APPG 2011: QUESTIONS WITH EXPLANATIONS

APPG 2011: QUESTIONS WITH EXPLANATIONS

1)Scottish terrier sign is best seen in 
Lateral view, 
PA view , 
AP View 
Oblique view 

Ans D 
Spondylolisthesis is defined as the anterior displacement of one vertebral body on another. Typically, the posterior portion of the arch, including the inferior facets, remains aligned with the sacrum, while the anterior portion of the vertebral body slips forward. If disruption of the interarticular portion of the vertebral arch occurs without anterior displacement of the vertebral body, it is termed spondylolysis. Spondylolisthesis occurs with a prevalence of 5% in the general population, and is equally distributed between the sexes. 

friend to make it better and easy...i hav toiled to make this effort..pls add answered the left out unanswered and controversial questions with explanations or references. 

please do not add questions which are already in this post so that it reduces the confusion. 


Spondylolisthesis is graded based on the degree of anterior displacement of the upper vertebra relative to the lower: 
Grade 1: <25 displacement="" nbsp="" span="">
Grade 11: 25-50% displacement 
Grade 111: 50-75% displacement 
Grade 1V: >75% displacement 


Spondylolisthesis is also divided into five etiologic classifications: 

Type I: Dysplastic- congenital abnormality of the upper or lower sacral facets that allows slipping of L5 on S1. No pars interarticularis defect is present. 
Type II: Isthmic- bilateral defect in the pars interarticularis allows slipping of L5 on S1. This type is typical of pars interarticularis fractures. 
Type III: Degenerative- typically occurs in patients >50 yo with degenerative changes in the facet joints. 
Type IV: Traumatic- occurs with posterior vertebral fracture at a site other than the pars interarticularis. 
Type V: Pathological- occurs secondary to localized or generalized bone disease. 


For radiographic examination of spondylolisthesis, the views of choice include lateral and oblique radiographs of the lumbar spine. The normal oblique view of the LS spine shows a "Scotty Dog" shape 


2) Hemochromotosis gene- HFE gene…answer 
Human hemochromatosis protein also known as the HFE protein is a protein which in humans is encoded by the HFE gene. The HFE gene is located on short arm of chromosome 6 at location 6p21.3. Unusually, the official gene symbol (HFE for High Iron Fe) is not an abbreviation of the official name (hemochromatosis).[1] 

3) To do endoscopic Dacryocystorhinostomy , anaesthesia used is ? 
Nasociliary block 
Frontal block 
Local anesthesia 
Ans C 
Anesthesia used: 4% xylocaine mixed with 1 in 10,000 adrenaline for topical anesthesia. Cotton pledgets dipped in this solution is used to pack the nasal cavity. Before attempting to pack the nose the cotton pledgets must be squeezed dry of xylocaine solution to avoid xylocaine overdosage and toxicity. It is safe to use only 7 ml of 4% xylocaine for topical nasal packing. Three pledgets are used for packing. One each is placed inside each meatus. The packing must be left in place for atleast 15 minutes for optimal effec t. 


4) Eculizumab used in paroxysmal nocturnal hemoglobinuria 

Eculizumab belongs to a class of medications called monoclonal antibodies and treats a type of blood disease called paroxysmal nocturnal hemoglobinuria (PNH). 
Eculizumab blocks substances in the blood, called complements, and reduces the premature breakdown of red blood cells, called hemolysis. By minimizing hemolysis, eculizumab treats many of the underlying complications associated PNH. 

5) danazol side effects all except 
vaginal dryness 
acne 
hirsutism 
gynaecomastia 
ANS D 

Side-effects 
Androgenic side effects are of concern, because in sensitive female patients, danazol can enhance unwanted hair growth, leading to hirsutism. On rare occasion, it can deepen the voice. Other possible side effects include acne and oily skin. Because danazol is metabolized by the liver, it cannot be used by patients with liver disease, and in patients receiving long-term therapy, liver function must be monitored on a periodic basis. Some patients who use danazol experience weight gain and fluid retention. Due to these limitations, danazol is seldom prescribed continuously beyond six months. 
The use of danazol for endometriosis has been linked to an increased risk of ovarian cancer.[6] Patients with endometriosis have specific risk factors for ovarian cancer so this may not apply for other uses. 
Danazol has, like most other androgenic agents, been linked with an increased risk of liver tumors. These are generally benign.[7] 
Unlike GnRH agonists, danazol does not induce osteoporosis. Also, symptoms of hot flushes tend to be less common or severe. 
Danazol is used for treatment for gynecomastia. 

6) aplastic crisis caused by 
cmv 
coxsakie 
parvo b19 
ANS C 

In patients with hemolytic anemia, parvovirus B19 supresses bone marrow erythropoietic activity, leading to transient aplastic crisis 


7 } B/L acral, target like lesions - erythema multiforme 

Erythema multiforme (EM) was initially described in 1866 by Ferdinand von Hebra as an acute self-limited skin disease, symmetrically distributed on the extremities with typical and often recurrent concentric "target" lesions (see the first image below). Lesions may also appear as arcuate lesions (see second image below). The term EM minor was proposed later to differentiate the mild cutaneous syndrome from the more severe form, EM major, which involves several mucous membranes 


8) highest produced placental hormone 
estradiol 
progesteron 
hcg 
hpl 

READ THE BELOW LINES FROM WILLIAMS OBSTETRICS 22ND EDITION : 

There are five genes in the growth hormone–placental lactogen gene cluster that are linked and located on chromosome 17. Two of these genes, hPL2 and hPL3, both encode hPL, and the amount of mRNA in the term placenta is similar for each. In contrast, the prolactin gene is located on chromosome 6 (Owerbach and colleagues, 1980, 1981). The production rate of hPL near term, about 1 g/day, is the greatest, by far, of any known hormone in humans. 

9) Ocular cicatrial pemphigoid not true ?? 

occurs in young females 
leads to cicatrical synblepharon 
tear drops used 
distribution differs with geography and race …………answer… 

Distribution appears to be worldwide. No geographical predilection is reported. 
OCP can occur in all races. 


10)morbidly adherent placenta is due to lack of 

Nitabauchs fibrinoid layer Decidua basalis 

Placenta accreta is a life-threatening condition characterized by placental 
villi being abnormally adherent to the myometrium due to the absence of, or defects in, the normal decidual basalis and the fibrinous Nitabuch layer . 


11)kehr sign is 
pain in left shoulder ..answer 
pain in right shoulder 
pain legs 

Kehr's sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Kehr's sign in the left shoulder is considered a classical symptom of a ruptured spleen.[1] May result from diaphragmatic or peridiaphragmatic lesions, renal calculi, splenic injury or ectopic pregnancy. 
Kehr's sign is a classical example of referred pain: irritation of the diaphragm is signalled by the phrenic nerve as pain in the area above the collarbone. This is because the supraclavicular nerves have the same cervical nerves origin as the phrenic nerve, C3 and C4. 
The discovery of this is often attributed to a German gall bladder surgeon named Hans Kehr, but extensive studies into research he conducted during his life shows inconclusive evidence as to whether or not he actually discovered it.[2] 

12)Epulis arises from-gingiva…answer 

The word, "epulis", can be used to describe any gingival tumor… 


13)mucocoele of GB-cholecyetectomy is treatment of choice 

Treatment 
Medical Therapy 
Do not consider a medical line of management with oral dissolution therapy in obstructed gallbladders. In acalculous hydrops observed in children as a part of a wider spectrum, expectant management may be considered. 
Surgical Therapy 
Cholecystectomy is the definitive treatment for an obstructed gallbladder. Laparoscopic cholecystectomy is the criterion standard procedure.11,12,13 (A 2009 study derived from database information and a literature review found evidence that even when gallstones are absent in patients with RUQ pain and a positive HIDA scan, symptom relief is more likely to occur following cholecystectomy than it is after medical treatment.14 ) 

Open cholecystectomy may be performed in patients with a very large gallbladder, with greatly thickened gallbladder walls, and with an obliterated Calot triangle, in whom laparoscopic dissection could be difficult and time-consuming. 
In some patients, percutaneous (ultrasonographically guided) or open cholecystostomy may be used as a temporary measure; cholecystostomy is usually performed in patients who are very sick or when the dissection is technically very difficult. A subsequent completion cholecystectomy may be carried out once the initial condition improves. 

14)saints triad all except renal stones….. answer 
Saint's triad is a medical term used to describe the concurrence of the following: 
1. Cholelithiasis 
2. Hiatal Hernia 
3. Diverticular Disease 

15)splenic vein thrombosis …treatment of choice is splenectomy 
The treatment of ISVT is conservative, given the low risk of associated gastric variceal bleeding. 
Once there is an index episode of 
gastrointestinal bleeding, splenectomy is the treatment of choice. 


16)adequate colposcopy…visualization of squamocolumnar jn …answer.. 
The ability to see the transformation zone and the entire extent of any lesion visualized determines whether an adequate colposcopic examination is attainable. 

17)lethal dose of krait venom -6mg 


18)hbf composition-alpha2 gaama 2 
fetal hemoglobin is composed of two alpha and two gamma subunits, commonly denoted as α2γ2 

19)hallwerdenspatz disease…its iron storage disorder in brain 

HALLERVORDEN-SPATZ DISEASE: (PANTOTHENATE KINASE-ASSOCIATED NEURODEGENERATION) 
Hallervorden-Spatz disease (HSD) is a rare disorder characterized by progressive extrapyramidal dysfunction and dementia. Onset is most commonly in late childhood or early adolescence. 
Abnormal peroxidation of lipofuscin to neuromelanin and deficient cysteine dioxygenase lead to abnormal iron accumulation in the brain. 

20)apt test…detect blood in stools 

Finally, the Apt test can be used after birth (postpartum hemorrhage) if the newborn has bloody vomiting, bloody stool, or active bleeding from the nasogastric tube. A positive apt test would mean that the blood is either due to gastrointestinal or pulmonary bleeding from the neonate. A negative Apt test would indicate that the blood is of maternal origin, suggesting that the neonate swallowed or aspirated maternal blood, either during delivery or during breastfeeding (e.g., from breast fissures). 

21)emergency contraception mechanism all except? 
1 inhibiting ovulation 
2 prev of implantation 
3interreference in early pregnancy 
4 inhibiting fertilization 
answer D 

Emergency contraceptive pills (ECPs)—sometimes simply referred to as emergency contraceptives (ECs) or the "morning-after pill"—are drugs that act both to prevent ovulation or fertilization (contraceptive) and possibly post-fertilization implantation of a blastocyst (contragestive).[1] ECPs are distinct from medical abortion methods that act after implantation. 


22)absolute indication for tonsillectomy – 5yr child with OSA 
• Absolute indications 
o Enlarged tonsils that cause upper airway obstruction, severe dysphagia, sleep disorders, or cardiopulmonary complications 
o Peritonsillar abscess that is unresponsive to medical management and drainage documented by surgeon, unless surgery is performed during acute stage 
o Tonsillitis resulting in febrile convulsions 
o Tonsils requiring biopsy to define tissue pathology 
• Relative indications 
o Three or more tonsil infections per year despite adequate medical therapy 
o Persistent foul taste or breath due to chronic tonsillitis that is not responsive to medical therapy 
o Chronic or recurrent tonsillitis in a streptococcal carrier not responding to beta-lactamase-resistant antibiotics 
o Unilateral tonsil hypertrophy that is presumed to be neoplastic 

23) Not a demyleinating disorder?? 
GPI 
MLD 
SSPE ,PMLE 
ANS. A 
general paresis is due do parenchymatous inflammation.. 

24)mechanism of injury in anterior dislocation of shoulder 
1 internal rotation adduction 
2 internal rotation in extension 
3 abduction external rotation 
ANS 3 

Mechanism 
Anterior dislocation is caused by a combination of abduction, extension, and external rotation forces. Due to this force is indirectly transferred to the anterior capsule and ligament resulting in dislocation. Trauma is the most common cause of anterior dislocation. 

25)diagnostic test of carpal tunnel syndrome…nerve conduction velocity 

Carpal tunnel syndrome is most accurately diagnosed using the patients' descriptions of symptoms, and electrodiagnostic tests that measure nerve conduction through the hand. If electrodiagnostic testing is not available, symptom descriptions and a series of physical tests are useful. 

26)soft lens true is??????? 

for astigmatism 
made up PMMA 
high water content 
do not tear 

ANS C 

27)which is not a quadrant of tympanic membrane… posterior anterior… answer 

28)Chlamydia not true ?? 
divides by binary fission 
has DNA only …..answer…. 
freely filterable 
Chlamydia has both dna and rna.. 

29)min amt of blood to cause melena 
10 
40 
60ml 
Answer 60ml ..previous repeat 

30)NRHM ans year 2005..answer 

31)ESSURA..hysterscopic micro inserts…answer 
Essure is a permanent birth control device that has recently become available as an alternative to traditional tubal ligation methods. The spring-like device is inserted through the uterine cavity into the tubal openings using a hysteroscope. This can be done as an in-office procedure. The device expands to fill the tubal opening and then becomes scarred into place, forming a barrier so that sperm cannot reach the egg. Because of the scar formation, it cannot be pulled out of the tube. It is advertised by the manufacturer as a permanent method of birth control. In this respect, it is similar to other tubal ligation methods that are considered by most doctors to be permanent. 

32)Not a radiological involvement in sarcoidosis? 
Milliary mottling 
Egg shell calcification 
Enlarged b/l lymphadenopathy 
Pleural involvement 
Ans D Pleural involvement >a 

33)chlorination in of well in rainy season.......? 
once daily 
once weekly 
twice weekly 
once monthly 

usually its done 2-3 times a week and during cholera epidemics daily..dont know what the examiner means. 

34)pepsin gets inactivated at ph of? 
4.5 answer. 

Pepsin can be inhibited in two ways. The first method is introducing a pepsin inhibitor compound, and the second method is decreasing the acidity level to which the pepsin becomes inactive. This is usually around a pH of 4-5. 

35)crypta magna seen in palatine tonsils. 

36)large breast seen in all except ? 

large fibroadenoma 
schirrous ca 
filariasis breast 
Ans – Schirrous carcinoma 

37)which is not safety system ? 
1 pin index 
2 link25 system 
3Minimal mandatory airflow?? 4Air flow meter 
answer.D???. 

38)pulmonary hypertention… BMPR2 gene answer 

39)medullary thyroid carcinoma treatment of choise is..total thyroidectomy..answer 
• 
Surgical treatment goals of medullary thyroid carcinoma (MTC) are as follows: 
o Provide local control of the cancer. 
o Maintain laryngoesophageal function (speech and swallowing). 
o Tailor surgical treatment according to the type of MTC presentation (ie, sporadic, familial). 
• Sporadic MTC occurring in patients presenting with a palpable thyroid nodule verified by fine-needle aspiration is treated as follows: 
o Perform a total thyroidectomy and central neck dissection for cases of symptomatic (clinically detected) MTC. 
o For patients with microscopic involvement of regional lymph nodes, advocate a central neck dissection, which involves complete dissection of structures and removal of node-bearing tissue between the hyoid bone and innominate vessels, sternothyroid resection, removal of paratracheal lymph nodes, and possible thymectomy. 
o Autograft an inferior parathyroid gland that is histologically confirmed as cancer-free into the sternocleidomastoid or forearm muscle. 

40)not a test of ovulation test ? 
21 day progestron 
3 day progestron 
transvaginal us g 
21 day estrogen 
answer..D 

41)abacept used in rx of rheumatoid arthritis..answer 

Abatacept is currently approved for use in rheumatoid arthritis patients who have had an inadequate response to one or more DMARDs.[3] It is useful in delaying the progression of structural damage and reducing symptoms of rheumatoid arthritis 

42)enfuvirtide is a fusion inhibitor..answer 

Enfuvirtide (INN) is an HIV fusion inhibitor, the first of a novel class of antiretroviral drugs used in combination therapy for the treatment of HIV-1 infection. It is marketed under the trade name Fuzeon (Roche) 

43)drugs not used for menopausal flushing..SERM . 

SERMs are a category of drugs that act selectively as agonists or antagonists on the estrogen receptors throughout the body. Tamoxifen, a drug used in the treatment of some types of breast cancerand which can cause hot flashes as a side effect. 

44)Not a branch of celiac trunk-superior mesenteric artery . 

the superior mesenteric artery (SMA) arises from the anterior surface of the abdominal aorta, just inferior to the origin of the celiac trunk, and supplies the intestine from the lower part of the duodenum through two-thirds of the transverse colon, as well as the pancreas. 

45)not a part of basal ganglion..thalamus…answer 
. 
The main components of the basal ganglia are the striatum (also called neostriatum) composed of caudate and putamen, globus pallidus or pallidum composed of globus pallidus externa (GPe) or globus pallidus interna (GPi), substantia nigra composed of both substantia nigra pars compacta (SNc) & substantia nigra pars reticulata (SNr), and the subthalamic nucleus (STN) 

y not claustrum…?? bcz The claustrum, which is suspected to be present in all mammals, is a fairly thin (fraction of 1 mm to multiple mms) vertical curved sheet of subcortical gray matter oriented sagittally between the white matter tracts of the external capsule and extreme capsule. The Claustrum is lateral to the putamen and medial to the insular cortex and is considered by some sources to be part of the basal ganglia 

46)miliary tuberculosis in children spread thru 

lympho hematogenous ….answer.. 
bronchogenic 
rupture of cavity 

Disseminated tuberculosis (TB)(milliary tb) is a contagious bacterial infection that has spread from the lungs to other parts of the body through the blood or lymph system 

47)rotator cuff muscles a/e 
deltoid 
supraspinatus 
infra spinatus 
teres minor 
ANS A 

Muscle Origin on scapula Attachment on humerus Function Innervation 
Supraspinatus muscle 
supraspinous fossa 
superior and middle facet of the greater tuberosity 
abducts the arm 

Suprascapular nerve (C5) 
Infraspinatus muscle 
infraspinous fossa 
posterior facet of the greater tuberosity 
externally rotates the arm Suprascapular nerve (C5-C6) 

Teres minor muscle 
middle half of lateral border 
inferior facet of the greater tuberosity 
externally rotates the arm Axillary nerve (C5) 

Subscapularis muscle 
subscapular fossa 
lesser tuberosity (60%) or humeral neck (40%) 
internally rotates the humerus 
Upper and Lower subscapular nerve (C5-C6) 

48)roll back malaria..answer all 

Three Components of the Global Strategy: Control, Elimination and Research 
The Global Strategy consists of three components (Figure II.1) that will ensure these ambitious goals can be achieved: 1) Controlling malaria, 2) Eliminating malaria and 3) Research into new tools and approaches. 
1. Control. The majority of malaria-endemic countries can make a substantial impact on their malaria burden by controlling it with existing tools. By first scaling up appropriate interventions for all populations at risk and then sustaining control over time, malaria will cease to be a major source of deaths world-wide. 
2. Elimination. Reducing to zero all locally-acquired infections within a country will bring the world closer to the ambitious goal of global eradication. Some countries are currently engaging in elimination and more will transition to elimination after achieving control provided there is strong rationale for this move. In high transmission settings, complete interruption of malaria transmission will require additional, new control tools. 
3. Research. Malaria control and elimination efforts will require continued research to be successful. International research is needed to create new tools, as well as inform policy and improve operational implementation of strategies. Then, national and local health systems must focus on how to use the tools and sustain the gain 


49)true about cochlear implants…not contraindicated in cochlear malformation..answer 

Contraindications 
Contraindications to cochlear implantation may include deafness due to lesions of the eighth cranial nerve or brain stem. In addition, chronic infections of the middle ear and mastoid cavity or tympanic membrane perforation can be contraindications. The absence of cochlear development as demonstrated on CT scans remains an absolute contraindication. Certain medical conditions that preclude cochlear implant surgery (eg, specific hematologic, pulmonary, and cardiac conditions) also may be contraindications. The lack of realistic expectations regarding the benefits of cochlear implantation and/or a lack of strong desire to develop enhanced oral communication skills poses a strong contraindication for implant surgery 


50)A man with monoclonal gammmopathy plasma cells 10-30 percent, no symptoms, esr lymphoplasmacytic lymphoma 
Smoldering myeloma vs Monoclonal gammopathy of undetermined significance (MGUS): 
In mgus 
1. Serum paraprotein <30 and="" g="" nbsp="" span="">
2. Clonal plasma cells <10 and="" biopsy="" bone="" marrow="" nbsp="" on="" span="">
3. NO myeloma-related organ or tissue impairment


A panel consists of a small group of six or eight persons 

who carry on a guided and informal discussion before an audience as if the panel were meeting alone. The proceedings of the panel should be the same as those described for informal discussion: volunteering of facts, asking questions, stating opinions-all expressed with geniality, with respect for the contributions of other members, without speech making, and without making invidious personal references. This primary function should occupy approximately two-thirds of the allotted time-say forty minutes of an hour’s meeting. The secondary function of the panel is to answer questions from the audience. This discussion method is suitable for use when a relatively large audience is anticipated. The disadvantage of the method is that it confines most of the discussion to the panel itself. The audience listens and is given a chance to ask questions, but for the most part is passive and receptive. 
Panel discussions, if well conducted, are usually more interesting to the audience than is the single-speaker forum. They provide sufficiently varied clash of opinion and presentation of facts to give even the quiet members of the audience a feeling of vicarious participation. 
Quality and tasks of leadership in panel discussion are similar to those described for informal discussion. The leader must in addition take special care to select panel members who can think and speak effectively. He must also be sure that they prepare themselves to discuss the subject. During the discussion by the panel the leader has substantially the same duties as in informal discussion except that he should keep himself more in the background as chairman of the panel. He can do so because each member of the panel is in reality an assistant to the leader and is responsible for specific contributions to the proceedings. 

52)acute epiglottitis …thumb sign on lateral view..answer.. 

53)which of the following not found in greater wing 
foramin ovale 
formin spinosum 
foramuin rotundum 
optic canal 
answer…. D 

The superior or cerebral surface of each greater wing forms part of the middle cranial fossa; it is deeply concave, and presents depressions for the convolutions of the temporal lobe of the brain. It has a number of foramina (holes) in it: 
 The foramen rotundum is a circular aperture at its anterior and medial part; it transmits the maxillary nerve. 
 The foramen ovale is behind and lateral to this; it transmits the mandibular nerve, the accessory meningeal artery, and sometimes the lesser petrosal nerve. 
 The sphenoidal emissary foramen is occasionally present; it is a small aperture medial to the foramen ovale, opposite the root of the pterygoid process; it opens below near the scaphoid fossa, and transmits a small vein from the cavernous sinus. 
 The foramen spinosum, in the posterior angle near to and in front of the spine; it is a short canal which transmits the middle meningeal vessels and a recurrent branch from the mandibular nerve. 
Lateral surface 
The lateral surface [Fig. 2] is convex, and divided by a transverse ridge, the infratemporal crest, into two portions. 
 The superior temporal surface, convex from above downward, concave from before backward, forms a part of the temporal fossa, and gives attachment to the temporalis; 
 the inferior infratemporal surface, smaller in size and concave, enters into the formation of the infratemporal fossa, and, together with the infratemporal crest, serves as an attachment to the lateral pterygoid muscle. 
It is pierced by the foramen ovale and foramen spinosum, and at its posterior part is the sphenoidal spine, which is frequently grooved on its medial surface for the chorda tympani nerve. 
To the sphenoidal spine are attached the sphenomandibular ligament and the tensor veli palatini muscle. 
Medial to the anterior extremity of the infratemporal crest is a triangular process which serves to increase the attachment of the lateral pterygoid muscle; extending downward and medialward from this process on to the front part of the lateral pterygoid plate is a ridge which forms the anterior limit of the infratemporal surface, and, in the articulated skull, the posterior boundary of the pterygomaxillary fissure. 
Orbital surface 
The orbital surface of the great wing [Fig. 2], smooth, and quadrilateral in shape, is directed forward and medially and forms the posterior part of the lateral wall of the orbit. 
 Its upper serrated edge articulates with the orbital plate of the frontal bone. 
 Its inferior rounded border forms the postero-lateral boundary of the inferior orbital fissure. 
 Its medial sharp margin forms the lower boundary of the superior orbital fissure and has projecting from about its center a little tubercle which gives attachment to the inferior head of the lateral rectusmuscle; at the upper part of this margin is a notch for the transmission of a recurrent branch of the lacrimal artery. 
 Its lateral margin is serrated and articulates with the zygomatic bone. 
 Below the medial end of the superior orbital fissure is a grooved surface, which forms the posterior wall of the pterygopalatine fossa, and is pierced by the foramen rotundum. 


54)Dacryocytes …tear drop cells,, ,answer…. 

These abnormal erythrocytes have a teardrop, or pearlike, shape. They are associated with disorders with an abnormal spleen or bone marrow, such as idiopathic myelofibrosis, thalessemia, or myelophthisis. 

55)DOC in stress incontinence ..tolteridene…answer. 

MEDICATIONS 
Medicines tend to work better in patients with mild to moderate stress incontinence. There are several types of medications that may be used alone or in combination. They include: 
• Anticholinergic agents (oxybutynin, tolterodine, enablex, sanctura, vesicare, oxytrol) 
• Antimuscarinic drugs block bladder contractions (many doctors prescribe these types of drugs first) 
• Alpha-adrenergic agonist drugs, such as phenylpropanolamine and pseudoephedrine (common ingredients in over-the-counter cold medications), help increase sphincter strength and improve symptoms in many patients 
• Imipramine, a tricyclic antidepressant, works in a similar way to alpha-adrenergic drugs 
Estrogen therapy can be used to improve urinary frequency, urgency, and burning in postmenopausal women. It also can improve the tone and blood supply of the urethral sphincter muscles. 
However, whether estrogen treatment improves stress incontinence is controversial. Women with a history of breast or uterine cancer usually should NOT use estrogen therapy for the treatment of stress urinary incontinence. 

56)Paltauffs hemorrhages …lungs…answer 

*Paltauf’s hemorrhage 
Shining, pale bluish red and may be minute or 3-5 cm in diameter, subplerual hemorrhage seen due to alveolar rupture in drowning. 

57)Dry drowning…laryngeal spasm..answer.. 

Dry drowning occurs when a person's lungs become unable to extract oxygen from the air, due primarily to: 
 Muscular paralysis 
 Puncture wound to the torso (affecting ability of diaphragm to create respiratory movement) 
 Changes to the oxygen-absorbing tissues 
 Persistence of laryngospasm when immersed in fluid 
 Prolonged exposure to any gas that is not inherently toxic, but that displaces oxygen from the lungs. (e.g. methane) 
 Overdose of free water (solute free) which leads to decreased sodium in the blood hyponatremia which leads to massive swelling in the brain. 


58)Not seen in lateral condylar fracture??malunion..answer..??? 

59)Adduction type of hyoid# 
manual strangulation 
ligature strangulation 
bansdola 
hanging 
Ans A 

60) ITGCN predisposes TO 
spermatocytic seminoma 
Yolk sac tumour 
Endodermal tomour 
Embryonal cell ca 
answer..D 

ITGCNU is seen in the following settings:[3] 
 Almost all invasive germ cell tumours of the testis in adults 
 Fifty percent of patients with ITGCNU developed invasive germ cell tumours within five years of initial diagnosis. 
 Five percent of contralateral testes in men with a history of prior testicular germ cell tumour. 
 Less than five percent of cryptorchid testes. 
 Less than one percent of patients with infertility. 
[edit]Germ cell tumors that do not arise from ITGCNU 
Not all germ cell tumors (GCTs) arise from intratubular germ cell neoplasia. The following testicular GCTs do not arise from ITGCN: 
 Spermatocytic seminoma[5] 
 Pediatric Yolk sac tumors (endodermal sinus tumour).[6] This is currently an area of controversy as some authors dispute the absence of ITGCN in these cases.[3] 
 Teratoma (rare exceptions)[3 


61)world wide mc cause for contact dermatitis ?? 
Nickel 
Chromium 
gold 
mercury 
Ans A 

62)Periungual telangiectasia not seen in?? 
SLE 
Dematomyositis 
Scleroderma 
Mixed connectine tissue disorder 
answer..D 

Periungual telangiectasias are pathognomonic signs of the 3 major connective tissue diseases, ie, lupus erythematosus, scleroderma, and dermatomyositis. 


63)Trendenlenberg sign not seen in ???? 

Perthes ds 
CDH 
Ununited # neck femur 
Tom smith arthritis sequelae 

64)Symmetric tonic reflex…not true…its abnormal and reflects CNS dysfunction…answer.. 

a normal response in infants to assume the crawl position by extending the arms and bending the knees when the head and neck are extended. The reflex disappears when neurologic and muscular development allows independent limb movement for actual crawling. Also called crawling reflex. See also tonic neck reflex. 

65)Seligiline mechanism of action not true is?? 

MAO-B inhibitor 
antioxidant property 
increase dopamine synthesis 
increase dopamine release 
answer....D 

Metabolites... 
1) Desmethylselegiline 

Desmethylselegiline may have neuroprotective antiapoptotic properties. A large multicenter study suggests a decrease in the disease progression of parkinsonism but may have reflected other symptomatic response.[16] Desmethylselegiline is metabolized by CYP2C19.[17] 

2) L-amphetamine and L-methamphetamine 
Selegiline is partly metabolized to l-methamphetamine, one of the two enantiomers of methamphetamine in vivo.[18] A characteristic metabolic pattern was noted, exemplified by a ratio of l-methamphetamine to l-amphetamine of about 2.8.[19] This stereoisomer is not considered psychoactive and has little abuse potential.[20] 

The stimulatory effect on locomotor activity and dopamine synthesis[/u} may be contributed to by the action of l-methamphetamine. If anyone is prescribed and takes selegiline, they can and will test positive for amphetamine/methamphetamine on most drug tests, however the prescription for selegiline would explain why they test positive for amphetamine/methamphetamine. 

Mechanism of Action 
Selegiline is a selective inhibitor of MAO-B; MAO-B metabolizes dopamine and phenylethylamine.[16] Selegiline exhibits little therapeutic benefit when used independently, but enhances and prolongs the anti-Parkinson effects of levodopa. 

66) Criminal negligence..304A …answer… 

67)All are used for skeletal traction except 
k wire 
steinmann pin 
danhams pin 
knowles pin 
answer…D ..it’s a intramedulary devise… 


68)sudden ophthalmoplegia in thai child eating raw fish n cooked rice-thiamine..answer.. 

69)increased viscosity of blood causes increase in 
MAP 
diameter of resistance vessels 
diameter of capacitance vessels CVP 

70)Adult with U/L proptosis, illdefined lesion extending into orbit from eye ball??? 
malignent melanoma 
choirdal hemangioma 
lymphoma Pseudo tumour 

71)baciillary angiomatosis not true?? 
Caused by b.henslae 
Can cause peliosis heaptis 
Aminoglycosisdes used 
Brain is involved in AIDS pt. 

Ans C 

Bacillary angiomatosis: A bacterial infection due to a cat scratch most often seen today in people with HIV. The disease characteristically presents with swollen lymph nodes (lymphadenitis), sore throat, fatigue, and fever, chills, sweats, vomiting, loss of appetite, and weight loss. There is usually a little bump (a papule) which may be pus-filled (a pustule) at the site of the scratch. Then more nodules appear on and under the skin. As the number of nodules increases, patients get sicker. 

In normal people the disease is self-limited and usually goes away by itself in a few weeks. It can also be treated with antibiotics. 

In persons with HIV/AIDS the disease can cause severe inflammation of the brain, bone marrow, lymph nodes, lungs, spleen and liver. The disease can be fatal in persons with HIV. It can be easily treated with antibiotics such as erythromycin and doxycycline. Treatment is given until the skin lesions resolve, usually in 3 to 4 weeks. 

Bacillary angiomatosis is so characteristic today of AIDS that it is an AIDS defining disease, according to the CDC (Centers For Disease Control). 

The disease is caused by a bacterium called Rochalimaea henselae, which was reclassified as Bartonella henselae, named for Diane Hensel, a microbiologist. Bacillary angiomatosis has also been called cat scratch disease, cat scratch fever, regional lymphadenitis, and benign lymphoreticulosis. 

treatment erythromycin drug of choice....... 


72)Inverted - Y shaped sutures present 
ant adult n infantile 
ant infantile n foetal 
post adult n infantile 
post infantile n foetal 
ANS D 

Lens fibers continue to form from the cells at the equator so that several layers are produced. The new fibers extend anteriorly and posteriorly to join with other fibers in a linear fashion forming suture lines which take on an upright 'Y' appearance anteriorly and an inverted 'Y' appearance posteriorly. This is the appearance of the lens at birth. 


73)sniff test- ???bact vaginosis> trichomonas answer 


74)perichondritis of ear ----pseudomonas>s.aureus…answer… 

75)oval window opens into ------scala vestubuli…answer… 

76)nobel prize for work on vascular ligature and grafting of blood vessels and organs .. Alexis Carrel …answer.. 

77)MC tumor of liver…..mets… 

78)Baby developed signs and symtoms of cong.syphilis after two ween..supported by?? 
Kassowitz’s law 
Profeta law 
Colles law 
Didays law 

Ans c 

78)Diuretic with direct vasodilatory effect..indapamide..answer.. 

79)Drug used to delay uterine contractions in labour …salbutamol..answer.. 

80)Difference between vaginal cyst and cystocele… answer..vaginal cyst not reducible..ref shaw..prolapse dd.. 

81) Mechanism of camp action on GIT causing diarrhea?? 
Increased secretion of chlorides…answer.. 

82)Not done in PMSTR 

knot release 
Deep deltoid lig release 
Achilles tendon release 
spring ligament release. 
Ans B 
Sequential Strategy for Release: 
- supine position; 
- posteromedial skin incision; 
- initial identification, mobilization, and protection of the neurovascular bundle; 
- release of plantar fascia inorder to adress forefoot equinus (first ray is now aligned with the talus); 
- the abductor hallucis is released inorder to optimize exposure of the medial structures; 
- distal tendon excision preferred; 
- superficial deltoid ligament is released but deep deltoid ligament is preserved; 
- identification and mobilization of the tibialis posterior, FDL, and FHL tendons w/ determination of excursions of each; 
- Z lengthening of contracted tendons w/ some excursion; 
- resection of tendons w/ no excursion 
- excision of tendon sheaths from above the medial malleolus thru the Knot of Henry; 
- excision of tissue filling the interval between the medial malleolus, tuberosity of the navicular, and sustentaculum tali; 
- medial and dorsal release of the talonavicular joint capsule; 
- the navicular is moved away from the medial malleolus and then realigned with the talus 
- tendon-achilles z-lengthening and posterior ankle joint capsular release to fibula and posterior deltoid ligament release; 

83)Not seen in HUS 
1)subnephrotic range protinuria 
2)hypofibrogenimia 
3)thrombocytopenia 
4)positive coombs test 

ans 4 coz HUS is mechanical hemolysis not immune 

84)Hyperchloremic acidosis seen with…uretero sigmoidostomy..answer.. 

As well as this, the urine entering the colon can cause diarrhea and salt imbalance due to the sodium and chloride in the urine. Urea levels in the blood are higher due to urea crossing the colon wall. In the large intestine, sodium is swapped for potassium, and chloride for bicarbonate, this causes an acidosis and hypokalaemia. Many patients take sodium bicarbonate to combat this. 

85)regarding spingomylein?? Choline or amino cooh group not sure?? 

86)starvation – alanine ANS 

When food intake ceases, the body enters the starvation response. Initially, the body's glycogen stores are used up in about 24 hours.[citation needed] The level of insulin in circulation is low and the level of glucagon is very high. The main means of energy production is lipolysis. Gluconeogenesis converts glycerol into glucose and the Cori cycle converts lactate into usable glucose. Two systems of energy enter the gluconeogenesis: proteolysis provides alanine and lactate produced from pyruvate, while acetyl CoA produces dissolved nutrients (Ketone bodies), which can be detected in urine and are used by the brain as a source of energy. 

87)2.5cms renal stone in child- pyelolithotomy answer 

The American Urological Association Stone Guidelines Panel has classified ESWL as a potential first-line treatment for ureteral and renal stones smaller than 2 cm. 

88)Rt pleural effusion - rt lateral decubitus best view …answer.. 

89)Frozen section used in diagnosis of fat..answer.. 

sually a lower temperature is required for fat or lipid rich tissue 

90)Mc side effect of pyrizinamide is arthritis/arthalgia…answer… 


91)acarbose MOA… inhibits alphaglucosidase …answer.. 

Acarbose inhibits enzymes (glycoside hydrolases) needed to digest carbohydrates, to be specific, alpha-glucosidase enzymes in the brush border of the small intestines and pancreatic alpha-amylase. Pancreatic alpha-amylase hydrolyzes complex starches to oligosaccharides in the lumen of the small intestine, whereas the membrane-bound intestinal alpha-glucosidases hydrolyze oligosaccharides, trisaccharides, and disaccharides to glucose and othermonosaccharides in the small intestine. Inhibition of these enzyme systems reduces the rate of digestion of complex carbohydrates. Less glucose is absorbed because the carbohydrates are not broken down into glucose molecules. In diabetic patients, the short-term effect of these drugs therapies is to decrease current blood glucose levels; the long-term effect is a reduction in HbA1c level.[1] This reduction averages an absolute decrease of 0.7%, which is a decrease of about 10% in typical HbA1c values in diabetes studies. 

92)LCAT activator apo A???? 

93)Drug causing HDL elevation…Nicotinic acid/niacin…answer.. 

Causes of hyperalphalipoproteinemia (HALP) may be primary or acquired (secondary). Primary factors can include familial syndromes of elevated high-density lipoprotein (HDL) cholesterol levels, which in some cases may be associated with a decreased risk for coronary artery disease . 
• Primary causes 
o Familial HALP - Familial HALP includes CETP deficiency, familial hepatic lipase deficiency, and primary HALP. A selective up-regulation of apo A-I production is one metabolic cause of familial HALP and leads to high plasma concentrations of HDL cholesterol, apo A-I, and lipoprotein A-I. It possibly may also result in protection from atherosclerotic coronary heart disease (CHD).17,18Familial HALP can involve premature corneal opacity, reduced hepatic lipase activity, and reduced uptake of HDL by lymphocytes. 
o Primary HALP - This is a term used for familial elevated HDL cholesterol levels that are not due to CETP deficiency. Epidemiologic studies have suggested that this syndrome is associated with a decreased risk for coronary artery disease and with increased longevity. 
o CETP deficiency - This asymptomatic, hereditary syndrome is caused by low CETP levels. Decreased CETP activity slows the transport of cholesteryl esters from HDL to apo B–containing lipoproteins. The condition is frequently observed in Japanese Americans. Clinical features include marked elevations of plasma HDL cholesterol in homozygotes (usually >100 mg/dL) and probably lower rates of CHD. In heterozygotes, the HDL levels are only moderately elevated. CETP deficiency has not yet been demonstrated to be associated with a decreased risk for atherosclerotic cardiovascular disease, and some experts do not consider this condition protective against cardiovascular disease.19 
o LCAT overexpression - Rarely, HALP has been reported to be due to LCAT overexpression. The activity of LCAT is increased in blood plasma and is associated with high levels of HDL. Reduction in the fractional catabolic rate of HDL is considered to be the predominant mechanism by which LCAT overexpression modulates HDL concentrations. Such patients may have reduced risk of developing CHD. 
o Up-regulation of apo A-I production - Selective up-regulation of apo A-I production is another cause of familial HALP. Affected individuals have elevated HDL cholesterol and apo A-I levels. Additionally, many patients have a reduced risk of atherosclerotic CHD. 
• Secondary causes4,6 
o Vigorous and sustained aerobic exercise (eg, long-distance running) 
o Regular, substantial alcohol consumption 
o Treatment with oral estrogens, particularly if not opposed by progestins 
o Treatment with statins 
• 
o Treatment with nicotinic acid (niacin) at doses greater than 1 g/d 
• 
o Treatment with phenytoin 
o Primary biliary cirrhosis 
o Treatment with fibrates (eg, bezafibrate, clofibrate, fenofibrate, gemfibrozil) 


94)normal distribution curve what is correct . .mean=median…answer 

The normal distribution is a symmetric distribution with well-behaved tails and a single peak at the center of the distribution. By symmetric, we mean that the distribution can be folded about an axis so that the 2 sides coincide. That is, it behaves the same to the left and right of some center point. For a normal distribution, the mean, median, and mode are actually equivalent. The histogram above generates similar estimates for the mean, median, and mode. Therefore, if a histogram or normal probability plot indicates that your data are approximated well by a normal distribution, then it is reasonable to use the mean as the location estimator. 

95)vortex keratopathy NOT seen in…copper excess..answer.. 

Rest all..ie fabry,amiodarone and chloroquine cause it. 


96)pregnancy by ELISA first detected on….first day of missed cycle of 28 day duration..answer… 


97)not used in heroine detoxification….disulfiram answer.. 

A range of treatments exist for heroin addiction, including medications and behavioral therapies. Science has taught us that when medication treatment is combined with other supportive services, patients are often able to stop using heroin (or other opiates) and return to stable and productive lives. 
Treatment usually begins with medically assisted detoxification to help patients withdraw from the drug safely. Medications such as clonidine and buprenorphine can be used to help minimize symptoms of withdrawal. However, detoxification alone is not treatment and has not been shown to be effective in preventing relapse—it is merely the first step. 
Medications to help prevent relapse include the following: 
• Methadone has been used for more than 30 years to treat heroin addiction. It is a synthetic opiate medication that binds to the same receptors as heroin; but when taken orally, it has a gradual onset of action and sustained effects, reducing the desire for other opioid drugs while preventing withdrawal symptoms. Properly administered, methadone is not intoxicating or sedating, and its effects do not interfere with ordinary daily activities. Methadone maintenance treatment is usually conducted in specialized opiate treatment programs. The most effective methadone maintenance programs include individual and/or group counseling, as well as provision of or referral to other needed medical, psychological, and social services. 
• Buprenorphine is a more recently approved treatment for heroin addiction (and other opiates). Compared with methadone, buprenorphine produces less risk for overdose and withdrawal effects and produces a lower level of physical dependence, so patients who discontinue the medication generally have fewer withdrawal symptoms than those who stop taking methadone. The development of buprenorphine and its authorized use in physicians’ offices give opiate-addicted patients more medical options and extend the reach of addiction medication. Its accessibility may even prompt attempts to obtain treatment earlier. However, not all patients respond to buprenorphine—some continue to require treatment with methadone. 
• Naltrexone is approved for treating heroin addiction but has not been widely utilized due to poor patient compliance. This medication blocks opioids from binding to their receptors and thus prevents an addicted individual from feeling the effects of the drug. Naltrexone as a treatment for opioid addiction is usually prescribed in outpatient medical settings, although initiation of the treatment often begins after medical detoxification in a residential setting. To prevent withdrawal symptoms, individuals must be medically detoxified and opioid-free for several days before taking naltrexone. 
• Naloxone is a shorter-acting opioid receptor blocker, used to treat cases of overdose. 
For pregnant heroin abusers, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse. Preliminary evidence suggests that buprenorphine may also be a safe and effective treatment during pregnancy, although infants exposed to either methadone or buprenorphine prenatally may still require treatment for withdrawal symptoms. For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with medical supervision, although potential risks to the fetus and the likelihood of relapse to heroin use should be considered. 
There are many effective behavioral treatments available for heroin addiction—usually in combination with medication. These can be delivered in residential or outpatient settings. Examples are individual or group counseling; contingency management, which uses a voucher-based system where patients earn “points” based on negative drug tests—these points can be exchanged for items that encourage healthy living; and cognitive-behavioral therapy, designed to help modify a patient’s expectations and behaviors related to drug abuse, and to increase skills in coping with various life stressors. 


99)once a week pill…centchroman…answer.. 
Ormeloxifene(centchroman) may be used as a weekly oral contraceptive. This is touted as a major advantage by its developer and its manufacturer. Hormonal birth control pills should be taken at approximately the same time each day. In the case of progestogen only pills other than Cerazette that do not consistently inhibit ovulation, a delay of as little as three hours can increase the risk of pregnancy because of the limited duration of their effect on the cervical mucus. Ormeloxifene's weekly schedule is an advantage for women who prefer an oral contraceptive, but find it difficult or impractical to adhere to a daily schedule. 
For the first sixteen weeks of use, it is advised to take the ormeloxifene pill twice per week. From the thirteenth week on, it is taken once per week. [5] The consensus is that backup protection in the first month is a cautious but sensible choice. A standard dose is 30mg weekly, but 60mg loading doses can reduce pregnancy rates by 38%. [6] 

100)no birth dat…child woman ratio …answer..