthetic valve endocarditis is Coagulase negative staphylococcus. After one year the most common organism causing prosthetic valve infection is Streptococcus viridans Most common cause of community acquired native valve endocarditis : Streptococcus viridians Most common cause of health care–associated Native valve endocarditis :Staphylococcus aureus Most common cause Injection drug use–associated endocarditis : Staphylococcus aureus Etiology of endocarditis that occurs in association with colonic polyps and tumors : Streptococcus gallolyticus (previously called S.bovis) Q-267 A 35-year-old dialysis patient presents to the emergency department complaining of being unable to move.He had missed his dialysis treatment the previous day because of weakness. An electrocardiogram shows peaked T waves,Next Step a. Schedule emergent dialysis b. Give a sodium polystyrene sulfonate retention enema c. Administer insulin and glucose d. Administer calcium gluconate Ans-267: (d) Administer calcium gluconate Ref: Read the text below Sol : www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Peaked T waves are a sign of hyperkalemia, and the patient’s history of missed dialysis treatment and profound weakness is consistent with the diagnosis. Given the changes in the ECG, immediate therapy is needed. The aim of therapy is to antagonize the membrane effects of the hyperkalemia and effect potassium removal from the body. The physician should not wait for confirmatory laboratory work in this setting. Calcium gluconate has its onset of action within minutes and would be the first line of therapy in this patient. Insulin and glucose are effective at causing a shift of potassium into the intracellular space, but onset of action is 20 to 30 minutes. Sodium polystyrene sulfonate is effective at removing potassium, but it takes 30 to 60 minutes to be effective, and there may be a similar delay in getting dialysis started. An inhaled B- against and NaHCO3, are also effective , but they take effect more slowly than calcium. Q-268 All of the following conditions may be seen as an expression of myelomaassociated renal disease except a. Chronic tubulointerstitial nephropathy b. Acute renal failure (ARF) c. Isolated functional tubular defects d. Membranoproliferative glomerulonephritis Ans-268: (d) Membranoproliferative glomerulonephritis Ref: Read the text below Sol : Renal insuffiency or renal failure can occur in 35% to 50% of patients with multiple myeloma (MM) and can have variable expressions. Renal failure can be classified in one of four general categories, including chronic tubulointerstitial nephropathy, acute renal failure, chronic glomerulopathy and isolated functional tubular defects. It is believed that Bence Jones proteinuria plays an important role in each of these syndromes. Q-269 A 29-year-old woman is in the intensive care unit with rhabdomyolysis due to compartment syndrome of the lower extremities after a car accident. Her clinical course has been complicated by acute renal failure and severe pain. She has undergone fasciotomies and is admitted to the intensive care unit. An electrocardiogram (ECG) is obtained (shown below). What is the most appropriate course of action at this point? www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 a. 18-lead ECG b. Coronary catheterization c. Hemodialysis d. Intravenous fluids and a loop diuretic Ans-269: (d) Intravenous fluids and a loop diuretic Ref: Read the text below Sol: This ECG shows a short ST segment that is most prominent in V2, V3, V4, and V5. Hypercalcemia, by shortening the duration of repolarization, abbreviates the total time from depolarization through repolarization. This is manifested on the surface ECG by a short QT interval. In this scenario, the hypercalcemia is due to the rhabdomyolysis and renal failure. Fluids and a loop diuretic are an appropriate therapy for hypercalcemia. Hemodialysis is seldom indicated. Hemodialysis is indicated for significant hyperkalemia, which may also develop after rhabdomyolysis, manifest by “tenting” of the T waves or widening of the QRS. Classic ECG manifestations of a pulmonary embolus (S1, Q3, T3 pattern) are infrequent in patients with pulmonary embolism (PE), though the changes may be seen with massive PE. There are no signs of myocardial ischemia on this ECG, which would make coronary catheterization and 18- lead ECG interpretation of low yield. Q-270 Which of the following is the most appropriate therapy for a 60-year-old male with 2 weeks of productive cough, fever, shortness of breath, and the chest radiogram as shown in the following figure? www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 a. Cephalexin b. Ciprofloxacin c. Clindamycin d. Penicillin Ans-270: (c) Clindamycin Ref: Read the text below Sol: The radiograph describes a lung abscess that most likely is due to anaerobic infection. The anaerobes involved are most likely oral, but Bacteroides fragilis is isolated in up to 10% of cases. Vancomycin, ciprofloxacin, and cephalexin have no significant activity against anaerobes. -lactamase. For many years penicillin was considered the standard treatment for anaerobic lung infections. However, clinical studies have demonstrated the superiority of clindamycin over penicillin in the treatment of lung abscess. When there are contraindications to clindamycin, penicillin plus metronidazole is likely to be as effective as clindamycin. Q-271 In erectile dysfunction, which of the following drug is not used? a. Apomorphine b. Phenylephrine c. Sildenafil d. Papaverine Ans-271: (b) Phenylephrine Ref:Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 List of drugs causing erectile dysfunction Classification Drugs Diuretics Thiazides Spironolactone Antihypertensives Calcium channel blockers Methyldopa Clonidine Reserpine -Blockers Guanethidine Cardiac/anti-hyperlipidemics Digoxin Gemfibrozil Clofibrate Antidepressants Selective serotonin reuptake inhibitors Tricyclic antidepressants Lithium Monoamine oxidase inhibitors Tranquilizers Butyrophenones Phenothiazines H2 antagonists Ranitidine Cimetidine Hormones Progesterone Estrogens Corticosteroids GnRH agonists 5 -Reductase inhibitors Cyproterone acetate Cytotoxic agents Cyclophosphamide Methotrexate Roferon-A Anticholinergics Disopyramide Anticonvulsants Recreational Ethanol Cocaine Marijuana Q-272 A73-year-old patient has heart failure that has worsened over the past 12 months. Which of the following drugs is likely to slow progression even though it has no direct positive or negative effects on cardiac contractility? a. Digoxin www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 b. Dobutamine c. Losartan d. Nesiritide Ans-272: (c) Losartan Ref:Read the text below Sol: Losartan, an AT1 angiotensin receptor antagonist, has been shown to slow the progression of heart failure, in common with the ACE inhibitors, beta blockers, and spironolactone, which also slow progression of this disease. Positive inotropic agents such as digoxin and dobutamine do not slow progression although they may be useful for reducing symptoms. Nesiritide is a peptide that causes vasodilation and sodium diuresis and may have value in acute but not chronic failure. Q-273 Measurement of which urinary electrolyte is particularly useful in the diagnosis of a patient with metabolic alkalosis? a. Urine urea b. Urine Na c. Urine Cl d. Urine volume Ans-273: (c) Urine Cl Ref: Read the text below Sol : Measurement of the urinary chloride (UCL) is a particularly useful parameter in gauging the volume status of patients with metabolic alkalosis, and is used to classify patients with metabolic alkalosis as either volume repleted (UCL >30 m Eq/L) or volume depleted (UCL < 30 m Eq/L). This allows determination of a differential diagnosis and guides the course of treatment. In cases of metabolic alkalosis,theurine sodium is not a good indicator of volume status, because the HCO3 lost in the urine forces with it a certain amount of Na. Q-274 A 47 year old HIV patient presents with a white,frond like lesions on the lateral border of the tongue as shown.Which of the following statements regarding the lesion is not true ? www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 a. The etiological agent is Epstein-Barr Virus b. The lesion is premalignant c. Lesions may respond to Acyclovir d. It is a WHO stage III disease in HIV infection Ans-274: (b) The lesion is premalignant Ref: Read the text below Sol: The image shows the classical appearance of Oral Hairy Leucoplakia. Oral hairy Leucoplakia The etiological agent of OHL is considered to be Epstein-Barr virus OHL lesions appear to be relatively specific for HIV infection, since they are only rarely observed in patients with other immunodeficiencies OHL is not considered a premalignant lesion, being unlikely to progress to squamous cell carcinoma Severe cases have been reported to respond to topical podophyllin or systemic therapy with anti-herpesvirus agents. Q-275 All the following statements regarding Daptomycin are true except: a. It is active against VRSA b. It acts by depolarization of the cell membrane and Potassium efflux c. Can be used in pneumonia caused by MRSA d. Dose reduction is needed in patients with renal failure Ans-275: (c) Can be used in pneumonia caused by MRSA Ref: Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Pulmonary surfactant antagonizes the action of Daptomycin, and therefore it should not be used to treat pneumonia Daptomycin : Daptomycin is a novel cyclic lipopeptide antibiotic This drug is active against staphylococci (including MRSA and coagulase-negative staphylococci), streptococci, and enterococci. Daptomycin remains active against Staphylococcus aureus and enterococci that are resistant to vancomycin. Mechanism of action : It bind to the cell membrane via calcium-dependent insertion of its lipid tail. This results in depolarization of the cell membrane with potassium efflux and rapid cell death. Daptomycin is cleared renally. Dose modification is required if creatinine clearance of less than 30 mL/min. Side effects : Myopathy,Allergic pneumonitis Q-276 Which of the following agents causes non inflammatory diarrhea? a. Salmonella enteritidis b. Clostridum perfringens c. Yersinia enterocolitica d. Shigella flexneri Ans-276: (b) Clostridum perfringens Ref: Read the text below Sol: Clostridium perfringens causes a toxin mediated non inflammatory diarrhea , while all the other three organisms causes invasive inflammatory diarrhea Inflammatory Diarrhea Non inflammatory diarrhea Mechanism Invasion or cytotoxin mediated Enterotoxin mediated Site of intestine Distal small bowel and colon Proximal small bowel affected Clinical presentation Dysentery or inflammatory diarrhea Watery diarrhea Stool finding Fecal polymorphonuclear leukocytes; No fecal leukocytes; mild substantial increase in fecal lactoferrin or no increase in fecal lactoferrin Examples Shigella spp., Salmonella spp., Vibrio Campylobacterjejuni,EHEC,EIEC,Yersinia cholerae,ETEC,EAEC, enterocolitica, Listeria monocytogenes, Clostridium perfringens, Vibrio parahaemolyticus, Clostridium Bacillus cereus, difficile,Entamoeba histolytica, Staphylococcusaureus, Klebsiella oxytoca rotavirus, norovirus, enteric adenoviruses, Giardia lamblia, Cryptosporidium spp., Cyclospora spp., www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 microsporidia Q-277 The most common valvular lesion seen in carcinoid is a. Mitral regurgitation (MR) and aortic stenosis (AS) b. Pulmonary stenosis (PS) and tricuspid regurgitation (TR) c. Pulmonary stenosis and aortic stenosis d. Mitral stenosis (MS) and aortic stenosis Ans-277: (b) Pulmonary stenosis (PS) and tricuspid regurgitation (TR) Ref: Read the text below Sol : The cardiac lesion seen in carcinoid heart disease may be related to large quantities of circulating serotonin,bradykinin or other substances that are inactivated by the lung. This deactivation spares the aortic and mitral valves from the downstream fibrous plaques that form. The most common hemodynamic lesion seen with carcinoid is tricuspid regurgitation and occasional pulmonary stenosis. Sixty to ninety percent of tumors arise from the appendix, and the bronchus. It is rare for carcinoid heat disease to resultfrom lesions that have not invaded the liver. Q-278 The presence of which of the following conditions portends the poorest longterm prognosis in patients with aortic stenosis? a. Angina b. Syncope c. Valve area of less than 0.5cm2 d. CHF Ans-278: (d) CHF Ref: Read the text below Sol : CHF has the poorest long-term prognosis at 2 years,while syncope and angina have a prognosis of 3 and 5 years,respectively. The valve area or calcification offer no information concerning prognosis. Q-279 All the following are considered as Complicated UTI except: a. Pyelonephritis in a nonpregnant woman b. Cystitis in males c. Catheter associated UTI d. Cystitis in pregnant females Ans-279: (a) Pyelonephritis in a nonpregnant women Ref: Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Uncomplicated UTIrefers to acute cystitis or pyelonephritis in nonpregnant outpatient women without anatomic abnormalities or instrumentation of the urinary tract; the term complicated UTI encompasses all other types of UTI Q-280 Which of the following organisms causes chronic recurrent meningitis? a. HSV 2 b. Mycobacterium tuberculosis c. Treponema pallidum d. Cryptococcus neoformans Ans-280: (a) HSV 2 Ref: Read the text below Sol: Chronic meningitis is diagnosed when features of meningitis exists for >4 weeks and is associated with a persistent inflammatory response in the cerebrospinal fluid (CSF) (white blood cell count >5/μL). There are two clinical forms of chronic meningitis : Chronic persistent meningitis Chronic recurrent meningitis In chronic recurrent meningitis there is recurrent, discrete episodes of illness.All the symptoms, signs, and CSF parameters of meningeal inflammation resolve completely between episodes without specific therapy. Causes of chronic recurrent meningitis : Herpes simplex virus (HSV) type 2 Chemical meningitis due to episodic leakage from an epidermoid tumor, craniopharyngioma, or cholesteatoma into CSF Primary autoimmune inflammatory conditions, including Vogt- Koyanagi-Harada syndrome, Behcet’s syndrome, systemic lupus erythematosus (SLE), and Mollaret’s meningitis; and drug hypersensitivity with repeated administration of the offending agent. Q-281 The condition least likely to be associated with prolonged hyperamylasemia is a. Pseudocyst b. Macroamylasemia c. Passage of a common duct stone d. Pancreatic ascities Ans-281: (c) Passage of a common duct stone Ref: Read the text below Sol : Prolonged hyperamylasemia after a bout of acute pancreatitis usually signifies continuing pancreatitis or pseudocyst or abscess,and may present with pancreatic ascites. If a patients has macroamylasemia,the amylase is attached to a protein,usually a globulin, and is renal clearance is diminished and circulating values may be high and continue to be elevated after a course of acute pancreatitis. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Passage of a common duct stone is associated with pancreatitis, which generally rapidly resolves after passage of stone. Q-282 DMARDs that may cause hematologic toxicity include all of the following except a. Aurothioglucose b. Aurothiomalate c. Azathioprine d. Hydroxycholoroquine Ans-282: (d) Hydroxycholoroquine Ref: Read the text below Sol : The parenterally administered gold compound aurothioglucose and aurothiomalate may cause blood dyscrasias, including panytopenia. Azathioprine, a purine analogue that interfers with DNA synthesis, may cause bone narrow suppression and carries a longterm risk of lymphoproliferative malignancy. D-penicillamine, a metal chelate, causes neutropenia and thrombocytopenia. Hydroxychloroquine is not known to be a hematologic toxin. Q-283 The most common ophthalmologic manifestation of Reiter’s syndrome isa. Conjuctivitis b. Episcleritis c. Keratitis d. Posterior uveitis Ans-283: (a) Conjuctivitis Ref: Read the text below Sol : Reiter’s syndrome is defined as the triad of arthritis, urethritis,and conjunctivitis. Conjunctivitis is unilateral or bilateral , and it occurs in 40% of patients with Reiter’s syndrome. Anterior uveitis occurs less often but is more severe. Posterior uveitisoccurs rarely , as do keratitis, corneal ulceration, and optic neuritis. Scleritis and episcleritis occur in RA. Q-284 Uniform swelling of the finger or toe(“sausage digit”) is characteristic of all of the following except a. Reiter’s syndrome b. Ankylosing spondylitis c. Psoriatic arthritis d. Sarcoid arthropathy Ans-284: (b) Ankylosing spondylitis Ref: Read the text below Sol : www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 The sausage digit results from inflammation at the sites of attachment of the tendons of the intrinsic muscles onto the phalanges,rather than the inflammation of the synovial joint ,which is characteristic of RA. The sausage digit resulting from dactylitis is seen in Reiter’s syndrome, psoriatic arthritis, and chronic sarcoid arthropathy. Sausage digits are not a manifestation of ankylosing spondylitis. Q-285 A 30- year old man is noted to be hypertensive. A complete blood count reveals mild leukocytosis,hematocrit of 55% ,and thrombocytosis.Uric acid is elevated and ultrasound confirms splenomegaly.Comment on the diagnosis: a. Polycythemia vera b. Spurious polycythemia c. Second polycythemia d. Essential thrombocytosis Ans-285: (a) Polycythemia vera Ref: Read the text below Sol : Patients with spurious polycythemia frequently are dehydrated and volume contracted; with future –hyderation, their hematocrit may indeed normalize. There is usually no evidence of a true myeloproliferative disorder ,including splenomegaly or extensive thrombocytosis. Patients with secondary polycythemia frequently have underlining chronic obstructive pulmonary disease and an elevation in red blood cell mass as a compensatory mechanism. Patients with true polycythemia vera usually have significant splenomegaly, elevated leukocyte alkaline phosphatase, and frequently also exhibit leukocytosis and thrombocytosis. Q-286 In a patient with catheter related blood stream infection all the following are indication for removal of the catheter, except: a. Hemodynamic instability b. Persistent bacteremia after 72 hours of antimicrobial therapy c. Isolation of Coagulase negative staphylococcus from the blood d. Endocarditis Ans-286: (c) Isolation of Coagulase negative staphylococcus from the blood Ref: Read the text below Sol: In patients with catheter related blood stream infection the following are indication for removal of the catheter : Severe sepsis, Hemodynamic instability, Suppurative thrombophlebitis, Endocarditis, www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Persistent bacteremia after 72 hours of antimicrobial therapy to which the organism is susceptible Infection due to S. aureus, P. aeruginosa, fungi or mycobacteria. Q-287 An 80 year old man presents to the emergency department with complaints of fever and headache for 5 days duration. On examination the patient is drowsy and has neck stiffness. Which of the following is the preferred empirical therapy for suspected meningitis in this patient? a. Vancomycin and ceftriaxone b. Gentamicin and Ceftriaxone c. Vancomycin,Ampicillin and Ceftriaxone d. Cefepime and Vancomycin Ans-287: (c) Vancomycin,Ampicillin and Ceftriaxone Ref: Read the text below Sol: Ampicillin should be added to the empirical regimen for coverage of Listeria monocytogenes in individuals <3 months of age, those >55, or those with suspected impaired cell-mediated immunity because of chronic illness, organ transplantation, pregnancy, malignancy, or immunosuppressive therapy. Peculiarities of Listeria meningitis: 1)A sub acute presentation when compared to acute meningitis due to other bacterial agents 2)Nuchal rigidity and meningeal signs are less common. 3)Focal findings and seizures are common 4)CSF neutrophil predominance is modest when compared to other bacterial meningitis 5)Direct invasion of parenchyma can lead to cerebritis and focal abscess 6)Invasion of brain stem can cause rhombencephalitis Q-288 All the following statements regarding the nontypable strains of Haemophilus influenzae is correct, except: a. It is encapsulated b. It is the most common bacterial cause of infective exacerbation of COPD c. There is no vaccines available currently d. Causes mucosal infections like otitis media by contiguous spread Ans-288: (a) It is encapsulated Ref: Read the text below Sol: Differences between haemophilus influenzae b and non-typable strains of haemophilus influenzae is summarized as : Feature Type b Strains Nontypable strains Capsule Made of Ribosyl-ribitol Non capsulated phosphate Pathogenesis Invasive infections due to Mucosal infections due to www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Clinical manifestations Vaccine hematogenous spread Meningitis and invasive infections in incompletely immunized infants and children Highly effective conjugate vaccines contiguous spread Otitis media in infants and children; lower respiratory tract infections in adults with chronic bronchitis Not available Nontypable H. influenzae is the most commonbacterial cause of exacerbations of COPD Q-289 All the following features in a patient with pneumonia may suggest Legionella pneumophila as the possible etiological agent, except: a. Diarrhea b. Hyponatremia c. Good response to beta-lactam agents d. Numerous neutrophils but no organisms revealed by Gram’s staining of respiratory secretions Ans-289: (c) Good response to beta-lactam agents Ref: Read the text below Sol: The following features in a patient with pneumonia may be suggestive of Legionella as the possible etiological agent Diarrhea High fever (>40°C; >104°F) Numerous neutrophils but no organisms revealed by Gram’s staining of respiratory secretions Hyponatremia (serum sodium level <131 mg/dL) Failure to respond to β-lactam drugs (penicillins or cephalosporins) and aminoglycoside antibiotics Occurrence of illness in an environment in which the potable water supply is known to be contaminated with Legionella Onset of symptoms within 10 days after discharge from the hospital (hospital-acquired legionellosis manifesting after discharge or transfer) Q-290 Which of the following antibiotics has the weakest association with the development of Clostridium difficile associated disease? a. Ceftriaxone b. Ciprofloxacin c. Moxifloxacin d. Piperacillin/Tazobactum Ans-290: (d) Piperacillin/Tazobactum Ref: Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Clindamycin was the first antibiotics associated with CDI. The second- and third-generation cephalosporins, particularly cefotaxime, ceftriaxone, cefuroxime, and ceftazidime, are frequently responsible for this condition, and the fluoroquinolones (ciprofloxacin, levofloxacin, and moxifloxacin) are the most recent drug class to be implicated in hospital outbreaks. Penicillin/ β-lactamase-inhibitor combinations such as ticarcillin/clavulanate and piperacillin/tazobactam pose significantly less risk. However, all antibiotics, including vancomycin and metronidazole (the agents most commonly used to treat CDI), carry a risk of subsequent CDI. Rare cases are reported in patients without prior antibiotic exposure. Q-291 Inprosapagnosia, lesion is in a. Temporo-occipital junction b. Temporo-parietal junction c. Parieto-occipital junction2 d. None of the above Ans 291: (a) Temporo-occipital junction Ref: Read the text below Sol: Kaplan synopsis textbook of psychiatry quotes “In humans, the clinical syndrome of prosopagnosia describes the inability to recognize faces, in the presence of preserved recognition of other environmental objects. On the basis of pathological and radiological examination of individual patients, prosopagnosia is thought to result from disconnection of the left ITC from the visual association area in the left parietal lobe.” Q-292 Mechanism of action of atypical antipsychotics? a. 5HT2C agonism b. 5HT2C antagonism c. 5HT2B antagonism d. 5HT2A antagonism Ans 292: (d) 5HT2A antagonism Ref: Read the text below Sol: 5 HT2A : (agonism) Target of hallucinogens, (antagonism) atypical antipsychotics 5HT2B: Regulation of stomach contraction, 2B agonism : cardiac valvulopathy 5HT2C : Regulation of appetite,anxiety,seizures Metabolic side effects Q-293 All are included under “Date Rape Drugs” except? a. GHB b. Ketamine www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 c. Flunitrazepam d. Ecstasy Ans 293: (d) Ecstasy Ref: Read the text below Sol: The use of a certain group of substances popularly called club drugs is often associated with dance clubs, bars, and all-night dance parties (raves). The group includes LSD, γ-hydroxybutyrate (GHB), ketamine, methamphetamine, MDMA (ecstasy), and Rohypnol or roofies (flunitrazepam). These substances are not all in the same drug class, nor do they produce the same physical or subjective effects. GHB, ketamine, and Rohypnol have been called date rape drugs because they produce disorienting and sedating effects, and often users cannot recall what occurred during all or part of an episode under the influence of the drug. Hence, it is alleged that these drugs might be surreptitiously placed in a beverage, or a person might be convinced to take the drug and then not recall clearly what occurred after ingestion. Q-294 The patient shown in the image presented with chief complaints of itching over left foot. This is an example of: a. Organic hallucination b. Functional hallucination c. Illusion d. Pseudo hallucination Ans 294: (a) Organic hallucination Ref: Read the text below Sol: www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 The phantom limb is the most common organic somatic hallucination of psychiatric origin. In this case the patient feels that they have a limb from which in fact they are not receiving any sensations either because it has been amputated or because the sensory pathways from it have been destroyed. In rare cases with thalamo−parietal lesions the patient describes a third limb. In most phantom limbs the phenomenon is produced by peripheral and central disorders. Phantom limb occurs in about 95% of all amputations after the age of 6 years. Occasionally a phantom limb develops after a lesion of the peripheral nerve or the medulla or spinal cord. The phantom limb does not necessarily correspond to the previous image of the limb in that it may be shorter or consist only of the distal portion so that the phantom hand arises from the shoulder. If there is clouding of consciousness, the patient may be deluded that the limb is real. Equivalent perceptions of phantom organs may also occur after other surgical procedures such as mastectomy, enuleation of the eye, removal of the larynx or the construction of a colostomy. The person is aware of the existence of the organ or limb and describes pain or paraesthesia in the space occupied by the phantom organ and this persists in a minority of patients. When the experience is related to a limb the perception shrinks over time, with distal parts disappearing more quickly than those that are proximal. Lesions of the parietal lobe can also produce somatic hallucinations with distortion or splitting-off of body parts. Q-295 6 yr old boy presented with bed wetting at night but dryness by day. Urine microscopy normal. No developmental delay.Next step? a. Refer to child psychiatrist b. Reassurance and follow up after 6 months c. Complete blood count d. USG Kidney and Bladder Ans 295: (d) USG Kidney and Bladder Ref: Read the text below Sol: "To make the diagnosis of enuresis, organic causes of bladder dysfunction must be investigated and ruled out. Organic syndromes, such as urinary tract infections, obstructions, or anatomical conditions, are found most often in children who experience both nocturnal and diurnal enuresis combined with urinary frequency and urgency" Q-296 A patient presented with low mood, lethargy, easy fatigue ability, lack of enjoyment in life for 2 months, with no past history of similar symptoms, no past history of medical or surgical illness. He was started on escitalopram 10 mg, 1 tablet in morning after breakfast by the psychiatrist. On 4th day of treatment, patient returns with complaints of worsening www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 of mood symptoms, some anxiety symptoms, and saying that no relief from medication, what should be the next step? a. Increase the dose of escitalopram b. Substitute escitalopram with another antidepressant belonging to different mechanism of action c. Augment escitalopram with another antidepressant d. Reassure the patient that the drug will show the effect, and no change needed at present Ans 296: (d) Reassure the patient that the drug will show the effect, and no change needed at present Ref: Read the text below Sol: SSRI are the drugs of first line in treatment of depression, and they usually take upto 2-3 weeks to show the therapeutic response (at least 1 week). Patient sometimes may have episodic exacerbations or worsening of symptoms, where he is reassured that the drug will show action within 2-3 weeks time. Q-297 Which metabolite of nicotine is observed in urine of passive smokers? a. Cotinine b. Anabasine c. Nornicotine d. Polycyclic aromatic hydrocarbons Ans 297: (a) Cotinine Ref: Read the text below Sol: Urine cotinine has been observed to accumulate up to 20 ng/mL from passive exposure. Neither anabasine nor nornicotine accumulates from passive exposure. Q-298 Which of the following best differentiates delirium from dementia? a. Impairment of memory b. Global cognitive impairment c. Fluctuating in nature d. Psychomotor hyperactivity Ans 298: (c) Fluctuating in nature Ref: Read the text below Sol: Although the best to differentiate is “altered sensorium” but thats not in options here. “The hallmark symptom of delirium is an impairment of consciousness, usually occurring in association with global impairments of cognitive functions.” Frequency of Clinical Features of Delirium Contrasted with Dementia Feature Dementia Delirium Onset Slow Rapid Duration Months to years Hours to weeks Attention Preserved Fluctuates www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Memory Impaired remote memoryImpaired recent and immediate memory Speech Word-finding difficulty Incoherent (slow or rapid) Sleep wake cycleFragmented sleep Frequent disruption (e.g., day night reversal) Thoughts Impoverished Disorganized Awareness Unchanged Reduced Alertness Usually normal Hypervigilant or reduced vigilance Q-299 Rett's syndrome is characterized by all except: a. Regression of acquired skills b. Breath holding spells c. Autistic behavior d. Macrocephaly Ans 299: (d) Macrocephaly Ref: Read the text below Sol: In Rett’s syndrome, during the first 5 months after birth, infants have age-appropriate motor skills, normal head circumference, and normal growth. Social interactions show the expected reciprocal quality. At 6 months to 2 years of age, however, these children develop progressive encephalopathy with a number of characteristic features. The signs often include the loss of purposeful hand movements, which are replaced by stereotypic motions, such as hand-wringing; the loss of previously acquired speech; psychomotor retardation; and ataxia. Other stereotypical hand movements may occur, such as licking or biting the fingers and tapping or slapping. The head circumference growth decelerates and produces microcephaly. All language skills are lost, and both receptive and expressive communicative and social skills seem to plateau at developmental levels between 6 months and 1 year. Poor muscle coordination and an apraxic gait with an unsteady and stiff quality develop. All of these clinical features are diagnostic criteria for the disorder. Associated features include seizures in up to 75 percent of affected children and disorganized EEGs with some epileptiform discharges in almost all young children with Rett's disorder, even in the absence of clinical seizures. An additional associated feature is irregular respiration, with episodes of hyperventilation, apnea, and breath holding. The disorganized breathing occurs in most patients while they are awake; during sleep, the breathing usually normalizes. Many patients with Rett's disorder also have scoliosis. As the disorder progresses, muscle tone seems to change from an initial hypotonic condition to spasticity to rigidity. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Q-300 Following brain regions involved, as shown in image is related to pathophysiology of which psychiatric disorder? a. b. c. d. OCD Depression Dementia Schizophrenia Ans 300: (a) OCD Ref: Read the text below Sol: Neuroimaging in patients with OCD has produced converging data implicating altered function in the neurocircuitry between orbitofrontal cortex, caudate, and thalamus. Various functional brain-imaging studies for example, positron emission tomography (PET) have shown increased activity (e.g., metabolism and blood flow) in the frontal lobes, the basal ganglia (especially the caudate), and the cingulum of patients with OCD. The involvement of these areas in the pathology of OCD appears more associated with corticostriatal pathways than with the amygdala pathways that are the current focus of much anxiety disorder research. Pharmacological and behavioral treatments reportedly reverse these abnormalities. Data from functional brain-imaging studies are consistent with data from structural brain-imaging studies. Both computed tomographic (CT) and magnetic resonance imaging (MRI) studies have found bilaterally smaller caudates in patients with OCD. www.damsdelhi.com Email: [email protected] DAMS CBT 2016 SET - 1 Both functional and structural brain-imaging study results are also compatible with the observation that neurological procedures involving the cingulum are sometimes effective in the treatment of OCD. One recent MRI study reported increased T1 relaxation times in the frontal cortex, a finding consistent with the location of abnormalities discovered in PET studies. www.damsdelhi.com Email: [email protected]