Anatomy

1. Gluteus medius is supplied by Superior gluteal nerve artery.

1. Flexor hallucis longus tendon passes below the sustentaculum tali.

2. Tibialis posterior has attachments on sustentaculum tali.

3. Urogenital diaphragm is made up of Deep transverse perineal, perineal membrane and superior and inferior fascia of Urogenital diaphragm.

4. Hypogastric sheath is a condensation of Pelvic fascia.

5. Lymphatics from spongy urethra drain into deep inguinal nodes.

6. Location of celiac plexus is Anterolateral to aorta.

7. In post-ductal coarctation of aorta collaterals may be formed by vertebral artery, Suprascapular artery, Subscapular artery and posterior intercostal artery.

8. Vertebral artery passes through foramen magnum.

9. Movements occurring during abduction of shoulder includes elevation of humerus, axial rotation of clavicle and acromioclavicular joint movement.

10. Flexor digitorum profundus, Pectineus and Biceps femoris are composite muscles.

11. Left sided superior vena cava drains into Coronary sinus.

Physiology

1. Vitamin K dependent coagulation factors includes factors IX and X.

1. During heavy exercise cardiac output (CO) increases upto 5 times while pulmonary arterial pressure rises very little. This physiological ability of the pulmonary circulation is best explained by increase in number of open capillaries.

2. Venous return to heart during quiet standing is facilitated by Calf muscles contraction during standing, Valves in perforators and sleeves of deep fascia.

3. During cardiac imaging the phase of minimum motion of heart is mid diastole.

4. Bronchial circulation contribute 2% of systemic circulation, causes venous admixing of blood and provides nutritive function to lung.

5. An important non-respiratory function of lungs is Sodium balance.

6. Maximum water reabsorption in the gastrointestinal tract occurs in Jejunum.

7. Primary action of Nitric oxide (NO) in GI tract is gastrointestinal smooth muscle relaxation.

8. Hot water bottle relieves pain of abdominal spasm of stimulation of adrenergic fibers.

9. Insulin secretion is inhibited by Epinephrine.

10. Estrous cycle is not seen in humans.

11. Lesions of the lateral cerebellum causes Incoordination, Intention tremors and Ataxia.

12. Low CSF protein may be seen in Recurrent lumbar puncture, pseudotumor cerebri and Infants.

13. Basal metabolic rate depends most closely on Lean body mass.

14. Decreased basal metabolic rate is seen in Obesity.

Biochemistry

1. Inulin Like fructans are used as prebiotics as they are non-digestible resistance to digestion in the upper GI tract results from beta configuration of anomeric C2.

1. Branched chain keto acid decarboxylase is defective in Maple syrup urine disease.

2. Sphingomyelinase deficiency is seen in Niemann Pick disease.

3. VLDL, LDL and HDL moves towards charges end in electrophoresis but Chylomicrons do not.

4. Method of chromatography where molecules that are negatively charged are selectively released from stationary phase into the positively charged molecules in mobile phase is termed Ion exchange chromatography.

5. Rothera’s test is used for detection of Ketones.

6. Predominantly mitochondrial liver enzyme is SGOT (AST).

7. Microarray is used for detection of variation in DNA sequence and Gene expression.

8. FISH, RT-PCR and QF-PCR are used for detection of specific aneuploidy.

9. Prenatal diagnosis of Hemophilia is best done by PCR.

Pharmacology

1. Narrow therapeutic index is seen with Lithium.

1. Omeprazole is a Proton pump inhibitor.

2. Mechanism of action of Theophylline in Bronchial asthma includes Phosphodiesterase inhibition, adenosine receptor antagonism and increased Histone deacetylation.

3. Methyldopa is primarily used in pregnancy induced hypertension.

4. Naloxone can be used for treatment of opioid induced constipation.

5. Naltrexone may be used for treatment of alcohol dependence.

6. Nalmefene has a longer half-life than Naloxone.

7. L-Dopa is combined with Carbidopa in the treatment of Parkinsonism to inhibit peripheral decarboxylation of levodopa.

8. Tricyclic antidepressants should not be used with Rivastigmine in patients with Alzheimer’s disease.

9. Ethosuximide is the drug of choice for absence seizures.

10. Phenytoin follows saturation kinetic, is teratogenic and is highly protein bound.

11. Fetal hydantoin syndrome is caused by Phenytoin.

12. Teratogenic effect of Phenytoin is cleft lip/ palate, Valproate causes neural tube defects and Warfarin causes nasal bone dysplasia.

13. Drugs causing Hirsutism includes Danazol, Phenytoin and Norethisterone.

14. Most common congenital anomaly associated with Lithium is Cardiac malformations.

15. Drugs used for prophylaxis of Migraine includes Propranolol, Valproate and Topiramate.

16. MAO inhibitors should not be used with Pethidine/ Meperidine, Pentazocine, Dextromethorphan and Tramadol.Serotonin syndrome may be precipitated by Pentazocine, Buspirone and Meperidine.

17. Most suitable drug for young male with meningococcal meningitis and allergy to penicillin is Chloramphenicol.

18. Platelet count should be monitored in patient receiving linezolid therapy.

19. Thalidomide has been reintroduced for its activity in ENL, it was developed as antiemetic in pregnancy but withdrawal because of phocomelia and used for new and relapsed cases of Multiple myeloma.

20. Pancreatitis occurs with Didanosine.

21. Lapatinib has activity on both HER 1 and HER 2 neu receptors.

22. Tyrosine kinase inhibitors are used in treatment of gastrointestinal stromal tumours (GIST).

23. Imatinib is recommended for treatment of GIST.

24. Amphotericin B toxicity can be lowered by using liposomal delivery systems.

25. Mycophenolate Mofetil is used in transplant rejection, it is a prodrug and converted to Mycophenolic acid and is not used with Azathioprine.

26. Drug recommended for the treatment of Heparin induced thrombocytopenia is Lepirudin.

27. Trientine is alternative o penicillamine in non-tolerant, it is not given with iron within two hours of ingestion and may cause iron deficiency anemia.

28. Allopurinol is used in the treatment of Gout.

29. In equivalent concentrations, steroids are more potent in Ointment form.

Pathology

1. Features of Apoptosis includes Nuclear compaction, intact cell membrane and cytoplasmic eosinophilia.

1. Caspases are involved in Apoptosis.

2. Actions of Bradykinin includes Vasodilatation, increased vascular permeability and pain.

3. Most important role of Bradykinin in acute inflammation is to increase vascular permeability.

4. Heterozygous sickle cell anemia gives protection against Malaria.

5. PNH is associated with a deficiency of DAF, MIRL and GP1 anchored protein.

6. PNH is associated with deficiency of GPI anchored proteins (glycosyl phosphatidylinositol anchored proteins).

7. Burkitt’s lymphoma is associated with t (8:14).

8. Translocation t (2:8) (p12:q24) is associated with Burkitt’s lymphoma.

9. Plasmacytoid lymphomas may be associated with IgM.

10. Infective endocarditis has most friable vegetation.

11. Characteristic pathological finding in carcinoid heart disease is fibrous endocardial thickening of right ventricle, tricuspid valve and pulmonary valve.

12. Woman with progressive breathlessness and heterogeneous patchy fibrosis with several fibroblastic foci. Most likely diagnosis is usual interstitial pneumonia.

13. Chromophobe variant of Renal cell carcinoma is associated with Monosomy of  and Y (-1, -Y).

14. Hypercoagulation in nephrotic syndrome is caused by Loss of antithrombin III.

15. CD117 is marker specific for GIST.

16. Wegener’s granulomatosis, Takayasu arteritis and Giant cell arteritis are associated with granulomatous pathology.

17. Electron microscopy is diagnostic in Alport’s syndrome.

18. Most characteristic ultrastructural features of paraganglioma on electron microscopy is dense core neuroendocrine granules.

19. CD 1a is a marker for Langerhans cell histiocytosis.

20. Down’s syndrome is most commonly caused by Maternal nondisjunction.

21. A normal couple with 1 daughter affected with autosomal recessive disease. Chances of sibling being affected by the disease is 1/4.

22. Males are more commonly affected than women in X-linked recessive diseases.

Microbiology

1. Peptide binding site on class 1 MHC molecules for presenting processed antigens to CD8 T cells is formed by Distal domain of alpha subunit.

1. Penicillin binding proteins (PBP 0 are essential for cell wall synthesis, they act as carboxypeptidases and transpeptidases and alteration in PBP’s is the primary bases of resistance in MRSA.

2. In penicillin resistance Beta lactamase production is the most common mechanism of resistance, alteration in permeability/ penetration of antibiotic causes resistance only in Gram negative bacteria and beta lactamase production causes resistance in both gram positive and gram negative bacteria.

3. About 30% of general population is healthy nasal carriers, epidermolysis and TSS toxin are superantigens and methicillin resistance is chromosomally mediated.

4. Child with sepsis, beta hemolysis on blood agar, resistance to bacitracin and a positive CAMP test. Most probable organism causing infection is S. agalactiae.

5. El tor vibrios have humans as only reservoir, can survive in ice-cold water for 2-4 weeks and killed by boiling for 30 seconds.

6. Isolation of Chlamydia from tissue specimen can be done by Yolk sac inoculation.

7. Varicella zoster remains latent in Trigeminal ganglion.

8. Most common genital lesion in HIV patient is Herpes.

9. Clonorchis may be caused by biliary obstruction.

10. Young woman with recurrent rhinitis, nasal discharge and bilateral nasal blockage since1 year, h/o allergy and asthma, multiple polyps with mucosal thickening and impacted secretions in nasal hyphae with dichotomous branching typically at 45 degree. Most likely organism responsible is Aspergillus.

11. Diabetic patient with bloody nasal discharge, orbital swelling and pain and on culture showed branching septate hyphae. Most probable organism involved is Aspergillus.

Forensic Medicine

1. Primary impact injuries are commonly seen in Legs.

1. Dum Dum bullet leaves a visible mark, so that a person can see it.

2. Lightning flash can cause injury by direct effect of electric current, superheated air and expanded and repealed air.

3. For a suspected dowry death within 5 years of marriage, magistrate can authorize autopsy of the case under section 176 CrPC.

4. Factory worker with excessive salivation, blue lines on gums, tremors, disturbed personality, insomnia and loss of appetite. Most likely poisoning is Lead.

5. Aconite poisoning causes hypersalivation, tingling and numbness and chest pain.

6. Drug used for Narco Analysis are Scopolamine, Na Pentothal, Na amytal and Na seconal.

PSM

1. Movement across socioeconomic levels is termed as social mobility.

1. Practice is associated with emotional valence and is most likely to be influenced by motivation.

2. ASHA is posted at PHC.

3. JSY stands for janani Suraksha Yojana.

4. Provision of Primary health care was done by Alma-Ata declaration.

5. Essential components of primary health care includes provision of essential drugs, immunization against infectious diseases and health education.

6. Community participation is the current trend in health care.

7. Planning of intervention by community best reflects the highest level of community participation.

8. Maternal mortality rate (MMR) has numerator that includes total number of women deaths within 42 day’s of delivery, it is expressed as a rate and not a ratio and it is expressed per 100000.

9. Perinatal mortality rate includes stillborns and death within 7 days of birth.

10. IMNCI differs from IMCI in that malaria and anemia are included in it, 0-7 days neonates are included and emphasis on management of sick neonates over sick older children.

11. Mass chemoprophylaxis in endemic area is recommended for Yaws, Trachoma and Filaria.

12. Rural and urban difference in prevalence is seen in lung cancer, TB and chronic bronchitis.

13. For tuberculosis Annual Rate of Infection (ARI0, he average estimated ARI for India is 1.7%, AIRI reflects the current trend and effectiveness o control measures and ARI represents the percentage new infections.

14. Scrub typhus is caused by O. tsutsugamushi, mites act as reservoir and tetracycline is the drug of choice.

15. Factors contributing to resurgence of malaria includes drug resistance in parasite, drug resistance in vectors and antigenic variation in parasite.

16. A case of acute flaccid paralysis must be observed for 60 days for residual weakness.

17. Indian aims to eliminate Filariasis by 2015.

18. Screening strategy for prevention of blindness from diabetic retinopathy according to NPCB involves high risk screening.

19. 95% confidence interval will cover 2 standard errors around the mean.

20. A standard Z-score is related to normal distribution.

21. For a new test for diabetes, 80 people tested positive out of which only 40 had diabetes and out of 9920 people who were tested negative only 9840 did not have disease. Sensitivity of this new test is 33%.

22. Population on 1st June was 1, 65,000, Total number of new cases of TB from 1st-31st June were 22. Total registered cases of TB in community were recorded as 220. Incidence of TB in this community per 10 lakh population is 133.

23. In Red Cross emblem size of bars in the cross is equal horizontally and vertically, misuse of emblem is punishable offense under Indian law and was convened in Geneva.

24. Synthetic pyrethroid compounds includes Permethrin, propathrin and Cypermethrin.

Medicine

1. 16 year old girl with h/o fatigability, weakness and lethargy. Hb 7, MCV 70, MCH 20 pg/cell and red cell distribution width (RDW) of 20. Most likely diagnosis is Iron deficiency anemia.

1. Presence of JAK2 mutation is a major criteria for diagnosis of polycythaemia.

2. Fanconi’s anemia has hypo cellular bone marrow, congenital anomalies and usually normocytic/ microcytic cell morphology.

3. Direct Coomb’s test should be done immediately to best confirm a non-matched blood transfusion reaction.

4. Bence Jones proteinuria may be seen in ‘Mu’ heavy chain disease.

5. Bence Jones proteins are derived from Gamma globulins.

6. 3rd heart sound is seen in constrictive pericarditis, in atrial septal defect (ASD) and in VSD.

7. A young asymptomatic woman is observed to have a Midsystolic Click on routine examination. Valves are likely to show Myxomatous degeneration.

8. Beck’s Triad is seen in Cardiac tamponade.

9. Accelerated idioventricular rhythm (AIVR) is the common arrhythmia associated with Myocardial reperfusion.

10. Streptokinase and urokinase are contraindicated in Intracranial malignancy.

11. Patient with pH 7.5, pCO2 30 mm Hg, pO2 102 mm Hg and HCO3 16 meq/L. This compensatory mechanism is seen in Metabolic acidosis.

12. 29-year-old anxious woman with h/o progressive breathlessness and exercise intolerance since 4 months. Her FVC is 90% and FEV1/FVC is 86%. Oxygen saturation after exercise was observed to drop from 92% to 86%. Likely diagnosis is Primary pulmonary hypertension.

13. Truck driver with h/o fever since 4 weeks, dry cough, weight loss of 10 kg and X-ray shows bilateral reticulonodular infiltrates. Most likely diagnosis is Pneumocystis carinii Pneumonia.

14. Cavitary lesions in lung are seen in Staphylococcal pneumonia.

15. Oat cell variant of lung carcinoma is typically associated with hilar adenopathy.

16. Plasma urea/ creatinine ratio of 20:1 may be seen in Pre-renal failure.

17. Prerenal azotemia is characterized by fractional excretion of Na <1%, urinary osmolality >200 mosm/kg and reversible with replacement fluids.

18. Lady with non-progressive dysphagia only for solids and barium study shows proximal esophageal dilatation with distal constriction. Most likely diagnosis is Lower esophageal ring.

19. Young girl with abdominal pain, recent change in bowel habit with passage of mucus in stool. No associated blood in stool and symptoms are increased with stress. Most likely diagnosis is Irritable bowel syndrome.

20. Elderly patient with prolonged h/o weakness and lethargy, he is anemic and stool is positive for occult blood. Investigation of choice is Colonoscopy.

21. HBsAg asymptomatic patient with normal liver enzymes. He is inactive HBV carrier.

22. Male is HbsAg and anti Hbe antibody positive and HBeAg positive. HBV DNA copies are 10, 00,000/ml while SGOT and SGPT are elevated to 6 times the upper limit of normal value. Likely diagnosis is HBV pre-core mutant.

23. Patient with unconjugated hyperbilirubinemia and urobilinogen in urine. Probable diagnosis includes Hemolytic jaundice (most likely), Crigler Najjar syndrome and Gilbert’s syndrome.

24. Wilson’s disease has low serum ceruloplasmin and high urinary copper.

25. Gout is a disorder of Purine metabolism.

26. In primary Gouty arthritis uric acid levels am ybe normal at the time of an acute attack, men are more commonly affected than women and definitive diagnosis requires aspiration of synovial fluid.

27. Antiphospholipid antibody (APL) syndrome is associated with thrombotic disorders, coagulation disorder, recurrent fetal loss, may cause pulmonary hypertension and Warfarin is given as treatment.

28. Recommended treatment in a woman with antiphospholipid antibodies and h/o prior abortions/ stillbirth is Aspirin + LMW Heparin.

29. Myasthenia gravis, hypogammaglobulinemia and Cushing’s syndrome may be associated with Thymoma.

30. Plasmapheresis is used in Myasthenic crisis, Guillain Barre Syndrome.

31. Low calcium and high phosphate is seen in Hypoparathyroidism.

32. In pseudohypoparathyroidism there is decreased serum calcium, increased phosphate and Albright’s hereditary osteodystrophy.

33. Patient with symptoms of hypoglycemia, decreased blood glucose, increased insulin levels, C-peptide assay is done which shows normal levels of C-peptide. Most likely diagnosis is Accidental exogenous insulin administration.

34. Conditions associated with hypogonadotropic hypogonadism in males includes Viral orchitis, Klinefelter’s syndrome (most common) and Noonan syndrome.

35. Insulin deficiency is associated with peripheral artery disease, coronary heart disease and stroke.

36. Hyponatremia associated with hyperglycemia has high plasma osmolality, hyponatremia associated with SIADH is normovolemic and NSAIDS increase the potency of vasopressin.

37. Likely diagnosis of a patient with ataxia, urinary incontinence and dementia is Normal pressure hydrocephalus.

38. Patient with mitral stenosis and atrial fibrillation presents with acute onset of weakness in the left upper limb which recovered completely in 2 weeks. Most likely diagnosis is Ischemic stroke.

39. 25-year-old with acute onset fever and focal seizures. MRI shows hyperintensity in temporal lobe and frontal lobe with enhancement. Most likely diagnosis is Herpes simplex encephalitis.

40. In a patient with head injury, damage in the brain is aggravated by Hyperglycemia.

41. Anterior horn cells represents the site of lesion in Motor neuron disease.

42. Features of Guillain Barre Syndrome (GBS) includes ascending paralysis, flaccid paralysis and albuminocytological dissociation.

43. Kayser-Fleischer rings (KGF rings) are seen in Wilson’s disease.

Surgery

1. Lord’s plication is done for Hydrocele.

1. Calcium oxalate monohydrate stones are hard to break by ESWL.

2. 50-year-old woman is admitted with abdominal pain and anuria. Radiological studies revealed bilateral impacted ureteral stones with hydronephrosis. Urine shows RBCs with pus cells. Serum creatinine level was 16 mg/dL and urea 200 mmol/L. Immediate treatment should be ‘J’ stent drainage.

3. Complication expected when PCNL is done through 11th intercostal space is Hematuria.

4. Most common renal vascular anomaly is Supernumerary renal arteries.

5. 1st autologous renal transplantation was done by Hardy.

6. Most common site of urethral carcinoma is men is Bulbomembranous urethra.

7. Best time for surgery of undescended testis is 12 months of age.

8. Grayhack shunt is established between Corpora cavernosa and saphenous vein.

9. Adult with hematemesis, upper abdominal pain, growth at pyloric antrum of stomach, growth involving pyloric antrum without infiltration or invasion into surrounding structures and no evidence of distant metastasis. At laparoscopy neoplastic growth was observed to involve posterior wall of stomach and pancreas extending 6 cm upto tail of pancreas. Most appropriate surgical management is Partial gastrectomy + distal pancreatectomy.

10. Small intestine and appendix account for almost 60% of all gastrointestinal carcinoid, 5 year survival for carcinoma tumours is >60% and appendiceal carcinoids are more common in women than men.

11. Surgery of choice for a young male patient with complete rectal prolapse is abdominal rectopexy.

12. Treatment of choice for annular pancreas is Duodenojejunostomy.

13. Woman with recurrent attacks of giddiness and abdominal pain since 3 months, normal endoscopy, fasting blood glucose 40 mg%, insulin elevated, on CT abdomen well-defined 8mm enhancing lesion in head of pancreas seen. Treatment plan is Enucleation.

14. According to the Bismuth/ Strasberg classification ‘Cystic blow out’ is classified as Type A.

15. In orthotopic liver transplantation, best way to get bile drainage in donor liver is by donor bile duct with recipient bile duct or Roux en Y choledochojejunostomy.

16. Most common cysts of the spleen are Hydatid cysts.

17. Patient with fever for 3 weeks, splenomegaly, on USG hypoechoic shadow in spleen near hilum and on blood culture gram negative bacilli are isolated. Most causative organism is Salmonella.

18. Patient with ITP has a platelet count of 50,000 and is being planned for splenomegaly. Best time for platelet infusion in this patient is after ligating splenic artery.

19. Most common cause of abdominal aortic aneurysm is Atherosclerosis.

20. Primarily restrictive operations for morbid obesity includes Vertical band gastroplasty, Roux en Y operation and laparoscopic adjustable gastric banding.

21. Trauma and injury severity score (TRISS) includes RTS + ISS + Age.

22. 27-year-old patient with left sided abdominal pain to emergency room 6 hours after an RTA, hemodynamically stable, FAST positive, and CECT scan showed grade III splenic laceration. Most appropriate treatment is Conservative management.

23. Woman with stab injury to left side of abdomen, hemodynamically stable, CECT reveals laceration in spleen. Laparoscopy was patient’s pO2 suddenly dropped as soon as pneumoperitoneum was created. Most likely cause is Gaseous embolism through splenic vessels.

24. Grading method is used to evaluate prognosis/ outcome after subarachnoid hemorrhage is Hess and Hunt scale.

Pediatrics

1. Health status of a child under 5 years of age will be adversely affected by malnutrition, low birth weight and infections.

1. Neonate presented with fever, lethargy, abdominal distension, vomiting and constipation. He was diagnosed as volvulus neonatorum with suspected perforation. Best investigation would be plain X-ray.

2. 10-year-old with seizures, BP 200/140 mm Hg and femoral pulses not palpable. Most likely diagnosis is Coarctation of Aorta.

3. 7-year-old asymptomatic girl is found to have persistent hypertension, no significant history and urine examination normal. Most likely cause is Renal parenchymal disease.

4. Child presented with intermittent episodes of left sided flank pain, USG reveals large hydronephrosis with dilated renal pelvis and cortical thinning with a normal ureter, kidney differential function was observed to be 19% then best management is Pyeloplasty.

5. Child with hepatomegaly, hypoglycemia and no improvement in blood sugar even after administration of epinephrine. Likely diagnosis is Von Gierke’s disease.

6. Factors associated with a substantially greater risk of developing epilepsy after febrile seizures includes complex febrile seizures, developmental abnormalities and positive family history of epilepsy.

7. Child presents with short episodes of vacant stare several times a day which begins abruptly and child remains unresponsive during episode, no associated history of aura or postictal confusion and child is otherwise normal. Likely diagnosis is Absence seizures.

8. Drugs used in Juvenile Myoclonic Epilepsy (JME) includes Topiramate, Zonisamide and Valproate.

9. Child with h/o seizures and mental retardation, examination reveals multiple hypopigmented macules. Most likely diagnosis is Tuberous sclerosis.

10. Most common cause of meningoencephalitis in children is Enterovirus.

11. Agent most commonly associated with recurrent meningitis due to CSF leaks is Pneumococci.

12. 2-year-old child with long h/o purulent nasal discharge and fever, presents with conjunctival congestion and edema. Fever is 102 degree F and WBC count 12,000, culture of eye discharge was negative. X-ray shows opacification of ethmoid sinus. Next step of evaluation should be CT scan.

13. Boy with weakness in lower limbs, calf hypertrophy, positive Gower’s sign and elevated CPK of 10,000. Most likely diagnosis is Duchenne Muscular Dystrophy.

14. Primary metabolic bone disorder in scurvy is decreased osteoid matrix formation.

Obstetrics and Gynaecology

1. Hormonal study is the best way to assess female fertility during menstrual cycle.

1. Primary amenorrhea with absent uterus, normal breasts and scanty pubic hair is seen in Androgen insensitivity syndrome.

2. Primary amenorrhea with normal ovaries, normal external genitalia and normal;l breasts is seen in Mayer-Rokitansky-Kuster-Hauser syndrome.

3. Condition presenting with absence of both Mullerian and Wolffian duct structures is Androgen insensitivity syndrome.

4. Woman with secondary amenorrhea 6 months after having an abortion with FSH 6 mIU/ml. Most probable diagnosis is uterine synechiae.

5. Agent most commonly associated with carcinoma of cervix is HPV 16.

6. 40-year-old woman with abnormal cervical cytology on Pap smear suggestive of CIN III (HSIL). Next best step of management is Colposcopy and LEEP.

7. Sentinel lymph node biopsy is most useful for Carcinoma of vulva.

8. 52-year-old woman with constant leakage of urine and dysuria 2 weeks after complicated total abdominal hysterectomy. Diagnosis of Vesicovaginal fistula is suspected which can be confirmed by Triple swab test.

9. 52-year-old woman with vesicovaginal fistula after abdominal hysterectomy is not responding to conservative management. Most important investigation is Cystoscopy.

10. Partial mole is usually associated with Triploidy, it rarely causes persistent gestational trophoblastic neoplasia and usually present as missed abortions.

11. Conversion of a complete hydatidiform into invasive mole is indicated by Plateau HCG, enlarged uterine size and suburethral nodule.

12. Ovarian carcinoma, endometrial carcinoma and insulin resistance are associated with polycystic ovarian syndrome.

13. Most specific marker for Neural Tube defects is Acetylcholinesterase.

14. AFP is raised in Yolk sac tumor.

15. Increased Nuchal Translucency at 14 weeks gestation is seen in Down’s syndrome.

16. Non-immune hydrops fetalis is caused by parvovirus.

17. Weight gain in pregnancy depends on socioeconomic status, pre-pregnancy weight and ethnicity.

18. Twin peak sign is seen in chorionicity.

19. Treatment of choice for intrahepatic cholestasis in pregnancy is ursodiol (ursodeoxycholic acid).

20. Cardiac contraindications to pregnancy includes Eisenmenger’s syndrome, pulmonary hypertension and coarctation of aorta.

21. DOC to treat Chlamydia infection in pregnancy is Azithromycin.

22. Cleft palate is associated with polyhydramnios.

23. Lady presented with features of threatened abortion at 32 weeks of pregnancy. Antibiotic use includes, Metronidazole if patient asymptomatic but with significant bacterial vaginosis, antibiotics if asymptomatic but significant bacteremia and antibiotics for preterm premature rupture of membrane.

24. Woman with leakage for fluid per vaginum and meconium stained liquor at weeks of gestation. Most likely organism causing infection would be Listeria monocytogenes.

25. Interventions recommended in active management of 3rd stage of labour includes administered of uterotonic within 1 minute of delivery, gentle massage of uterus and controlled cord traction and not recommended is immediate clamping, cutting and ligation of cord.

26. Active management of 3rd stage of labor includes oxytocin injection, ergometrine injection, controlled cord traction and gentle massage of uterus.

27. Maneuvers used in shoulder dystocia includes Woods maneuver, McRoberts maneuver and Suprapubic pressure.

28. Interventions recommended to prevent mother to child transmission of HIV includes highly active antiretroviral therapy (HAART), elective caesarian section and intrapartum Zidovudine.

Ophthalmology

1. Endophthalmitis involves inflammation o Uvea, retina and vitreous.

1. Multidrug resistant Pseudomonas aeruginosa on keratitis has mechanism of antimicrobial resistance due to ability of Pseudomonas to produce biofilms.

2. Common types of corneal dystrophy includes Lattice type I, lattice type II and granular corneal dystrophy.

3. For corneal transplantation, specular microscopy analysis is used to assess endothelial cell count.

4. Cherry red spots are seen in Niemann Pick disease, GM1 gangliosidosis, Tay Sach’s disease and Gaucher’s disease.

5. Relative afferent pupillary defect (RAPD) is characteristically seen in damage to Optic nerve.

6. A patient with ptosis presents with retraction of the ptotic eyelid on chewing. This represents Marcus Gunn Jaw winking syndrome.

7. A patient with known mutation in ‘Rb gene’ is ‘disease free’ from Retinoblastoma. This Patient is at highest risk of developing Osteosarcoma.

8. Arden index is related to EOG (electro-oculogram).

ENT

1. Sodium fluoride in otosclerosis acts by inhibiting proteolytic enzymes in cochlea, is contraindicated in chronic nephritis and in indicated in patients with a positive Schwartze sign.

1. Vestibular Schwannoma arises most frequently from Superior vestibular nerve.

2. Otoacoustic emission arises from Outer hair cells.

3. Nasopharyngeal carcinoma has bimodal age distribution, IgA antibody to EBV is observed and squamous cell carcinoma is most common histological subtype.

4. Most common site of CSF leak is fovea ethmoidalis, beta 2 transferrin estimation is highly specific for diagnosis of CSF leak and Fluorescein dye can be used intrathecally for diagnosis of site of leak.

5. Extrinsic laryngeal membrane/ Ligaments includes Hyoepiglottic, cricotracheal and thyrohyoid.

6. Structures seen on bronchoscopy includes Trachea, Vocal cords and 1st segmental division of bronchi.

7. Child with stridor, barking cough, difficulty in breathing since 2-3 days, fever and elevated leukocyte count. Then subepiglottic stenosis and hypopharyngeal dilatation may be seen on X-ray, boys are more commonly affected than girls and symptoms are predominantly caused by involvement of subglottis.

8. Drug of choice laryngeal stenosis is Mitomycin C.

9. Co2 laser is most commonly used in Laryngeal surgery.

Orthopaedics

1. Lift off test is done to assess the function of Subscapularis.

1. Median nerve lesion at wrist causes Thenar atrophy, weakness of 1st and 2nd lumbricals and weakness of flexor pollicis brevis.

2. Lateral meniscus covers more tibial articular surface than lateral, medial meniscus is more commonly injured than lateral and Menisci are predominantly made up of Type I collagen.

3. Changes seen in articular cartilage with aging includes total proteoglycan content is decreased, synthesis of proteoglycans is decreased and total water content of cartilage is decreased.

4. Metal on Metal articulation should be avoided in Young female.

5. Patient developed breathlessness and chest pain on 2nd postoperative day after a total hip replacement. Echocardiography showed right ventricular dilatation and tricuspid regurgitation. Most likely diagnosis is Pulmonary embolism.

6. Characteristic triad of Klippel-Feil syndrome includes Short neck, low hairline and limited neck movements.

7. Progression of congenital is likely in vertebral anomalies which includes fully segmental hemivertebra, wedge vertebra and unilateral unsegmented bar with Hemivertebra.

8. Patient involved in RTA presents with quadriparesis sphincter disturbance, sensory level up to level of upper border of sternum and a respiratory rate 35/min. Likely diagnosis is C4-C5.

9. Synovial cell sarcoma occurs more often at extra articular sites, usually seen in patients less than 50 years of age and knee and foot are common sites involved.

10. Brown tumor is seen in Hyperparathyroidism.

Skin

1. Young woman with white lacy lesions in oral cavity and her proximal nail fold has extended onto nail bed. Likely diagnosis is Lichen planus.

1. Healthy male presents with creamy curd like white patch on tongue. Probable diagnosis is Candidiasis.

2. 17-year-old with acne has been taking a drug for las 2 years, now presents with blue black pigmentation of nails. Likely cause is Minocycline.

3. Treatment of erythematous rash with multiple pus lakes in a pregnant woman is Corticosteroids.

4. PAS is used to study fungal morphology in tissue sections.

Anaesthesia

1. Patient with bilirubin 8 mg/dL and serum creatinine 1.9 mg/dL is planned for surgery. Muscle relaxant of choice in this patient is Atracurium.

1. For neuromuscular blockade produced by succinylcholine there is no fade on train of four stimulation, no post tetanic facilitation and train of four ratio >0.4.

2. 25-year-old overweight woman given fentanyl-pancuronium anaesthesia for surgery. After surgery and extubation she had limited movement of upper body and chest wall in recovery, she was conscious, alert but voluntary respiratory effort was limited, BP and HR normal. Likely diagnosis is Pulmonary embolism.

3. 27-year-old woman with acute abdominal pain, laparotomy done, speedy intubation performed but after intubation breath sounds were observed to be decreased on left side and high end tidal CO2 was recorded. Likely diagnosis is Endobronchial intubation.

Radiology

1. Walls of the CT scanner room are coated with Lead.

1. Major difference between X-ray and light is Energy.

2. Alpha rays are most ionizing radiation.

3. “Background radiation’ is radiation present constantly from natural sources.

4. Absorbed dose, best estimated the amount of radiation delivered to an organ in radiation field.

5. Probability of stochastic effects is a function of dose (comulative dose).

6. ‘Eggs on side’ appearance is seen in transposition of great arteries.

7. Ct scan features of adrenal adenoma  includes calcification is rare, low attenuation and regular margins.

8. For a patient with acute renal failure and anuria, USG normal. Investigation which will give best information regarding renal function is DTPA scan.

9. Dense renogram is obtained by Rapid (bolus) injection of dye.

Psychiatry

1. Autism is characterized by lack of social interaction, delayed development of speech and stereotypic movement.

1. Cognitive error/dysfunction includes catastrophic thinking, arbitrary inference and overgeneralization.

2. Behavioural therapy includes Operant conditioning, negative reinforcement and reward.

3. Parts of cognitive behaviour change technique includes pre-contemplation, action and contemplation.

4. 60-year-old had undergone cardiac bypass 2 days back, started forgetting things and was not able to recall names and phone numbers of his relatives. Probable diagnosis is Cognitive dysfunction.

5. Alcoholic paranoia is associated with fixed delusions.

6. 60-year-old thinks he had committed sins throughout his life, is depressed and has considered committing suicide but has not through hot to go about it. He had also attended sessions of spiritual guru. He is not convinced by his wife that he has lead a pious life. He doesn’t want to hear anything on contrary. Treatment should be antipsychotic + antidepressant.

7. 30-year-old man since 2 months suspects that his wife is having affair with his boss, his friend is also involved from abroad and is providing technology support and people talk about him. His friend tried to convince him but he is not. Most likely diagnosis is Persistent delusional disorder.

8. 25-year-old woman with sadness, palpitations, loss of appetite and insomnia. No complaints of hopelessness, suicidal thoughts and no past h/o any precipitating event and otherwise normal life and behaviour. Most probable diagnosis is generalized anxiety disorder (GAD).

9. Patient in emergency with self-harm and indicates suicidal intent. Condition that does not warrant an immediate specialist assessment is acute alcohol intoxication.

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