Medcoffee 2 Flashcards
Cervical sympathetic chain damage will cause?
sweating
decrease hearing
shoulder drop
increased papillary constriction
dec. pupil response
D) Reason
Miosis (pupil constriction)Associated with lesion of spinal cord above T1 (e.g., Pancoast tumor, Brown-Séquard syndrome [cord hemisection], late-stage syringomyelia).
maximum oxygen concentration in fetal blood is in?
umblical artery
umblical vein
umbilical cord
umbilical vesicle
pulmonary artery
B) Reason
During fetal circulation, oxygenated blood from the placenta to the fetus passes through the umbilical vein. Three vascular shunts develop in the fetal circulation to bypass blood flow around the liver and lungs.
unmyelinated pain receptors?
C fibers
A fibers
B fibers
delta fiber
D fibers
A) Reason
■ Fast pain is carried by group III fibers. It has a rapid onset and offset, and is localized.■ Slow pain is carried by C fibers (unmylenated). It is characterized as aching, burning, or throbbing that is poorly localized.
bronchopulmonary segment is supplied by?
primay bronchioles
secondary broncheoles
tertiary bronchioles
main bronchus
Quaternary bronchioles
C) Reason
Bronchopulmonary segments are the anatomic, functional,and surgical units of the lungs. Each lobar (secondary)bronchus, which passes to a lobe of the lung, gives offbranches called segmental (tertiary) bronchi
immediate action of angiotensin2?
vasoconstrition
Vasodilation
dec. renin
dec. Sympathetic flow
dec. BP
A) Reason
There are 4 effects of Angiotensin-II: 1) Increases Aldosterone 2) Increases Na-H exchange at PCTs (3) It increases thirst and therefore water intake.(4) It causes vasoconstriction of the arterioles, thereby increasing TPR and arterial pressure.
vitamin required for ALT?
B1
B3
B2
B9
B6
E) Reason
FUNCTION: Converted to pyridoxal phosphate, a cofactor used in transamination (e.g., ALT and AST), decarboxylation reactions, glycogen phosphorylase.
danger area of scalp containing vessels connecting emissary vein?
calvaria
loose conective tissue layer
pia matter
dura matter
Arachnoid
B) Reason
• Emissary veins are valveless channels that course through the bones of the skull and allow dural sinuses to communicate with extracranial veins. They can spread infection to dural sinuses when loose connective tissue layer is damaged
cortisol decreases ?
gluconeogenesis
peripheral utilization of glucose
glycogenolysis
pigmentation
pain threshold
B) Reason
Funtions: Increases Insulin resistance (diabetogenic)leading to decreased glucose use in periphral tissue.Increases Gluconeogenesis, lipolysis, and proteolysisDecreases ibroblast activity (causes striae) Decreases Inflammatory and Immune responses:
posterior cervical lymph node biopsy,nerve most likely to damage is?
CN XI
CN IX
CN X
spinal part of CN IX
CN XII
D) Reason
The spinal root of the accessory nerve arises from the nervecells in the anterior gray column of the upper five segmentsof the cervical part of the spinal cord .
About immunodeficiency conditions
The AIDS is secondary to HIV
The swiss type agammaglobulinemia is hereditary and deficient in both humoral as well as in cellular immunity
The bruton”s disease is an aplasia of T lymohocytes.
The multiple myloma is associatd with hypegammaglobulinemia
They may be primary to anemia, malnutrition, and metastases of bone
B) Reason
This is severe combined immunodeficiency deficiency that affects both B & T-cells.
A diabetic patient with ketoacidosis is being treated ,which will potentiate hypokalemia?
insulin
epinephrine
ampicillin
glucagon
cortisol
A) Reason
intracellular K+ comes out in exchange for H+ moving into the cells. Hence care should be taken while correcting acidosis which may lead to sudden hypokalemia. This is more likely to happen in treating diabetic ketoacidosis by giving glucose and insulin together.
Afebrile young patient presents with signs and symptoms of increased intracranial pressure ,what is probable cause?
miningitis
encephalitis
hydrocephalus
alzehmer disease
Parkinson”s
C) Reason
decreased CSF absorption or increased production by arachnoid granulations, which can lead to increased intracranial pressure, papilledema, and herniation .
scabies itching due to HSR of mice
proteins
lipids
feaces
polysacchride coat
wings
C) Reason
The pruritic lesions result from a delayed hypersensitivity reaction to the feaces of the mite. The mite is located within the stratum corneum of the epidermis.
scenario of RTA,maximum blood loss from?
heart
arterioles
arteries
kidneys
vein and venules
E) Reason
Veins and venules have more calibre and capacitance than that of arteries and accumulate more blood, and hence blood loss will be max from these vessels.
connected to desmosome are?
Tubulin
Intermediate filaments
Microfilaments
microtubules
cillia
B) Reason
Cadherins span between the cell membranes of desmosomes and internally desmosomes are anchored to intermediate filaments in large bundles called tonofilarnent
Most commonly associated with smoking among these?
CA bladder
CA esophagus
thromboangitis obilitarans
CA stomach
Churg Strauss
C) Reason
Thromboangiitis obliterans ( Buerger disease) is an acute inflammation involving small- to medium-sized a rteries of the extremities, extending to adjacent veins and nerves.1. This disease results in painful ischemic disease. often leading to gangrene. 2. It is clearly exacerbated by heavy cigarette smoking.
HCO3 is absorbed from?
DCT
collecting ducts
loop of henle
PCT
PCT & DCT
D) Reason
Early proximal convoluted tubule (PCT)—contains brush border. Reabsorbs all of the glucose and amino acids and most of the HCO3–, Na+, Cl–, PO4–, K+, and H2O.
injury to foramen ovale,which part of face is affected?
forehead
upper 1/3rd
middle 1/3rd
scalp
lower 1/3rd
E) Reason
The foramen ovale lies posterolateral to the foramen rotundum . It perforates the greater wing of the sphenoid, and it transmits the sensory and the motor roots of themandibular division (supplies the lower 1/3 rd of face) of the trigeminal nerve. It also transmitsthe lesser petrosal nerve .
a man running on a tread mill heart rate is doubled,effect on cardiac cycle?
0.2sec
- 1 sec
- 4 sec
- 6 sec
- 8 sec
C) Reason
Cardiac Cycle= 1mint/ number of beats that 60 sec/72= 0.82 sec. As the heart rate becomes double, the cardiac cycle duration will become half that is 0.4sec.
TM joint stability ligament?
articular surfaces
joint capsule
stylomandibular
stylomastoid
lateral temporomandibular
E) Reason
The lateral temporomandibular ligament is attached aboveto the articular tubercle at the root of the zygomatic archand below to the neck of the mandible. The fibers extenddownward and backward. This ligament limits the posteriormovement of the mandible.
An old man presents with history of bone pains, serum alkaline phosphatase is high and serum calcium is normal .most likely is is
Metastatic bone disease
Multiple myeloma
Osteomalacia
Paget”s disease of bones
Renal osteodystrohy
D) Reason
Paget Disease is the localized lesion of the bones in which there is imbalance b/w the osteoblasts and osteoclasts activity but serum Ca remains normal.
maximum feedback for blood pressure?
baroreceptor
brain bridge reflex
CNS Ischemic response
renin
chemoreceptor
A) Reason
■ The most important mechanisms for regulating arterial pressure are a fast, neurally mediated baroreceptor mechanism and a slower, hormonally regulated renin–angiotensin–aldosterone mechanism
Textile factory worker,which disease?
bysinosis
asbestosis
silicosis
asthma
pneumoconeosis
A) Reason
Organic Dusts include: Cotton, flax, hemp present in Textile manufacturing cuase ByssinosisRed cedar dust present in Lumbering, carpentry cause Asthma.
markers on B-cell?
CD3
CD 8,9
CD 19,20
CD 10,11
CD 22,28
C) Reason
B cells Ig (binds antigen)CD19, CD20, CD21 (receptor for EBV), CD40MHC II, B7
least mediated by local metabolites?
brain
blood vessels
kidney
skin
heart
D) Reason
Skin is richly supplied by the extensive distribution of the sympathetic nerve fibers. Its blood flow is least affected hy local metabolites rather is mediated by sympathetic stimulation or inhibition.
knee jerk?
L1-2
L2-3
L5-S1
L4-5
L3-4
E) Reason
Route Values of the different Deep Tendon reflexes are as: Bicep C5-6, Tricep: C3-4, Supinator C6-7, Knee Jerk L3-4, Ankle S1 and Jaw jerk V5 (CN V).
HIV patient is sero positive,what first step you would do?
isolate the patient for 1-2 months then test
treat immidiately
divorce spouse
leave home
admit in HIV clinic
A) Reason
ELISA/Western blot tests look for antibodies to viral proteins; these tests often are falsely negative in the first 1–2 months of HIV infection till you isolate the patient. It is falsely positive initially in babies born to infected mothers (anti-gp120 crosses placenta).
at FRC?
chest wall recoil
chest wall expand and lung recoils
lung expand
chest wall expand
lungs recoil
B) Reason
At FRC, inward pull of lung is balanced by outward pull of chest wall, and system pressure is atmospheric
Right sided weakness and left sided eye deviation,lesion is in?
right cortex
left cerebral cortex
corpus callosum
corona radiata
midbrain
B) Reason
In our brain, right side of body is controlled by left hemisphere and vice versa. So right side of body weakness is the feature of left sided lesion in brain and vice versa.
blood transfusion reaction?
O to A
O to B
O to AB
O+ to O-
A to AB
E) Reason
When A blood group is donated to a patient with blood group AB, Anti-B Antibodies of A blood group will damage the B antigens of AB blood group laeding to mismatch reaction.
virulence of staph aureus?
membrane lipids
cell membrane
polysacchride coat
coagulase +ve
cell wall
D) Reason
Staph make catalase because they have more “staff.” Bad staph (aureus) make coagulase and toxins. Forms fibrin clot around self leading to abscess.
minimum amount of urine reqired for draining wastes from body in
100ml
200-300ml
300-400ml
1200ml
500-600ml
E) Reason
Minimum amount (volume) of urine output that can prevwnt the adverse level of nitrogeneous wastes is 0.5ml/kg/hr that comes to be about 500-800ml in a person of 50-70kg.
In a patient with COPD which will inc
ERV
FVC
FEV
FRC
None of these
D) Reason
Obstructive lung volumes > normal (inc. TLC, inc. FRC, inc.RV); restrictive lung volumes < normal. In both obstructive and restrictive, FEV1 and FVC are reduced. In obstructive, however, FEV1 is more dramatically reduced compared to FVC, resulting in a decreased FEV1/FVC ratio.
Pterygoplatine fossa is also called
retropharyngeal
hypopharyngeal
parapharyngeal
deep vertebral
deep cervical
C) Reason
The pterygopalatine ganglion is a parasympathetic ganglion, which is suspended from the maxillary nerve in thepterygopalatine fossa (parapharyngeal fossa). It is secretomotor to the lacrimal andthe nasal glands .
which factor stabilize fibrinogen
factor X
Factor XI
factor XII
factor IX
factor 13
E) Reason
Factor X: Stuart factor; Stuart-Prower factorFactor XI: Plasma thromboplastin antecedent (PTA); antihemophilic factor CFactor XII: Hageman factorFactor XIII: Fibrin-stabilizing factorPrekallikrein: Fletcher factorHigh-molecular-weight Fitzgerald factor; HMWK.
Sudden loss of vision in one eye in an old man, what can be the cause
hypertension
Diabetes meillitis
retinal detachment
SLE
giant cell arteritis
E) Reason
Giant cell Arteritis: Clinical manifestations include: (1) Malaise and fatigue (2) Headache or claudication of the jaw (3) Tenderness, absent pulse, and palpable nodules along the course of the involved artery (4) Visual impairment, especially with involvement of the ophthalmic artery (5) Polymyalgia rheumatica, a complex of symptoms.
Muscle involved in dorsiflexion at ankle joint
tibialis longus
peroneus brevis
peroneus longus
tibialis posterior
tibialis anterior
E) Reason
• Dorsiflexion (toes pointing upward): Tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus tertius muscles
In Hypertensive retinopathy, which vessels will be affected
Capillaries
arterioles
arteries
venules
veins
A) Reason
- Non-proliferative: Manifestations include micro aneurysms, dilation of veins, hemorrhages, soft (cottonwool) exudates (microinfarcts), and hard exudates (deposits of protein that have leaked from damaged capillaries) , all of which can be viewed with the ophthalmoscope. b. The retinopathy also includes increased capillary permeability, edema, and diffuse thickening of basement membranes (microangiopathy) . c. The disorder is related to the duration of the disease, occurring in most patients with diabetes mellitus after 10 years. 2. Proliferative retinopathy:. New retinal vessel formation (neovascularization) and fibrosis, both extending into the vitreous, is characteristic.
Free nerve endings are the receptors for
touch
pressure
deep touch
tactile
Pain
E) Reason
The receptors for pain are free nerve endings in the skin, muscle, and viscera.■ Neurotransmitters for nociceptors include substance P. Inhibition of the release of substance P is the basis of pain relief by opioids.
Upper fibers of external oblique interdigitate with
serratus posterior
external oblique
tranversus abdominis
quadratus lumborum
serratus anterior
E) Reason
External oblique aponeurosis, reinforced laterally by origin of the internal oblique from the inguinalligament. Posteriorly, its upper fibers interdigitate with serratus anterior
Major Primary fetal adrenal cortex hormone is
estrogen
LH
Testosterone
DHEA
Aldosterone
D) Reason
Estrogens are produced by the interplay of the fetal adrenal gland and the placenta. The fetal adrenal gland synthesizes dehydroepiandrosterone-sulfate (DHEA-S), which is then hydroxylated in the fetal liver.
Bone marrow is present in
metaphysis
epiphysis
diaphysis
prophysis
compact bone
C) Reason
The central most portion of the diaphysis of larger long bones is filled with bone marrow, either hematopoietically active or fatty, without intervening bony trabeculae.
Cause of Atheroma can be
inc. HDL
dec. chylomicron
increased LDL
dec. LDL
inc. glycogen
C) Reason
Inflammation important in pathogenesis. Endothelial cell dysfunction causes macrophage and LDL accumulation leads to foam cell formation- fatty streaks- smooth muscle cell migration (involves PDGF and FGF), proliferation, and extracellular matrix deposition lead to fibrous plaque leads to complex atheromas
Athelet at rest, what will be changed in comparison to non-athlete
dec. stroke vol.
increased stroke vol.
dec. Cardiac output
inc. cardiac output
no effect in stroke vol.
B) Reason
In Athletes, there is physiological polycythemia that causes dec. heart rate. But at rest heart rate decreases more and hence stroke volume increases in order to maintain the cardiac output. (Cardiac Output= stroke volume x heart rate).
Satiety center is present in which part of hypothalamus
anterior
medial
anterolateral
anteromedial
ventmedial
E) Reason
Ventromedial area: It contains Satiety. Destruction (e.g.craniopharyngioma) leada to hyperphagia. Stimulated by leptin.
Increased time for ventricular filling, cause is
AV nodal delay
SA node
Purkingi fibers
bundle of his
AV fibers
A) Reason
SA node “pacemaker” inherent dominance with slow phase of upstroke.AV node—100-msec delay—atrioventricular delay; allows time for ventricular filling
Warfarin quick reversal by
vit. K
ffp
vit. K & FFP
Protamin
protein C
B) Reason
In an acute setting, Warfarin toxicity is treated with FFP and in prolong management, it is treated with vit. K.
Patient pleural effusion sample is exudative, what is in it
inc. fibroelasts
dec. proteins
increased protein
inc. eosinophils
inc. specific gravity
C) Reason
Increased protein content, cloudy. Due to malignancy, pneumonia, collagen vascular disease, trauma (occurs in states of increased vascular permeability). Must be drained in light of risk of infection.
A graft from same specie is
isograft
xenograft
synergic graft
allograft
autograft
D) Reason
Autograft From self.Syngeneic graft From identical twin or clone.Allograft From nonidentical individual of same species.Xenograft From different species.
A patient with chest pain was given aspirin, its MAO
Inhibit platelet synthesis
Inhibit coagulation factors
inhibit TXA2
inhibit prostacyclin
Inhibits prostagladin synthesis
E) Reason
MECHANISM: Irreversibly inhibits cyclooxygenase (both COX-1 and COX-2) enzyme by covalent acetylation. Platelets cannot synthesize new enzyme, so effect lasts until new platelets are produced: inc. bleeding time, dec. TXA2 and prostaglandins. No effect on PT or PTT
Old age women with hx of IHD with irregular heart beat
sotalol
proparanolol
amoidarone
cardioversion
Digoxin
E) Reason
CLINICAL USE: CHF (increases contractility); atrial fibrillation (decreases conduction at AV node and depression of SA node). Patient in this scenario is a case of atrial fibrillation.
End stage renal disease, what will be the finding
hypokalemia
hypernatremia
dec. Creatinine
increased creatinine
dec. urea
D) Reason
Consequences (MAD HUNGER):Metabolic Acidosis, Dyslipidemia (especially increased triglycerides), HyperkalemiaUremia—clinical syndrome marked by inc. BUN and inc. creatinineNausea and anorexia
Ligamentum teres of liver is derived from
left umbilical vein
right umbilical vein
colon remnant
fossa ovalis
none of these
A) Reason
After birth, the umbilical veins are closed, and the remnant in adults is the Ligamentum teres of the liver
Right homonomous heminopia, lesion in
left occipital lobe
left temoral lobe
left optic tract
right optic radiation
upper optic chiasma
A) Reason
Homonemous hemianopia is contralatral half eye vision vision and is due to the lesion of occipital lobe.
Aortic pressure is maximum during
isovolumic contraction
isovolumic relaxation
end of ventriclular ejection
atrial filling
ventricular filling
C) Reason
Systolic ejection—period between aortic valve opening and closing, at end of this phase, the aortic pressure becomes maximum
On an anomaly scan, anencehaly is suspected, what is serum marker
Alpha fetoprotein
β hcg
sudan red
dec. vimentin
inc. keratin
A) Reason
Anencephaly Malformation of anterior neural tube resulting in no forebrain, open calvarium (“frog-like appearance”). Clinical findings: increased AFP; polyhydramnios (no swallowing center in brain). Associated with maternal diabetes (type I). Maternal folate supplementation inc. risk.
Structure post to medial mellulous
tibialis anterior
tibialis posterior
peroneus longus
sural nerve
tibial artet
B) Reason
The tuberosity lies infront of and below the medial malleolus, and it attaches tothe main part of the tibialis posterior tendon (posterior to medial maleolus).
Hunger centre is located in which part of hypothalamus
inferior
superior
posterior
lateral
anterior
D) Reason
Lateral area: Hunger. Destruction causes anorexia, failure to thrive (infants). Inhibited by leptin.
Submandibular gland stone result in
hypertrophy
hypoplasis
dysplasia
Apoptosis
necrosis
D) Reason
Obstruction to secretion of any body fluid is trigger Factor for inflammation, in glandular organs, obstruction to secretions can lead to self digestion or Autophagy of the cell- Apoptosis
Retrorbital swelling is due to
lymphocytes
fibroelastic tissue
fat deposits
thyroid stimulating Igs
SM Igs
D) Reason
Striking exophthalmos (protrusion of the eyes), possibly due to autoimmune (Thyroid Stimulating Igs) mechanisms and independent of thyroid hyperfunction, is characteristic. Manifestations include the signs and symptoms of hyperthyroidism.
blood will accumulate in epidural space due to trauma to which artry
MMA
AMA
cerebral artery
spinal artery
posterior cerebral artery
A) Reason
Lucid interval after traumatic brain injury are the features of Epidural hematoma (middle meningeal artery rupture)
lupus nephritis is associated with
nephrotic syndrome
nephritic syndrome
drug induced
allergic
SLE
E) Reason
Classic presentation of SLE: rash, joint pain, and fever, most commonly in a female of reproductive age and African descent.Libman-Sacks endocarditis—wart-like vegetations on both sides of valve.Lupus nephritis (type III hypersensitivity reaction
cervical vertebra is closely associated with
cilliary ganglion
ophthalmic ganlion
sympathetic ganglion
stellate ganglion
salivary ganglion
D) Reason
In most people, the inferior cervical ganglion is fused to thefirst thoracic ganglion to form the stellate ganglion. It is located between the transverse process of the seventh cervical vertebra and the neck of the first rib.
Notochord derivative is
spinal cord
spinal nerves
nucleus pulposus
CSF
miningies
C) Reason
Nucleus pulposus is an inner soft, elastic, compressible material thatfunctions as a shock absorber for external forces placed on the vertebral column. The nucleus pulposus is the postnatal remnant of the notochord.
Calcitonin released from
thyroid gland
parathyroid
adrenal cortex
pituitary
hypothalamus
A) Reason
SOURCE: Parafollicular cells (C cells) of thyroid. FUNCTION: bone resorption of Ca2+. It opposes the effect of PTH
There is infection in between deep layers of cervical fascia and pre tracheal fascia , pus will go to
posterior to pericardium
in pericardium
anterior to pericardium
anterior mediastinum
posterior mediastinum
D) Reason
The pretracheal layer is a thin layer that is attached above tothe laryngeal cartilages . Infection between deep cervical fascia and pre tracheal fascia can affect the anterior mediastinum.
IgE bound to which of following
Basophils & mast cells
Basophils only
mast cell only
eosinophils
lymphocytes
A) Reason
Anaphylactic and atopic—free antigen cross links IgE on presensitized mast cells and basophils, triggering immediate release of vasoactive amines that act at postcapillary venules (i.e., histamine). Reaction develops rapidly after antigen exposure because of preformed antibody
Patient has pneumonia , now he has chest pain radiating to back and rustle sound on left side of chest even when breathing is held , which is affected
pleura
pericardium
anterior mediastinum
lateral mediastinum
posterior mediastinum
B) Reason
Acute pericarditis: Commonly presents with sharp pain aggravated by inspiration, and relieved by sitting up and leaning forward. Presents with friction rub. ECG changes include widespread ST-segment elevation and/or PR depression. Suppurative/purulent Type: usually caused by bacterial infections (e.g Pneumococcus, Streptococcus). Rare now with antibiotics.
Bronchopulmonary segment is
functional unit
structural unit
respiratory unit
lymphatic unit
broncheal unit
A) Reason
Bronchopulmonary segments are the anatomic, functional, and surgical units of the lungs. Each lobar (secondary) bronchus, which passes to a lobe of the lung, gives offbranches called segmental (tertiary) bronchi
Host versus graft reaction can be due to what
kidney transplant
blood transfusion
liver transplant
FFP transfusion
lung transplant
B) Reason
In rest of all conditions (except FFP) GVHD occurs Graft-versus-host Reaction/disease:Onset Varies. Grafted immunocompetent T cells proliferate in the immunocompromised host and reject host cells with “foreign” proteins leading to severe organ dysfunction.
Emphysema can be due to deficiency of
lipase
phospholipase A2
α1 anti-trypsin
ALP
fibroelastic growth factor
C) Reason
Enlargement of air spaces, decreased recoil,increased compliance, decreased DLCO resulting from destruction of alveolar walls.Two types:1. Centriacinar—associated with smoking B.2. Panacinar—associated with α1-antitrypsin deficiency
Source of creatinine is by breakdown of
heart
muscle
kidneys
blood
liver
B) Reason
Creatinine is the end product of the muscle metabolism that is the reason that Creatinine increases in myositis and other cases of muscle breakdown
Glucokinese is present in
muscle
Liver
heart
lungs
pancreas
B) Reason
Glucokinese is an enzyme that phosphorylates glucose to glucose-6-P, it present in liver β cells unlike that of hexokinase that is present in muscles but not in liver or pancreas
Leimyoma with glands and stroma covering
Metaplasia
dysplasia
hypertrophy
dystrophy
hyperplasia
E) Reason
Leiomyoma (fibroid):A Most common tumor in females. Often presents with multiple discrete tumors A. Increased incidence in blacks. Benign smooth muscle tumor; malignant transformation is rare. Estrogen sensitive—tumor size increased with pregnancy and decreased with menopause.
which of the following doesn’t have basement membrane
clara cell
Ependymal cells
peumocytes
osteoclasts
transitional epithelium
E) Reason
Transitional epithelium is a stratified epithelium in which the shape of the surface cells changes (undergoes transitions) depending on the degree of stretch. This epithelium has no basement membrane.When a transitional epithelium is not stretched (for example in an empty bladder) the cells of the surface layers are large and rounded.
A patient is diagnosed to have Hepatitis A, labs could be
inc. ALP
inc. bilurubin
inc bilirubin and ALT
dec. ALT
decreased heptoglobins
C) Reason
Acute viral hepatitis is characterized by jaundice and extremely high elevations of serum aspartate and alanine aminotransferases. Hyperbilirubinemia is also there
In an RTA Pelvis avulsion, muscle involved
rectus femoris
quadricep femoris
adductor longus
adductor brevis
sartorius
A) Reason
• Among the muscles of the anterior compartment, Iliopsoas, rectus femoris, sartorius, and adductormuscles, most prominent and superficial muscle is rectus femoris that is injured first in avulsion injury.
1/3rd of posterior Interventricular septum blood supply of heart is
LAD
RCA
LCA
LXA
posterior artery
B) Reason
Posterior interventricular artery: It is the terminal distribution of the right coronary artery and courses in the posterior interventricular sulcus to supply parts of the right and left ventricles and, importantly, the posterior third of the interventricular septum.
In Myasthenia gravis, what is responsible for pathogenesis
IgA
IgD
IgG
IgM
IgE
C) Reason
M. gravis is the most common NMJ disorder, PATHOPHYSIOLOGY: Autoantibodies (IgGs) to postsynaptic ACh receptors. CLINICAL Manifestations are Ptosis, diplopia, weakness.Worsens with muscle use
A female presented with some growth in vulvar region, it can be
atrophy
dysplasia
hyperplasia
dystrophy
hypertrophy
B) Reason
Dysplasia and carcinoma in situ:Disordered epithelial growth; begins at basal layer of squamocolumnar junction (transition zone) and extends outward
lesion in left somatosensory area will affect
agraphesthesia
asteriagnosis
right lower limb
left lower limb
paraplegia
C) Reason
Lesions in somatosensory cortex result in impairment of all somatic sensations on the opposite side of the body, including the face and scalp.
Congenital Toxoplamosis can be diagnosed by
IgA
IgD
IgE
IgM
IgG
D) Reason
For the diagnosis of acute and congenital infections, an immunofluorescence assayfor IgM antibody is used. IgM is used to diagnose congenital infection, because IgG can be maternal in origin.
Clara cells are present in
primary bronchiole
secondary bronchiole
tertiary bronchiole
terminal bronchioles
alveolar sacs
D) Reason
The epithelial lining of the airway is composed of ciliated cells (goblet and basal cells are absent in the terminal bronchioles) and an additional type called the Clara cell.
A patient presents with features of dysphagia and horner syndrome ,artrey involved is
AICA
MCA
PICA
ACA
vertebral artery
A) Reason
Features of obstruction of anterior communicatin Artery: Vomiting, vertigo, nystagmus; decreased pain and temperature sensation from ipsilateral face and contralateral body; dysphagia,hoarseness, decreased gag reflexipsilateral Horner syndrome; ataxia, dysmetria.
Spinal cord artery supply is by
vertebral artery
spinal artery
posterior cerebral artery
posterior cervical artey
occipital artery
A) Reason
There is only one anterior spinal artery formed bythe union of branches from each vertebral artery. Vertebral artery is the main supply of the spinal cord.
Anterior surface of heart is supplied by
posterior Interventricular artery
RCA
LCA
LXA
LAD
E) Reason
Left anterior descending artery (LAD)—supplies anterior 2/3 of interventricular septum, anterior papillarymuscle and anterior surface of left ventricle. LAD is the most common cardiac artery to be occluded.
ECG findings of hypoglycemia
ST depression
No P wave
short QT
tall T wave
prolong QT interval
E) Reason
Long QT interval:1. Bradycardia2. Hypocalcemia3. Acute MI4. Acute myocarditis5. Cerebrovascular accident6. Hypertrophic cardiomyopathy7. Hypothermia
Mediastinal pleura is supplied by
C1-2
Phrenic nerve
C4
pleural nerve
vagus nerve
B) Reason
The phrenic nerve is the only motor nerve supply to thediaphragm. It also sends sensory branches to the pericardium, the mediastinal parietal pleura, and the pleura and peritoneum covering the upper m and lower surfaces of thecentral part of the diaphragm.
Lady with pregnancy malnurished now present with anemia, what is cause..?
sideroblastic anemia
Megaloblastic anemia
Thalasemia
pernicous anemia
iron deficiency
E) Reason
Causes are: Decreased iron due to chronic bleeding (GI loss, menorrhagia), malnutrition/absorption disorders or increased demand (e.g., pregnancy)decreased final step in heme synthesis.
Progressive PR prolongation followed by missing a beat on ECG is diagnostic of
atrial flutter
2nd degree block
mobitz type2
mobitz type 1
3rd degree block
D) Reason
Mobitz type I (Wenckebach):Progressive lengthening of the PR interval until a beat is “dropped” (a P wave not followed by a QRS complex). Usually asymptomatic.
sulpha drug Mechanism of action
activate B6
activate B3
block DNA gyrase
block RNA synthesis
Inhibit dihydropteroate synthetase
E) Reason
Sulfonamides interfere with folic acid synthesis by preventing addition of para-aminobenzoic acid (PABA) into the folic acid molecule through competing for the enzyme dihydropteroate synthetase. Sulfonamides are therefore bacteriostatic and inhibit growth and multiplication of bacteria, but do not kill them. Humans, in contrast to bacteria, acquire folate (vitamin B9) through the diet.
Patient doctor relationship is based on
informed working
mutual benefit
mutual respect
mutual trust
long relation
D) Reason
Doctor and Patient relationship is very special and based on absolute privacy and mutual trust
Retinal art occlusion in previously healthy man, can be due to
rupture
Amylodosis
emboli
aneurysm rupture
silent hypertension
C) Reason
Sudden loss of vision commonly occurs in central retinal artery occlusion and central retinalvein occlusion, retinal detachment, papillitis, acute congestive glaucoma, emboli, vitreous haemorrhage,etc.
Skin malignancy with most malignant potentail
melanoma
SCC
BCC
lymphoma
juvenile nevus
A) Reason
MELANOMA:A. Malignant neoplasm of melanocytes; most common cause of death from skin cancer B. Risk factors are based on UVB-induced DNA damage and include prolonged exposure to sunlight, albinism, and xeroderma pigmentosum
Scapula is firmly attached to chest wall through
teres major
serratus posterior
external oblique
serratus anterior
teres minor
D) Reason
Serratus anterior Insertion is to the Medial border and inferiorangle of the scapula where it stabilizes the bone
Tunica albogenia gives rise to which of following
processus vaginalis
tunica vaginalis
umbilical cord
inguinal canal
inguinal ligament
A) Reason
Processus vaginalis(evagination of peritoneum):Forms tunica vaginalis as its remnant in male
Pt is on hormone replacement therapy for 10 yr , sister died due to breast ca, she has high risk of
CA endometrium
Ovarian cancer
Fallopian tube CA
Lung cancer
CA breast
E) Reason
Risk factors: inc. estrogen exposure, inc. total number of menstrual cycles, older age at 1st live birth, obesity (inc. estrogen exposure as adipose tissue converts androstenedione to estrone), BRCA1 and BRCA2 gene mutations, African American ethnicity (inc. risk for triple inc. breast cancer).
Kidney in relationship with lower ribs by
facia covers glands
garota facia
psoas muscle
quadratus lumborum
perinehric fat
A) Reason
Renal fascia: This is a condensation of areolar tissue outside the perirenal fat. It encloses the kidneys and thesuprarenal glands
Face sensation is carried by which nerve
facial
mandibular
ophthalmic
maxillary
Trigeminal
D) Reason
he maxillary nerve is purely sensory. It leaves the skull through the foramen rotundum and crosses thepterygopalatine fossa to enter the orbit through the inferiororbital fissure. It then continues as the infraorbital nerve in the infraorbital groove, and it emerges on the facethrough the infraorbital foramen. It gives sensory fibers tothe skin of the face and the side of the nose.
In asthma, which is involved
small bronchioles
terminal bronchioles
alveolar ducts
main bronchus
medial bronchioles
E) Reason
Asthma: Bronchial hyperresponsiveness causes reversible bronchoconstriction. Smooth muscle hypertrophy, Curschmann spirals (shed epithelium forms mucus plugs), and Charcot Leyden crystals (formed from breakdown of eosinophils in sputum).
Most common involved in carcinoma
vimentin
keratin
cadherin
fibrin
kertinocytes
B) Reason
A first step in the invasion of malignant cells through an epithelium results from a loss of expression of cadherins and loss of keratin that weakens the epithelium.
lesion at L1 , there was loss of pain and temp on right side, which path is affected
spinobulbar
medial leminiscus
lateral spinothalamic
anterior horn
lateral horn
C) Spinothalamic and dorsal columns/medial lemniscus:Take Pain and temperature; pressure, touch, vibration, and proprioceptionDestination to 1° somatose nsory cortex
Max calcium influx at cardiac cycle, in
R wave
ST segment
P wave
Q wave
T wave
B) Reason
Phase 2 = plateau (corresponds to ST Segment): Ca2+ influx through voltage-gated Ca2+ channels balances K+ efflux. Ca2+influx triggers Ca2+ release from sarcoplasmic reticulum and myocyte contraction.
Medial rotation of arm is by
teres minor
deltoid
triceps
serratus posterior
teres major
E) Reason
• Lateral rotation:Infraspinatus, teres minor, and posteriorfibers of deltoid muscles.• Medial rotation: Subscapularis, latissimus dorsi, teresmajor, and anterior fibers of deltoid muscles
What lies in the floor of the Lateral ventricle
thalamus
hypothalamus
uncus
amydala
hippocampus
E) Reason
The hippocampal formation extends along the floor of the inferior horn of the lateral ventricle in the temporal lobe and includes the hippocampus, the dentate gyrus, the subiculum, and adjacent entorhinal cortex.
Muscles of forceful expiration
diaphragm
rectus abdominis
scalenae anterior
scalenae posterior
intercostal muscle
B) Reason
Function: Compresses abdominal contents and flexes vertebral column, is also an accessory muscle of expiration especially forceful expiration
In aspirin overdose, which drug will increase its renal excretion
Cl
K
HCO3
Na
Ca
C) Reason
Overdose:causes respiratory alkalosis initially, which is then superimposed by metabolic acidosis (by increased urinary excretion).
ALT and AST require which cofactor
B1
B2
B6
B12
vit.D
C) Reason
FUNCTION: Converted to pyridoxal phosphate, a cofactor used in transamination (e.g., ALT and AST), decarboxylation reactions, glycogen phosphorylase.
How to prevent tetanus in population
toxoid
antitoxin
vaccination
clean instruments
proper care
A) Reason
Tetanus can be prevented by Toxoid.
type of hypersensitivity in post streptococcal GN
delayed response
type 1 HSR
type 2 HSR
type 4 HSR
type 3 HSR
E) Reason
Type III: SLEPolyarteritis nodosaPoststreptococcal glomerulonephritisSerum sicknessArthus reaction (e.g., swelling and inflammation following tetanus vaccine).
Pain from the mininges of middle cranial fossa
Trigeminal ganglion
Cilliary ganglion
ophthalmic ganglion
cerebellum
basal ganglia
A) Reason
The trigeminal ganglion lies in middle cranial fossa within a pouchof dura mater called the trigeminal cave. Middle cranial fossa pain is due to pressure of this ganglion on minininges.
common carotid artery has lateral relation with
recurrent laryngeal nerve
parathyroid
external carotid
internal jugular vein
common carotid
D) Reason
In the carotid sheath, the artery is related laterally to the internal jugular vein; the vagus nerve lies between these two structures.
A young Patient with Dx of Aplastic anemia was given Anti-thymocyte Igs, developed reaction at 10 days..cause..?
type 1 HSR
type 2 HSR
type 3 HSR
type 4 HSR
delayed response
C) Reason
Type III: SLEPolyarteritis nodosaPoststreptococcal glomerulonephritis, Serum sicknessArthus reaction (e.g., swelling and inflammation following tetanus vaccine)
A 7 year old boy has unilateral blindness, gene affected
RET
BRCA1
Rb
p53
neu1
C) Reason
The prototype is retinoblastoma, an intraocular childhood tumor (causing unilateral blindness) caused by inactivation of the Rb gene. The “two-hit” hypothesis of Knudson holds that two mutagenic events are required to induce alterations on both chromosomes.
splitting of s2 is because of
early mitral closure
early pulmonary close
early aortic closure
late aortic closure
late mitral closure
C) Reason
Normal splitting is due to delayed closure of pulmonic valve than aortic valve.decreased pulmonary impedance ( increased capacity of the pulmonary circulation) also occurs during inspiration, which contributes to delayed closure of pulmonic valve.
what is true regarding Crohn”s disease
transmural lesions
continuous lesion
only colon involved
only mucosa involved
female predominant
A) Reason
GROSS MORPHOLOGY: Transmural inflammation, fistulas. Cobblestone mucosa, creeping fat, bowel wall thickening (“string sign” on barium swallow x-ray), linear ulcers, fissures.
A middle age patient with chest pain and raised CK but normal troponin and ECG, cause is
MI
angina
musculosketal pain
stable angina
gastric pain
C) Reason
In this scenario, the most specific marker that is cardioselective (troponin and ECG ) are normal while CK can be raiswd in muscular pain.
If sodium absorption is increased at DCT it will result in?
inc. plasma vol.
dec. plasma vol.
inc. interstitial cells
inc. urine vol.
dec. urine vol.
A) Reason
When the Na is reabsorbed in DCTs, it causes fluid retention in the body and thus leading to increased plasma volume.
Connexins are part of
RER
SER
ribosomes
Golgi complex
nucleus
D) Reason
Each connexon consists of 6 connexin molecules. Unlike other intercellular junctions, gap junctions are not associated with any cytoskeletal filament and Golgi complex.
Regarding Hemostasis, Most common risk factor for thrombosis is
OCPs
endothelial injury
trauma
aspirin
Clopidogrel
A) Reason
Most common is OCP . Most initial is endothelial injury.
which sign differentiate ganglionic or muscrinic blockers
selectivity
postural hypotension
dosing
quantity
specificity
B) Reason
Unlike the muscrinic blockers, the ganglion blockers interrupt sympathetic control of venous tone, they cause marked venouspooling; postural hypotension is a major manifestation of this effect.
side effect of documerol
delayed coagulation
early coagulation
acidosis
dec. RBC
dec. WBC
A) Reason
TOXICITY: Nausea, headache, facial flushing, coagulopathy, hypotension, abdominal pain.
Regarding the vectors, which virus is transmitted by mosquitoes
HHV
RSV
gray fever
yellow fever
hey fever
D) Reason
Yellow fever virus: A flavivirus (also an arbovirus) transmitted by Aedes mosquitoes. Virus has a monkey or human reservoir
In patient with previous case of Vasculitis, hepatitis associated with Vasculitis is
EBV
hep. D
hep. A
hep. C
Hepatitis B
E) Reason
Polyarteritis nodosa: Young adults.Hepatitis B seropositivity in 30% of patients.Fever, weight loss, malaise, headache.
CSF has what difference as compared to plasma
low pH
high pH
low Na
low Ca
low Cl
A) Reason
A total of 400-500 cc of CSF is produced per day; ventricles and subarachnoid space contain 90-150 cc, so all of CSF is turned over 2-3 times per day. In comparison with plasma, it has less glucose, more proteins, less cells and low pH.
nuclei of cells producing proteins
eosinophilic
dark staining
basic stippling
light staining
purple staining
B) Reason
Hematoxylin is a blue dye which stains basophilic substrates that are the acidic cellular components such as DNA and RNA. Hematoxylin stains nuclei blue, and may tint the cytoplasm of cells with extensive mRNA (proteins synthesis) in their cytoplasm.
hypovolumic shock & anaphylaxis differ in ?
BP
cardiac output
heart rate
aetiology
manifestations
B) Reason
Difference between the Anaphylactic shock and hypovolumic shock is the cardiac output, it is decreased in hypovolumic shock and increased in anaphylactic shock.
Acrosome is formed from
RER
SER
nucleus
ribosomes
golgi complex
E) Reason
The acrosome, which is located over the anterior half of the nucleus, is derived from the Golgi complex of the spermatid and contains several hydrolytic enzymes.
Patient with Ptosis, dilated pupils and downward outward eye, nerve affected
CN I
CN-II
CN III
CN IV
CNVVII
C) Reason
The oculomotor nerve, therefore, is entirely motor. It isresponsible for lifting the upper eyelid; turning the eye upward, downward, and medially; constricting the pupil; andaccommodating the eye.
In a 49 year old man with chronic Hx of HCV positive, inflamation of portal triads and adjacent lobules with necrotic foci, diagnosis
cirrhosis
hep. A
hep. E
chronic hep. C
chronic hep. D
D) Reason
Chronic hepatitis is characterized by symptoms that last > 6 months. l. Inflammation predominantly involves portal tract and adjacent lobules and necrotic foci 2. Risk of progression to cirrhosis
gunshot injury to neck, patient is in respiratory distress, what affected
C1
C2
S1-2
L3-4
diaphragm
E) Reason
Respiratory distress is due to diaphragm paralysis caused by Phrenic nerve injury at cervical C3-C4 spinal segments.
Hemisection of spinal cord causes complete sensation loss at
at level of lesion
bellow lesion
above lesion
ipsilatrally
contralatrally
A) Reason
Hemisection: Ipsilateral loss of all sensation at the level of the lesion Ipsilateral LMN signs (e.g., flaccid paralysis) at the level of the lesionIf lesion occurs above T1, patient may present with Horner syndrome due to damage of oculosympathetic pathway
receptors responsible for total periphral resistance
alpha 1
alpha 2
beta 2
beta 1
muscrinic
A) Reason
Alpha 1 receptors are Present at blood vessels and they maintain the total periphral resistance due the state of vasoconstriction or Vasodilation.
majority of growth factors have their receptors on
cell wall
SER
RER
membrane
nucleus
D) Reason
Growth factor Receptors: ■ Hormone binds to the extracellular side of the receptor. As many of the growth factor receptors are located in cell membrane.
In Barrett esophagus, pathogenesis is
hypertrophy
hyperplasia
dysplasia
columnar Metaplasia
anaplasia
D) Reason
Barrett esophagus: Glandular metaplasia—replacement of nonkeratinized (stratified) squamous epithelium with intestinal epithelium (nonciliated columnar with goblets cells) in the distal esophagus
which of following is associated with decreased risk of cancer
banana
apple
guava
orange
strawberry
D) Reason
It is a normal notation the antioxidants are regarded as protective against the carcinogenesis. Orange contains vit. C that is a strong antioxidant.
Dicyclomine acts on which receptors
sympathetic
nicotinic
muscrinic
alpha 1
alpha 2
C) Reason
The anticholinergicdrugs dicyclomine (antimuscrinic) and hyoscyamine are used as antispasmodics to relieve abdominal pain; however,their efficacy has not been convincingly demonstrated
during exercise resp. rate increases because of?
tactile reflex
inc. K
inc. O2
inc. K
inc. CO2
E) Reason
■ Sensory information (Pco2, lung stretch, irritants, muscle spindles, tendons, and joints) is coordinated in the brain stem.■ The output of the brain stem controls the respiratory muscles and the breathing cycle.
which will prevent wound contraction
vit. C
vit. D
GH
glucagon
corticosteroids
E) Reason
Functions of Corticosteroids: Increases Insulin resistance (diabetogenic)Increases Gluconeogenesis, lipolysis, and proteolysisDecreases Fibroblast activity (causes striae)Decreases Inflammatory and Immune responses:
fracture of neck of fibula will cause injury to which artery?
fibular
peroneal
posterior tibial
anterior tibial
dorsalis pedis
D) Reason
Neurovascular Structures related to the head of the fibula are anterior tibial artry and common peroneal nerve that can be damaged during the fractures
Patient with CABG 10 days back is with C/O purpra, sec. platelets, diagnosis
ITP
drug induced TTP
DIC
HUS
Thrombocytopenia
B) Reason
Thrombotic thrombocytopenic purpura (TIP) (1) Characteristics include platelet-derived hyaline microaggregates in small vessels, thrombocytopenia, and microangiopathic hemolytic anemia.
If superior mesenteric artery is damaged, which structure is likely to be spared?
spleen
liver
pancreas
dudenum
descending colon
E) Reason
Forgut Derivatives Esophagus, Stomach, Duodenum (first and second parts), Liver, Pancreas, Biliary apparatus, Gallbladder are supplied by the Superior mesenteric artery.
An 8 months baby was born to HIV positive mother, how to confirm infection
WBCs
CBC
ELISA
PCR RNA
western blots
D) Reason
HIV PCR/viral load tests determine the amount of viral RNA in the plasma. High viral load associated with poor prognosis. Also use viral load to monitor effect of drug therapy. It also determines the viral load in new born uptill age of 18 months
Which is bounded by inner and outer membrane and continued with nuclear membrane
cristae
cisternae
F1 particles
fibrils
Perinuclear cisteria
E) Reason
RER is a single, lipid bilayer continuous with the outer nuclear membrane. It is organized into stacks of large flattened sacs called cisternae, nuclear cisternae to the nuclear membrane.
drug for angina that cause no vasodilation
Captopril
hydralazine
Methyldopa
Hydraline
metoprolol
E) Reason
Metoprolol is a cardiac selective beta blockers that acts centrally on heart and least on blood vessels and hence has no Vasodilation property.
2nd vertebra has characteristic feature of?
atlas
spinous process
odontoid process
lateral body
spine
B) Reason
The axis (C2) is the point of articulation where the head turns on the neck, providing an “axis of rotation” through the odontoid.
A young boy with long term history of dirrohea, biopsy show villous atrophy, no improvement with gluten free diet, diagnosis is
giardiasis
celiec disease
amebiasis
intestinal TB
whipples sprue
A) Reason
Giardia lamblia:Giardiasis: bloating, flatulence, foul-smelling, fatty diarrhea (often seen in campers/hikers)—think fat-rich Ghirardellichocolates for fatty stools of Giardia. Villous atrophy on microscopy. Treated with metronidazole.
As an SHO, which sample would you send for blood gases analysis
heart
coagulated
serum sample
Arterial
veinous
D) Reason
Arterial blood gases are examined in the fresh sample of an arterial blood with a heparanized syringe.
Patient presents with long term memory loss, lesion is at
amygdala
cerebellum
basal ganglia
limbic system
uncus
D) Reason
Limbic system Collection of neural structures involved in emotion, long-term memory, olfaction, behavior modulation, and autonomic nervous system function.
What prevent complications in procedures
proper care
regard
profeciency
Professional competence
informed consent
D) Reason
In an any medical, the chances of complications are reduced by better management as well as high level of professional competence.
Among the following, most common method to detect tumor in blood
RFTs
LFTs
CBC
grading
tumor marker
E) Reason
Tumor markers Tumor markers should not be used as the 1° tool for cancer diagnosis. They may be used to monitor tumor recurrence and response to therapy, but definitive diagnosis can be made only via biopsy
hormone which brings about protein anabolism and fat catabolism
LH
FSH
Cortisol
glucagon
GH
E) Reason
Direct actions of growth hormone(a) ↓ glucose uptake into cells (diabetogenic)(b) ↑ lipolysis(c) ↑ protein synthesis in muscle and ↑ lean body mass(d) ↑ production of IGF.
5g protein is lost in pt. what is probable cause of edema.
inc. capillary pressure
dec. capillary pressure
increased vascular pressure
dec. vascular pressure
colloid osmotic pressure
E) Reason
Decreased Colloid osmotic pressure: Decreased plasma protein concentrationSevere liver disease (failure to synthesize proteins)Protein malnutritionNephrotic syndrome (loss of protein in urine).
which post-Op analgesia given in an asthmatic patient
spinal
sub dural
epidural
morphine
ketorolac
E) Reason
Ketorolac is only contraindicated in asthmatic if patient also has known aspirin allergy, otherwise is best post-Op analgesia.
what changes hb dissociation curve to extreme left
CO2
CO
SO2
NO3
N2O
B) Reason
In addition, binding of CO to hemoglobin increases the affinity of remaining sites for O2, causing a shift of the curve to the left
which nerve damage will lead to supination loss
radial
radial & muskulocutaneus
muskulosketal
ulnar
axillary
B) Reason
Supination: Biceps (radial nerve) and supinator (muskulosketal nerve) muscles. This movement returns the pronated hand to the anatomic positionso that the palm faces anteriorly and the thumb lies on thelateral side.
Role of parathyroid hormone
stimulate adenylate cyclase
inhibit adenylate cyclase
increase IP3
increase guanulate
increase DAG
A) Reason
Adenylate cyclase mechanism 1. Hormone binds to a receptor in the cell membrane (step 1).2. GDP is released from the G protein and replaced by GTP (step 2), which activates the G protein. The G protein then activates or inhibits adenylate cyclase. If the G protein is stimulatory (Gs), then adenylate cyclase will be activated
which receptor cause secretion of epinephrine from adrenal medulla
nicotinic
parasympathetic
sympathetic
nicotinic ganglionic
muscrinic
D) Reason
Epinephrine is stress hormone that is secreted by the adrenal medulla in case of stressful conditions by the activation of sympathetic nicotinic ganglionic receptors.
Bile salts cause
Proteins absorption
absorption of fat
Carbohydrates absorption
Vitamins absorption
minerals absorption
B) Reason
Functions of Bile salts: Digestion and absorption of lipids and fat-soluble vitaminsCholesterol excretion (body’s only means of eliminating cholesterol) Antimicrobial activity (via membrane disruption)
CSF is present in
sub arachnoid space
sub dural
sub pia
spinal canal
epidural
A) Reason
• Subarachnoid space lies between the arachnoid and pia mater containing CSF: site of subarachnoid hemorrhage (described later).
shortest acting hypnotic
dorzolamide
fentinyl
midazolam
ketamine
halothane
C) Reason
Midazolam is widely used adjunctively with inhaled anesthetics and intravenous opioids. Theonset of its CNS effects is slower than that of thiopental, and has shortest duration of action.
Diagnostic test for TB
Pleural Biopsy
AFB
Chest X-ray
Gram staining
wall polysacchride
A) Reason
Diagnostic test of T.B. is Pleural Biopsy
A pt. is diagnosed with bilateral S2-S4 lesion. Consequences?
urinary incontinence
dribbling
UV prolapse
atonic bladder
rectal incontinence
D) Reason
Lesion at S2-S4 causes atonic bladder
milk production is result of which hormone activity?
Dopamine
oxytoxin
5 HT
Prolactin
LH
D) Reason
Prolactin—induces and maintains lactation and decreases reproductive function. Oxytocin—assists in milk letdown; also promotes uterine contractions.
Why to prefer Troponin over CK-MB
fast to detect
low price
fear
tissue specific
sensitive
D) Reason
CK-MB is is non-specific enzyme that can also be increased in stress, muscle and other tissue disorder, but troponin is cardiac specific enzyme.
what cell layers are present at 2nd week of development
epiblast
hypoblast
epiblast & hypoblast
meroblast
xenoblast
C) Reason
In 2nd week: • The embryoblast differentiates into the epiblast and hypoblast, forming a bilaminar embryonic disk. • The epiblast forms the amniotic cavity and hypoblast cells migrate to form the primary yolk sac.
A patient taking carbonic anhydrase for 4 Week, what change will occur
dec. K
dec. Cl
dec. HCO3
inc. HCO3
no change in HCO3
C) Reason
TOXICITY Hyperchloremic metabolic acidosis, inc. plasma HCO3, paresthesias, NH3 toxicity, sulfa allergy
Dicrotic notch in aortic pressure is due to
aortic closure
pulmonary closure
mitral closure
tricuspid closure
bicuspid closure
A) Reason
Isovolumic ventricular relaxation, Ventricular volume is constant (isovolumetric) because all of the valves are closed.■ The “blip” in the aortic pressure tracing occurs after closure of the aortic valve and is called the dicrotic notch, or incisura.
what will be cardiac cycle in sec if H/R varies from 75 to 225/min
0.1 sec.
- 26 sec
- 22 sec
- 29 sec
- 3 sec
B) Reason
Cardiac cycle = 60 sec/number of beats = 60/225 = 0.26 sec
short term effect of angiotensin 2?
Vasodilation
inc. renin
vasoconstriction
dec. K absorption
onc. Cl absorption
C) Reason
(1) It increases thirst and therefore water intake.(2) It causes vasoconstriction of the arterioles, thereby increasing TPR and arterial pressure
Purkinje fibers have higher velocity. reason?
fast fibers
more Na channel
less K channel
less Cl channel
less number of myofibrils
E) Reason
■ reflects the time required for excitation to spread throughout cardiac tissue.■ depends on the size of the inward current during the upstroke of the action potential. The larger the inward current, the higher the conduction velocity.■ is fastest in the Purkinje system due to less number of myofibrils.
Which among the following is the most superficial structure in parotid gland
nerve
lymph nodes
vein
artery
gland
B) Reason
• Parotid nodes: Situated on usually superficially or within the parotid salivarygland. They receive lymph from the scalp above theparotid gland, the eyelids, the auricle, and the external auditory meatus.
A person on oral anticoagulant with controlled INR (2-2.5), developed pulmonary edema and INR of 5, what drug caused this change
vancomycin
metronidazole
Clopidogrel
aspirin
ciprofloxacin
E) Reason
TOXICITY:Bleeding, teratogenic, skin/tissue necrosis A, drug-drug interactions ( Pulmonary edema with quinolones).
Gunshot to the radial groove will cause
loss extension of wrist
loss of Flexion of wrist
loss of supination
loss of pronation
loss of reversion
A) Reason
Behind and below the deltoid tuberosity isa spiral groove, in which the radial nerve lies. As it supplies extensors of wrist that is why loss of wrist extension due to radial nerve injury.
An 18 year old boy from remote area, with Hx of high grade fever for 5 days, is now presented with toxic look and dec. platelets and RBC and derranged coagulation, diagnosis
DIC
CML
sepsis
Thrombocytopenia
anemia
A) Reason
Widespread activation of clotting leads to a deficiency in clotting factors, which creates a bleeding state.Causes: Sepsis (gram-negative), Trauma, Obstetric complications, acute Pancreatitis, Malignancy, Nephrotic syndrome,
A foreign body will lodge into which segment?
right bronchus
left bronchi
laft upper
right middle
right upper
A) Reason
Right lung is more common site for inhaled foreign body because the right main stem bronchus is wider and more vertical than the left.
In last trimester what changes are mostly found regarding respiration.
dec. CO
dec. CO2
dec. HCO3
dec. K
dec. O2
E) Reason
In 3rd trimester of pregnancy, gravid utrus pushes causes upward push of the diaphragm and decreases tidal volume and hence increases respiratory rate and dec. O2 saturation.
What extends into sulci and fissures of brain tissue
dura matter
pia mater
Arachnoid
sub Arachnoid
ventricles
B) Reason
Pia mater tightly invests the surfaces of the brain and cannot be dissected away, having the same relationship with the brain extends into sulci as well as spinal pia mater.
Rise in blood flow is seen in a stroke pt. cause?
inc. O2
inc. pCO2
dec. pCO2
dec. K
dec. Na
B) Reason
The Cushing reaction is an example of the response to cerebral ischemia. Increases in intracranial pressure cause compression of the cerebral blood vessels, leading to cerebral ischemia and increased cerebral Pco2. The vasomotor center directs an increase in sympathetic outflow to the heart and blood vessels, which causes a profound increase in arterial pressure.
thrombus of which artery will lead to Infarct of 1/3 of posterior Interventricular septum
LCA
RCA
LAD
LXA
posterior coronary artery
B) Reason
Posterior descending/interventricular artery (PDA)— a branch of RCA supplies posterior 1/3 of interventricular septum and posterior walls of ventricles
Iron absorbed from which part of GIT plays role in iron absorption
ileum
jejunum
duodenum
Colon
stomach
C) Reason
Iron is Absorbed as Fe2+ in duodenum.Folate is Absorbed in jejunum and ileum.B12 is Absorbed in terminal ileum along with bile acids, requires intrinsic factor.
A new born developed hemolysis of severe form, type of hypersensitivity in Erythroblastosis fetalis
type 1 HSR
type 2
type 3 HSR
type 4 HSR
delayed response
B) Reason
Type II: Autoimmune hemolytic anemiaPernicious anemiaIdiopathic thrombocytopenic purpuraErythroblastosis fetalisAcute hemolytic transfusion reactions, Rheumatic fever
Lumber puncture should be done where
above L4
above L3
at L3
above L3
bellow L3
A) Reason
A lumbar puncture is used to inject anesthetic material in the epidural space or to withdraw CSF from the subarachnoid space. • A spinal tap is typically performed at the L4-L5 or above L4 interspace.
Free radicals mainly removed by
transferrin
ferritin
transferrtin
iron
Phosphatase
A) Reason
Free radicals can be eliminated by enzymes (e.g., catalase, superoxide dismutase, transferrin, glutathione peroxidase), spontaneous decay, antioxidants (e.g., vitamins A, C, E).
After an accident an old lady can’t understand spoken words but canunderstand written words lesion in ?
broca
wernicke
temporal lobe lesion
primary auditory
secondary auditory
D) Reason
Patient can understand the written words indicating that his visual and the frontal cortex are intact but only problem is the primary auditory cortex lesion
Regarding neoplasm, best way to detect spreading tumors
grading
tumor marker
staging
HIDA scan
bone scan
C) Reason
Staging of the tumors is the best way to detect the spread and extent of the tumors, one important system is the TNM staginh system.
What is the span of the isthmus of the thyroid
2nd tracheal ring
2nd to 4th tracheal ring
3rd-4th tracheal
3-5th tracheal ring
5th-6th tracheal ring
B) Reason
The thyroid gland (from 2nd-6th tracheal rings) consists of right and left lobes connectedby a narrow isthmus from 2nd-4th tracheal rings. It is surrounded by a sheathformed of pretracheal fascia, and this sheath attaches thegland to the larynx and the trachea. I
patient has Tedency to fall on left, lesion is on
basal ganglia lesion
flocular lobe
cerebellar peduncle
left cerebellum
right cerebellum
D) Reason
Cerebellum Modulates movement; aids in coordination and balance.Input:Contralateral cortex via middle cerebellar peduncle. Ipsilateral proprioceptive information via inferior cerebellar peduncle from the spinal cord (input nerves = climbing and mossy fibers). Lesion causes ipsilatral ataxia.
No x wave is found on EEG in a pt. Dx?
REM
Non REM
wake
deep sleep
opened eyes
A) Reason
REM sleep (25%) beta waves: Loss of motor tone, brain O2 use, and variable pulse and blood pressure; when dreaming and penile/clitoral tumescence occur; may serve a memory processing function
An 11 year boy developed carpopedal spam after radius fracture, serum Ca 6.8 urinary Ca is normal, cause..?
rickets
hypokalemia
secondary hypoparathyroid
tertiary hypoparathyroid
primary hypoparathyroid
A) Reason
Rickets is the most appropriate answer.
vertical nystagmus is due to?
occipital lobe lesion
basal ganglia lesion
tippling up and down
cerebellar lesion
tipping head sideways
E) Reason
Lesions of the vestibular nuclei and pathways may produce nystagmus, vertigo, nausea, and vomiting. It can be horizontal by up & down tippling or vertical by side by side tippling of head.
Gram negative UTI,culture gives foul smelling greenish colonies treatment .
clindanycin
metronidazole
vancomycin
gentamicin
ampicillin
E) Reason
E.Coli is the causative agent here.
Tumor involved superior bronchus of lung, which segment is likely to collapse?
apical
middle
lower
superior
7th segment
A) Reason
Superior Bronchus of the lungs is closely related with the apical segment and it contains superior apical segment that can be involved in carcinoma of superior bronchus.
Regarding carcinogenesis of CA stomach, which cause CA stomach
alcohol
hydrocarbon
phenacetin
aniline
H. pylori
E) Reason
Stomach cancer:Almost always adenocarcinoma. Early aggressive local spread and node/liver metastases. Often presents with acanthosis nigricans. Intestinal—associated with H. pyloriinfection, dietary nitrosamines (smoked foods), tobacco smoking, achlorhydria, chronic gastritis.
A 50 year old man with factory worker exposed to hydrocarbons is at risk of
pancreatic cancer
HCC
CA stomach
CA urinary bladder
CA lung
D) Reason
Risk Factors of CA Urinary bladder are: Associated with problems in your Pee SAC: Phenacetin, Hydrocarbons, Smoking, Aniline dyes, and Cyclophosphamide.
reflex system of ANS is directly controlled by?
medulla
pons
Midbrain
cerebrum
cerebellum
D) Reason
A large part of the frontal cortex rostral to the central sulcus is related to the control of movements, reflex action, primarily on the opposite side of the body
A boy ARF now has fever with pancystolic murmur and speelomegaly, treatment
gentamicin
Penicillin
metronidazole
clarythromycin
azithromycin
B) Reason
IE: Mitral valve is most frequently involved. Tricuspid valve endocarditis is associated with IV drug abuse (don’t “tri” drugs). Associated with S. aureus, Pseudomonas, and Candida.Complications: chordae rupture, glomerulonephritis, suppurative pericarditis, emboli. Treated with with IV penicillin.
A 14 year old boy with Spleenomegaly and all cell line dec. what investigation
CBC
USG
CT
periphral smear
bone marrow biopsy
E) Reason
Characteristics include decreased platelet count and prolonged bleeding time; bone marrow aspiration reveals decreased megakaryocytes when caused by decreased platelet production and increased megakaryocytes when caused by increased platelet destruction.
Regarding carcinogenesis, which cancer is related to oncogene
CA uterus
CA ovary
CA breast
Cervical cancer
HCC
C) Reason
Risk factors: inc. estrogen exposure, inc. total number of menstrual cycles, older age at 1st live birth, obesity (inc. estrogen exposure as adipose tissue converts androstenedione to estrone), BRCA1and BRCA2 gene mutations, African American ethnicity (inc. risk for triple breast cancer)
sesamoid cartilage is found in
elbow
vertebral disc
ear lobule
knee
ala of nose
E) Reason
NASAL CAVITY: The nasal cavity is divided into right and left halves by thenasal septum. Ala of nose contain a small suspended cartilage, sesamoid cartilage. The septum is made up of the septal cartilage, the vertical plate of the ethmoid, and the vomer.
19 years old girl history of repeated infections , CBC done Hb=>5, WBC=>3.5 , plt40,000 , neutrophils18%, lymphosytes 80%, next to do ?
marrow biopsy
CBC
periphral smear
Electrophoresis
USG abdomen
A) Reason
All cell line are decreased RBCs, WBCs and Platelets (Pancytopenia) in a case of Aplastic anemia manifests as anemia, repeated infections and dec. platelets, can be diagnosed by bone marrow biopsy (shows pancytopenia)
Skilled motor activity is carried via
corticobulbar
spinothalamic
corticospinal tract
medial leminiscus
faciculus cuneatus
C) Reason
Corticospinal tract: UMNcell body in 1° motor cortex then descends ipsilaterally (through internal capsule), most fibers decussate at caudal medulla (pyramidal decussation) then descends contralaterally. Associated with skilled motor actions.
part of ECG from end of P wave to start of R wave is known as
PR interval
PR wave
PR segment
QR wave
QR segment
C) Reason
PR segment is the part of ECG from end of P wave to start of R wave and it represents the atrial depolarization.
Chief parameter for plasma blood flow measurment?
Urea
Creatinine
Inulin
PABA
PAH
E) Reason
Measurement of renal plasma flow (RPF)—clearance of para-aminohippuric acid (PAH)■ PAH is filtered and secreted by the renal tubules.■ Clearance of PAH is used to measure RPF.
patient with RHC pain now developed lung abscess, route of spread?
Hematogenous
lymphatic
direct spread
veinous
peritoneal
C) Reason
In the hiven scenario, the patient was fisrt having liver abscess that later on directly invaded into the chest causing right lung abscess.
All are rick Factors for CA stomach except
H. pylori
blood type O
smoking
nitrites
smoked food
B) Reason
associated with H. pyloriinfection, dietary nitrosamines (smoked foods), tobacco smoking, achlorhydria, chronic gastritis. Commonly on lesser curvature; looks like ulcer with raised margins.
right sided relation of trachea as it descends into Superior mediastinum
hemi azygus vein
Phrenic nerve
sympathetic chain
vagus nerve
azygus vein
E) Reason
Relations of Trachea in Superior Mediastinum are Right side: Azygos vein, right vagus nerve, and pleura.• Left side: Arch of the aorta, left common carotid, left subclavian arteries, left vagus nerve, left phrenic nerve, andpleura.
single gene autosomal dominant
Achondroplasia
Fredreck ataxia
Cri du chat syndrome
PCOD
meatal atresia
A) Reason
Achondroplasia: Is a single gene autosomal dominant trait. Failure of longitudinal bone growth (endochondral ossification) leading to short limbs. Membranous ossification is not affected and cause large head relative to limbs.
how to differentiate leukocytes from other cells on bone marrow
golgi complex
RER
cell membrane
staining
presence of nuclei
E) Reason
Leukocyte: Are the nucleated cell developed in marrow.Divided into granulocytes (neutrophil, eosinophil, basophil) and mononuclear cells (monocytes, lymphocytes). Responsible for defense against infections.
anterior mediastinum consists of?
thymus
heart
Phrenic nerve
azygus vein
trachea
A) Reason
ANTERIOR MEDIASTINUMThe contents of the anterior mediastinum include thesternopericardial ligaments, lymph nodes, and remains ofthymus.
A pt. has cardiac pacemaker. on ECG p wave absent & QRS present. location on pacemaker?
bundle of His
ventricle
Atria
AV node
SA node
D) Reason
Normal pacemaker of the heart is the SA node, but in case of any ectopic pacemaker especially the AV node, the P wave will be absent but the QRS complexes will be present.
alongwith thermo receptors, pain receptors also carry sensation of
cold
tactile
pressure
touch
vibration
A) Reason
Nociceptors: ■ are associated with the detection and perception of noxious stimuli (nociception).■ The receptors for pain are free nerve endings in the skin, muscle, and viscera. They also sense for extreme of temperature (heat and cold)
Regarding fibrocartilage truth is
elbow
knee
intervertebral disc
hip joint
sutures
C) Reason
Fibrocartilage has type I collagen in addition to type II, giving it greater resistance to being stretched (tensile strength), and is the type of cartilage found in intervertebral disks of the vertebral column and the menisci of the knee, and may form the attachment of ligaments and tendons to bone
A 54 yr lady concerned with her family history, with positive family H/O CA breast and IHD, what to take to avoid fracture
Ca supplements
complete HRT
vit. D
estrogen
tamoxifen
B) Reason
Hormone replacement therapy: Used for relief or prevention of menopausal symptoms (e.g., hot flashes, vaginal atrophy) and osteoporosis (decrease estrogen, decrease osteoclast activity).
In pseudostratified epithelium, nuclei lies
at lower pole
at different level
upper pole
lateral border
at top
B) Reason
The epithelial lining of the trachea and bronchi is pseudostratified columnar in which all cells lie on the same basal membrane with their nuclei at different levels but only some reach the luminal surface.
How does K enters in cells of hypokalemic pt?
K gates
Na/K ATPase
K/Cl chanel
H-K exchange
K/HCO3 chanel
B) Reason
Na+/K+ATPase (or Na–K+ pump) in cell membranes transports Na+ from intracellular to extracellular fluid and K+ from extracellular to intracellular fluid; it maintains low intracellular [Na+] and high intracellular [K+].
Inc. neuronal activity before skilled action occurs in
cortical association area
motor cortex
prefrontal
temporal lobe
uncus
A) Reason
Lesions, usually in the dominant hemisphere and which include areas 5 and 7 of the posterior parietal association areas, often result in apraxia (also seen with lesions to the premotor cortex). Apraxia is a disruption of the patterning and execution of learned motor movements
most early sign of vit. A deficiency
keratitis
keratosis
dry skin
Bitot spot
night blindness
E) Reason
DEFICIENCY: Night blindness (nyctalopia); dry, scaly skin (xerosis cutis); alopecia; corneal degeneration (keratomalacia); immune suppression.
viscosity of blood is mainly due to?
WBCs
platelets
lymphocytes
RBCs
plasma proteins
D) Reason
Erythrocyte: Carries O2 to tissues and CO2 to lungs. Anucleate and biconcave A, with large surface area-to-volume ratio for rapid gas exchange. It is the main contributer of blood viscosity.
Which bone forms glenoid fossa?
temporal
mandible
maxilla
zygomatic
vomer
A) Reason
The temporomandibular joint articulates above with themandibular fossa (glenoid fossa) and the articular tubercle of the temporalbone. It articulates below with the head of the mandible.
A 42 year old patient has chronic cough and right lung upper lobe consolidation and fatty liver with inc. AST and ALT, cause
hepatitis C
chronic hepatitis B
acute hepatitis A
chronic alcoholism
acute hepatitis D
D) Reason
Alcoholic cirrhosis: Final and irreversible form. Micronodular, irregularly shrunken liver with “hobnail” appearance. Sclerosis around central vein (zone III). Has manifestations CLD, derranged coagulation, raised AST and ALT and sometimes Pnemonia.
In left suprarenal surgery what is likely to be damaged?
renal vein
IVC
aorta
sympathetic chain
renal artery
B) Reason
VEINS:There is a single vein on each side. The right suprarenal veindrains into the inferior vena cava; the left suprarenal veindrains into the left renal vein.
newly laid uncalcified bone matrix is called
osteoblast
osteoid
spongy material
costeod
immature bone
B) Reason
Osteoblasts and osteocytes produce the type I collagen in bone, along with other components of bone ECM (osteoid). That is ossified later on.
After cerebral hemorrhage pt. lacks motivation. site of involvment?
frontal lobe
temporal lobe
parietal lobe
basal ganglia
uncus
B) Reason
Temporal lobe lesion causes depression and loss of motivation along with auditory impairment. Patients with unilateral damage to the primary auditory cortex show little loss of auditory sensitivity but have some difficulty in localizing sounds in the contralateral sound field.
A man got stab wound on right chest, consequences?
contralatral collapse
open pneumothorax
ipsilatral collapse
right consolidation
left consolidation
C) Reason
During the chest stab wound, ipsilatral lung is developed into an opened valve pneumothorax leading to ipsilatral lung collapse.
progesterone has a vital role which is
dec. uterus contraction
inc. utrus contraction
ripen cervix
mature the follicle
prevent leakage
A) Reason
FUNCTION: Stimulation of endometrial glandular secretions and spiral artery developmentMaintenance of pregnancydec. myometrial excitability
Amoebic liver abscess, treatment
tinidazole
ampicillin
gentamicin
ciprofloxacin
neomycin
A) Reason
Entamoeba hisrolytica:Amebiasis: bloody diarrhea (dysentery), liver abscess (“anchovy paste” exudate), RUQ pain (histology shows flask-shaped ulcer if submucosal abscess of colon ruptures). Treated with metronidazole and tinidazole.
basal ganglia has avital neurotransmitter which is?
glutamate
Aspartate
glycine
GABA
Ach
D) Reason
Excitatory pathway—cortical inputs stimulate the striatum, stimulating the release of GABA, which disinhibits the thalamus via the GPi/SNr (inc. motion).Inhibitory pathway—cortical inputs stimulate the striatum, which disinhibits STN via GPe, and STN stimulates GPi/SNr to inhibit the thalamus (dec. motion).
cause of fatty liver in our society
smoking
alcohlism
fast food
obesity
diabetes
D) Reason
In Western society, most common cause of fatty liver is alcohlism and in our society where alcohlism is not common, here cause is obesity.
Time from atrial depolarization to start of ventriclar depolarization
P wave
ST wave
PR wave
PR segment
PR interval
E) Reason
P wave—atrial depolarization. Atrial repolarization is masked by QRS complex.PR interval is the time from atrial depolarization to start of ventriclar depolarization—represents conduction delay through AV node (normally < 200 msec).
ICF & ECF differ by
has no cations
has inorganic anions
has more Na
has less K
has more K
E) Reason
Intracellular fluid (ICF)■ is two-thirds of TBW.■ The major cations of ICF are K+ and Mg2+
Bronchoconstriction on taking penicillin, now drug of choice
Norepinephrine
epinephrine
glutamine
acetylcholine
ranitidine
B) Reason
Epinephrine: Affects β > α Clinical uses: Anaphylaxis, open angle glaucoma, asthma, hypotension; α effects predominate at high doses.
a person lost hearing in a bomb blast, type of deafness
conductive
sensory
mixed
central
destructive
C) Reason
As in case of blast injury, both the eardrum and choclea are affected, so mixed type of hearing loss it is
A rock crusher developed lymphadenopathy and bireferengence on biopsy, Dx..?
asbestosis
pneumoconiosis
anthracosis
byssinosis
silicosis
E) Reason
Rock crush is associated with silicosis exposure
Patient after an RTA has pH of 7.5, CO2 as 20mmHg and HCO3 as 20meq. Dx…?
respiratory acidosis
metabolic acidosis
respiratory alkalosis
metabolic alkalosis
ARDS
C) Reason
Patient given in this scenario is having high pH (alkalosis) and dec. CO2 shows it to be respiratory alkalosis. Respiratory alkalosis■ is caused by increased alveolar ventilation and loss of CO2.a. Decreased arterial Pco2, which is the primary disturbance, causes a decrease in [H] and [HCO3] by mass action.
Patient after an RTA has pH of 7.5, CO2 as 20mmHg and HCO3 as 20meq. Dx…?
respiratory acidosis
metabolic acidosis
respiratory alkalosis
metabolic alkalosis
ARDS
C) Reason
Patient given in this scenario is having high pH (alkalosis) and dec. CO2 shows it to be respiratory alkalosis. Respiratory alkalosis■ is caused by increased alveolar ventilation and loss of CO2.a. Decreased arterial Pco2, which is the primary disturbance, causes a decrease in [H] and [HCO3] by mass action.
Bicarb absorb in nephron at?
PCT and DCT
thick limb
loop of henle
only DCT
PCT only
E) Reason
a. Early proximal tubule—special features■ reabsorbs Na+ and H2O with HCO3 glucose, amino acids, phosphate, and lactate.
patient with CRF has productive cough, drug of choice
gentamicin
vancomycin
methotrexate
Cisplatin
ciprofloxacin
E) Reason
As the patient is having compromised renal functions, and quinolones are relatively safe in CRF than Aminoglycosides and penicillin.
A lady with HTN, hirsuitism and inc. ACTH, cause
paraneoplastic syndrome
Wilms tumors
pheochromocytoma
Cushing syndrome
histiocytoma
D) Reason
FINDINGS: Hypertension, weight gain, moon facies, truncal obesity, buffalo hump, hyperglycemia (insulin resistance), skin changes (thinning, striae), osteoporosis, amenorrhea, and immune suppression.
Patient presents with hypoventilation and pin point pupil, cause
morphine poisoning
atropine poisoning
organophosphate
CCl4 poisoning
alcohlism
A) Reason
TOXICITY: Addiction, respiratory depression, constipation, miosis (pinpoint pupils), additive CNS depression with other drugs.
final diagnosis of COPD is by
V/Q= 0
V/Q= 0.1
V/Q= infinite
V/Q= 2
V/Q= 1
B) Reason
V/Q approaches 0 = airway obstruction (shunt) and in COPD. In shunt, 100% O2 does not improve Po2.V/Q approaches ∞ = blood flow obstruction (physiologic dead space). Assuming < 100% dead space, 100% O2 improves Po2
lesion in non-dominant Broca”s area
global aphasia
sensory aphsia
anomic aphasia
agraphesthesia
combined aphasia
C) Reason
Broca area Lesion: Nonfluent/Anomic aphasia with intact comprehension.Broca area—inferior frontal gyrus of frontal lobe.
sulphar containing amino acid
glutamate
glycine
aspartate
methionine
tryptophan
D) Reason
• Sulphur containing amino acids: Cysteine,Methionine • Amino acids with amide group: Asparagine, Glutamine
Blunt trauma immediately below and lateral to knee will injure
common peroneal
tibial
sural
anterior tibial
posterior tibial
A) Reason
The common peroneal nerve descends through thepopliteal fossa. It then passes laterally aroundthe neck of the fibula, pierces the peroneus longus muscle,and divides into the superficial and the deep peroneal nerves.
RR 18/min, tidal volume 350ml and dead space is 100ml, alveolar ventilation would be?
2.5 L
3 L
4 L
4.5L
5L
D) Reason
TV-D space x RR = 350-100 x 18 = 250 x 18= 4500ml/min = 4.5L/ min
At which level does 10th intercostal nerve enter rectus sheet?
hypochondrium
lumber region
hypogastrium
umblicus
iliac fossa
D) Reason
T 10 vertebra is located at the level of umblicus, and its nerve root enters the rectus sheet at its level
Premalignant lesion of SCC is
lichen planus
actinic keratitis
dermatitis
leukoplakia
keratosis
B) Reason
Actinic keratosis:1. This premalignant epidermal lesion is caused by chronic excessive exposure to sunlight. 2. Characteristics include rough, scaling, poorly demarcated plaques on the face, neck, upper trunk, or extremities
Patient with recurrent infections and hypocalemia since birth, what is the defect
inc. cell in paracortex
dec. cell in paracortex
abnormal T cells
IgA deficiency
abmormal B cells
B) Reason
Paracortex Houses T cells. Region of cortex between follicles and medulla. Contains high endothelial venules through which T and B cells enter from blood. Not well developed in patients with DiGeorge syndrome.
In SLE, biopsy shows immune complexes deposits on renal biopsy, mechanism is?
thick basement membrane
Antigen-Ig complexes
effaced membrane
Villous atrophy
dec. connective tissue
B) Reason
Systemic lupus erythematosus (SLE) 1. SLE, the prototype connective tissue disease, most often affects women (80% of patients), usually those of childbearing age. 2. SLE is marked by the presence of a spectrum of ANAs and by extensive deposits of antigen-antibody complexes mediated inflammatory lesions involving multiple organ systems.
Pt. is undergoing EEG with eyes closed but fully awake. which waves will be seen?
gamma wave
delta wave
theta wave
alpha waves
beta wave
D) Reason
Awake (eyes open) Alert, active mental concentration Beta (highest frequency, lowest amplitude)Awake (eyes closed) Alpha waves.
most common aquired thrombotic disorder
OCP induced thrombosis
Bud chiari syndrome
pulmonary embolism
SLE
anti phospholipid syndrome
E) Reason
Antiphospholipid Antibody Syndrome: This syndrome (previously called the lupus anticoagulant syndrome) is the most common aquired thrombotic disorder, it has protean clinical manifestations, including recurrent thromboses, repeated miscarriages, cardiac valve vegetations, and thrombocytopenia.
Graft between genetically identical twins
need HLA matching
lab. limitation
ethically not done
not rejected
sometime rejected
D) Reason
Identical twins are the genetically same to each other in all the antigenic and cellular proteins, so their no tissue rejection reaction occur in transplant of identical twins.
Drug that dec. LES and inc. emptying
domperidone
5HT3 inhibitor
Metoclopramide
ampicillin
eryhromycin
C) Reason
MECHANISM: D2 receptor antagonist. decrease resting tone, contractility, LES tone, motility. Does not influence colon transport time.
A young boy has a soft to firm mass below hyoid from past a few months.What is the diagnosis?
adenoma
thyroglossal sinus
thyroglossal fistula
MNG
thyroglossal duct cyst
E) Reason
Thyroglossal duct cyst presents as an anterior midline neck mass that moves with swallowing or protrusion of the tongue (vs. persistent cervical sinus leading to branchial cleft cyst in lateral neck).
drug to avoid in CRF
ampicillin
cisplatin
ciprofloxacin
metronidazole
6-MP
B) Reason
TOXICITY of Cisplatin and Carboplatin: Nephrotoxicity and acoustic nerve damage. Prevent nephrotoxicity with amifostine (free radical scavenger) and chloride diuresis.
failure of ant. neuropore to close
myelocele
miningeocele
miningomyelocele
acraniotomy
anencephaly
E) Reason
Anencephaly: Malformation of anterior neural tube resulting in no forebrain, open calvarium (“frog-like appearance”). Clinical findings: inc. AFP; polyhydramnios (no swallowing center in brain). Associated with maternal diabetes (type I). Maternal folate supplementation dec. risk.
Propylthiouracil oxidizes what
monoiodide
iodide
thyroglobulin
thyroid binding globulin
thyroxine
B) Reason
MECHANISM: Block thyroid peroxidase, inhibiting the oxidation of iodide and the organification (coupling) of iodine leading to inhibition of thyroid hormone synthesis. Propylthiouracil also blocks 5′-deiodinase, which dec. peripheral conversion of T4 to T3
blood antigen secreted in
urine
marrow
feaces
saliva
csf
D) Reason
Crosses epithelial cells by transcytosis. Most produced antibody overall, but released into secretions (tears, saliva, mucus) and early breast milk (known as colostrum).
pain of appendicitis is referred to?
T8
T9
T10
T11
T12
C) Reason
PAIN OF APPENDICITISVisceral pain in the appendix is produced by distention of its lumen or spasm of its muscle. The afferentpain fibers enter the spinal cord at the level of thetenth thoracic segment, and a vague referred pain isfelt in the region of the umbilicus (T10). Later, the pain shiftsto where the inflamed appendix irritates the parietalperitoneum, and then the pain is precise, severe, and localized.
Gastric ulcer is most commonly found at
antrum
pylorus
body
fundus
cardia
A) Reason
Disruption of mucosal barrier leads inflammation. Antrum is the most common site of ulceration.Can be caused by stress, NSAIDs (dec. PGE2and hence dec. gastric mucosa protection), alcohol, uremia.
while inspiring s2 splits as a result of?
late aortic closure
early closure of aortic
early pulmonary close
late tricuapid closure
late bicuspid closure
B) Reason
Normal splitting: Inspiration, drop in intrathoracic pressure inc. venous return to the RV increased RV stroke volume leading to decreased RV ejection time causing delayed closure of pulmonic valve. decreased pulmonary impedance (increased capacity of the pulmonary circulation) also occurs during inspiration, which contributes to delayed closure of pulmonic valve.
which phase of sleep has theeta waves?
REM sleep
wake
non REM stage 1
colsed eyes
frightened
C) Reason
Non-REM sleep:Stage N1: (5%) Light sleep Thetawaves.Stage N2: (45%) Deeper sleep; when bruxism occurs Sleep spindles and K complexesStage N3: (25%) Deepest non-REM sleep (slow-wave sleep); when sleepwalking, night terrors, and bedwetting occur.Delta waves: (lowest frequency, highest amplitude)
what is the Origin of systemic arterial thrombi
pulmonary embolism
veinous thrombi
mural thrombi
periphral fibrosis
MI
C) Reason
Arterial thrombi a. These thrombi are formed inside the vessels in the areas of active blood flow. b. When mature, they demonstrate alternate dark gray layers of platelets interspersed with lighter layers of fibrin. This layering results in the lines of Zahn.
right sided hemiplegia with no sensory loss, lesion is in
Right cerebral cortex
cerebellam
medulla oblongata
internal capsule
mid brain
D) Reason
Most commonly caused by systemic hypertension D . Also seen with amyloid angiopathy, vasculitis, and neoplasm. Typically occurs in basal ganglia and internal capsule (Charcot-Bouchard aneurysm of lenticulostriate vessels), but can be lobar. Presents with crossed hemiplegia.
right sided hemiplegia with no sensory loss, lesion is in
Right cerebral cortex
cerebellam
medulla oblongata
internal capsule
mid brain
D) Reason
Most commonly caused by systemic hypertension D . Also seen with amyloid angiopathy, vasculitis, and neoplasm. Typically occurs in basal ganglia and internal capsule (Charcot-Bouchard aneurysm of lenticulostriate vessels), but can be lobar. Presents with crossed hemiplegia.
Regarding kidney what is right?
separate fascia for gland
left relates to aorta
right is little bellow
covered with fat
covered with fascial sheath
E) Reason
• Renal fascia: This is a condensation of areolar tissue outside the perirenal fat. It encloses the kidneys and thesuprarenal glands.
1 alpha hydroxilation of vit. D takes place in
liver
kidney
lungs
suprarenal
spleen
B) Reason
SOURCE: D3 from sun exposure in skin. D2 ingested from plants. Both converted to 25-OH in liver and to 1,25-(OH)2 (active form) in kidney
Patient presents with parotid swelling & pain that exaggerate on chewing, nerve responsible is?
facial
ophthalmic nerve
auriculotemporal
mandibular nerve
maxillary nerve
C) Reason
• The auriculotemporal nerve, which supplies the skin ofthe auricle, the external auditory meatus, the temporomandibular joint, and the scalp. This nerve also conveys postganglionic parasympathetic secretomotor fibers fromthe otic ganglion to the parotid salivary gland .
How will ECG represent ventricular depolarization?
PR wave
Q wave
QRS complex
T wave
P wave
C) Reason
QRS complex—ventricular depolarization (normally < 120 msec).QT interval—mechanical contraction of the ventricles.
patient with fever, fits, dark urine and shivering, Dx..?
epilepsy
minigitis
cerebral malaria
encephalitis
hydrocephalus
C) Reason
All the features given in scenario are characteristics of black water fever ( dark colored urine is the clue), while CNS involvement is the point to the Dx of Cerebral Malaria.
Which of the following vessels does NOT supply the retina?
anterior cilliary
lateral Cilliary
superior Cilliary
posterior Cilliary artey
upper Cilliary
D) Reason
Blood Supply1. The choriocapillaris of the choroid supplies the pigment epithelium, the layers of rods and conesand the outer nuclear layers.2. Central retinal artery supplies rest of the layers of the retina. It is a branch of the ophthalmicartery and is an end artery
which phase of cardiac cycle posseses maximum aortic pressure?
rapid ejection
slow ejection phase
slow relaxation
rapid filling
slow contraction
B) Reason
Durig the slow ejection phase, Ventricular volume is constant (isovolumetric) because all of the valves are closed.■ The “blip” in the aortic pressure tracing occurs after closure of the aortic valve and increased pressure.
testosterone plays a role in puberty that is
thinning of laryngeal cartilage
thickening of laryngeal cartilage
edema of larynx
edema of pharynx
thinning of bones
B) Reason
FUNCTION of Testosterone: Differentiation of epididymis, vas deferens, seminal vesicles (genitalia, except prostate)Growth spurt: penis, seminal vesicles, sperm, muscle, RBCsDeepening of voice(thickens laryngeal cartilage) Closing of epiphyseal plates (via estrogen converted from testosterone) Libido
fetal part of placenta is formed by
amnion
chorion frundosum
amnion frundosum
allantois
allantois frundosum
B) Reason
Fetal componentof Placenta: Cytotrophoblast Inner layer of chorionic villi (the frundosum). Cytotrophoblast makes Cells.Syncytiotrophoblast Outer layer of chorionic villi; secretes hCG (structurally similar to LH; stimulates corpus luteum to secrete progesterone during first trimester).
Pregnant lady advised to eat green vegetables, because it contains
B12
B5
B6
B1
folate
E) Reason
FUNCTION: Converted to tetrahydrofolate (THF), a coenzyme for 1-carbon transfer/methylation reactions.Important for the synthesis of nitrogenous bases in DNA and RNA.Found in leafy green vegetables. Absorbed in jejunum. Folate from green vegetables and foliage.
Patient with raised bilirubin, direct is 9 and indirect bilurubin is 1, cause
Criglar najjar
hepatitis
HCC
bile deficiency
pancreatic enzymes deficiency
B) Reason
Conjugated or the direct bilurubin is raised in hepatitis in which conjugating system of enzymes is intact while unconjugated or the indirect bilurubin is increased in enzyme defects.
Olfactory pathway is/has
direct pathway
trochlear pathway
mitral cells to cortex
olfactory cells to cortex
mucosal cells to cortex
C) Reason
• The respiratory area is lined by pseudostratified, ciliated columnar epithelium. Goblet cells are present as well. The olfactory area is in the posterosuperior area and contains bipolar neurons and mitral cells. Olfactory neurons are constantly replenished.
Patient took antibiotics for 2 months post-Op develops dirrohea, what would be changes seen on microscopy
Villous atrophy
hyperkeratosis
Lymphocytic infiltrate
pseudomembrane
edematous villi
D) Reason
C. difficile: Produces 2 toxins. Toxin A, enterotoxin, binds to the brush border of the gut. Toxin B, cytotoxin, causes cytoskeletal disruption via actin depolymerization causing pseudomembranous colitis leading to diarrhea. Often 2° to antibiotic use, especially clindamycin or ampicillin
CHF can best be diagnosed by which of following
ANP
Chest X-ray
BNP
ECG
angiography
C) Reason
B-type (brain) natriuretic peptide(BNP): Released from ventricular myocytes in response to tension. Similar physiologic action to ANP, with longer half-life. BNP blood test used for diagnosing heart failure (very good negative predictive value). Available in recombinant form (nesiritide) for treatment of heart failure.
kidneys get how much %age of C/O?
25
27
29
30
45
A) Reason
The blood flow through the renal system circulation (25% of cardiac output) can be subdivided into the hepatic arterial flow (7% of cardiac output) and the mesenteric-portal circulation (18% of cardiac output
what struture is injured superficial to flexor retinaculum in wrist injury?
ulnar nerve & artey
ulnar nerve only
ulnar artery only
radial nerve
median nerve
A) Reason
Ulnar nerve and artery pass over the Flexor Retinaculum, and this bridge and the carpal bones form the carpaltunnel for the passage of the median nerve and the longflexor tendons of the fingers
single best drug for mild CHF
ACE Inhibitor
beta blockers
nephedipine
verapamil
furosemide
A) Reason
Treatment of CHF: ACE inhibitors, β-blockers (except in acute decompensated HF), angiotensin II receptor blockers, and spironolactone dec. mortality. Thiazide or loop diuretics are used mainly for symptomatic relief. Hydralazine with nitrate therapy improves both symptoms and mortality in select patients.
Which Structure is of same size in new born & adults?
retina
heart valves
uncus
middle ear
inner ear
E) Reason
Inner ear size remains same in child and adult.
HLA matching is important because it prevents
anaphylactic
urticaria
graft vs host reaction
arthus reaction
lupus reaction
C) Reason
HLA matching is necessary to prevent the transplant rejection reactions. Host antibodies against donor HLA antigens and leukocytes can cause type 2 HSR.
flexor reflex is carried out by which receptors
tactile
nociceptors
free nerve endings
meisssner
pacinian
B) Reason
Flexor withdrawal reflex■ is polysynaptic.■ results in flexion on the ipsilateral side and extension on the contralateral side.Somatosensory and pain afferent fibers elicit withdrawal of the stimulated body part from the noxious stimulus.
Venous supply of heart is through
left cardiac vein
coronary sinus
right cardiac vein
coronary hilum
SVC
B) Reason
• Coronary sinus The coronary sinus is the main vein of the coronary circulation; it lies in the posterior coronary sulcus. It drains to an opening in the right atrium. It develops from the left sinus venosus.
Patient ECG shows 3:1 ratio of P to QRS complexes, Diagnosis.?
3rd degree block
1st degree block
mobitz type 2
mobitz type 2
atrial fibrillation
D) Reason
Mobitz type II: Dropped beats that are not preceded by a change in the length of the PR interval (as in type I). It is often found as 2:1 block, where there are 2 or more P waves to 1 QRS response. May progress to 3rd-degree block. Often treated with pacemaker.
Virulent strain of staph are identified by
coagulase test
gram staining
ZN staining
lipase
Hemolytic reaction
A) Reason
The enzyme is coagulase.Coagulase, by clotting plasma, serves to wall off the infectedsite, thereby retarding the migration of neutrophils into the site. It is positive in virulent strains of Staphylococci.
How the patient of HIV is monitored
PCR
Elisa
CD4 count
CD8 count
Western blot
C) Reason
Also use viral load to monitor effect of drug therapy.AIDS diagnosis ≤ 200 CD4+ cells mm3(normal: 500–1500 cells/mm3).HIV-positive with AIDS-defining condition (e.g., Pneumocystis pneumonia) or CD4 percentage < 14%.
why people fear of hospitals
rude behavior
uncooperative staff
fear of microbes
fear of infection
fear of being handicap
E) Reason
people fear hospitals because they think they will become handicapped and dependent on the medications.
Structure close to crus cerebri
homocullus
uncus
striatum
substantia nigra
globus pallidus
D) Reason
The midbrain comprises two lateral halves called the cerebral peduncles; each of these is divided into an anterior part, the crus cerebri; and a posterior part, the tegmentum, by a pigmented band of gray matter, the substantia nigra.
V/Q is seen increased in a pt. reason?
pulmonary embolism
sleep
coma
ARDS
exercise
A) Reason
In pulmonary embolism V/Q become infinity.
left cercumflex artery occlusion causes infarct of
left atrium
posterior surface
right ventricle
left atrium & ventricle
left ventricle only
E) Reason
Left circumflex coronary artery (LCX)— a branch of LCA supplies lateral and posterior walls of left ventricle
A runner iinjured his foot dueing practice and now he has pain when he tries to stand on his toes.This is due to
plantaris tendon
achilles tendon
posterior retinaculum
dorsal interossi
plantaris muscle
A) Reason
Plantar flexion (toes pointing downward): Gastrocnemius, soleus, plantaris, peroneus longus, peroneus brevis,tibialis posterior, flexor digitorum longus, planteris tendon and flexor hallucis longus muscles.
A multigravid female has C/O something coming out of vagina.Upon examination, cervix is coming out of external os.This is caused by damage of
vaginal vault
utrosacral ligament
uterine ligament
cervical ligament
pelvic diaphragm
B) Reason
PROLAPSE OF THE UTERUS:The levatores ani muscles and the transverse cervical,pubocervical, uterosacral and sacrocervical ligaments are of verygreat importance in supporting and positioning the uterus. Damage to these structures during childbirthor as a result of general poor body muscular tone mayresult in downward displacement of the uterus, cal led uterine prolapse
trypsinogen is activated by
enterokinase
CCK
bile
lipase
secretin
A) Reason
Trypsinogen: is Converted to trypsin by enterokinase/enteropeptidase, a brush-border enzyme on the duodenal and jejunal mucosa
centrilobular congestion is due to
fatty liver
fatty hepatosis
cirrhosis
nutmeg liver
HCC
D) Reason
Nutmeg liver Due to backup of blood into liver. Commonly caused by right-sided heart failure and Budd-Chiari syndrome. The liver appears mottled like a nutmeg. If the condition persists, centrilobular congestion and necrosis can result in cardiac cirrhosis.
Bilateral loss of pain and temperature at T4-T8, lesion is..?
Hemisection
complete section
central spinal lesion
disc prolapse
pulposus rupture
C) Reason
Syringomyelia: Cystic cavity (syrinx) within the spinal cord A(if central canal leading to hydromyelia). Crossing anterior spinal commissural fibers are typically damaged first. Results in a “cape-like,” bilateral loss of pain and temperature sensation in upper extremities (fine touch sensation is preserved).
Which vein is formed by the union of subclavian vein with internal jigular vein?
bracheocephalic trunk
jugular vein
thoracic duct
sterna chylli
left thoracic duct
A) Reason
Subclavian veing alongwith internal jugulat vein forms the brachiocephalic trunk.
Pancreas is affected by secretin by?
HCl inhibition
thick secretion
inc. Cl secretion
dec. HCO3 secretion
inc. HCO3 secretion
E) Reason
Secretin S cells (duodenum):Functions: Increases pancreatic HCO3 secretion gastric acid secretionbile secretion.
a lady with dec. IgA, IgD, IgM and chronic dirrohea as well as recurrent cough, Diagnosis..?
IgG deficiency
IgE deficiency
IgM deficiency
IgD deficiency
IgA deficiency
E) Reason
Selective IgAdeficiency:Unknown. Most common 1° immunodeficiency.Majority Asymptomatic. Can see Airway and GI infections, Autoimmune disease, Atopy, Anaphylaxis to IgA-containing products.
true about paraneoplastic syndromes is
large cell CA
squamous cell CA
adeno CA
small cell CA lung
NeuroEndocrine tumor
D) Reason
Small Cell CA: Undifferentiated , very aggressive.Paraneoplastic Syndrome: May produce ACTH, ADH, or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome). Amplification of myconcogenes common. Inoperable; treat with chemotherapy
oxytocin is stimulated& released by
adrenaline
Dopamine
LH
prolactin
suckling
E) Reason
Lactation After labor, the dec. in progesterone and estrogen disinhibits lactation. Suckling is required to maintain milk production, since inc. nerve stimulation inc. oxytocin and prolactin.
L1 vertebra fractured, injury to which structure
conus medularis
filum terminale
sacral plexus
lumber plexus
S1
A) Reason
The spinal cord is tapered below to formthe conus medullaris (L1-L2). The filum terminale is aprolongation of the pia mater that extends from the conus tothe back of the coccyx
It tells distribution of value in a data
confidence interval
frequency distribution
Hazards ratio
p-value
none of these
B) Reason
Distribution of frequency is the number of values repetition that a specified quantity appears in the given data. Here the most frequently appeared quantity is known as mode.
what brings about stimulation of thirst
inc. Cl conc.
dec. Na conc.
renin directly
Angiotensin-II
Angiotensin-I
D) Reason
Functions of Angiotensin-II are: (1) It increases thirst and therefore water intake.(2) It causes vasoconstriction of the arterioles, thereby increasing TPR and arterial pressure.
what kind of receptors are Messner”s receptors ?
low frequency
high frequency
low adapting
free nerve endings
least distributed
A) Reason
Meissner corpuscle are low frequency receptors, Present in nonhairy skin sense the Velocity and are Rapidly adapting receptors.
Tumor marker for CA colon is
CEA
PPD
CA-19-9
RET
Rb
A) Reason
CA Colon: Screen patients > 50 years old with colonoscopy or stool occult blood test.“Apple core” lesion seen on barium enema x-ray.CEA tumor marker: good for monitoring recurrence, not useful for screening.
clot retraction is brought about via
lymphocytes
Basophils
platelets
RBCs
leukocytosis
C) Reason
Platelet (thrombocyte) Involved in 1° hemostasis. Small cytoplasmic fragment derived from megakaryocytes. Life span of 8–10 days. When activated by endothelial injury, aggregates with other platelets and interacts with fibrinogen to form platelet plug and clot retraction.
movement of larynx while swallowing
downward
upward
lateral
anterior
pushed back
B) Reason
The main part of the larynx is thus elevated to the posterior surface of the epiglottis, and the entrance into the larynx is now closed.
What kind of lesion results in pure sensory loss due to damage to nerve when it enters spinal cord
tabes dorsalis
Hemisection
complete section
canal lesion
motor lesion
A) Reason
Tabes dorsalis Caused by 3° syphilis. Results from degeneration (demyelination) of dorsal columns and roots leading to impaired sensation and proprioception and progressive sensory ataxia (inability to sense or feel the legs causes poor coordination)
Which artery gives rise to Right bronchial artery
right post-intercostal artery
left post. intercostal artery
descending aorta
arch of aorta
axillary artery
A) Reason
The bronchi, connective tissue, and visceral pleura are supplied by the bronchial arteries, which are branches of the descending thoracic aorta. Right broncheal artery is the branch of the right posterior intercostal artery.
Characteristic finding of Transudate is
high protein
high cells ratio
high specific gravity
low specific gravity
high lipids
D) Reason
Transudate: Decreased protein content, blood cells as well as low specific gravity. Causes are CHF, nephrotic syndrome, or hepatic cirrhosis.
in temperature regulation how does post. hypothalamus plays role
piloerection
thirst
vasoconstriction
Vasodilation
shivering
E) Reason
Shivering is the most potent mechanism for increasing heat production. ■ Cold temperatures activate the shivering response, which is orchestrated by the posterior hypothalamus
while performing surgery rise in TPR is due to?
epinephrine
ACTH
Cortisol
GH
Dopamine
B) Reason
Surgery is one of the stressful conditions, and releases stress hormones via activation the hypothalamus secretion of ACTH.
Triglycerides in plasma are hydrolized by
pancreatic lipase
protease
hydroxylase
lipase
lipoprotein lipase
E) Reason
Lipoprotein lipase (LPL)—degradation of TG circulating in chylomicrons and VLDLs. Found on vascular endothelial surface.
Blood flow to kidneys is maintained by?
tubuloglumerlar feedback
renin Angiotensin system
local metabolism
sympathetic
parasympathetic
A) Reason
Tubuloglomerular feedback:, in which increased renal arterial pressure leads to increased delivery of fluid to the macula densa. The macula densa senses the increased load and causes constriction of the nearby afferent arteriole, increasing resistance to maintain constant blood flow.
slowest growing organism in artificial media
S aureus
Pseudomonas
M. tuberculosis
N. miningitis
M. bovis
C) Reason
Mycobacterium Tuberculosis is one of the slow growing organism on the culture media, that is the reason that its culture is waited till 6-8 weeks at least.
A patient with liomyoma, has dec. endometrial glands embedded in stroma
atrophy
dystrophy
hypertrophy
anaplasia
dysplasia
B) Reason
Leiomyoma (fibroid):Most common tumor in females. Often presents with multiple discrete tumors with decreased glandular tissue and increased stroma by glandular dystrophy. Increased incidence in blacks. Benign smooth muscle tumor; malignant transformation is rare.
outer layer of nerve is called
epimysium
epineuron
epineurium
perimysium
perinureum
C) Reason
The whole nerve trunk is ensheathed by epineurium, each fasciculus by perineurium, and each nerve fibre by a delicate endoneurium. The toughness of a nerve is due to its fibrous sheaths, otherwise the nerve tissue itself is very delicate and friable
effect of drug in old age
more dose required
can cause toxicity at therapeutic dose
less dose required
more safe window
more side effects
B) Reason
In old age, drug elimination system of body (liver as well as kidneys) become senile and their clearing capacity become less than in adulthood. That”s why therapeutic dose can cause toxicity.
Body is caught in bacterial infection. what will be 1st line of defence?
eosinophils
basophils
neutrophils
mucous membranes
skin
E) Reason
Innate defenses can be classified into three major categories: (1)physical barriers, such as intact skin and mucous membranes; (2) phagocytic cells,such as neutrophils, macrophages, and natural killer cells; and (3) proteins, such ascomplement, lysozyme, and interferon
Hypoxic pulmonary vasoconstriction is through
Na-H antiport
Ca channels
Cl chanel
ATP sensing K chanel
ATP sensing Na chanel
D) Reason
■ In the lungs, hypoxia causes vasoconstriction.■ This response is the opposite of that in other organs, where hypoxia causes vasodilation by opening hyoxia induced K chanel.■ Physiologically, this effect is important because local vasoconstriction redirects blood away from poorly ventilated, hypoxic regions of the lung and toward well-ventilated regions.
blood flow to muscle during exercise is regulated by
sympathetic
parasympathetic
O2 level
local metabolites
working level
D) Reason
Local metabolic control■ Blood flow in skeletal muscle exhibits autoregulation and active and reactive hyperemia.■ Demand for O2 in skeletal muscle varies with metabolic activity level, and blood flow is regulated to meet demand.■ During exercise, when demand is high, these local metabolic mechanisms are dominant.■ The local vasodilator substances are lactate, adenosine, and K+.
Vasodilation by sympathetic system is through
muscrinic
alpha 2 agonist
alpha 1 agonist
beta 2 agonists
beta 1 agonist
D) Reason
β2 Activation: Vasodilation, bronchodilation, inc. heart rate, inc. contractility, inc. lipolysis, inc. insulin release, dec. uterine tone (tocolysis), ciliary muscle relaxation, inc. queous humor production
patient with gram -ve sepsis and bleeding diathesis
DIC
ITP
TTP
HUS
hemophilia
A) Reason
Widespread activation of clotting leads to a deficiency in clotting factors, which creates a bleeding state.Causes: Sepsis (gram-negative), Trauma, Obstetric complications, acute Pancreatitis, Malignancy, Nephrotic syndrome,
hyperpolarization is result of?
efflux of Ca
eflux of K
efflux of Na
influx of Cl
efflux of Cl
B) Reason
Hyperpolarization makes the membrane potential more negative (the cell interior becomes more negative).
What triggers RBCs production in marrow?
GH
testosterone
erythropoitin
Aldosterone
Cortisol
C) Reason
Erythropoietin Released by interstitial cells in the peritubular capillary bed in response to hypoxia. It is induces the production of RBCs.
low voltage QRS complex are characteristic of
recent MI
old MI
atrial fibrillation
atrial flutter
ventricular fibrillation
B) Reason
Delayed complications are Dressler syndrome, HF, arrhythmias, true ventricular aneurysm (outward bulge during contraction, “dyskinesia”).
connections of pons
substantia nigra
striatum
globus pallidus
ipsilatral cerebellum
contralatral cerebellum
D) Reason
- The telencephalon forms the cerebral hemispheres - The diencephalon forms 4 thalamic derivatives - The mesencephalon forms the midbrain - The metencephalon forms the pons and cerebellum that are closely related to wach other.- The myelencephalon forms the medulla
At site of injury which chemotactic factor appears 1st
IL2
IL3
IL4
IL8
TNF
D) Reason
IL-6: An endogenous pyrogen. Also secreted by Th2cells. Causes fever and stimulates production of acute-phase proteins.IL-8: Major chemotactic factor for neutrophils.
true hermaphrodite genotype
XO
XXY
XYY
XXXY
OY
B) Reason
True hermaphroditism (46,XX or 47,XXY):Also called ovotesticular disorder of sex development. Both ovary and testicular tissue present (ovotestis); ambiguous genitalia. Very rare.
commonest heart dominance circulation is
left side
codominance
ipsilatral
contralatral
right sided
E) Reason
Right-dominant circulation = 85% = PDA arises from RCA.Left-dominant circulation = 8% = PDA arises from LCX.Codominant circulation = 7% = PDA arises from both LCX and RCA.
In which phase of cell cycle, cell has double chromatid
prophase
metaphase
telophase
anaphase
interphase
C) Reason
Towards the end of the cell division, the telephase, chromatids reach to the corresponding opposite poles in form of double chromatids around which new membrane formed to give daughter cell nuclei.
Micronodular cirrhosis is best diagnosed by
serum Copper level
serum bilurubin
AST
serum cerulloplamin
ALT
D) Reason
Characterized by:Decreased Ceruloplasmin, Cirrhosis, Corneal deposits (Kayser-Fleischer rings). Copper accumulation, Carcinoma (hepatocellular)Hemolytic anemiaBasal ganglia degeneration (parkinsonian symptoms).
left renal vein is related to
posterior to aorta
anterior to aorta
lateral to aorta
superior to aorta
inferior to aorta
B) Reason
The renal vein emerges from the hilum of the kidney in front of the aorta and drains into theinferior vena cava.
which of following is the most common indication of mitral valve replacement
atheromatous
stenosis
rupture of papillary muscles
regurgitation
senile
C) Reason
Ventricular free wall rupture laeding to cardiac tamponade; papillary muscle rupture causes severe mitral Regurgitation; that is a one of the important indication of mitral valve replacement.
which drug at therapeutic dose causes tachycardia
captopril
Norepinephrine
isosorbide dinitrane
Methyldopa
hydralazine
C) Reason
TOXICITY Reflex tachycardia (treat with β-blockers), hypotension, flushing, headache, “Monday disease” in industrial exposure: development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend results in tachycardia, dizziness, and headache upon reexposure.
core temperature 99F but pt. is calm & cold, reason?
drowning
cardiogenic shock
hypovolumic shock
heat exhaustion
heat stroke
D) Reason
Heat exhaustion is caused by excessive sweating. As a result, blood volume and arterial blood pressure decrease laeding to cold clamy extrimities and syncope (fainting) occurs.
Which reaction occur in mitochondria
lipolysis
glycogesis
glycogenolysis
glycolysis
TCA
E) Reason
Reactions in Mitochondria: Fatty acid oxidation (β-oxidation), acetylCoA production, TCA cycle, oxidative phosphorylation.
Which reaction occur in mitochondria
lipolysis
glycogesis
glycogenolysis
glycolysis
TCA
E) Reason
Reactions in Mitochondria: Fatty acid oxidation (β-oxidation), acetylCoA production, TCA cycle, oxidative phosphorylation.
blood vessels are part of which ligament?
gastrospleenic
gastrodudenal
gastrohepatic
quadrate ligament
round ligament
A) Reason
Gastrosplenic Ligament: It connects Greater curvature and spleen. It contains Short gastrics, left gastroepiploic vesselsIt separates greater and lesser sacs on the left side.
initial sign of resuscitation after compensated shock is?
dec. BP
inc. pulse rate
dec. pulse rate
inc. BP
cold skin
C) Reason
Hypovolumia (blood loss aftr hemmorhage) causes hypoglycemic shock (low BP and high pulse rate). Fluid resuscitation causes heart rate to decrease to normal and than increase BP towards normal value.
hypothalmo-hypophysial portal system is
adrenal cortex
adrenal medulla
hypothalamus
posterior pituitary
adenohypophysis
E) Reason
Anterior pituitary (adenohypophysis):Secretes FSH, LH, ACTH, TSH, prolactin, GH, melanotropin (MSH). Derived from oral ectoderm (Rathke pouch).
How hormonal therapy dec. tumor size
necrosis
hypotrophy
hypertrophy
atrophy
Apoptosis
E) Reason
Hormones act by inhibiting the growth factors and dec. cancer growth. Tamoxifen is the typical example, Tamoxifenmoxifen, a selective estrogen receptor modulator (see Chapter 40), blocks the binding ofestrogen to receptors of estrogen-sensitive cancer cells in breast tissue.
Neurovascular bundle of rib lies in
superior border
lateral border
posterior border
internal border
inferior border
E) Reason
• The costal groove is located along the inferior border of each rib (upper aspect of the intercostal space) and provides protection for the intercostal nerve, artery, and vein which are located in the groove. The vein is most superior and the nerve is inferior in the groove (VAN).
Sympathetic neurotransmitter
epinephrine
Norepinephrine
Dopamine
phenylephrine
Ach.
B) Reason
Release of sympathetic neurotransmitter norepinephrine from a sympathetic nerve ending is modulated by norepinephrine itself, acting on presynaptic α2-autoreceptors, angiotensin II, and other substances.
BCG acts via
CD8 delayed response
CD4 delayed HSR
type 2 HSR
type 1 HSR
type e HSR
B) Reason
Type IV: Multiple sclerosisGuillain-Barré syndromeGraft-versus-host diseasePPD (test for M. tuberculosis)and BCG.Contact dermatitis (e.g., poison ivy, nickel allergy).
A patient with loss of appetite, HBc-Ab reactive, IgM unreactive, HBsAg unreactive
chronic infection
acute infection
carrier state
past HBV exposure
heavy infection
D) Reason
Here the markers of HBV given in this scenario show that no recent infection (absent IgM) and furthermore presence of antibodies indicates a previous infection.
regarding drug receptors
lipoprotein
glycoprotein
glycolipids
protein in nature
lipoploysacchride
D) Reason
Proteins:1. Integral proteins■ are anchored to, and imbedded in, the cell membrane through hydrophobic interactions.■ may span the cell membrane.■ include ion channels, transport proteins, receptors, and guanosine 5′-triphosphate (GTP)–binding proteins (G proteins).
A male loses 8% blood after RTA in half hr. most likely site of loss?
arterioles
arteries
veins
heart
spleen
C) Reason
Veins have more distensibility and calibre than that of arteries and accumulate more blood than that of arteries. Hence blood loss is mainly from veins.
hormone responsible for inc. pancreatic secretion and intracellular Ca
lipase
enterokinase
gastrin
secretin
CCK
E) Reason
Cholecystokinin (CCK): secreted from I cells (duodenum, jejunum)Increases pancreatic secretionIncreases gallbladder contractionDecreases gastric emptyingIncreases sphincter of Oddi relaxation
A pt. is on steroid therapy for a long time. sudden extraction is ill advised. why?
withdrawl effect
dec. Cortisol
inc. Cortisol
inc. ACTH
dec. ACTH
E) Reason
TOXICITY Iatrogenic Cushing syndrome—buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis (treat with bisphosphonates), adrenocortical atrophy, peptic ulcers, diabetes (if chronic).Adrenal insufficiency (dec. ACTHg when drug stopped abruptly after chronic use.
CHF pt has developed edema. mechanism?
dec. hydrostatic pressure
inc. hydrostatic pressure
sec. oncotic pressure
inc. oncotic pressure
dec. plasma
B) Reason
Causes of Edema by Increased capillary hydrostatic pressure: Arteriolar dilationVenous constrictionIncreased venous pressureHeart failureExtracellular volume expansionStanding (edema in the dependent limbs)
histological feature of PCT
less mucosa
more mucosa
less muscles
villi
microvilli
E) Reason
The lateral borders of adjacent cells are extensively interdigitated. These characteristics are typical of cells involved in active transport. The lumen of the PCT is frequently clouded by microvilli which do not preserve well during the histologic preparation process.
Which of following cell has variable life
RBC
osteoblast
osteoclast
macrophages
lymphocytes
C) Reason
Osteoclasts are derived from cells of blood monocyte lineage, which ultimately come from hematopoietic stem cells. They have variable life span depending body Ca and PO4 levels.
Refractory period of cardiac Myocytes
0.8 sec
- 7 sec
- 5 sec
- 3 sec
- 1 sec
D) Reason
Absolute refractory period■ is the period during which another action potential cannot be elicited, no matter how large the stimulus, eg: 0.3 sec in cardiac cycle.■ coincides with almost the entire duration of the action potential.
SA node is pacemaker, reason
higher rate of firing
superior location
intrinsic property
less myofibrils
more myofibrils
A) Reason
Sinoatrial (SA) node ■ is normally the pacemaker of the heart due to its fast rate and automaticity■ has an unstable resting potential.■ exhibits phase 4 depolarization, or automaticity
prosopagnosia is inability to
recoganize color
recoganize face
recoganize objects
recoganize shapes
recoganize location
B) Reason
Among the higher mental functions of the cortex, the cerebrum, lesion manifestations are agraphesthesia (inability to recognize the shape of objects) and prosopagnosia is inability to recognize the face.
Regarding diabetes insipidus truth is?
dec. urine vol.
dec. serum Na
inc. serun K
inc. urinary Osmolarity
dec. urine Osmolarity
E) Reason
Diabetes insipidus Characterized by intense thirst and polyuria with inability to concentrate urine (decreased urine Osmolarity) due to lack of ADH. Has a central or nephrogenic cause.
A young lady took 10 tablets of paracetamol, what changes on liver on 3rd day
fibrosis
extensive hepatic necrosis
periportal fibrosis
periportal congestion
sinus congestion
B) Reason
Findings: mitochondrial abnormalities, extensive hepatic necrosis, fatty liver (microvascular fatty change), hypoglycemia, vomiting, hepatomegaly, coma.
A patient has chronic H/O gastric ulcer.Now he presented to SEW with severe epigastric pain and hypostension.Surgeon suspects gastric perfortion.Pain is carried in this situation by
lumber plexus
lumber splanchnic
great splanchnic
thoracic splanchnic
vagus
C) Reason
Great splanchnic nerve supply to the abdomenal viscera. Foregut and midgut (thoracic splanchnic nerves: T5-T12) and to the hindgut and pelvic viscera (lumbar splanchnic nerves: L1-L2) synapse in collateral ganglia.
block of artery supplying medulla will cause
deltoid paralysis
tongue paralysis
serratus anterior
serratus posterior
latismus dorsi
B) Reason
Caudal medulla—origin of hypoglossal nerve.Lesion causes Ipsilatral hypoglossal dysfunction (tongue deviates ipsilaterally
A patient can”t feel pain or touch sensation over third and fourth fingers.Which nerve is damaged in this case?
cutaneous nerve
axillary nerve
radial nerve
ulnar nerve
median nerve
D) Reason
Ulnar (C8-T1) Fracture of medial epicondyle of humerus “funny bone”.“Ulnar claw” on digit extension and loss of sensation of 3rd and 4th fingers.
A patient sustained injury to chest with a knife.How.many layers of chest wall will be damaged?
2
4
8
10
14
C) Reason
layers to be penetrted are skin, subcutaneous tissue, fat, muscle layers (2 layers), pleural ligament, pleural layers (2 layers) to lungs.
reason of decline in PaO2?
high altitude
deap sea
low drowning
sea level
Hypoxia
A) Reason
Adaptation to high altitude (Table 4.9) Alveolar Po2 is decreased at high altitude because the barometric pressure is decreased. As a result, arterial Po2 is also decreased (hypoxemia).
true about ABO blood group antigen
autosomal dominant
autosomal recessive
X-linked recessive
X-linked dominant
Y-linked
B) Reason
Autosomal recessive Traits:Albinism, ARPKD (formerly known as infantile polycystic kidney disease), cystic fibrosis, glycogen storage diseases, ABO blood group antigen, hemochromatosis, Kartagener syndrome.
which factor dec. in pregnancy
antithrombin 3
anti-trypsin
heparin
thrombin
fibrin
A) Reason
Pregnancy is an hypercoagulative state due to loss of antithrombin 3. Acquired deficiency of the Anti-thrombin III is related to the loss of factor in urine.
which is same Marker in pancreatic cancer, colon cancer and colangitis
CA 19-9
C-myc
CA 19
CA 125
CEA
E) Reason
CEA: CarcinoEmbryonic Antigen. Very nonspecific but produced by ∼ 70% of colorectal and pancreatic cancers; also produced by gastric, breast, and medullary thyroid carcinomas.
left shift in Hb-O2 curve is result of?
dec. K
dec. Na
dec. O2
increased pH
dec. pH
D) Reason
An increased in all factors (including H+) causes a shift of the curve to the right.A decreased in all factors (including H+) causes a shift of the curve to the left.
sphincter of gall bladder and intestine are relaxed by
sympathetic
autonomic
parasympathetic
lumber plexus
ascral plexus
C) Reason
Parasympathetic system is the system of rest and digest. Its activation causes increased GI motility, relaxed GI sphincters and increased GI secretions.
1st approved gene therapy was introduced through
plasmid
insulin
mice
doli sheep
horse
A) Reason
Plasmid Contains a variety of genes for antibiotic resistance, enzymes, toxins. It was used in recombinant technology for the first time in history.
A patient suddenly lifted heavy weight and subsequently developed sciatica.On examination,ankle jerk is absent.This is caused by damage of
L4
L3
S1
L5
L2
C) Reason
Heavy weight lifting is most of the time associated with damage to the Lumbosacral spine and its roots. Loss of ankle jerk (root value S1) mean lesion at S1 level.
which is not enzyme of pancrease?
glactase
lipase
amylase
mucous
protease
D) Reason
The acinar cells of the exocrine pancreas make up most of its weight.Secretion (serous) are secreted by the pancreatic acini.a. Acinar cells■ produce a small volume of initial pancreatic secretion, which is mainly Na+ and Cl
AV node delay is shortened by
parasympathetic
Ach
lidocain
autonomic
sympathetic
E) Reason
sympathetic stimulation causes increased in heart rate and hence cardiac cycle is decreased and sympathetic activity causes increased firing of nodal fibers and shortens the AV nodal delay.
in hemorrhagic shock urine output is decreased. reason?
low heart rate
high heart rate
dec. oncotic pressure
low arterial pressure
high arterial pressure
D) Reason
In hemmorhage, plasma volume decreases laeding to decreased arterial pressure and hence decreased GFR and low urine output.
ALT and AST are raised in hepatitis by which mechanism
their increase synthesis
decreased absorption
released from bile accumulation
none of these
released from destruction of hepatocytes
E) Reason
ALT and AST are the enzymes of the liver cells. In inflamation of the liver cells membrane is damaged leading to release of these enzymes. Hence their level increased in serum.
MOst active transport of sodium takes place at?
jejunum
dudenum
ileum
cecum
Colon
A) Reason
■ Examples are Na+-glucose cotransport in the small intestine (jejunum) and renal early proximal tubule and Na+K/2Cl cotransport in the renal thick ascending limb.
A patient with previous Compylobacter infection now developed paraplegia, cause.?
UMNL
LMNL
NM junction disorder
flaccid paralysis
GBS
E) Reason
Campylobacter infection can result in reactive arthritis, primarily in patients with HLA-B27. Other extraintestinal complications, including erythema nodosum and GuillainBarré syndrome, a flaccid paralysis caused by immunologically mediated inflammation of peripheral nerves, are not HLA-linked.
Which of the following structure is related medially and posteriorly to parotid and might be damaged during parotidectomy?
azygus vein
hemi azygus vein
internal jugular
carotid sheath
external jugular
D) Reason
• Posterolateral relation of the parotid gland are: The carotid sheath and its contents
which bone make floor of cranial fossa
maxillary sinus
mndibular bone
cervical spine
greater wing of sphenoid
lesser wing of sphenoid
D) Reason
Sphenoid Complex bone composed of a central body, and greater and lesser wings. Its greater wing forms the floor of the middle cranial fossa.
AB+ lady need blood postpartum. which group is apropriate?
O-
O+
AB+
B+
all of above
E) Reason
AB positive blood group is an universal accepter, moreover all groups given here all are compatible with AB positive blood group.
Which hormone causes smooth muscle contraction via IP3 ?
cortisol
Aldosterone
Prolactin
renin
ADH
E) Reason
Vasopressin [antidiuretic hormone (ADH)], IP3 and DAG■ is involved in the regulation of blood pressure in response to hemorrhage, but not in minute-to-minute regulation of normal blood pressure.■ Atrial receptors respond to a decrease in blood volume (or blood pressure) and cause the release of vasopressin from the posterior pituitary.■ Vasopressin has two effects that tend to increase blood pressure toward normal.
right hemiplegia with left sided mouth deviation, lesion is at..?
crona radiata
Midbrain
medulla
pons
internal capsule
E) Reason
internal capsule lesion: Contralateral hemiparesis/Crossed hemiplegia (contralatral mouth deviation)Common location of lacunar infarcts, 2° to unmanaged hypertension.
taste sensation from tractus solitarius goes to cortex via
hypothalamus
pons
thalamus
Midbrain
medulla
C) Reason
Solitarius Visceral Sensory information (e.g., taste, baroreceptors, gut distention). Sensations are Transmitted through thalamus to the cortex.
inhibitor of prostaglandins are
GH
insulin
corticosteroids
glucagon
naltrisone
C) Reason
orticosteroids cause neutrophilia, but eosinopenia and lymphopenia. Corticosteroids decrease the formation of prostagladins and decrease the activation of neutrophil adhesion molecules, impairing migration out of the vasculature to sites of inflammation.
All or none action potential is feature of
dendrites
axon
astrocytes
oligodendrocyte
Schwann cells
B) Reason
During the action potential of the neurons, it follows the all or none principle. All the fibers are excited or no one is excited during the action potential.
lidocaine is given in treatment of
WPS syndrome
ventricular tachycardia
atrial fibrillation
atrial flutter
ventriclar fibrillation
B) Reason
CLINICAL USE of Lidocain : Acute ventricular arrhythmias (especially postMI), digitalis-induced arrhythmias especially post-MI.
A female with recurrent UTI, Pseudomonas on culture, drug of choice
Ciprofloxacin
metronidazole
ampicillin
gentamicin
clavulunate
A) Reason
Treatment: aminoglycoside plus extended spectrum penicillin (e.g., piperacillin, ticarcillin, cefepime, imipenem, meropenem) and quinolones (UTI and pylonephritis).
Hyperextension of tibia anteriorly over knee joint will damage
patella
anterior cruciate ligament
lateral ligament
tibial condyl
fibular head
B) Reason
The anterior cruciate ligament is attached below tothe anterior intercondylar area of the tibia, most commonly injured in excessive anterior movementa of the knee joint.
squamocolumnar junction of esophagus is associated with
achlasia
squamous metaplasia
cuboidal Metaplasia
Barrett esophagus
CA esophagus
D) Reason
Barrett esophagus Glandular metaplasia—replacement of nonkeratinized (stratified) squamous epithelium with intestinal epithelium (nonciliated columnar with goblets cells) in the distal esophagus at squamocolumnar junction. Due to chronic acid reflux (GERD).
myelination of periphral nervous system
astrocyte
dendrites
axons
schwann cells
oligodendrite
D) Reason
Schwarm cells are glial cells that make myelin for PNS axons. Unlike oligodendrocytes, which make C S myelin, individual Schwann cells myelinate only a small part of a single axon.
Complete loss of arm abduction rsults from damage to
supraspinatus
axillary
supraspinatus and axillary
radial
median
C) Reason
Abduction of arm is the combined function if the Supraspinatus muscle and deltoid, supplied by supraspinatus and axillary nerve respectively.
serum Ca and phosphate are regulated by?
PTH
renal function
liver function
lung function
bone function
B) Reason
Level of serum calcium and serum Phosphate are regulated by renal function. Ca is decreased and phosphate is increased in impaired renal functions.
Quiet inspiration is carried out by
diaphragm
pleura
intercostal
thoracic splanchnic
Trapezius
A) Reason
The phrenic nerve (C3–5).Action• Muscle of inspiration: On contraction, the diaphragmpulls its central tendon down and increases the vertical diameter of the thorax
true about vibrio cholera
survive in alkaline
survive in acidic
susceptible to alkaline
live in high temperature
live in high pH
A) Reason
Vibrio cholerae Produces profuse rice-water diarrhea via enterotoxin that permanently activates Gs, inc. cAMP. Comma shaped, oxidase positive, grows in alkaline media. Endemic to developing countries. Prompt oral rehydration is necessary
Injury to the phrenic nerve at its root will lead to loss of
respiratory reflex
gastric reflex
sneezing reflex
cough reflex
pharyngeal reflex
A) Reason
Diaphragm is innervated by C3, 4, and 5 (phrenic nerve). Lesion of the nerve leads to respiratory distress and loss of respiratory reflex.
Thrombocytopenia is side effect of
loop diuretics
osmotic diuretics
thiazide
spironolactone
amiloride
C) Reason
TOXICITY Hypokalemic metabolic alkalosis, Thrombocytopenia, hyponatremia, hyperGlycemia, hyperLipidemia, hyperUricemia, and hyperCalcemia. Sulfa allergy
true about SLE
type 1 HSR
type 3 HSR
tyep 2 HSR
type 4 HSR
Delayed response
B) Reason
Type III:Polyarteritis nodosaPoststreptococcal glomerulonephritisSerum sickness, SLEArthus reaction (e.g., swelling and inflammation following tetanus vaccine)
a pt with pacemaker comes for ecg, finding shows absent P wave, normal qrs complex & T wave. location of pacemaker?
bundle of His
SA node
AV node
atria
ventricle
C) Reason
Pacemaker action:Occurs in the SA and AV nodes. Key differences from the ventricular action potential. Normally in SA node. When in AV node, there is no P wave, rest is normal.
fatty acids combines with glycerol to form fat in..?
RER
SER
golgi complex
nucleus
cell membrane
C) Reason
In golgi apparatus, Glyceraldehyde-3-phosphate to glycerol-3-phosphate (combines with fatty acids to make triglycerides
A boy had injury to knee, 8 month later he had hematoma and bone trabeculi, Dx..?
dysplasia
metaplasia
anaplasia
neoplasia
dystrophy
B) Reason
Metaplasia mean transformation of the one type of cells into another type of cells. Here in this scenario, injury caused soft tissue to develop bony (metaplstic) tissue.
in mitral stenosis which jvp is not found?
a wave
x wave
y desent
d wave
V wave
E) Reason
v wave—inc. right atrial pressure due to filling against closed tricuspid valve. It is absent in mitral stenosis.
cells responsible for maintenance and integrity of bone
fibroblasts
osteiod
osteocytes
osteoclasts
osteoblasts
E) Reason
Osteoblasts are specialized to synthesize and secrete the components of osteoid, type I collagen, and GA Gs. The unique structure of the osteoid, in particular the ordering of the collagen, promotes the formation of a crystalline structure.
Which structure will be damaged in case of penetrating injury to posterior triangle of the neck?
deltoid
trapezius
supraspinatus
teres major
seratus posterior
B) Reason
The posterior triangle is bounded posteriorly by the trapezius muscle, anteriorly by the sternocleidomastoid muscle,and inferiorly by the clavicle
Cause of amenorhea in married female with pregnancy test negative
ectopic pregnancy
molar pregnancy
no pregnancy
twin pregnancy
anovulation
E) Reason
Most common causes of anovulationPregnancy, polycystic ovarian syndrome, obesity, HPO axis abnormalities, premature ovarian failure, Anovulatory cycles, hyperprolactinemia, thyroid disorders, eating disorders, female athletes, Cushing syndrome, adrenal insufficiency.
When fibrinogen changes to fibrin what will be seen in blood
lipase
fibrinolase
Fibrinopeptidase A
Fibrinopeptidase B
Fibrinopeptide
C) Reason
Fibrinogen: It is Coagulation factor; converts to fibrin by FibrinopeptidaseA, promotes endothelial repair; correlates with ESR
A middle age man is suspected of lymphoma, it is diagnosed by
Electrophoresis
bone marrow biopsy
CBC
Peripheral smear
immuno-histochemistry
E) Reason
Lymphoma Discrete tumor masses arising from lymph nodes. Presentations often blur definitions. Diagnosed witn immunohistochemistry.
Patient has no cough, but diffuse fibrosis on chest X-ray, cause
silicon
hydrocarbon
asbestos
inorganic dust
berrylium
D) Reason
Keeping types of joints in mind, wrist joint is a
hing type
sesamoid
fixed joint
condyloid
Ellipsoid
E) Reason
Wrist joint is an example of Ellipsoid type. Reference B.D.
A 70kg male will have a urinary output of?
0.5 L
1 L
2 L
3 L
1.5 L
E) Reason
Normal urine output is about 1ml/kg per hour. So, in a person of 70kg it would be, Urine output= 1ml x 70 x 24 = 1680ml, app = 1.5L.
IV drug abuser with cough not responding to ATT, bilateral infiltrates on CXR, cause..n
M. tuberculosis
P. aerogenosa
Candida
P. jirovecii
M. bovis
D) Reason
Pneumocystis jirovecii:Causes Pneumocystis pneumonia (PCP), a diffuse interstitial pneumonia. Yeast (originally classified as protozoan). Inhaled. Most infections are asymptomatic. Immunosuppression (e.g., AIDS) predisposes to disease. Diffuse, bilateral CXR appearance. Diagnosed by lung biopsy or lavage. Disc-shaped yeast forms on methenamine silver stain of lung tissue .
primordial germ cells are formed at
2nd month
8th day
2nd week
3rd week
4th week
E) Reason
Primordial germ cells arise from the lining cells in the wall of the yolk sac. At week 4, primordial germ cells migrate into the indifferent gonad.
temp maintenance of skeleto-motor system is via?
vasoconstriction
shivering
vasodilation
piloerction
sheltering
B) Reason
Shivering is the most potent mechanism for increasing heat production. ■ Cold temperatures activate the shivering response, which is orchestrated by the posterior hypothalamus.
loop diuretic cause what
no effect on medularry osmolarity
inc. reabsorption
inc. secretion
inc. medullary interstitial osmolarity
dec. Medullary Osmolarity
E) Reason
It causes decreased osmolarity.
which structure is responsible for keeping flexor tone of muscles?
fasiculus gracilis
fasiculus cuneatus
stratum
uncus
red nucleus
E) Reason
Rubrospinal tract■ originates in the red nucleus and projects to interneurons in the lateral spinal cord.■ Stimulation of the red nucleus produces stimulation of flexors and inhibition of extensors.
which has role in tissue remodeling
macrophages
metalloproteins
fibroelasts
collagenase
lipase
D) Reason
Collegenase is protein enzyme that functions to remodeling if the repaired tissues. Its defects leads to abnormal shape of the repaired tissues like abnormal scars.
There is a triangle in neck which is formed by mandible, sternocledomastoid and midline.This traingle is called
posterior
lateral
anterior
inferior
superior
C) Reason
The anterior triangle is bounded above by the body of themandible, posteriorly by the sternocleidomastoid muscle,and anteriorly by the midline
Epithelium of urinary bladder is dervied in embryological life from
urogenital sinus
urogenital ridge
urogenital diaphragm
urogenital membrane
urachus
A) Reason
In the 3rd week the yolk sac forms the allantois, which extends into the urogenital sinus. Later on, urogenital sinus forms the epithelium of the Urinary bladder.
brain gets what %age of total cardiac output?
5
7
10
15
20
D) Reason
These are the well perfused organs. 25% of the cardiac output goes to the liver; 4-5% (225 ml/min) to the heart; 15% to the brain; 20% to the kidneys; and 100% to the lungs.
a pt experiences conduction aphasia. site of lesion is?
Arcuate faciculus
gracilis
faciculus cuneatus
red nucleus
pons
A) Reason
Conduction Aphasia There is a large fiber bundle connecting areas 22, 39, and 40 with Broca area in the frontal lobe, known as the superior longitudinal fasciculus (or the arcuate fasciculus). A lesion affecting this fiber bundle results in a conduction aphasia.
frontal lobe tumor with optic tract affected will cause
Homonemous hemianopia
Heteronymous hemianopia
ipsilatral loss
contralatral loss
upper quadrant loss
A) Reason
Bitemporal hemianopia (pituitary lesion, chiasm) Left homonymous hemianopia(lesion of ipsilatral optic tract). Left upper quadrantic anopia (right temporal lesion, MCA)
what leads to osmotic diarrhea?
fructose
galactose
sucrose
dextran
lactose
E) Reason
Lactose intolerance results from the absence of brush border lactase and, thus, the inability to hydrolyze lactose to glucose and galactose for absorption. Nonabsorbed lactose and H2O remain in the lumen of the GI tract and cause osmotic diarrhea.
Pt. can”t diff. between red and green having red color blindness, condition is called
deutronopia
tritononopia
protanopia
gluconopia
rubronopia
C) Reason
Color blindness are named as Protonopia as red blindness, Deutronopia as green blindness and tritononopia is blue color blindness.
A lady with fasting sugar 98 and random 122, post meal is 190, Dx..?
diabetes
Impaired glucose tolerance
pre-diabetes
no diabetes
type 2 diabetes
B) Reason
Diagnosis: fasting sugar greater than 110mg/dl, random level greater than 126mg/dl or post glucose greater than 200mg/dl are diagnostic ojf diabetes mellitus.
Dermatome for cholecystitis pain
C5
C6
C6-C8
C4
C7-9
D) Reason
dermatome is same as of shoulder tip.
which carry impulses away from cell body
dendrites
axon
oligodendrite
astrocytes
schwann cells
B) Reason
Signal-relaying cells with dendrites (receive input), cell bodies, and axons (send output). Cell bodies and dendrites can be stained via the Nissl substance (stains RER).
fatty meal leading to bloating at night. work of which hormone?
GIP
CCK
VIP
secretin
gastrin
B) Reason
Can also lead to biliary colic—neurohormonal activation (e.g., by CCK after a fatty meal) triggers contraction of the gallbladder, forcing a stone into the cystic duct. May present with bloating and with or without pain (e.g., in diabetics).
after shock managment what will be corected first?
BP
temperature
Hb
leukocytes
Heart rate
E) Reason
In hypovolumic shock, Blood volume decreases that causes decreased BP and increased heart rate. As the fluid therapy is started, heart rate slow down to normal and then BP also goes up to normal.
A lady going to Saudi Arabia has clear fluid filled lesion in mouth, Dx..?
HSV1
HHV
HHV-8
HIV
HCV
A) Reason
HSV-1: Gingivostomatitis, keratoconjunctivitis, temporal lobe encephalitis (most common cause of sporadic encephalitis in the United States), herpes labialis. Latent in trigeminal ganglia.Transmitted by respiratory secretions, saliva.
which NSAID is contraindicated in CLD
Clopidogrel
aspirin
ampicillin
gentamycin
metronidazole
B) Reason
TOXICITY Gastric ulceration, tinnitus (CN VIII). Chronic use can lead to acute renal failure, interstitial nephritis (contraindicated in CRF), and upper GI bleeding. Risk of Reye syndrome in children treated with aspirin for viral infection.
In thrombus formation, 1st step is
clot retraction
platelets adhesion
clot formation
endothelial injury
tissue reaction
B) Reason
In thrombus formation, platelets adhesion takes place over the injured endothelium making platelet plug that is site for thrombus formation.
A female is declared infertile yet prolactin is increased. reason?
adenoma
hyperplasia
hypertrophy
macroprolactinoma
microprolectinoma
E) Reason
Functional tumor (microprolactinoma) presentation is based on the hormone produced (e.g., prolactinoma: amenorrhea, galactorrhea, low libido, infertility; somatotropic adenoma: acromegaly).
heart contractility is affected by all except?
Ach
epinephrine
Norepinephrine
Cortisol
GH
A) Reason
Sympathetic system stimulation or secretion of any stress hormone causes increased contratility of the heart . Ach. is a parasympathetic hormone.
Cost effective way of judging vit.A deficiency in community
clinical
diet
pharmacological
supplements
Screenig
B) Reason
It is easy to assess and manage the nuitrional deficiencies in the in diet rather to do it with clinical or the pharmacological interventions that would be expensive and complicated as well.
which is type 2 hypersensitivity reaction
SLE
Polyarteritis nodosa
serum sickness
arthus reaction
ITP
E) Reason
Type II: Autoimmune hemolytic anemiaPernicious anemiaIdiopathic thrombocytopenic purpuraErythroblastosis fetalisAcute hemolytic transfusion reactionsRheumatic feverGoodpasture syndromeBullous pemphigoidPemphigus vulgaris.
staging is defined as
extent of severity
extent of lesion
differentiation
anaplasia
prognosis
B) Reason
Staging of tumor: Degree of localization/spread based on site and size of 1° lesion, spread to regional lymph nodes, presence of metastases. Based on clinical (c) or pathology (p) findings. Example: cT3N1M0
Hepatic gulconeogenesis is done by
glucagon
insulin
GH
LH
Cortisol
A) Reason
FUNCTION of Glucagon are: Catabolic effects of glucagon:Increases Glycogenolysis, gluconeogenesis(in liver)Inc. Lipolysis and ketone production
A patient was injured in RTA and sustained fracture of hip joint.Now when he stands up,his pelvis and left leg sinks down.This is caused by a lesion of
rectus femoris
quadricep femoris
adductor longus
left maximus
Right minimus
E) Reason
If gluteus minimus then the pelviswill sink downward on the opposite, unsupportedside. The patient is then said to exhibit a positiveTrendelenburg’s sign.
parameter responsible for preload calculation?
stroke volume
heart rate
plasma flow
Left ventricle EDV
viscosity
D) Reason
Preload: Preload approximated by ventricular EDV; depends on venous tone and circulating blood volume.
Damage to which of the following will lead to loss of ankle jerk?
S1
L4
L5
S2
L1
A) Reason
Heavy weight lifting is most of the time associated with damage to the spinal nerve roots. Here ankle jerk (root value of S1) loss mean lesion is at S1 level.
reason of TPR
smooth muscle
sphincters
arterioles
vasomotor tone
capillaries
D) Reason
Total peripheral resistance: maintained by vasomotor tone.Changes in TPR leads to altered CO at a given RA pressure; however, mean systemic pressure (x-intercept) is unchanged.
Which of the following vessels starts at the level of ear lobule and ends at sternoclavicular joint?
external jugular vein
internal jugular vein
internal carotid
external carotid
common carotid
B) Reason
The internal jugular vein is a large vein that drains bloodfrom the brain, face, scalp, and neck . It starts as acontinuation of the sigmoid venous sinus and leaves theskull through the jugular foramen and ends at the medial border of clavicle by forming bracheocephalic vein.
fibrocartilage is present in
knee
elbow
Intervertebral disc
sutures
TM joint
C) Reason
Fibrocartilage has type I collagen in addition to type II, giving it greater resistance to being stretched (tensile strength), and is the type of cartilage found in intervertebral disks of the vertebral column and the menisci of the knee.
most common cause of Hyperbilirubinemia in neonates
hepatitis
hemolysis
maternal alcohlism
conjugated Hyperbilirubinemia
Gilbert syndrome
B) Reason
Most common cause of unconjugated /indirect hyperbilirubinemia are: Hemolytic, physiologic (newborns), Crigler-Najjar, Gilbert syndrome
Virulence of Staph aureus is determined by
protease
plasmin
coagulase
cell wall
capsule
C) Reason
Coagulase is an enzyme that causes plasma to clot byactivating prothrombin to form thrombin. It is the main virulent factor of staph. aureus. Thrombin then catalyzes the activation offibrinogen to form the fibrin clot.
which of following is Hypertonic solution
10% dextrose
- 9% NaCl
- 2% NaCl
5% Dextrose
0.1% NaCl
A) Reason
All the fluids given in the list are either hypotonic to the body (0.1, 0.2 percent NaCl) or Isotonic such as (0.9 percent NaCl or 5 percent dextrose) except 10 percent Dextrous that is Hypertonic.
Recently married female with lower abdominal pain. Urine gives pus cells, Dx..?
E. coli
Pseudomonas
staph. aureus
N. miningitis
Shagilla
A) Reason
E. coli is the leading cause of community-acquired urinary tract infections.These infections occur primarily in women; causing frequent burning Micturation and suprapubic tenderness.
what change will be seen in lung compliance if surface tension is decreased?
decrease
increase
shift to left
shift to right
become zero
B) Reason
Compliance—change in lung volume for a given change in pressure; maintained by surfactant decreased in pulmonary fibrosis, pneumonia, and pulmonary edema and increased surfactant; increased in emphysema, low or none surfactantand normal aging
what replicates itself
mitochondria
RER
SER
Golgi complex
nuclei
A) Reason
They synthesize adenosine triphosphate (ATP ), contain their own double-stranded circular DNA, and make some of their own proteins and replicate themselves by virtue of their own genetic material.
Patient presents with constipation, muscle weakness and short T-wave, Dx..?
hyperkalemia
hypokalemia
hypernatremia
atrial flutter
atrial fibrillation
B) Reason
T wave—ventricular repolarization. T-wave inversion may indicate recent MI. While short T wave in hypokalemia and tall T wave in hyperkalemia.
which connects laminae in vertebral column
Ligamentum teres
Ligamentum flavum
round ligament
introssious ligament
transverse ligament
B) Reason
LIGAMENTSbetween 2 Vertebra:• Supraspinous ligament: Connects adjacent spines.• Interspinous ligament: Connects adjacent spines.• Ligamentum flavum: Connects adjacent laminae
In a young pt. high levels of GH are seen it will lead to deficiency of what?
amino acids
carbohydrates
protein
vitamins
fatty acids
E) Reason
FUNCTION Stimulates linear growth and muscle mass through IGF-1/somatomedin secretion. Increases lipolysis and insulin resistance (diabetogenic).
Trypsinogen changes to trypsin ?
gastrin
secretin
bile
enterokinase
protease
D) Reason
Trypsinogen: Converted to active enzyme trypsin by enterokinaseto activation of other proenzymes and cleaving of additional trypsinogen molecules into active trypsin (positive feedback loop)
Pt has mild jaundice that is recurrent and has unconjugated Hyperbilirubinemia, Dx..?
Hepatitis
Wilson disease
Criglar naggar
Dubin johnson
Gilbert
E) Reason
Gilbert syndrome: Mildly dec. UDP-glucuronosyltransferase conjugation activity dec. bilirubin uptake by hepatocytes. Asymptomatic or mild off and on jaundice. Elevated unconjugated bilirubin without overt hemolysis.
which one has highest conductance rate
SA node
AV node
bundle of His
left atrium
Purkingi fibers
E) Reason
Speed of conduction—Purkinje > atria > ventricles > AV node.Pacemakers—SA > AV > bundle of His/Purkinje/ventricles.
Ends of long bones are supplied by
nutrient artery
periosteal artery
metaphyseal artery
periphyseal artery
epiphyseal artery
E) Reason
Epiphysial arteries • These are derived from periarticular vascular arcades (circulus vasculosus) found on the nonarticular bony surface. These supply the metaohysis and epiohysis.
drug of choice for tape worm
metronidazole
ciprofloxacin
albendazole
ampicillin
gentamicin
C) Reason
Ingestion of larvae encysted in undercooked pork.Ingestion of eggs. Treated with Albendazole or ivermectin.
Difference between plasma and serum
clotting factors
proteins
cells
ions
RBCs
A) Reason
Plasma is part of blood minus blood cells while serum is the part of plasma minus clotting factors.
Receptors which adjust swiftly?
Pacinian
Meissner”s
tactile receptor
Murcel discs
GTO
A) Reason
Rapidly adapting, or phasic, receptors (pacinian corpuscle; light touch)■ show a decline in action potential frequency with time in response to a constant stimulus.■ primarily detect onset and offset of a stimulus
Choose the correct narrayive about renal fascia
sheet of muscle
encloses vessels
encloses aorta
encloses IVC
encloses suprarenal
E) Reason
Renal fascia: This is a condensation of areolar tissue outside the perirenal fat. It encloses the kidneys and thesuprarenal glands
which cells of intestine may carry antigens?
M cells
G cells
goblet cells
enterocytes
villi
A) Reason
Peyer patches: Unencapsulated lymphoid tissue found in lamina propria and submucosa of ileum. Contain specialized M cells that sample and present antigens to immune cells
most commonly raised enzyme in liver disease
AST
ALP
pseudocholinestrase
ALT
enterokinase
D) Reason
Aminotransferases (AST and ALT) (often called “liver enzymes”)Viral hepatitis (ALT > AST), viral hepatitis is more common than alcoholic one.Alcoholic hepatitis (AST > ALT)
Outer covering of single muscle is called as
epimysium
perimysium
neuromysium
exomysium
endomysium
E) Reason
Endomysium surrounds each muscle fibre separately. Perimysium surrounds bundles (fasciculi or myonemes) of muscle fibres of various sizes. Epimysium surrounds the entire muscle.
Diabetic with HLA1, undergone transplant 1 month ago, which cells involved in rejection
CD4 cell
Th1 cells
HLA 4
CD4 with MHC1
CD8 with MHC1
E) Reason
Febrile nonhemolytic transfusion reaction:Type II hypersensitivity reaction. Host antibodies against donor HLA antigens and leukocytes. through MHC.
substantia gelatinosa is related to
temperature
tactile
pressure
pain
vibration
D) Reason
This is particularly important in relation to thespinothalamic and spinoreticular pathways and the perception of pain.Presynaptic inhibition influences many, possibly all, primary afferent terminals. Amuch-investigated site ofpresynaptic effects is the substantia gelatinosa.
which phase of action potential leads to rise in pulse pressure?
phase 1
phase 2
phase 0
phase 3
phase 4
E) Reason
Positive chronotropic effect■ increases heart rate by increasing the rate of phase 4 depolarization.■ More action potentials occur per unit time because the threshold potential is reached more quickly and, therefore, more frequently.
difference between plasma and interstitial fluid
less lipids
more proteins
less proteins
less cells
less clotting factors
C) Reason
Interstitial fluid is three-fourths of the ECF. Thus, it is one-fourth of TBW (3/4 × 1/3).■ The composition of interstitial fluid is the same as that of plasma except that it has little protein. Thus, interstitial fluid is an ultrafiltrate of plasma.
Anticoagulant which is present naturally?
plasminogen
thrombin
plasmin
factor 4
Hagmann factor
A) Reason
Thrombolytics Directly or indirectly conversion of plasminogen (a natural Thrombolytic) to plasmin, which cleaves thrombin and fibrin clots. inc. PT, inc. PTT, no change in platelet count.
Fibers of the cilliary ganglion are carried through which branch
nasocilliary
optic
maxillary
labial
nasal
A) Reason
Some fibers from the nasocilliary branch go and synapse in the ciliary ganglionand reach the eyeball in the short ciliary nerves.
Doctor can develop better communication by
informed consent
non malficence
compitence
active listening
knowledge
D) Reason
A better communication skill is one of the important step of the relationship between a Doctor and a patient, it can be best developed by active listening and respect the views and ideas of the patients at their level.
Percentage of fat in normal diet
5 to 10
10 to 15
15-20
20-25
52-30
C) Reason
Normal contribution of the major nutrients in diet are as: Carbohydrates 45-65 percent, proteins 25-40 percent and fats 15-20 percent.
38 years male with fever, and chills, now presented with Hb of 8 and spleenomegaly, Dx..?
CML
ALL
malaria
CLL
lymphoma
C) Reason
Here in this scenario, all the features given are in favour of malarial diagnosis. While decreased Hb is the feature of hemolysis by the RBC burst and leading to spleenomegaly.
secondary center of ossification is associated with
epiphysis
diaphysis
metaphysis
shaft
metaphyseal plate
A) Reason
Epiphysis The ends and tips of a bone which ossify from secondary centres are called epiphyses.
clorpromazine toxicity
hypokalemia
hyponatremia
hyperkalemia
dystonia
CRF
D) Reason
TOXICITY: Highly lipid soluble and stored in body fat; thus, very slow to be removed from body.Extrapyramidal system side effects (e.g., dystonia and dyskinesias). Treatment: benztropine or diphenhydramine.
nerve damaged in Erb”s paralysis
C1-2
C2-3
C5-6
C4-5
C6
C) Reason
UPPER TRUNK LESIONS OF THE BRACHIALPLEXUS (ERB-DUCHENNE PALSY)Upper trunk (C5-6) lesions of the brachial plexus result fromdisplacement of the head to the opposite side and depression of the shoulder on the same side, as during fallson the shoulder or in infants during a difficult delivery
what is true about Antibodies in Hashimoto thyroiditis
anti mitochondrial
anti SM Igs
anti globulin
anti thyroxin
antithyroglobulin
E) Reason
Hashimoto thyroiditis: Most common cause of hypothyroidism in iodine-sufficient regions; an autoimmune disorder (anti-thyroid peroxidase, antithyroglobulin antibodies).
quatran malaria is by which specie
P. malarie
P. falciparum
P. vivax
P. ovale
P. hilus
A) Reason
Plasmodium Malarie is a specie of the Malaria causing parasites. P.Malarie fever spikes are there after every 3 days (Qurtran malaria).
side effect of thiazide diuretics
hypokalemia
hyperkalemia
hypernatremia
hypercalcemia
hypocalemia
D) Reason
TOXICITY Hypokalemic metabolic alkalosis, hyponatremia, hyperGlycemia, hyperLipidemia, hyperUricemia, and hyperCalcemia. Sulfa allergy.
calcitonin is given in
hyperthyroidism
paget disease
akalosis
hypoparathyroidism
hypercalcemia
E) Reason
Calcitonin■ is synthesized and secreted by the parafollicular cells of the thyroid.■ secretion is stimulated by an increase in serum [Ca2+].■ acts primarily to inhibit bone resorption.■ can be used to treat hypercalcemia and hyperparathyroidism.
example of end artery is?
RCA
mesenteric
spleenic
central retinal
hepatic
D) Reason
Central retinal artery supplies rest of the layers of the retina. It is a branch of the ophthalmicartery and is an end artery. It enters the optic nerve on its lower surface 15-20 mm behind theglobe. The normal artery : vein ratio is 2 : 3
A middle age Pt. with bone pain but normal Ca and increased PO4, cause..?
hypercalcimia
Achondroplasia
multiple myeloma
paget disease
sarcoma
D) Reason
Clinical features 1. Bone pain- due to microfractures 2. Increasing hat size- Skull is commonly affected. 3. Hearing loss-impingement on cranial nerve 4. Lion-like facies- involvement of craniofacial bones 5. Isolated elevated alkaline phosphatase-most common cause of isolated elevated alkaline phosphatase in patients> 40 years old
A Pt. developed reaction aftet 15 min of transfusion, it is a type of reaction
type 1 HSR
delayed response
type 3 HSR
type 2 HSR
type 4 HSR
D) Reason
Type II: Autoimmune hemolytic anemiaPernicious anemiaIdiopathic thrombocytopenic purpuraErythroblastosis fetalisAcute hemolytic transfusion reactionsRheumatic feverGoodpasture syndromeBullous pemphigoidPemphigus vulgaris
post op pain killer to a diabetic
Nalbin
diclophenac
aspirin
Ketorolac
midazolam
D) Reason
As NSAIDs are contraindicated in chronic renal failure and for the best control in DM and its complication (as CRF) is the Ketorolac.
which structure is most commonly damaged in anatomical snuff box
axillary nerve
radial artery
radial nerve
ulnar nerve
brachial artery
C) Reason
When the thumb is fully extended, a depression known as the anatomical snuffbox is seen on the lateralaspect of the wrist, immediately distal to the radial styloid process. Radial nerve is susceptible to injury here in this box.
stress hormone is?
Cortisol
insulin
ADH
Aldosterone
Dopamine
A) Reason
Stress hormones are the hormones that cope with the stressful conditions. these include GH, Epinephrine, Norepinephrine, Cortisol and glucagon.
Which Lymph Nodes are involved in stage 4 cervical cancer
external iliac
internal iliac
aortic
internal & external iliac
deep inguinal
D) Reason
Lymph Drainage:The Cervical cancer drains into the internal and theexternal iliac nodes.
in cardiac potential which phase is plateu
1
2
3
4
5
B) Reason
Phase 2 = plateau—Ca2+ influx through voltage-gated Ca2+ channels balances K+ efflux. Ca2+ influx triggers Ca2+ release from sarcoplasmic reticulum and myocyte contraction.
A pt. presented with high grade fever and chill is collapsed, Hb is 5, Dx..?
miningitis
cerebral malaria
encephalitis
epilepsy
hydrocephalus
B) Reason
All the features given in scenario are characteristics of malaria while H/O collapse indicates its CNS association that is cerebral Malaria.
Submandibular gland surgery is performed & accidentally a nerve is damaged. most likely nerve is
facial
mandibular
marginal mandibular
maxillary
ophthalmic
C) Reason
Nerve SupplyParasympathetic secretomotor supply is from the facialnerve via the chorda tympani. Marginal mandibular branch is closely related to gland and is frequently injured in its surgery.
adrenal cortex is derived from
ectoderm
endoderm
Mesoderm
meuroectoderm
yolk sac
C) Reason
drenal cortex and medulla: Adrenal cortex (derived from mesoderm) and medulla (derived from neural crest).
A female with femur fracture now presented with limb swelling, what will be next pathology.?
DIC
DVT
sepsis
shock
fat embolism
B) Reason
Venous thrombosis arises most often in the deep veins of the lower extremities with extremely painful swollen limb. It is often associated with inflammation and is then termed thrombophlebitis.
In a 43 year old ill looking man, gene/nuclear amplification is characteristic of which of following condition
myxoma
neuroblastoma
ewing sarcoma
hemangioma
medulloblastoma
B) Reason
Most common presentation is abdominal distension and a firm, irregular mass that can cross the midline (vs. Wilms tumor, which is smooth and unilateral). Homovanillic acid (HVA), a breakdown product of dopamine, inc.in urine. Bombesin +ve . Less likely to develop hypertension. Associated with overexpression of N-myc oncogene.
poplitial fossa is medially bound to?
sartorius
semimembranosus
adductor longus
adductor brevis
quadricep
B) Reason
BOUNDARIES• Laterally: The biceps femoris muscle above and the lateralhead of the gastrocnemius and plantaris muscles below.• Medially: The semimembranosus and semitendinosusmuscles above and the medial head of the gastrocnemiusmuscle below
which bone fracture will result in radial nerve damage?
humerus
radius
scapula
ulnar head
radial head
A) Reason
FRACTURES OF THE HUMERUS AND INJURYTO THE RADIAL NERVEThe radial nerve can be damaged where it lies in thespiral groove on the posterior surface of the shaft ofthe humerus under cover of the triceps muscle.
adipose tissue are affected by insulin. How?
inc. glycogen synthesis
inc. gulconeogenesis
inc. lipolysis
inc. lipoprotein lipase
lipase
D) Reason
Anabolic effects of insulin:Inc. glucose transport in skeletal muscle and adipose tissueInc. glycogen synthesis and storageInc. triglyceride synthesisInc. lipoprotein lipase in adipose tissueInc. protein synthesis (muscles, proteins)Inc. cellular uptake of K+ and amino acids.
hip extension and knee Flexion is carried out by
gracillus
adductor longus
semitendinosus
sartorius
quadriceps
C) Reason
• Muscles for Flexion at Knee: Biceps femoris, semitendinosus, and semimembranosus muscles.
Which structure is found between bellies of digastric and mandible
parotid
Sublingual
sub maxillary
submental nodes
Submandibular gland
E) Reason
SUBMANDIBULAR GLANDThe submandibular gland consists of a mixture of serousand mucous acini. It lies beneath the lower border of thebody of the mandible and bellies of digastric. It is divided into superficial anddeep parts by the mylohyoid muscle.
mucopolysacchride is abundantly found in
elastin
bone
collagen
cartilage
Tendon
D) Reason
Cartilage is a connective tissue composed of cells (chondrocytes) and fibres (collagen or yellow elastic) embedded in a firm, gel-like matrix which is rich in a mucopolysaccharide
local anesthetic with rapid metabolism and less side effects
lignocaine
bupivacaine
prilocaine
mepivacaine
ropivacaine
C) Reason
There is considerable variation in the rate of liver metabolism of individual amide compounds, with prilocaine (fastest) > lidocaine > mepivacaine > ropivacaine ≈ bupivacaine and levobupivacaine (slowest).
posterior triangle biopsy was taken, nerve likely to be affected
axillary
hypoglossal
thoracodorsal
long thoracic
spinal part of acessary
E) Reason
POSTERIOR TRIANGLEThe posterior triangle is bounded posteriorly by the trapezius muscle, anteriorly by the sternocleidomastoid muscle,and inferiorly by the clavicle. Two most important structures in it are the spinal part of acessary nerve and Subclavian vein.
In a 42 year old man diabetic for 14 years, diabetic retinopathy is due to
macroangiopathy
hyperglycemia
osmotic pressure
microangiopathy
neuropathy
D) Reason
Small vessel disease (diffuse thickening of basement membrane) retinopathy (hemorrhage, exudates, microaneurysms, vessel proliferation) A, glaucoma, nephropathy (nodular sclerosis, progressive proteinuria, chronic renal failure, arteriolosclerosis leading to hypertension, Kimmelstiel-Wilson nodules)
pH of filterate is high in PCT than DCT as H ions is…..in DCT
reabsorbed
secreted
filtered
double
become half
B) Reason
Early distal convoluted tubule (DCT)—actively reabsorbs Na+, Cl-. Makes urine hypotonic.PTH—↑ Ca2+/Na+ exchange → Ca2+reabsorption.Secrets H ions.5–10% Na+ reabsorbed.
In Patient with mitral valve replacement, which infects artificial heart valve
staph epidermidis
staph aureus
staph mutan
strep viridan
strep Pneumoniae
A) Reason
Staphylococcus epidermidisInfects prosthetic devices and intravenous catheters by producing adherent biofilms. Component of normal skin flora; contaminates blood cultures. Novobiocin sensitive.
prostate is drained by
internal iliac
external iliac
internal & external iliac
deep inguinal
aortic
C) Reason
Lymph DrainageThe lymph drains from the prostate goes into the internal iliac and external iliec nodes.
On reaching mount everest a man developed severe dyspnea, reason.?
hypoxia
polycythemia
anemia
toxemia
pulmonary edema
E) Reason
Acute pulmonary edema. The cause of this is stillunknown, but a suggested answer is the following:The severe hypoxia causes the pulmonary arteriolesto constrict potently, but the constriction is muchgreater in some parts of the lungs than in otherparts, so that more and more of the pulmonaryblood flow is forced through fewer and fewer stillunconstricted pulmonary vessels.
abductor of thigh is mediated by
gluteus maximus
Obturator internus
sartorius
pectineus
gluteus minimus
E) Reason
Gluteus minimus is preferred answer here.
Regarding neoplasms, ameloblastoma is the tumor of
maxilla
mandible
vomer
ethmoid
palatine
B) Reason
Ameloblastoma (adamantinoma) is an epithel ial tumor arising from precursor cells of the enamel organ. (1) Most frequently, this tumor occurs in the mandible. It usually appears in individuals younger than 35 years of age
floculonodular lobe is associated with
uncus
substantia nigra
amygdala
hippocampus
cerebellum
E) Reason
Medial lesions—Lesions involving midline structures (vermal cortex, fastigial nuclei) and/or the flocculonodular lobe result in truncal ataxia, nystagmus, and head tilting.
A patient with chronic toothaches, after few days of 3rd molar extraction, patient developed submandibular swelling, organism involved
staph aureus
strep. mutans
staph epidermis
strep virridan
staph saprophyticus
B) Reason
Viridans streptococci are α-hemolytic. They are normal flora of the oropharynx and cause dental caries (Streptococcus mutans) andsubacute bacterial endocarditis at damaged valves (S. sanguinis)
A middle age female diabetic presents with femer fracture on X-ray, osteoporotic changes seen, etiology can be confirmed by?
DEXA scan
CT scan
bone scan
Serum Ca
PO4
A) Reason
Osteoporosis Trabecular (spongy) bone loses mass and interconnections despite normal bone mineralization and lab values (serum Ca2+ and PO43-). Diagnosis by a bone mineral density test (DEXA) with a T-score of ≤ -2.5. Can be caused by long-term exogenous steroid use.Can lead to vertebral crush fractures—acute back pain, loss of height, kyphosis
What can be histological changes on liver biopsy in chronic HCV
regeneration
portal fibrosis
portal congestion
sinus congestion
generalized fibrosis
E) Reason
Cirrhosis is a descriptive term for chronic liver disease characterized by generalized disorganization of hepatic architecture with scarring and nodule formation. Liver cell damage, regenerative activity, and generalized fibrosis reSUlting in a nodular pattern are also characteristic.
which is abundant in collagen and amorphous substance
hyaline cartilage
fibrocartilage
elastic cartilage
collagen type 5
elastin
B) Reason
Fibrocartilage has type I collagen in addition to type II, giving it greater resistance to being stretched (tensile strength), and is the type of cartilage found in intervertebral disks of the vertebral column and the menisci of the knee, and may form the attachment of ligaments and tendons to bone
myocardial muscles are affected by norepinephrine by?
sec. strength
inc. rate
inc. stroke volume
inc. contraction
inc. atrial contraction
D) Reason
Release of norepinephrine from a sympathetic nerve ending is modulated by norepinephrine itself, acting on presynaptic α2-autoreceptors, angiotensin II, and other substances. It has positive chronotropic effect on heart.
P wave has no relation with QRS complex in which cardiac state?
atrial flutter
1st degree block
2nd degree block
mobitz type 1
3rd degree block
E) Reason
3rd degree (complete):The atria and ventricles beat independently of each other. Both P waves and QRS complexes are present, although the P waves bear no relation to the QRS complexes. The atrial rate is faster than the ventricular rate.
peptic ulcer pain is carried by
small gastric
great splanchnic nerve
thoracic splanchnic
vagus
short gastric
B) Reason
Branches from the Great Splanchnic nerves supply the viscera of the Abdominal cavity. Sympathetics to the foregut and midgut (thoracic splanchnic nerves: T5-T12) and to the hindgut and pelvic viscera (lumbar splanchnic nerves: L1-L2) synapse in collateral ganglia
Before waking cortisol levels are at its peak in body. Cause?
circadian rhythm
stress
deep sleep
circannual
morning stress
A) Reason
Glucocorticoid secretion ■ oscillates with a 24-hour periodicity or circadian rhythm.■ For those who sleep at night, cortisol levels are highest just before waking (ª8 am) and lowest in the evening (≈12 midnight).
perineal region is derived from which dermatome
S1-2
S2-3
S3-4
S4-5
L5
C) Reason
L1—at the inguinal ligament.L4—includes the kneecaps.S2, S3, S4—erection and sensation of penile and anal zones
what can be the gross appearance of Fibroadenoma
desmoplasia
Metaplasia
hypoplasia
dysplasia
hyperplasia
A) Reason
FIBROADENOMA A. Tumor of fibrous tissue and glands by desmoplasia B. Most common benign neoplasm of the breast; usually seen in premenopausal women C. Presents as a well-circumscribed, mobile marble-like mass
Sudden up and back shoulder movement, later unable to abduct arm, reason is?
deltoid rupture
bursitis
cuff tendinitis
supraspinatus rupture
fatigue
C) Reason
ROTATOR CUFF TENDINITISThe rotator cuff is a common site of tendinitis and cancause severe pain in the shoulder region.
A patient is at end stage renal disease, and is ready for dialysis has Low Hb, MCV 76 and low MCHC, anemia type
microcytic
normocytic hypochromic
microcytic hypochromic
macrocytic hypochromic
microcytic normochromic
B) Reason
Anemia of chronic disease: Is an example of normocytic hypochromic anemia, Inflammation inc. hepcidin (released by liver, binds ferroportin on intestinal mucosal cells and macrophages, thus inhibiting iron transport) dec. release of iron from macrophages.
treatment for cutaneous Larvae migrans
ciprofloxacin
ampicillin
Doxycyline
gentamycin
rifampin
C) Reason
Common in northeastern United States.Initial symptoms—erythema chronicum migrans B, flu-like symptoms, +/- facial nerve palsy.Later symptoms—monoarthritis (large joints) and migratory polyarthritis, cardiac (AV nodal block), neurologic (encephalopathy, facial nerve palsy, polyneuropathy).Treatment: doxycycline, ceftriaxone.
CSF formation begins from
ultrafiltration of K
ultrafiltration of Na
ultrafiltration of Cl
ultrafiltration of H
ultrafiltration of Ca
B) Reason
A total of 400-500 cc of CSF is produced per day; most important step is the first one that is ultrafiltration of Na; ventricles and subarachnoid space contain 90-150 cc, so all of CSF is turned over 2-3 times per day.
right kidney is related anteriorly to
hepatic flexure
1at part of duedenum
spleenic vein
pancreas head
tail of pancreas
A) Reason
Important Relations, Right Kidney■ Anteriorly: The suprarenal gland, the liver, the second part of the duodenum, and the right colic flexure ■ Posteriorly: The diaphragm; the costodiaphragmatic recess of the pleura; the 12th rib; and the psoas, quadratus lumborum, and transversus abdominis muscles.
A patient in ER with atypical chest pain, on ECG, ST elevation in lead 4, artery involved
marginal artery
RCA
LCA
LXA
LAD
E) Reason
Left anterior descending artery (LAD)—supplies anterior 2/3 of interventricular septum, anterior papillarymuscle, and anterior surface of left ventricle (Lead 4 & 5 are lateral leads).
10 months old child, dehydration should be assessed by
lips
eyes
tongue
occiput
bregma
E) Reason
In neonates, due to immature sutures, their fontanelle become prominent in dehydrated states, that is why, bregma (anterior fontanelle) best to assess dehydration status.
A polyp is seen in endocervix with squamous epithelium, condition is..?
Metaplasia
dysplasia
Metaplasia
hypoplasia
anaplasia
A) Reason
Cervical polyps are inflammatory proliferations of cervical mucosa; they are not true neoplasms. Most common of these polyps are the squamous by Metaplasia of the cervical epithelium.
Which is not found at free margin of lesser omentum
hepatic artery
portal vein
potal vein & CBD
CBD
spleenic artery
E) Reason
BOUNDARIES OF THE EPIPLOIC FORAMEN• Anteriorly: Free border of the lesser omentum, the bileduct, the hepatic artery, and the portal vein.• Posteriorly: Inferior vena cava.• Superiorly: Caudate process of the caudate lobe of theliver.• Inferiorly: First part of the duodenum.
No. of muscle layers in sole
1
2
4
5
6
C) Reason
Sole of FootThe muscles of the sole are usually described in four layers (from inferior to superior).
lytic lesion on scalp X-ray, confirmatory test..?
Urine complete
Bone scan
Protein Electrophoresis
CT scan
PCR
C) Reason
Associated with:Inc. susceptibility to infectionPrimary amyloidosis (AL)Punched-out lytic bone lesions on x-ray AM spike on serum protein electrophoresisIg light chains in urine (Bence Jones protein) Rouleaux formation (RBCs stacked like poker chips in blood smear)
primary ossification of humerus starts at which week
2
4
8
10
12
C) Reason
The primary centre for the shaft appears near its middle in the eighth week of intrauterine life, andgradually extends towards the ends.
Anterior two third of tongue taste sensation is innervated by
facial
mandibular
auricular
auriculotemporal
glossopharyngeal
A) Reason
SENSORY INNERVATION• Anterior two thirds: The lingual nerve (general sensation) and chorda tympani (taste).• Posterior third: The glossopharyngeal nerve (general sensation and taste).
stratified squamous non keratinized epithelium is found in
sclera
conjunctiva
skin
cornea
lungs
D) Reason
The sclera is the external layer and continues anteriorly as the cornea, which is transparent (stratified squamous non keratinized epithelium) and allows light to enter the eye. The intermediate choroid layer is highly vascularized and pigmented.
lymphoid tissue with respiratory epithelium
lymph nodes
spleen
liver
suprarenal
thymus
E) Reason
THYMUS:The thymus is a lymphoid tissue with respiratory epithelium, is divided into a distinct cortex and medulla. The thymus serves as a site of maturation ofT-lymphocyte precursors after they exit from the bone marrow and arrive at the thymus via blood circulation.
most common metastatic malignancy in 2nd decade
SCC
HCC
ewing sarcoma
HPV
gastric CA
C) Reason
Ewing sarcoma:Boys < 15 years old.Commonly appears in diaphysis of long bones, pelvis, scapula, and ribs.
In a patient with multiple myloma, cause of polyurea is
hyperkalemia
hyponatremia
acidosis
hypokalemia
hypocalcemia
D) Reason
Clinical features include Bone pain with hypokalemia and hypercalcemia-Neoplastic plasma cells activate the RANK receptor on osteoclasts, leading to bone destruction. Lytic, “punched-out” skeletal lesions are seen on x-ray, especially in the vertebrae and skull; increased risk for fracture. Presents with polyuria, bone pain and lytic lesions.
After surgery, Pt. is with hypotension and shock, why?
hypovolumic
dehiscence
Toxemic
burst abdomen
shock
C) Reason
All the features given in scenario are characteristics of shock (low BP and tachycardia) while H/O surgery points to the Toxemic shock.
epicondyle ossification in female
4 yr
5 yr
6 yr
7 yr
8 yr
A) Reason
Ossification begins in the medial epicondyle in the fourth year in females, sixth in males, and in the lateralepicondyle about the 12th year.
crus cerebri are closely related to
cerebellum
uncus
amygdala
hippocampus
substantia nigra
E) Reason
For descriptive purposes, the midbrain may be divided into a dorsaltectum and right and left cerebral peduncles, each of which is further divided into a ventral crus cerebriand a dorsal tegmentum by a pigmented lamina, the substantia nigra.
resting tremors, expressionless face, lesion is at
striatum
substantia nigra
cerebellum
putamin
globus palidus
B) Reason
Parkinson —Tremor (at rest—e.g., pill-rolling tremor), cogwheel Rigidity, expressionless face,Akinesia (or bradykinesia), Postural instability and Shuffling gait.
In patient with acute chest pain, 5mm ST elevation in lead 2, artery involved
LXA
posterior branch
LCA
RCA
LAD
D) Reason
Posterior descending/interventricular artery (PDA)—supplies posterior 1/3 of interventricular septum (lead 1-4 are the anterior chest leads) and posterior walls of ventricles.
Tumor on anterior 2/3 of tongue, Lymph Nodes involved
submental
Sublingual
Submandibular
parotid
anterior cervical
C) Reason
LYMPH DRAINAGEf• Tip: Submental lymph nodes.• Sides of anterior two thirds: Submandibular lymphnodes.• Posterior third: Deep cervical lymph nodes.
which ligament is triangle shaped
pubovesical
pubofemoral
puborectalis
pectineal
perineal membrane
B) Reason
Pubofemoral LigamentThe pubofemoral ligament is triangular in shapeThe base is attached above to the superior ramus of the pubis, and the apex is attached below to the lower end of theintertrochanteric line.
Lactation is sustained by
LH
FSH
GH
Prolactin
Oxytoxin
D) Reason
Prolactin—induces and maintains lactation and reproductive function. Oxytocin—assists in milk letdown; also promotes uterine contractions
Most potent antioxidant
vit. A
vit C
vit. D
vit. B2
vit. E
E) Reason
Vitamin E (tocopherol/tocotrienol)FUNCTION: Antioxidant (protects erythrocytes and membranes from free radical damage).
mechanism of aqueous humor production
filtration
secretion
absorption
outflow
ultrafiltration
E) Reason
AQUEOUS HUMOR:The aqueous humor is a clear fluid formed by ultrafiltration that fills the anterior andthe posterior chambers.
Which is not boundary of lateral arch of foot
cuneform
cuboid
4th metatarsal
1st metatarsal
5th metatarsal
D) Reason
Lateral Longitudinal ArchThe lateral longitudinal arch is formed by the calcaneum,the cuboid, and the fourth and the fifth metatarsal bones.
IVC gives anterior branch known as?
spleenic vein
portal vein
IVC
hepatic vein
great splanchnic vein
D) Reason
TRIBUTARIES• Two anterior visceral tributaries (the hepatic veins).• Three lateral visceral tributaries: the right suprarenal vein(the left vein drains into the left renal vein), renal veins,and right testicular or ovarian vein (the left vein drains intothe left renal vein).
Which of these is responsible fro Quiet expiration?
diaphragm
intercostal
abdominal muscles
recoil of lungs
pleura
D) Reason
Quiet ExpirationQuiet expiration is a passive process accomplished by theelastic recoil of the lungs and the relaxation of the intercostal muscles and diaphragm.
veinous blood hematoma is?
epidural
subdural
subarachnoid
Interventricular
intracranial
B) Reason
A subdural hematoma results from head trauma that tears superficial (“bridging”) cerebral veins at the point where they enter the superior sagittal sinus. A subdural hemorrhage occurs between the meningeal dura and the arachnoid.
which measures variability among values
sensitivity
specificity
standard deviation
chi square test
controlled trials
C) Reason
Standard deviation = how much variability exists from the mean in a set of values.Standard error of the mean = an estimation of how much variability exists between the sample mean and the true population mean.
Regarding aspesis, Disinfectant for skin is
alcohol
formalin
H2O2
methylene
phenol
A) Reason
Ethanol is widely used to clean the skin before immunization or venipuncture. It actsmainly by disorganizing the lipid structure in membranes, but it denatures proteins aswell. Ethanol requires the presence of water for maximal activity (i.e., it is far moreeffective at 70% than at 100%).
What should not be absorbed without digestion?
glucose
glycerol
glactose
fructose
sucrose
E) Reason
All the carbohydrates given in the list are monosacchrides and need no further digestion being simplest except Sucrose that is discchride and must be digested further to a mono sugar before absorption.
A patient with long term history of raised B.P. and Creatinine, and dec. erythropoitin, defect..?
JG cells
glomerulus
DCTs
loop of Henle
interstium
A) Reason
Features in scenario are of CRF in which JG cells are damaged as well. JG cells (modified smooth muscle of afferent arteriole) and the macula densa (NaCl sensor, part of the distal convoluted tubule). JG cells secrete renin in response to dec. renal blood pressure, dec. NaCl delivery to distal tubule, and inc. sympathetic tone (β1)
Acrosome is formed in
RER
golgi complex
SER
cell membrane
nucleus
B) Reason
The acrosome, which is located over the anterior half of the nucleus, is derived from the Golgi complex of the spermatid and contains several hydrolytic enzymes such as hyaluronidase, neuraminidase, and acid phosphatase; these enzymes dissociate cells of the corona radiata and digest the zona pellucida of the recently produced secondary oocyte.
A young boy in Village developed severe respiratory infection, which is facultative anaerobe causing infection with unpasteurized dairy products
Pseudomonas
Actinomycetes
spirochete
L. monocytogenes
N. miningitis
D) Reason
Listeria monocytogenes:Facultative intracellular microbe; acquired by ingestion of unpasteurized dairy products and deli meats, via transplacental transmission, or by vaginal transmission during birth.
Role of pneumotaxic center
expiration center
limits inspiration
inc. respiration
limits expiration
control hypoxia
B) Reason
A pneumotaxic center, located dorsally in the nucleusparabrachialis of the upper pons, transmits signals tothe inspiratory area. The primary effect of this centeris to control the “switch-off” point of the inspiratoryramp, thus controlling the duration of the filling phaseof the lung cycle
function of , corticospinal tract voluntary movement
coordination
balance
involuntary movement
gaze control
A) Reason
• The corticospinal tract is involved in the voluntary contraction of skeletal muscle, especially in the distal extremities. This pathway consists of 2 neurons, an upper motor neuron, and a lower motor neuron
Which of these is neurohypophysis
adrenal medulla
anterior pituitary
median lobe
hypothalamus
posterior pituitary
E) Reason
Posterior pituitary (neurohypophysis)Secretes vasopressin (antidiuretic hormone, or ADH) and oxytocin, made in the hypothalamus and shipped to posterior pituitary via neurophysins (carrier proteins). Derived from neuroectoderm
A female has breast masses bilaterally, which Cancer has most potentail to involve breasts bilaterally
lobular in situ
ductal CA
Fibroadenoma
phyllodes
papilloma
A) Reason
LOBULAR CARCINOMA IN SITU (LCIS) A. Malignant proliferation of cells in lobules with no invasion of the basement membrane B. LCIS does not produce a mass or calcifications and is usually discovered incidentally on biopsy.
Pt has nystagmus, site of lesion
vermis
striatum
peduncles
floculonodular lobe
median lobe
D) Reason
Medial lesions—Lesions involving midline structures (vermal cortex, fastigial nuclei) and/or the flocculonodular lobe result in truncal ataxia, nystagmus, and head tilting.
Control of defecation reflex is by
lumber splanchnic
sacral plexus
pelvic splanchnic
internal sphincter
pelvic diaphragm
C) Reason
The internal anal sphincter is circular smooth muscle that surrounds the anal canal. The sympathetics (lumbar splanchnics) increase the tone of the muscle and the parasympathetics (pelvic splanchnics) relax the muscle during defecation.
A patient has got burnt accidently and developed edema, cause of edema in burn patient
plasma loss
shock
hypokalemia
hypoalbuminemia
hyponatremia
D) Reason
In a burn patient, ECF and plasma is lost along with the plasma proteins especially the albumin. This state of hypoalbuminemia causes edema.
A patient with positive family history, has fasting blood sugar of 140, what is your diagnosis
pre diabetes
poor control
abnormal glucose tolerance
diabetes
no diabetes
D) Reason
TESTS: Fasting serum glucose of >126mg/dl is diagnostic , oral glucose tolerance test, HbA1c (reflects average blood glucose over prior 3 months).
Pt. knowledge about disease and drug side effects will decide
informed consent
communication
prognosis
effectiveness
compliance
E) Reason
Complience is defined as the adherence of patients to the treatment and it largely depends upon knowledge of pt about disease and drug and its side effects.
part of urethra passes through urogenital diaphragm is?
prostatic
membranous
bulbar
spongium
cavurnus
B) Reason
MEMBRANOUS URETHRAThe membranous urethra passes through the urogenital diaphragm and is surrounded by the sphincter urethrae. It is the shortest and least dilatable part of the urethra.
epiploic foramin is formed inferiorly by?
colon
1st part of duodenum
spleen
hepatic flexor
3rd part of duodenum
B) Reason
BOUNDARIES OF THE EPIPLOIC FORAMEN• Anteriorly: Free border of the lesser omentum, the bileduct, the hepatic artery, and the portal vein.• Posteriorly: Inferior vena cava.• Superiorly: Caudate process of the caudate lobe of theliver.• Inferiorly: First part of the duodenum.
A chronic diabetic Pt with wound on thigh, now presented with hypotension amd tachycardia, cause
DIC
ITP
sepsis
hypovolumic shock
septic shock
E) Reason
All the features given in scenario are suggestive of shock (hypotension and tachycardia) while H/O wound previouly fevers the condition of being sepsis.
barorecptors act & detect alteration in?
venous pressure
diastolic pressure
TPR
arterial pressure
chemical response
D) Reason
Aortic arch barorecptors respond to inc but not to decreased while carotid sinus receptors dectect increase as well deceased in arterial pressure
Drainage of left gastric vein
spleenic vein
IVC
hepatic vein
splanchnic vein
portal vein
E) Reason
Veinsof Stomach:The veins drain into the portal circulation. The right and leftgastric veins drain into the portal vein. The short gastric and the left gastroepiploic veins drain into the splenic vein,and the right gastroepiploic vein drains into the superiormesenteric vein.
cachexia is mediated by
IL 1
TNF alpha
IL2
CRP
IL3
B) Reason
Cachexia Weight loss, muscle atrophy, and fatigue that occur in chronic disease (e.g., cancer, AIDS, heart failure, TB). Mediated by TNF-α (nicknamed cachectin), IFN-γ, and IL-6
All are secretions of ant. pituitary except
FSH
LH
ADH
GH
TSH
C) Reason
Anterior pituitary (adenohypophysis)Secretes FSH, LH, ACTH, TSH, prolactin, GH, melanotropin (MSH). Derived from oral ectoderm (Rathke pouch)
CSF is present in which space
subdural
epidural
sub Arachnoid
Arachnoid
spinal canal
C) Reason
• Subarachnoid space lies between the arachnoid and pia mater containing CSF: site of subarachnoid hemorrhage (described later).
Placenta normally acts as……for fetal blood?
channel
barrier
filter
facilitator
exchanger
B) Reason
The placenta permits exchange of nutrients and removal of waste products between maternal and fetal circulations. The fetal component consists of the chorionic plate and villi. The maternal component is decidua basalis. Maternal blood is separated from fetal blood by the cytotrophoblast and syncytiotrophoblast.
which lymphoid tissue lies posterior to nasopharynx
pharyngeal tonsil
palatine tonsil
thymus
Lymph Nodes
adenoid
A) Reason
The pharyngeal tonsil is an aggregate of nodular and diffuse lymphatic tissue within the posterior wall of the nasopharynx.
Glucose & sodium are actively absorbed in intestine. which part is main contributor?
duodenum
ilium
cecum
colon
jejunum
E) Reason
Examples are Na+-glucose cotransport in the small intestine especially jejunum and renal early proximal tubule and Na+–K+ –2Cl– cotransport in the renal thick ascending limb.
foot is everted by
sartorius
peroneus longus
adductor longus
soleus
popliteus
B) Reason
• Eversion (opposite movement of the foot so that the solefaces laterally): Peroneus longus, peroneus brevis, peroneus tertius, and lateral tendons of extensor digitorumlongus muscles.
In expiration, breathing lowers because of
diaphragm
abdominal muscles
intercostal
pleura
recoil of lungs
B) Reason
Forced ExpirationForced expiration is an active process accomplished bycontraction of the muscles of the anterior abdominal wall(forcing the relaxed diaphragm upward by raising intraabdominal pressure) and contraction of the quadratuslumborum (pulling the twelfth rib downward).
femoral artery begins at
adductor canal
femoral artey
femoral Ligament
inguinal ligament
adductor longus
D) Reason
Femoral ArteryThe femoral artery is a continuation of the external iliac artery. It begins behind the inguinal ligament, where itlies midway between the anterior superior iliac spine and thesymphysis pubis (the site for taking a femoral pulse).
A patient developed chest pain and cough, pain not related to respiration
muscular
ribs pain
myocardial
pericardial
pleural
C) Reason
A chest pain that doesn”t change with any body movements or respiration is a pain of myocardium While pain of muskulosketal origin changes with movements.
hyperventilation is accompanied by tetanic spasm. why?
dec. O2
dec. pH
lactic acidosis
fatigue
Ca squestration
E) Reason
In hyperventilation, CO2 is washed out leading to respiratory alkalosis. Conc. of H ions decreases and then plasma proteins use Ca for binding in place of H laeding hypocalcemia (and tetanic spasms).
In dehydrated pt. K is given. how will K enter through?
Na/K pump
H/K pump
H/Cl pump
H/glucose pump
K/Ca exchange
A) Reason
Na+, K+ -ATPase (or Na+–K+ pump) in cell membranes transports Na+ from intracellular to extracellular fluid and K+ from extracellular to intracellular fluid; it maintains low intracellular [Na+] and high intracellular [K+].
femoral triangle is laterally bound by
sartorius
gastricnemius
solius
popliteus
quadriceps
A) Reason
Its boundaries are as follows:• Superiorly: The inguinal ligament.• Laterally: The sartorius muscle.• Medially: The adductor longus muscle
Pt. utters few words, damage is to
Wernicke
global
fronatal
temporal lobe
Broca”s area
E) Reason
Broca”s Area lesion: Nonfluent aphasia with intact comprehension.Broca area—inferior frontal gyrus of frontal lobe.
facial nerve arises from
hypoglossal canal
facial canal
maxillary foramen
mastiod foramen
stylomastoid foramin
E) Reason
he facial nerve enters the internal acoustic meatus and thenthe facial canal. It emerges through the stylomastoid foramen, and it enters the parotid salivary gland.
difference of ECF to ICF
less Na
more Na
less HCO3
less proteins
less Osmolarity
B) Reason
Extracellular fluid (ECF)■ is one-third of TBW.■ is composed of interstitial fluid and plasma. The major cation of ECF is Na+.■ The major anions of ECF are Cl- and HCO3.
1st defense against microbes
skin
spleen
mucous membrane
neutrophils
lymphocytes
A) Reason
Innate defenses can be classified into three major categories: (1)physical barriers, such as intact skin and mucous membranes; (2) phagocytic cells,such as neutrophils, macrophages, and natural killer cells; and (3) proteins, such ascomplement, lysozyme, and interferon
Which of the following is a potassium sparing diuretic?
Amiloride
dorzolamide
ethazolamide
triamitrine
brinzolamide
A) Reason
K+-sparing diuretics: Spironolactone and eplerenone; Triamterene, and Amiloride. CLINICAL USE: Hyperaldosteronism, K+ depletion, CHF.
hypoglycemia brings about ecg changes. which one?
Tall T wave
small T wave
dec. QT interval
Inc. QT interval
bizzare complexs
D) Reason
Causes of Long QT interval:1. Bradycardia 2. Hypocalcemiaor hypoglycemia 3. Acute MI 4. Acute myocarditis 5. Cerebrovascular accident 6. Hypertrophic cardiomyopathy 7. Hypothermia
Measure of Cardiac thermodilution mechanism
dye method
Inulin method
NH4 method
dilution method
Fick method
D) Reason
When asked technique mark dilution technique. When asked law then mark Ficks law.
in superior mediastinum, on right side trachea is related to?
vagus nerve
azygus vein
hemi azygus vein
inferior thyroid artery
inferior thyroid vein
A) Reason
Relation of Trachea in Superior mediastinum: • Right side: Azygos vein, right vagus nerve, and pleura.• Left side: Arch of the aorta, left common carotid, left subclavian arteries, left vagus nerve, left phrenic nerve, andpleura.
Arterial branch of celiac trunk:
spleenic artery
pancreatic artery
right gastric artery
cystic artery
hepatic artery
E) Reason
Celiac Artery (Trunk):The celiac artery is a short, large artery that arises from thefront of the abdominal aorta as it emerges through the diaphragm. It has three terminal branches: the leftgastric, the splenic, and the hepatic arteries.
In a liver transplant pt, Drug causing neurotoxicity-nephrotoxicity but doesnt cause bone marrow suppression.
cyclophosphamide
6-MP
Cyclosporine
Methotrixate
Ethambutol
C) Reason
MoA: Calcineurin inhibitor; binds cyclophilin. Blocks T cell activation by preventing IL-2 transcription. USES: Transplant rejection prophylaxis, psoriasis, rheumatoid arthritis. TOXICITY: Nephrotoxicity,hypertension, hyperlipidemia, hyperglycemia, tremor, hirsutism, gingival hyperplasia.
Folia are present in:
corpus callosum
basal ganglia
cerebellum
vermis
pons
C) Reason
The cerebellum consists of a midline vermis and 2 lateral cerebellar hemispheres. The cerebellar cortex consists of multiple parallel folds that are referred to as folia. The cerebellar cortex contains several maps of the skeletal muscles in the body
A 42 year old female patient with septic shock and bruises and d-dimer were raised possible cause..?
vWB disease
septic shock
Hypercoagulable state
thrombosis
DIC
E) Reason
DIC: Widespread activation of clotting leads to a deficiency in clotting factors, which creates a bleeding state.Causes: Sepsis (gram-negative), Trauma, Obstetric complications, acute Pancreatitis, Malignancy, Nephrotic syndrome, Transfusion (STOP Making New Thrombi).Labs: schistocytes, increased fibrin split products (d-dimers), decreased fibrinogen, decreased factors V and VIII.
To correct hypokalemia, IV K is given. K enters the cell through:
H/K exchange
Na/K ATPase
K/Cl exchange
K/glucose symport
K/HCO symport
B) Reason
Na/K ATPase (or Na+/K+ pump) in cell membranes transports Na+ from intracellular to extracellular fluid and K+ from extracellular to intracellular fluid; it maintains low intracellular [Na+] and high intracellular [K+].
which vasoactive amines are demolished at lungs:
histamine
Angiotensin
epinephrine
dopamine
serotonin
E) Reason
Serotonin (5-hydroxytryptamine)■ causes arteriolar constriction and is released in response to blood vessel damage to help prevent blood loss.It is destroyed at lungs.■ has been implicated in the vascular spasms of migraine headaches.
What causes Plateau of action potential?
Ca in
K out
Ca in Na out
Ca in K out
Ca in Cl out
D) Reason
Cardiac muscle action potential has a plateau, which is due to Ca2+ influx and K+ efflux; myocyte contraction occurs due to Ca2+-induced Ca2+ release from the sarcoplasmic reticulum
dermatome from lower end of clavicle to sternal angle:
C1
C2
C3
T1
T2
D) Reason
Dermatomes: C2—posterior half of a skull “cap.”C3—high turtleneck shirt.C4—low-collar shirt.T1–Lower end of clavicle to sternumT4—at the nipple.T7—at the xiphoid process.T10—at the umbilicus (important for early appendicitis pain referral).L1—at the inguinal ligament.L4—includes the kneecaps.S2, S3, S4—erection and sensation of penile and anal zones.
2 x 2 table is used for
standard deviation
Sensitivity
specificity
positive productive value
chi square test
E) Reason
Chi-square (χ²) Checks difference between 2 or more percentages or proportions of categoricaloutcomes (not mean values). It uses 2 x 2 table.
Patient with decrease salivation submandibular damage. Which nerve damage?
maxillary nerve
mandibular nerve
CN V
CN VI
CN VII
E) Reason
The submandibular ganglion is a parasympathetic ganglionthat lies deep to the submandibular salivary gland and is attached to the lingual nerve by small nerves. Preganglionicparasympathetic fibers reach the ganglion from the facialnerve via the chorda tympani and the lingual nerves.Postganglionic secretomotor fibers pass to the submandibular and the sublingual salivary glands.
A pt. undergoes gastric antral removal. what deficiency will occur eventually
rapid emptying
dec. gastric complience
delayed emptying
malabsorption
Dumping syndrome
B) Reason
Pyloric antrum: This extends from the incisura angularisto the pylorus. Its removal can lead to decreased complience of the stomach.
Consequences of deudenal resection
malnutrition
delayed emptying
GERD
Ulcerations
Rapid stomach emptying
E) Reason
The duodenum begins at the pyloric sphincter ofthe stomach, and it ends by becoming continuous with the jejunum. It smoothens the gastric emptying by sphincter. It removal as in cases of Whipple Procedure, can lead to rapid gastric emptying.
Chlorpromazine side effect:
depression
psychosis
rigidity
heat intolerance
dystonia
E) Reason
Drugs that block the activity ofdopaminergic pathways include older antipsychotics (eg, chlorpromazine, haloperidol), which maycause dystonia and parkinsonian symptoms.
atmospheric pressure is 700mmhg, what will be gases content
PaO² 47, CO² 53
PaO² 153, paCO² 147
PaO2 will be 147 and Nitrogen will be 553 mmHg
PaO² 147, pa N 153
PaO² 147, Pa N 253
C) Reason
O2 percentage in air is 21, so 700 x 21/100=147Nitrogen percentage is 79, so 700 x 79/100=553
Thiazide causing hypotension by:
dec. Na
inc. Na
dec. K
inc. H²O
inc. renin
A) Reason
MECHANISM Thiazide diuretic. Inhibits NaCl reabsorption in early distal tubule, decreased diluting capacity of the nephron. Decreased Ca2+ excretion.
Most potent antioxidant:
vit. D
B3
B6
vit. C
vit. E
E) Reason
Remember the sequence Glutathione is most potent anti oxident if given in options then Vit. E (correct here) and then Vit. C
Cushing triad
inc. ICP, tacchycardia, hypotension
HTN, dec. Na & inc. K
hyperpigmentation, HTN, dec. HR
Inc ICP, HTN, Bradycardia
hypoglycemia, HTN, brasycardja
D) Reason
FINDINGS Hypertension, weight gain, moon facies, truncal obesity B, buffalo hump, hyperglycemia (insulin resistance), skin changes (thinning, striae), osteoporosis, amenorrhea, and immune suppression.
Man with gunshot wound in spine at L1 has Loss of pain and temp of right Side of lower limb. Which pathway has been damaged?
right cuneatus
left cuneatus
right gracilis
medial laminiscus
Left spinothalmic tract
E) Reason
pain and temperature sensation is carried by opposite side spinothalmic tract at L1 level.
Non consanguineous marriage, child was born who was short stature due to short limbs, trunk was of normal size. What can be the mode of inheritance:
X-linked dominant
X-linked recessive
autosomal recessive
autosomal dominant
Y-linked
D) Reason
Pseudohypoparathyroidism (Albright hereditary osteodystrophy)—autosomal dominant unresponsiveness of kidney to PTH. Hypocalcemia, shortened 4th/5th digits, short stature.
A 2 year old baby with sickle cell anemia with Hb 6 and mild jaundice, cause is
Hemolytic crisis
hypoxic crisis
recent infection
inc. reticulocytes
dec. reticulocytes
A) Reason
Complications in sickle cell disease (SS):1. Aplastic crisis (due to parvovirus B19).2. Autosplenectomy (Howell-Jolly bodies) 3. risk of infection with encapsulated organisms; early splenic dysfunction occurs in childhood.4. Splenic sequestration crisis.5. Salmonella osteomyelitis.
Basophilia of cell is due to:
Golgi appratus
RER
SER
nucleus
ribosomes
E) Reason
Hematoxylin is a blue dye which stains basophilic substrates that are the acidic cellular components such as DNA, RNA and ribosomes. Hematoxylin stains nuclei blue, and may tint the cytoplasm of cells with extensive mRNA in their cytoplasm.
wasting of thenar eminence, nerve responsible?
ulnar
radial
median
axillary
musculocutaneous
C) Reason
Median nerve lesions commonly result from supracondylar fractures of the humerus and from wounds just proximal to the flexor retinaculum. Among the clinical signs, the muscles of the thenar eminence areparalyzed and wasted so that the eminence is flattened and the thumb is laterally rotated and adducted. The hand looks apelike.
Policeman got shot and lost knee jerk reflex where will be the lesion:
L3
L4
L5
L2-3
L4-5
B) Reason
Values of the different deep tendon reflexes are as: Bicep C5-6, Tricep C6-7, Jaw jerk CN V, and knee jerk as L4 and ankle jerk as S1.
A 32 year old female diabetic pt, draining abscess from jaw. What is the finding on microscopy?
Granuloma with abcess
granuloma
abscess
Fibrinoid necrosis
caseous necrosis
A) Reason
Mononuclear cell and fibroblast mediated; characterized by persistent destruction and repair. Associated with blood vessel proliferation, fibrosis. Granuloma: nodular collections of epithelioid macrophages and giant cells. Acute on chronic inflamation can lead to abcess formation.
Upper slips of external oblique muscle interdigitate with:
serratus posterior
serratus anterior
latismus dorsi
internal oblique
facia transversalis
B) Reason
The upper slips of muscle merge and fuse with the slips of Serratus anterior. The inferior slips interdigitate with Latissimus dorsi.
A 5 years old girl with Hx of failure to thrive, anemia. Hb electrophoresis showed maximum amount of 2 alpha and 2 gamma chains. Diagnosis?
HbA²
HbF
HbA
HbS
M-spike
B) Reason
Newborns are initially asymptomatic because of Increased HbF and decreased HbS.Heterozygotes (sickle cell trait) have resistance to malaria.
A 52 Year old man got gunshot in thigh, after few days he developed hypotension. On examination of wound found foul smelling greenish discharge, what is your dx:
DIC
hypovolumic shock
Toxemic shock
anaphylactic shock
neurogenic shock
C) Reason
Obligate anaerobes give foul smelling discharge, Examples include Clostridium, Bacteroides, and Actinomyces. They lack catalase and/or superoxide dismutase and are thus susceptible to oxidative damage. Generally foul smelling (short-chain fatty acids), are difficult to culture, and produce gas in tissue (CO2 and H2).
Aspirin overdose side effect
acidosis
Alkalosis
Thrombocytopenia
decreased BT
decreased PT
B) Reason
TOXICITY Gastric ulceration, tinnitus (CN VIII). Chronic use can lead to acute renal failure, interstitial nephritis, and upper GI bleeding. Reye syndrome in children with viral infection. Overdose causes respiratory alkalosis initially, which is then superimposed by metabolic acidosis.
Artery contributing in formation of circle of Willis except
Basilar artery
spinal artery
anterior communicating artery
anterior cerebral
posterior cerebral
B) Reason
Arteries contributing to Circle of Willis are: anterior communicating,anterior cerebral, internal carotid, posterior communicating, posterior cerebral, and basilar (formed by the junctionof the two vertebral arteries).Cortical and central branches arise from thecircle and supply the brain.
Triad microtubules are present in:
Centrioles
cilia
flagella
spindle
dynein
A) Reason
Centrioles are the eukaryotic organelles that are composed of 9 circular arrangement of clusters of triad of microtubules and function as mitotic spindle formation
A patient gone for colostomy & was on parentral nutrition. What metabolic abnormality will be present:
hypernatremia
hypokalemia
hyperglycemia
hypoglycemia
hypomagnesemia
C) Reason
Complications of total parenteral nutrition (TPN) include sepsis, thrombosis, hyponatraemia, hyperglycaemia and liver damage. To minimize sepsis, the central venous catheter is tunnelled with a subcutaneous Dacron cuff at the exit site to reduce the risk of line infection.
Fibrocartilage contain which fibers
type 1 collagen
Reticular Fiber
fibronectin
type 3 collegen
type 5 collegen
A) Reason
Fibrocartilage has type I collagen in addition to type II, giving it greater resistance to being stretched (tensile strength), and is the type of cartilage found in intervertebral disks of the vertebral column and the menisci of the knee, and may form the attachment of ligaments and tendons to bone
Conduction system of heart is found in
pericardium
myocardium
epicardium
endocardium
sub endocardium
E) Reason
The cardiac conduction system located subendocardially is a specialized group of myocardial cells that initiates the periodic contractions of the heart due to their ability to depolarize at a faster rate than other cardiac myocytes.
sympathetic supply of Lower respiratory bronchioles
T1-2
T3-4
T2-3
T4-5
T6
B) Reason
Each lung is supplied by the pulmonary plexus. Theplexus is formed by branches of the sympathetic trunk (T3-T4) andreceives parasympathetic fibers from the vagus nerve (CN X).
A normal diet should contain protein up to:
15-20%
20-25%
25-40%
10-15%
0.4
C) Reason
Normal percentage of the major nutrients in a normal diet are Carbohydrates 45-65 %, Proteins 25-40% , Lipid as 15-20%.
Drug that acts on AV node?
amlodipine
propranolol
carvedilol
Verapamil
metoprolol
D) Reason
MECHANISM: Block voltage-dependent L-type calcium channels of cardiac and smooth muscle, thereby reduce muscle contractility.Vascular smooth muscle—amlodipine = nifedipine > diltiazem > verapamil.Heart—verapamil > diltiazem > amlodipine = nifedipine (verapamil = ventricle).
If Heart rate is doubled cardiac cycle duration will become?
0.8 sec
- 6 sec
- 2 sec
- 4 sec
- 6 sec
D) Reason
Cardiac Cycle= 1 minute/ number of beats= 60 sec/ 72= 0.8 sec. As heart rate doubles the cycle will become half e.g: cardiac cycle= 60/144= 0.4 sec.
Which parameter doesn’t change in restrictive lung disease:
FEV1
FEV1/RV
FEV1/FEV
FEV1/ FRC
FEV1/FVC
E) Reason
in restrictive lung disease FEV1/FVC can be increased or normal.
Botulinum toxin cause
toxic shock
necrosis
muscular weakness
respiratory muscle paralysis
muscle rigidity
D) Reason
Flaccid paralysis, floppy baby; toxin prevents release of stimulatory (ACh) signals at neuromuscular junctions leading to flaccid paralysis and can cause respiratory muscle paralysis.
Stage of Theta waves on EEG?
REM sleep
NON-REM
Full wake state
REM 1st stage
REM 2nd stage
D) Reason
- Awake (eyes open) Alert, active mental concentration Beta (highest frequency, lowest amplitude)2. Awake (eyes closed) Alpha3. Non-REM sleepStage N1 (5%) Light sleep- theta waves
A 32 old female with low grade fever, hypercalcemia stones with B/L lymphadenopathy\ histopathological findings will be?
Granuloma
Granuloma with asteroid bodies
abscess
Fibrinoid
Cassius
B) Reason
Sarcoidosis is Associated with restrictive lung disease (interstitial fibrosis), erythema nodosum, lupus pernio, Bell palsy, epithelioid granulomas containing microscopic Schaumann and asteroid bodies, uveitis, and hypercalcemia (due to increased 1α hydroxylase–mediated vitamin D activation in macrophages). Treatment: steroids.
Function of Pneumotaxic center
control apnea
cause apnea
control respiration
control expiration
limit inspiration
E) Reason
A Pneumotaxic Center Limits theDuration of Inspiration and Increasesthe Respiratory Rate: A pneumotaxic center, located dorsally in the nucleusparabrachialis of the upper pons, transmits signals tothe inspiratory area.
A player has lateral malleolar fracture, what other findings should be present in this case?
loss of dorsal sensation of foot
loss of toe sensation
loss of ankle jerk
loss of sole sensation
upgoing planters
A) Reason
The sensory supply from most of the dorsal surface of the foot is provided by the superficial fibular nerve, except between the great and second toes, which is supplied by the deep fibular nerve.
In diarrhea metabolic acidosis and hypokalemia are observed, from where fluid loss is happening
Colon
ilium
rectum
jejunum
dudenum
A) Reason
Water and electrolytes are reabsorbed in large intestine esp. the colon. When there is any abnormality of this absorption mechanism, it leads to dirrohea and electrolytes loss
If Posterior cord of brachial plexus is damaged it will result in loss of action of:
teres major
teres minor
tricep
bicep
Deltoid
E) Reason
Posterior cord: Upper subscapular nerveThoracodorsal nerve, Lower subscapular nerveAxillary nerve (C5, 6)..supplies deltoid and teres minor muscles.Radial nerve (C5, 6, 7, 8; T1)
AV node is supplied by
LCA
RCA
LXA
LAD
Posterior Interventricular artery
B) Reason
SA and AV nodes are usually supplied by RCA. Infarct may cause nodal dysfunction (bradycardia or heart block)
Old age bed ridden male pt having c/o burning micturition. Urine sample was taken for culture, on microscopy there was greenish growth on culture, what drug will you prescribe him?
ampicillin
ciprofloxacin
metronidazol
moxifloxacin
albendazole
B) Reason
Clinical Uses of Fluroquinolones: Gram-negative rods of urinary and GI tracts (including Pseudomonas), especially Ciprofloxacin, Neisseria, some gram-positive organisms.
after 2 hours of surgery pt. developed hypotension, tachycardia and abdominal distension, due to?
sepsis
wound leakage
Hypovolumia
wound dehiscence
stress response
C) Reason
Abdominal distention might be due to intra-abdominal bleed after surgery leading to hypovolemic shock. Moreover, sepsis takes time.
A 35 years old woman patient with raised BP and erythropoietin was decreased creatinine raised , possible site of defect
interstitium
nephron
collecting tubules
glumerulus
JG cells
E) Reason
JG cells (modified smooth muscle of afferent arteriole) and the macula densa (NaCl sensor, part of the distal convoluted tubule). JG cells secrete renin in response to decreased renal blood pressure, decreases NaCl delivery to distal tubule, and increases sympathetic tone (β1).
Distinctive character of olfaction:
cells are replaced continually
No true neurons
permanent cells
mixed nerve
without epithelium
A) Reason
The olfactory nerves arise from olfactory nerve cells in theupper part of the nasal mucous membrane that is replaced continually.
In hypoxia, mechanism of cellular swelling?
inc. water entry from surrounding
inc. entry from lymph
inc. entry from tissues
dec. drainage to lymph
increase entry from plasma
A) Reason
Decreased cardiac output leads to Hypoxia. This supplement the baroreceptor mechanism by increasing sympathetic outflow to the heart and blood vessels. This increased outflow causes cellular edema.
What is secreted by Outflow tract of basal ganglia?
Glycine
glutamate
Aspartate
lysine
GABA
E) Reason
Excitatory pathway—cortical inputs stimulate the striatum, stimulating the release of GABA, which disinhibits the thalamus via the GPi/SNr (increasess motion).
In a young female with 3rd or 2nd degree burn pt was in emergency, due to electrolyte imbalance what could cause low grade voltage potential:
hypokalemi
hylercalcemia
hyponatremia
hyperglycemia
hypermagnecemia
C) Reason
Causes of Low voltage QRS (less than 5 mm in leads I, II, III and <10 mm in chest leads):1. Improper standardization2. Obesity or thick chest wall3. Pericardial effusion4. Emphysema5. Chronic constrictive pericarditis6. Hypothyroidism7. Hypothermia
Renal plasma flow in kidney is calculated by?
PAH
Inulin
PABA
Creatinine
urea
A) Reason
Measurement of renal plasma flow (RPF)—clearance of para-aminohippuric acid (PAH)■ PAH is filtered and secreted by the renal tubules.■ Clearance of PAH is used to measure RPF.
Nutmeg liver, site of congestion
portal congestion
periportal congestion
periportal fibrosis
sinosidal congestion
centrilobular
E) Reason
Nutmeg liver Due to backup of blood into liver. Commonly caused by right-sided heart failure and Budd-Chiari syndrome. The liver appears mottled like a nutmeg. If the condition persists, centrilobular congestion and necrosis can result in cardiac cirrhosis
Which of the following has maxmimum value upon standing at the apex of lung?
inc. V/Q value
dec. V/Q value
increased Ventilation
decreased perfusion
increased profusion
A) Reason
Ideally, ventilation is matched to perfusion (i.e., V/Q = 1) in order for adequate gas exchange.Lung zones:1. Apex of the lung—V/Q = 3 (wasted ventilation)2. Base of the lung—V/Q = 0.6 (wasted perfusion)Both ventilation and perfusion are greater at the base of the lung than at the apex of the lung
Prominent feature of malignancy
pleumorphism
anaplasia
anrchy
metastasis
dysplasia
D) Reason
Neoplastic progression Hallmarks of cancer—evasion of apoptosis, growth signal self-sufficiency, anti-growth signal insensitivity, sustained angiogenesis, limitless replicative potential, tissue invasion, and metastasis. Metastasis is especially prominent in malignant lesions.
Serous acinus gland, interlobular septa, connective tissue and striated ducts are feature of
Submandibular
Sublingual
minor salivary gland
Parotid
pancreatic acini
D) Reason
The parotids are entirely serous salivary glands with septa and striated ducts that drain inside each cheek through Stensen”s ducts which open above the second upper molar tooth
Cardiac muscle work as syncytium due to:
SA node
AV node
gap junction
tight junction
hemidesmosomes
C) Reason
Gap junctions:■ are present at the intercalated disks.■ are low-resistance paths between cells that allow for rapid electrical spread of action potentials.■ account for the observation that the heart behaves as an electrical syncytium.
which clinical feature helps in diagnosing cardiac temponade?
pulsus alternans
Pulsus paradox
water hammer pulse
hypotension
jerky pulse
B) Reason
Pulsus paradoxus decrease in amplitude of systolic blood pressure by ≥ 10 mmHg during inspiration. Seen in cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, and croup.
Propanalol acts mainly on:
alpha 1 receptor
alpha 2 receptor
beta 1 receptor
beta 2 receptor
nicotinic receptor
C) Reason
All of the β blockers used clinically are competitive pharmacologic antagonists. Propranolol is theprototype. Drugs in this group are usually classified into subgroups on the basis of 1 selectivity.
How does insulin act on adipose tissue:
sec. lipoprotein lipase
inc. lipoprotein lipase
inc. glucose uptake
dec. glucose uptake
no effect
B) Reason
Insulin-dependent glucose transporters:GLUT-4: adipose tissue (increases lipoprotein lipase) and skeletal muscle.
Nor Epinephrine is given to increase heart rate. It will act on which receptors?
beta 1 receptor
beta 2 receptor
alpha 1 receptor
alpha 2 receptor
central acting
A) Reason
Norepinephrine effects are α1 > α2 > β1 ( β1 increase heart rate, increase contractility, increase renin release, increase lipolysis) Clinical use are Hypotension (but decreases renal perfusion)
mechanism of CO2 transport from tissues to lungs
uptake of HCO3
exchange of K
uptake of HCO3 in exchange of Cl
uptake of HCO3 in exchange of K
uptake of K in exchange forCl
C) Reason
HCO3- leaves the RBCs in exchange for Cl- (chloride shift) and i is transported to the lungs in the plasma. HCO3- is the major form in which CO2 is transported to the lungs.
If needle is passed just 2 cm below and lateral to pubic tubercle which nerve will be pierced?
tibial nerve
peroneal
femoral
Obturator
sciatic
D) Reason
The posterior division descends through the obturatorexternus muscle and passes behind the adductor brevis andin front of the adductor magnus muscles
A 46 year old female was operated, hysterectomy was done, after week she developed SOB and hemoptysis, her calf muscles are tender, what can be possible dx:
Pulmonary embolism
fat embolism
DIC
ARDS
toxic shock
A) Reason
Pulmonary embolism: V/Q mismatch leading to hypoxemia and cause respiratory alkalosis. Sudden-onset dyspnea, chest pain, tachypnea. May present as sudden death
Supply of Upper 1/3rd of esophagus
superior thyroid artery
middle thyroid artery
inferior thyroid artery
bracheocephalic trunk
internal carotid
C) Reason
• The inferior thyroid artery ascends to reach the posterior surface of the thyroid gland, where it is closely relatedto the recurrent laryngeal nerve. The inferior thyroidartery supplies the thyroid, upper 1/3rd of esophagus and the inferior parathyroidglands.
2ndary peristalsis of esophagus is caused by?
distention of esophagus
by gravity
by food particles
by saliva
by acrdiac sphincter
A) Reason
A primary peristaltic contraction creates an area of high pressure behind the food bolus. The peristaltic contraction moves down the esophagus and propels the food bolus along. Gravity accelerates the movement.d. A secondary peristaltic contraction by the dilatation of esophagus clears the esophagus of any remaining food.
A 6 year old young boy developed shortness of breath during PT class. He has 2-3 weeks back previous history of sore throat and joint pain; what test will you advise him:
Echocardiography
Chest X-ray
Blood culture
ECG
ASO titer
E) Reason
Associated with Aschoff bodies (granuloma with giant cells [blue arrows in ]), Anitschkow cells (enlarged macrophages with ovoid, wavy, rod-like nucleus [red arrow in A]), increased ASO titers. Immune mediated (type II hypersensitivity); not a direct effect of bacteria. Antibodies to M protein cross-react with self antigens.
What drug Enhance alpha 2 responses at presynaptic cleft
Methyldopa
amolodipine
Clonidine
prazosin
Timolol
C) Reason
Clonidine MoA: It enhance alpha 2 responses at presynaptic cleft. Clinical: Hypertensive urgency (limited situations); does not decrease renal blood flowADHD, severe pain, and a variety of off label indications (e.g., ethanol and opioid withdrawal)
In a 36 years married women cervical dysplasia is caused by:
nulliparity
dysplasia
multiparty
Metaplasia
atrophy
C) Reason
Risk factors for Cervical dysplasia : multiple sexual partners (#1), smoking, early sexual intercourse, multiparty, HIV infection.
A 5 year old child having 6 g/dl proteinuria where will be the defect:
Basement membrane
interstium
nephron
tubules
glomerulus
A) Reason
Nephrotic syndrome includes a group of conditions characterized by increased basement membrane permeability, permitting the urinary loss of plasma proteins, particularly low weight proteins, such as albumin.
Glans penis is drained by?
superficial inguinal
deep inguinal
inferior hypogastric
internal illeic
external iliec
B) Reason
The glans penis drains into the deep inguinal and the external iliac nodes. The skin of the remainder of the organ drains into the superficial inguinal nodes. The erectile tissuedrains into the internal iliac nodes.
which component of blood recovers last after massive hemorrhage?
Heart rate
Blood pressure
blood volume
CBC
LFTs
D) Reason
After blood loss, fisrt of all, the hemodynamics are corrected due to fast and slow acting mechanisms. Hematopoisis takes larger time and hence CBC is corrected last.
Pt is having nystagmus where will be the lesion:
vermis
striatum
floculonodular
cerebellar peduncles
cerebellar cortex
C) Reason
Medial lesions—Lesions involving midline structures (vermal cortex, fastigial nuclei) and/or the flocculonodular lobe result in truncal ataxia, nystagmus, and head tilting. These patients also may have a wide-based (cerebellar) gait and deficits in truncal coordination.
Muscle causing heat released from contraction?
radiant heat
contraction heat
initial heat
secondary heat
tertiary heat
C) Reason
Shivering is the most potent mechanism for increasing heat production. ■ Cold temperatures activate the shivering response (initial heat production), which is orchestrated by the posterior hypothalamus.
Which drug is given in Pregnancy in a patient with Graves disease
Propylthiouracil
propranolol
iodine
radiation
chemotherapy
A) Reason
CLINICAL USE: Hyperthyroidism. PTU blocks Peripheral conversion, used in Pregnancy because it can”t cross placenta.
Chondrocytes present in?
immature cartilage
mature cartilage
bone
epiphyseal plate
metaphysis
B) Reason
Chondroblasts (cartilage forming) and chondrocytes (mature cartilage) produce the type II collagen in cartilage. Cartilage covers the articular surfaces of bones, and is found in the ears, nose, larynx, and tracheobronchial tree.
A 47 years old man with Chronic hepatitis C microscopic finding?
cirrhosis
periportal congestion
portal congestion
fibrosis
portal hypertension
D) Reason
Cirrhosis—diffuse fibrosis and nodular regeneration destroys normal architecture of liver , risk for hepatocellular carcinoma (HCC).
A pt with MCV 86fL, HB: 7.6g/dl, malabsorption with change in RBC shape and size. The area affected in GIT Is?
duodenum
jejunum
iIium
colon
cecum
C) Reason
Intrinsic factor is Vitamin B12–binding protein (required for B12uptake in terminal ileum). Damage to Intrinsic factor or malabsorption due ilial defects causes pernicious anemia.
A 35 years old man with Hodgkin lymphoma develops fever headache and neck rigidity responsible organism?
Mycobacterium
Pseudomonas
cryptococcus
S. aureus
Miningococcus
C) Reason
Cryptococcus neoformans:Cryptococcal meningitis (sometimes associated with lymphoma), cryptococcosis. Heavily encapsulated yeast. Not dimorphic. Found in soil, pigeon droppings. Acquired through inhalation with hematogenous dissemination to meninges
Benzodiazepine cause significant hypotension if given to?
septic patient
hypovolumic patient
hypertensive
diabetic
COPD patient
B) Reason
High doses of conventional sedative-hypnotics, especially alcohols and barbiturates, can causedepression of medullary neurons in deblitated or hypovolumic patients , leading to respiratory arrest, hypotension, and cardiovascularcollapse. These effects are the cause of death in suicidal overdose
Tabes dorsalis causes?
atonic bladder
autonomous bladder
UV prolapse
tumling gait
loss of vibration
A) Reason
Associated with Charcot joints, shooting pain, atonic bladder, Argyll Robertson pupils (small bilateral pupils that further constrict to accommodation and convergence, not to light)
Relation of steady pressure ?
Pacinian
free nerve endings
Ruffni”s
tactile
murckle discs
C) Reason
Ruffini corpuscle are the Encapsulated receptors that carry Pressure sensations and are Slowly adapting receptors.
Patient post GA in recovery room stops breathing and is cyanosed. What drug caused this?
halothane
ketamine
pancurium
isoflurane
fentinyl
C) Reason
The action of full doses of crurae NM blockers leads directly to respiratory paralysis. Ifmechanical ventilation is not provided, the patient will asphyxiate.
In a young female, Most probable cause of negative Montoux test?
prior exposure
acute infection
chronic infection
past TB
immunosuppressant
E) Reason
PPD positive: if current infection, past exposure, or BCG vaccinated.PPD negative: if no infection or anergic (steroids, malnutrition, immunocompromise) and in sarcoidosis.
Free end of small intestine lies in?
left upper quadrant
right upper quadrant
Righ iliac fossa
left iliac fossa
bellow diaphragm
B) Reason
Small intestine is attached to the mesentery of the small intestine and is placed at its place exept the right hypochondriac region where it is free.
In which of the following maximum chemotaxis occur?
acute inflammation
chronic inflammation
granuloma
bleeding
wound dehisence
A) Reason
Acute inflammation is rapid onset (seconds to minutes), lasts minutes to days by the chemotaxis of the acute inflammatory cells to the site. Outcomes include complete resolution, abscess formation, andprogression to chronic inflammation
prime key to measure GFR?
Creatinine
urea
PAH
Inulin
PABA
D) Reason
Best way to measure GFR =inulin ClearanceBest way to measured GFR clinically by =creatinineBest way to estimate GFR = creatinine clearance
During male gametogenesis, what inhibits FSH?
LH
Progesterone
Aldosterone
estrogen
inhibin
E) Reason
Sertoli cells (non–germ cells):Secrete inhibin that inhibit FSHSecrete androgen-binding protein that maintain local levels of testosterone.
Pt with lower backache pain radiating to back of thigh cause?
lesion at L5
lesion at L5-S1
lesion at S1-2
lesion at L4-5
lesion at L3-4
B) Reason
Herniation usually occurs in the lower lumbar (L4/LS or LS/Sl) when pain radiates to posterior of thigh. or lower cervical (CS/C6 or C6/C7) when pain radiates to arm parts of the vertebral column.
main difference b/w ECF & ICF?
water concentration
organic cation
inorganic cation
organic anion
inorganic anions
E) Reason
The major anions of ICF are protein and organic phosphates. While anions of the ECF are the inorganic such as Cl and HCO3.
Mannitol given with caution in?
CHF
MI
CLD
CKD
cirrhosis
A) Reason
In a patient with heart failure, Mannitol should be given with caution because of risk of precipitating pulmonary edema
Association of blood transfusion reaction?
hemoglobinurea
Myoglobinurea
urticaria
WBC casts
RBC casts
A) Reason
Blood transfusion risks include infection transmission (low), transfusion reactions, iron overload, hypocalcemia (citrate is a calcium chelator), and hyperkalemia (RBCs may lyse in old blood units leading to hemoglobinurea and hypokalemia)
Chief inhibitory hormone from hypothalamus is?
ACTH
TRH
TSH
Prolactin
Dopamine
E) Reason
Prolactin is regulated by Dopamine and TRH. Prolactin in turn inhibits its own secretion by increased dopamine synthesis and secretion from hypothalamus.
Which cell type decreases in HIV patient commonly?
CD4-Th2
CD8
CD4-Th1
CD8-Th1
CD8-Th2
C) Reason
AIDS diagnosis ≤ 200 CD4+ cells/mm3(normal: 500–1500 cells/mm3). HIV-positive with AIDS-defining condition (e.g., Pneumocystis pneumonia) or CD4 percentage < 14%.
Radiation cause damage via?
cellular protein
cellular lipid
cellular carbohydrates
chromosome
cell wall
A) Reason
Ionizing radiation is a classic cause of chronic inflammation and cancer as these damage geneetic material and cellular proteins, as exemplified by the increased incidence of cancers in those exposed to radiation.
Polyp in Endocervix shows stratified squamous epithelia?
Dysplasia
Metaplasia
hyperplasia
hypertrophy
anaplasia
A) Reason
Dysplasia and carcinoma in situ:Disordered epithelial growth; begins at basal layer of squamocolumnar junction (transition zone) and extends outward. Classified as CIN 1, CIN 2, or CIN 3 (severe dysplasia or carcinoma in situ), depending on extent of dysplasia.
Automatic bladder caused?
at S5
lesion above S1
at S4
at S4-5
at S3
B) Reason
Atonic bladder results from lesions to the sacral spinal cord segments or the sacral spinal nerve roots. Loss of pelvic splanchnic motor innervation with loss of contraction of the detrusor muscle results in a full bladder with a continuous d ribble of urine from the bladder.
After a few days of typhoid, the bacili reside in?
spleen
payers patches
liver
ilium
jejunum
B) Reason
In typhoid and other enteric fevers, infection begins in the small intestine, but few gastrointestinal symptoms occur. Then after few days organisms enter, multiply in themononuclear phagocytes of Peyer’s patches, and then spread to the phagocytes of theliver, gallbladder, and spleen
stress hormone of utmost value?
glucagon
cortisol
GH
insulin
FSH
B) Reason
FUNCTION: It is an important stress hormone and functions to increase Blood pressure (upregulates α1-receptors on arterioles and increases sensitivity to norepinephrine and epinephrineIncreases nsulin resistance (diabetogenic)Increases luconeogenesis, lipolysis, and proteolysisDecreases Fibroblast activity (causes striae)Decreases Inflammatory and Immune responses
Sinus venosum develops into?
AV node
coronary sulcus
coronary sinus
pulmonary trunk
aorta
C) Reason
The sinus venosus at the venous end of the heart tube will develop into the coronary sinus and the smooth part of the right atrium.
Food poisoning in 10 people, it is
infectivity
infection rate
poisoning rate
virulence
infectious rate
D) Reason
Virulence is a quantitative measure of pathogenicity and is measured by thenumber of organisms required to cause disease. As many people are affected, means more virulent is the organism or its poison.
Crus cerebri closely related to?
cerebellum
striatum
substantia nigra
globus pallidus
uncus
C) Reason
The substantia nigra is the largest nucleus of the midbrain. It appears black to dark brown in the freshly cut brain because nigral cells contain melanin pigments. It is closely related to crus cerebri.
Antibodies in TB are?
inside cell
inside nucleus
bound to cell
inside Golgi complex
inside vacules
C) Reason
Tuberculosis is an example of type 4 delayed HSR and is associated with chronic infection. Its antibodies are attached to the cells.
Which organ compensates its blood supply if the blood supply is compromised?
Intestine
liver
spleen
heart
kidney
A) Reason
Submucosal plexus (Meissner plexus):■ primarily controls secretion and blood flow by virtue of which it can compensates its blood supply in case of hemmorhage or hypovolumia.
thoracic part of esophagus is supplied by?
arch of aorta
left gastric
bronchial artery
ascending aorta
Internal thoracic branch of descending aorta
E) Reason
Blood Supplyof the Esophagus:• Upper third: Inferior thyroid artery.• Middle third: Branches from the descending thoracicaorta (internal thoracic artery).• Lower third: Left gastric artery.
Standard deviation is calculated along mean because it shows
average
above values
bellow values
central tendency
variability
E) Reason
Standard deviation = how much variability exists from the mean in a set of values.Standard error of the mean = an estimation of how much variability exists between the sample mean and the true population mean.
Adrenergic response on muscarinic receptors of heart are by…
epinephrine
nicotinic
Norepinephrine
muscrine
Dopamine
C) Reason
Norepinephrine released from a sympathetic nerve ending is modulated by norepinephrine itself, acting on presynaptic α2-autoreceptors, angiotensin II, and other substances.
1st phase in the CSF production in choroid plexus?
filtration of K
filtration of Na
secretion
protein dilution
ultrafiltration of Na
E) Reason
B. Formation of CSF by the choroid plexus epithelium:■ Ultrafiltration of Na ions followed by the Lipid-soluble substances (CO2 and O2) and H2O freely cross the blood–brain barrier and equilibrate between blood and CSF.■ Other substances are transported by carriers in the choroid plexus epithelium. They may be secreted from blood into the CSF or absorbed from the CSF into blood.
Highest percentage of protein is in?
VLDL
LDL
HDL
chylomicron
adipose tissue
C) Reason
In lipoproteins, as the percentage of lipids increases the percentage of protein decreases and vice versa. So, protein conc. being highest in HDL and lowest in VLDL.
Direct activation of immune system by?
bacterial membrane
bacterial coat
Bacterial cell wall CHO
bacterial wall proteins
bacterial capsule
C) Reason
Induced to kill when exposed to a nonspecific activation signal on target cell and/or to an absence of class I MHC on target cell surface (carbohydrates on cell wall).
continous phase of contraction without relaxing
tetnus
summation
adding
tetany
rhythmicity
D) Reason
Sometimes, spontaneous discharge occurs without relaxation in someperipheral nerves, often causing muscle “tetany.”
18th month’s baby, surgeon needs to do a tracheostomy which vascular structure should he save from injury?
carotid artery
internal carotid artery
external jugular vein
recurrent laryngeal nerve
internal jugular vein
E) Reason
Recurrent laryngeal nerves, inferior thyroid veins, carotid arteries & internal jugular veins could be damaged this is a real risk in obese or paediatric patients.
Staging of tumor is based on?
extent of severity
Extent of invasion
anaplasia
metastasis
prognosis
B) Reason
Degree of localization/spread based on site and size of 1° lesion, spread to regional lymph nodes, presence of metastases. Based on clinical (c) or pathology (p) findings. Example: cT3N1M0
UV light causes?
glaucoma
cataract
sudden vision loss
retinal detachment
conjunctivitis
B) Reason
Cataract:Painless, often bilateral, opacification of lens , decreased in vision. Risk factors: increasing age, smoking, EtOH, excessive sunlight, UV light, prolonged corticosteroid use, classic galactosemia, galactokinase deficiency, diabetes (sorbitol), trauma, infection.
In a 56 year old male with Colon cancer surgery done, no mets present. Colon cancer marker?
CEA
RET
Rb
CA 19
CA 19-9
A) Reason
Diagnosis: Screen patients > 50 years old with colonoscopy or stool occult blood test.“Apple core” lesion seen on barium enema x-ray.CEA tumor marker: good for monitoring recurrence, not useful for screening
If parasympathetic is lost which of these will be affected mostly
muscle of GIT
muscle of heart
kidney
liver
suprarenal gland
A) Reason
This is a major parasympathetic nucleus of the brain stem, and it supplies preganglionic fibers innervating terminal ganglia in the thorax and the foregut and midgut parts of the gastrointestinal tract. It damage mainly affects the gastrointestinal tract muscles.
Phase of Pharyngeal swallowing ?
raising of larynx
pulling larynx
upward palate
down the larynx
close glottis
A) Reason
During pharyngeal swallowing larynx and the laryngeal part of the pharynx are pulled upward by the contraction of the stylopharyngeus,the salpingopharyngeus, the thyrohyoid, and the palatopharyngeus muscles.
The part of developing long bone which develops after birth from a secondary center of ossification is known as
metaphyseal plate
diaphysis
metaphysis
epiphyseal plate
epiphysis
E) Reason
Later in development, secondary (or late) centers of ossification form separately through a process of cartilage hypertrophy, ingrowth of vessels from outside the cartilage template, and replacement of cartilage by new trabecular bone and marrow. This takes place at the ends (epiphyses) of long bones.
In Sarcoidosis, Which cell types?
T-cells
B-cells
macrophages
mast cells
eosinoplils
A) Reason
Sarcoidosis Characterized by immune-mediated, widespread noncaseating granulomas containing T-cells and elevated serum ACE levels. Common in black females. Often asymptomatic except for enlarged lymph nodes.
receptors which adapt readily?
touch receptor
pain receptors
pacinian
murkle disc
Ruffini”s
A) Reason
Rapidly adapting, or phasic, receptors (pacinian corpuscle; light touch)■ show a decline in action potential frequency with time in response to a constant stimulus.■ primarily detect onset and offset of a stimulus.
Parasympathetic secretomotor fibers to submandibular salivary gland are innervated by?
lacrimal
Cilliary ganglion
auricular
auriculotemporal
corda tympani
E) Reason
chorda tympani nerve: it supplies the mucous membrane of the anterior two thirds of the tongue and the floor of the mouth. It also gives off preganglionic parasympatheticsecretomotor fibers to the submandibular ganglion
Plasmodium found in which form during the dormant phase:
oozyte
merozoite
haptozoite
haplozoite
hypnozoites
E) Reason
P. vivaxand P. ovale produce a latent form (hypnozoite) in the liver; this form is the causeof relapses seen with vivax and ovale malaria.
Sudden protection after injury is given by?
blood vessels
skin
barorecptors
renin Angiotensin
sympathetic
A) Reason
The compensatory responses to acute blood loss are as follows: First of all vasoconstriction followed by A decrease in blood volume produces a decrease in venous return. As a result, there is a decrease in both cardiac output and arterial pressure
Ventricular rate less than atria on ECG. Diagnosis?
atrial fibrillation
WPS syndrome
1st degree block
3rd degree block
2nd degree block
E) Reason
Progressive lengthening of the PR interval until a beat is “dropped” so that ventricular rate is less than that of atria (a P wave not followed by a QRS complex).
Which of the following remains normal in chronic respiratory acidosis?
plasma H conc.
plasma HCO3
plasma Cl
plasma K
plasma Ca
A) Reason
■ In chronic respiratory alkalosis, renal compensation (decreased HCO3− reabsorption) has occurred. Thus, arterial pH is decreased toward normal (i.e., a compensation). Symptoms of hypocalcemia (e.g., tingling, numbness, muscle spasms) may occur because H+ and Ca2+ compete for binding sites on plasma proteins. So, plasma H concentration remains almost unchanged.
Plasmodium with longest incubation period?
P. falciparum
M. malariae
P. Ovale
P. vivax
P. Ovax
B) Reason
P. malariae infects onlymature red cells; therefore, they produce much lower levels of parasites in theblood and these have the longest incubation period of than other Plasmodium species.
Dorsal column medial leminiscus conducts ?
touch
pain
temperature
vibration
pressure
D) Reason
Function of Dorsal column-medial lemniscal system is to carryDiscriminative touch, conscious proprioception, vibration, pressure
Consequence of decrease carotid sinus pressure ?
inc. heart rate
inc. heart rate
inc. BP
inc. stroke volume
inc. cardiac output
A) Reason
Decreased pressure on carotid sinus decreased stretch leads to decreased afferent baroreceptor firing that leads to decreased AV node refractory period and ultimately increases HR.
A 4 years old child presented with progressive pallor, HB: 4.9g/dl MCV 56fl, hepatosplenomegaly. Diagnosis?
sickle cell
sideroblastic anemia
Thalasemia major
iron deficiency anemia
Thalasemia minor
C) Reason
β-thalassemia major (homozygote):β chain is absent causing severe anemia requiring blood transfusion (2° hemochromatosis).Marrow expansion (“crew cut” on skull x-ray) skeletal deformities. “Chipmunk” facies. Extramedullary hematopoiesis (leads to hepatosplenomegaly).
to preserve blood volume what alters in kidney?
inc. Angiotensin
inc. H secretion
inc. ADH
dec. ADH
inc. renin
E) Reason
Renin–angiotensin–aldosterone system■ is a slow, hormonal mechanism.■ is used in long-term blood pressure regulation by adjustment of blood volume by increasing Aldosterone and hence plasma volume.■ Renin is an enzyme.■ Angiotensin I is inactive.■ Angiotensin II is physiologically active.
Ability of a test to produce repeated results
reliability
sensitivity
specificity
PPV
NPV
A) Reason
When the results of a test are same repeatedly, the confidence of the professional and reliability of the test increases.
lateral side of wrist is derived from which dermatome
C3
C4
C5
C6
C7
D) Reason
Landmark dermatomes C2—posterior half of a skull “cap.”C3—high turtleneck shirt.C4—low-collar shirt. C5–Deltoid, C6– lateral side of wrist
Which site must be damaged in brain for short term memory loss?
Uncus
agygdala
Reticular substance
pineal gland
hippocampus
E) Reason
Hippocampus: Bilateral lesions lead to inability to consolidate short-term to long-term memory.
in mediolateral episiotomy which muscle will be injured
bulbourethral
bulbospongiosus
rectal ani
Perianal membrane
Levator ani
B) Reason
Root of the clitoris is attached to the undersurface of the urogenital diaphragm and is covered by the bulbospongiosus muscles. It the same muscle that is cut in mediolateral episiotomy.
what must be done to prevent complications of an intervention?
informed consent
non malificence
good communication
beneficence
professional competence
E) Reason
In order to have better results and least complications, it is an important aspect to fulfill the best level of professional competence.
which of these consists of clara cells
terminal bronchioles
trachea
bronchi
tertiary bronchus
alveoli
A) Reason
The epithelial lining of the airway is composed of ciliated cells (goblet and basal cells are absent in the terminal bronchioles) and an additional type called the Clara cell.
A 47 years old Pt with HCC has abdominal distension, tumor has spread to
portal vein
spleenic vein
hepatic vein
IVC
gastric vein
A) Reason
Findings: jaundice (Hyperbilirubinemia), tender hepatomegaly, ascites (portal hypertension) , and anorexia. Spreads hematogenously.Diagnosis: inc. α-fetoprotein; ultrasound or contrast CT.
which mechanism helps in activity of smooth muscles of alveoli?
O2
Ca/H
O2/K
K/Cl
Na/H
C) Reason
Lung stretch receptors:■ are located in the smooth muscle of the airways.■ When these receptors are stimulated by differential concentration of alveolar O2 and K and distention of the lungs, they produce a reflex decrease in breathing frequency (Hering–Breuer reflex).
Among the following, most common method to detect tumor in blood
staging
grading
receptor status
metastasis
tumor markers
E) Reason
Tumor markers should not be used as the 1° tool for cancer diagnosis in blood. They may be used to monitor tumor recurrence and response to therapy, but definitive diagnosis can be made only via biopsy.
A 46 year old man Diabetic and HTN patient presents with nose bleed and orbital invasion of cellulitis, organism
Actinomycetes
mucormycosis
Pseudomonas
spirochete
S.aureus
B) Reason
Mucor and Rhizopus spp:Mucormycosis. Disease mostly in ketoacidotic diabetic and leukemic patients. Fungi proliferate in blood vessel walls when there is excess ketone and glucose, penetrate cribriform plate, and enter brain. Rhinocerebral,assocaited with frontal lobe abscesses. Headache, facial pain, black necrotic eschar on face; may have cranial nerve involvement.Treatment: amphotericin B.
increased H secretion in exchange with Na or K in distal tubules, is the Mechanism of action of which drug
thiazide
loop diuretic
Acetazolamide
amiloride
manitol
C) Reason
AcetazolamideMECHANISM Carbonic anhydrase inhibitor. Causes self limited NaHCO3 diuresis and dec. total-body HCO3- stores.
bicuspid aortic valve associated with
Rheumatic fever
Coarctation of aorta
mitral stenosis
mitral regurgitation
aortic regurgitation
B) Reason
Coarctation of the aorta:Associated with bicuspid aortic valve.Infantile type: Aorta narrowing is proximal to insertion of ductus arteriosus (preductal). Associated with Turner syndrome. Can present with closure of the ductus arteriosus (reverse with PGE2).
Pt with genotype 46XX and ambiguous genitalia, Dx..??
true hermaphrodite
CAH
klinefilter syndrome
Turner syndrome
Patau syndrome
B) Reason
Clinical features CAH include:I. Salt wasting with hyponatremia, hyperkalemia, and hypovolemia due to lack of aldosterone. 2. Life-threatening hypotension due to lack of cortisol. 3. Clitoral enlargement (females) or precocious puberty (males) due to excess androgens
projection fibers of cerebrum present in
striatum
putamin
internal capsule
globus pallidus
cerebellum
C) Reason
The white matter of the cerebral hemisphere are of three types:1.commissural fibers(The commissural fibers interconnect the corresponding regions of the two cerebral hemispheres eg Corpus callosum).2.association fibers(These fibers connect the various cortical regions of a cerebral hemisphere eg short and long association fibers).3.projection fibers(These fibers connect the cerebral cortex with lower part of the brain or brainstem and the spinal cord, in both directions eg Internal capsule).
PDGF are derivatives of?
mast cells
eosinophils
platelets
Basophils
fibroelasts
C) Reason
PDGF Secreted by activated platelets and macrophages Induces vascular remodeling and smooth muscle cell migration Stimulates fibroblast growth for collagen synthesis
tumor compressing anterior surface of sternocleidomastoid, vessel engorged will be
common carotid
internal jugular vein
external jugular vein
internal carotid artery
Subclavian vein
C) Reason
The muscle is covered superficially by skin, fascia, the platysma muscle, and the external jugular vein. It is the common site of compression of external jugular vein.
Activity of osteoblasts is accelerated with?
Cortisol
LH
FSH
GH
ADH
D) Reason
FUNCTION: Stimulates linear growth (activating osteoblasts)and muscle mass through IGF-1/somatomedin secretion. inc. insulin resistance (diabetogenic)
role of sternocleidomastoid
turn head to opposite
turn head to same
rotate neck
overhead abduction
circumduction
A) Reason
STERNOCLEIDOMASTOID MUSCLEWhen the sternocleidomastoid muscle contracts,it appears as an oblique band crossing the side of the neckfrom the sternoclavicular joint to the mastoid process of theskull. Its main function is to move the head to opposite side.
dorsalis pedis is absent in child, foot will be supplied by
acessary peroneal
sural
great saphinous
tibial
fibular
A) Reason
Here in this scenario when dorsalis pedis artery absent, the perforating branch of the peroneal artery (acessary peroneal artery) will supply the foot.
labia majora is drained by
superficial inguinal
deep inguinal
para aortic
Pudendal
pelvic
A) Reason
LYMPH DRAINAGEThe upper half of the anal canal drains into the pararectalnodes and then into the inferior mesenteric nodes. Thelower half including the labia majora drain into the medial group of superficial inguinal nodes.
length of ureter in cm?
25
22
21
20
18
A) Reason
UretersThe two ureters are muscular tubes that extend from the kidneys to the posterior surface of the urinary bladd. Each ureter measures approximately 10 inch (25 cm) inlength and has an upper expanded end called the renalpelvis.
major blood vessels present in which space
subdural
epidural
subarachnoid
intra canal
Arachnoid space
C) Reason
• Subarachnoid space lies between the arachnoid and pia mater containing CSF: contains blood vessels; site of subarachnoid hemorrhage.
loss of movement of thumb and index finger due to gunshot but no sensory loss, nerve responsible?
superficial brand of ulnar
deep branch radial
Deep branch of Ulnar n.
Superficial brand of ulnar
Median Nerve
B) Reason
In damage of superficial branch of radial nerve there is sensory loss as well, but in case of deep nerve damaged, there is motor loss only.
Which lesion will lead to lumber pain with loss of ankle jerk
S1
L5
S2
L4
L1
A) Reason
Ankle jerk has the root value of S1. Moreover Lumbosacral pain is associated with spine injury mostly. Ankle jerk lost mean lesion at S1.
very long chain fatty acids are catalyzed in
glyoxisomes
peroxisomes
golgi complex
RER
SER
B) Reason
Peroxisome Membrane-enclosed organelle involved in catabolism of very-long-chain fatty acids, branched-chain fatty acids, and amino acids.
common peroneal nerve damage will result in
rotation
planter flexion
dorsiflexion
inversion
eversion
E) Reason
Eversion: (opposite movement of the foot so that the solefaces laterally): caused by peroneus longus, peroneus brevis, peroneus tertius, and lateral tendons of extensor digitorumlongus muscles. It is lost in lesions of common peroneal nerve.
relation of lateral fornix of vagina
Fallopian tube
ureter
Pudendal nerve
Pudendal artery
sciatic nerve
B) Reason
Uterine Artery thenpasses above the lateral fornix of vagina just close to the ureter to reach theuterus, where it ascends between the layers of the broadligament along the lateral margin of the uterus. It ends byfollowing the uterine tube laterally, where it anastomoseswith the ovarian artery.
For what affinity of taut hemoglobin is reduced?
CO
O2
CO2
HCO3
K
B) Reason
Hemoglobin Hemoglobin (Hb) is composed of 4 polypeptide subunits (2 α and 2 β) and exists in 2 forms:T (taut) form has low affinity for O2.R (relaxed) form has high affinity for O2
where is mostly pulsating abdominal mass found?
T10
T9
T8
T7
T12
E) Reason
Aortic aneurysms: Localized pathologic dilation of the aorta. Presents with pulsating mass most commonly over T10 level. May cause pain, which is a sign of leaking, dissection, or imminent rupture.
1st route of spread of retinoblastoma out of optic cavity is
retinal artery
optic nerve
retinal vein
soft tissues
orbital fat
B) Reason
Retinoblastoma is a malignant retinal tumor of childhood. 1. The tumor is sporadic in approximately 60% of cases; sporadic cases are unilateral and mono centric in origin. 2. It is familial in approximately 40% of cases; familial cases are frequently bilateral and multicentric in origin. It involves the Optic nerve and spread through it to the extraocular tissues.
Regarding neoplasia most common tumor after radiation
lymphoma
SCC
BCC
miningioma
HCC
D) Reason
MENINGIOMA A. Benign tumor of arachnoid cells, most of the time associated with radiation exposure.B. Most common benign CNS tumor in adults More commonly seen in women; rare in children C. May present as seizures; tumor compresses, but does not invade, the cortex. D. Imaging reveals a round mass attached to the dura.
embryonic tumor of childhood
neuroblastoma
meningioma
nephroblastoma
medulloblastoma
astrocytoma
C) Reason
Wilms tumor (nephroblastoma) is the most common renal malignancy of early childhood (ages 2–4). Contains embryonic glomerular structures. Presents with huge, palpable flank mass and/or hematuria.
1b fibers innervate
free nerve endings
Pacinian
murkle disc
GTO
muscle spindles
D) Reason
1b fibers inervate golgi tendon organ (GTO), While 1a fibers inervate the muscle spindles.
febrile blood reaction after transfusion occurs. Best managment?
Adrenaline
Nor adrenaline
steroids
antipyretics
antihistamines
D) Reason
Non Hemolytic febrile reaction is just a febrile manifestation and is most of the time self remitting condition, can be managed by antipyretics.
which drug used in headache is contraindicated in peripheral vascular disease
Ketorolac
NSAID
diclophenac
ergotamine
fluxetine
D) Reason
Ergotamine causes severe vasoconstriction of the periphral vasculature leading to adverse complications.
A 30 year old man with bloody diarrhea, petachea and schistocytes on peripheral smear,diagnosis is?
ITP
TTP
DIC
HUS
sepsis
D) Reason
Hemolytic uremic syndrome, causes bloody diarrhea and hemolytic manifestations of petechiai, which typically is associated with enterohemorrhagic Escherichia coli (EHEC), also may occur after infection with shigellae that secrete Shiga toxin.
A 29 year old man with abdominal pain and dirrohea, amoeba most commonly affects which part
cecum
jejunum
Illium
colon
rectum
A) Reason
Entamoeba histolytica:Amebiasis: bloody diarrhea (dysentery), usually involves cecum, liver abscess (“anchovy paste” exudate), RUQ pain (histology shows flask-shaped ulcer if submucosal abscess of colon ruptures)
intermediate mesoderm develop into
urinary system
genital system
genitourinary system
Mesoderm
Endoderm
C) Reason
• The indifferent gonad begins development in a column of intermediate mesoderm called the urogenital ridge during week 4, and develops into the genitourinary system.
ischiorectal fossa is related medially to
Uterus
bulbourethral
bulbospogiosus
internal sphincter
external anal sphincter
E) Reason
The ischiorectal fossa is a wedge-shaped space on each sideof the anal canal. The base of the wedge is superficial and is formed by the skin. The edge of the wedge is formed by the junction of the medial and the lateral walls.The medial wall is formed by the sloping levator ani muscle, external anal sphincter and the anal canal.
relation of lesser sac
stomach & spleen
stomach & pancreas
stomach & GB
Stomach & lesser omentum
D) Reason
The lesser sac lies behind the stomach and the lesseromentum. It extends upward as far as the diaphragm and downward between the layers of the greater omentum
A pt took antibiotics 2weeks back, now developed pancytopenia, Dx..?
sideroblastic anemia
iron deficiency anemia
G6PD deficiency
Aplastic anemic
Myelodysplastic disorders
D) Reason
Not a single features given in scenario is suggestive of Myelodysplastic disorders (pancytopenia with blast cells and ring sideroblasts), so most probable diagnosis js the Aplastic anemic.
mucinous and serous staining is feature of which gland
parotid
Sublingual
Submandibular
maxillary
submaxillary
C) Reason
Submandibular gland is mixed, and Parotid is pure serous while Sublingual is pure mucous.
Large intestine is removed. which deficiency is likely to occur?
water
electrolytes
minerals
vitamins
water and electrolytes
E) Reason
Large intestinal motility:■ Fecal material moves from the cecum to the colon (i.e., through the ascending, transverse, descending, and sigmoid colons), to the rectum, and then to the anal canal. Water and electrolytes are absorbed from colon.
A 36 year old male patient with neck swelling and yellowish discharge, organism..?
Pseudomonas
spirochete
shegella
Actinomycetes
gardenella
D) Reason
Pigment-producing bacteria:Actinomyces israelii—yellow “sulfur” granules, which are composed of filaments of bacteria.Israel has yellow sand.S. aureus—yellow pigment. aureus (Latin) = gold.Pseudomonas aeruginosa—blue-green pigment. Aerugula is green.Serratia marcescens—red pigment. Serratia marcescens—think red maraschinocherries.
prenatal diagnosis of Thalasemia is done by
genetic coding
CVS
USG
amnioscentesis
genotyping
B) Reason
β-thalassemia minor (heterozygote):β chain is underproduced.Usually asymptomatic.Diagnosis confirmed by inc. HbA2 (> 3.5%) on electrophoresis. Prenatal diagnosis by Chorionic Villous sampling (CVS).
Tumor at outer upper quadrant, lymph drainage is by
anterior axillary
posterior axillary
apical
superior
lateral wall
A) Reason
Lymphatic Drainage:The lateral quadrants of the breast drain into the anterior axillary or the pectoral node. The medial quadrantsdrain into the internal thoracic nodes. A few lymph vesselsalso drain posteriorly into the posterior intercostal nodes,and some communicate with the lymphatic vessels of theopposite breast and with those of the anterior abdominalwall.
Tumor at outer upper quadrant, lymph drainage is by
anterior axillary
posterior axillary
apical
superior
lateral wall
A) Reason
Lymphatic Drainage:The lateral quadrants of the breast drain into the anterior axillary or the pectoral node. The medial quadrantsdrain into the internal thoracic nodes. A few lymph vesselsalso drain posteriorly into the posterior intercostal nodes,and some communicate with the lymphatic vessels of theopposite breast and with those of the anterior abdominalwall.
adrenal medulla derived from
ectoderm
mesoderm
endoderm
neural crest cell
yolk sac
D) Reason
Adrenal cortex (derived from mesoderm) and medulla (derived from neural crest)
Cause of neurogenic shock
volume loss
sepsis
CVA
CRF
vasomotor tone loss
E) Reason
Shock occasionally results without any loss of bloodvolume. Instead, the vascular capacity increases somuch that even the normal amount of blood becomesincapable of filling the circulatory system adequately.One of the major causes of this is sudden loss of vasomotor tone throughout the body, resulting especially inmassive dilation of the veins. The resulting conditionis known as neurogenic shock.
Type A agglutinins on cell membrane of RBCs, blood group???
B
AB
0+
A+
0-
D) Reason
Blood group A is one which contains antigen A on Red blood cells and antibodies B in serum.
Thrombus in which vessel will lead to infarction of base of heart
LCA
LAD
LXA
marginal branch of RCA
posterior branch
D) Reason
Acute marginal artery—A branch of RCA: supplies right ventricle and hence the base of the heart. Its occlusion can lead to infarction of the base of the heart.
Levator ani is innervated by
pelvic
Pudendal
sciatic
femoral
sacral plexus
B) Reason
Nerve Supply Pudendal nerve, Function: Supports the pelvic viscera;sphincter to the anorectal junction and vagina
prostate is drained by
internal inguinal
external inguinal
para aortic
external iliac
internal iliac
E) Reason
The lymph drains into the internal iliac nodes.Nerve SupplyInferior hypogastric plexuses supply the prostate.
structure found between extra peritoneal fat and transverse abdominus
internal oblique
transversalis facia
oblique fascia
facia lata
conjoint tendon
B) Reason
Layers of the anterior abdominal wall from outer to inside are:1. Skin 2. Superficial fascia a. Camper (fatty) b. Scarpa (fibrous) 3. External oblique 4. I nternal oblique 5. Transversus abdominis 6. Transversalis fascia 7. Extra peritoneal 8. Parietal peritoneum
true about diphtheria produces
endotoxin
Both endotoxin and exotoxin
none of these
factor A2
exotoxin
E) Reason
Corynebacterium diphtheriae:Produces exotoxinInactivate elongation factor (EF-2)Manifestations: Pharyngitis with pseudomembranes in throat and severe lymphadenopathy (bull neck).
Of the following list, bleeding time is normal in
hemophilia A
hemophilia B
VW disease
DIC
vit. k deficiency
A) Reason
Hemophilia A or B — Intrinsic pathway coagulation defect but bleeding time is normal A: deficiency of factor VIII, inc. PTT.B: deficiency of factor IX, inc. PTT.Macrohemorrhage in hemophilia—hemarthroses (bleeding into joints), easy bruising, inc. PTT. Treatment: recombinant factor VIII (in hemophilia A).
smallest of the RNAs is
nuclear RNA
mitochondrial RNA
rRNA
mRNA
tRNA
E) Reason
tRNA Structure: 75–90 nucleotides, 2º structure, cloverleaf form, anticodon end is opposite 3′ aminoacyl end. All tRNAs, both eukaryotic and prokaryotic, have CCA at 3′ end along with a high percentage of chemically modified bases.
deep sleep can be specified by?
beta wave
theta wave
gamma wave
delta wave
alpha wave
D) Reason
Deepest non-REM sleep (slow-wave sleep); when sleepwalking, night terrors, and bedwetting occur.Delta (lowest frequency, highest amplitude) is the charecteristic wave of deep sleep.
lateral surface of foot is drained by
superficial inguinal
deep inguinal
para aortic
exrenal iliac
popliteal
E) Reason
Popliteal Lymph NodesSituated in the popliteal fossa, the popliteal lymph nodes receive the superficial lymph vessels that accompany thesmall saphenous vein from the lateral side of the foot andfrom the back and the lateral side of the calf. They also receive lymph from the deep structures from lateral side of foot.
sciatic nerve damaged but still sensation over dorsum of foot is intact, reason
sural nerve
tibial nerve
femoral nerve
saphenus nerve
sciatic nerve
D) Reason
Saphnous nerve is the continuation of the femoral nerve, and supplies the medial side of foot and ball of big toe.
lymph drainage of right thumb
trochenteric
axillary
internal thoracic
supraclavicular
infraclavicular
E) Reason
Infraclavicular (deltopectoral) nodes are not strictlyaxillary nodes, because they are located outside the axilla.They lie in the interval between the deltoid and the pectoralis major muscles. They receive lymph from the superficial vessels of the lateral side (thumb) of the hand, the forearm, and the arm; the lymph vessels accompany thecephalic vein.
ovary is drained by
para aortic
internal iliec
external illeic
deep inguinal
superficial inguinal
A) Reason
Lymph Drainageof The Ovaries:The lymph drains into the para-aortic nodes at the level ofthe first lumbar vertebra.
referal system is for
informed consent
experimental
better management
educational purposes
training purposes
C) Reason
Referral system is established to provide the better management to the patient from a center with less facilitates to the one with better facilitates.
Among the following, the most common complication of DM
wet gangrene
Ischemic ulcer
dry gangrene
neuropathy
cataract
C) Reason
Large vessel complications of DM: atherosclerosis, CAD, peripheral vascular occlusive disease, and gangrene causing limb loss, cerebrovascular disease. MI most common cause of death.
when vagus stimulates myocardium which phenomenon occurs?
AV node
bundle of His
Purkingi fibers
atria
SA node
E) Reason
Parasympathetic effects on heart rate and conduction velocity■ The SA node, atria, and AV node have parasympathetic vagal innervation, but the ventricles do not. The neurotransmitter is acetylcholine (ACh), which acts at muscarinic receptors.
pt with rta sustained multiple fractures, low b.p. 1st line of treatment will be?
secure airway
close reduction
open reduction
tie bleeding
IV fluid
E) Reason
According to the standard ATLS protocol for the accident and emergency management, ABCDE is followed, while in an hypotensive bleeding pt. IV fluids are the 1st management in ATLS protocol.
wound contraction is prevented with help of?
steroids
chloroquin
vit. C
Cu
Fe
A) Reason
FUNCTION: inc. Blood pressure (upregulates α1-receptors on arterioles dec. sensitivity to norepinephrine and epinephrineInc. Insulin resistance (diabetogenic)Inc. Gluconeogenesis, lipolysis, and proteolysisDec. Fibroblast activity (causes striae) Dec. Inflammatory and Immune responses, infalmatory and wound contraction.
SA nodal branch in 60 percent is branch of?
LCA
RCA
LAD
LXA
LDA
B) Reason
Right-dominant circulation = 85% = PDA arises from RCA.Left-dominant circulation = 8% = PDA arises from LCX.Codominant circulation = 7% = PDA arises from both LCX and RCA
Hypoxic injury affects most?
alveoli
Myocytes
nephron
osteoblasts
neuron
E) Reason
Neurons are one of the example of the permanent tissues that don”t regenerate usually. Neurons are the cells that bears least anoxia.
most common complication of epidural anesthesia
hypotension
urinary retention
headache
pelvic pain
anal incontinence
B) Reason
Epidural anesthesia can often cause injury to the lower spinal nerves that often cause its manifestations most common of which is the atonic bladder or the urinary retention.
glucose transport is enhanced by
inc. carrier
dec. carrier
inc. glycogen
inc. glucose conc.
inc. temperature
A) Reason
As glucose transport is an example of the facilitated transport, that is why its transport increases by increasing the carrier proteins (GLUT).
In a 46 year old male with productive cough, cells of inflamation in lobar Pneumonia goes to
alveoli
bronchus
terminal bronchioles
alveolar ducts
alveolar sacs
A) Reason
Lobar Pneumonia: Causative organisms are S. pneumoniae most frequently, also Legionella, KlebsiellaFindings: Intra-alveolar exudate leading to consolidation; may involve entire lung.
bifurcation of common illiac artry is crossed by
Fallopian tube
vesical urethra
ureter
vesical artery
pelvic splanchnic nerves
C) Reason
URETERIC CONSTRICTIONS AND STONESUreteric stones may be arrested at the following sites:• Where the renal pelvis joins the ureter.• Where the ureter is kinked as it crosses the pelvicbrim along the bifurcation of common iliac artry to enter the pelvis.• Where the ureter pierces the bladder wall.
which of following inhibits thrombus formation
thromboxan
prostacyclin
GGA1
PG E2
PGE1
B) Reason
Prostaglandins■ Prostacyclin is a vasodilator in several vascular beds and it inhibits the formation of thrombus.■ E-series prostaglandins are vasodilators.
common cause of liver cirrhosis in our country
Hep. B
Hep. D
Hep. A
Hep. C
Wilson disease
D) Reason
In our country, being a Muslim state, there is less cases with alcoholic cirrhosis. But due to the overuse of contaminated objects, cases of hep. C are more common.
myelination in peripheral nerves is caused by
astrocytes
oligodenrocytes
glial cells
Ependymal cells
Schwan cells
E) Reason
Myelination increases conduction velocity of signals transmitted down axons. Results in saltatory conduction of action potential between nodes of Ranvier, where there are high concentrations of Na+channels. CNS—oligodendrocytes; PNS—Schwann cells
hypertensive patient on diuretics, presents in ER in coma and K level of 6, cause..?
ARF
ATN
nephrotic syndrome
Acute GN
CKD
A) Reason
Acute kidney injury(acute renal failure)In normal nephron, BUN is reabsorbed (for countercurrent multiplication), but creatinine is not. Presentation can be azotemia or commatose state.
deep inguinal ring opens at?
external oblique
internal oblique
transversalis facia
tranversus abdomen
conjoint tendon
C) Reason
The deep inguinal ring is an oval opening in the fascia transversalis and lies approximately 0.5 in. (1.3 cm)
1 glucose molecule yeilds how many ATPs in O2
30
38
32
28
12
B) Reason
Completeoxidation of glucose through glycolysis pluscitric acid cycle will yield a net 38 ATPs .
A 43 year old male Pt. has long standing GERD, endoscopy show esophagitis and goblet cells with columner cell
Carcinoma
dysplasia
anaplasia
Barrett esophagus
hyperplasia
D) Reason
Barrett esophagus Glandular metaplasia—replacement of nonkeratinized (stratified) squamous epithelium with intestinal epithelium (nonciliated columnar with goblets cells) in the distal esophagus. Due to chronic acid reflux (GERD)
What kind of joints are intervertebral joints
primary Cartilagenous
secondary cartilaginous
Symphysis
gomphosis
Synchondrosis
B) Reason
Intervertebral disc forms secondary cartilaginous joint between the bodies of the vertebrae. If the nucleus pulposus part of the disc gets protruded backwards, it may press on the spinal nerve leaving out from the intervertebral foramina. The condition is known as herniation of the disc
obiliteration of uterine cavity occurs due to fusion of decidua parietalis with
basalis
temporalis
occipitalis
centralis
capsularis
E) Reason
The part covering the conceptus is the decidua capsularis; that betweenthe conceptus and the uterine muscular wall is the decidua basalis (where the placenta subsequentlydevelops); and that which lines the remainder of the body of the uterus is the decidua parietalis. Uterus is obiliterated by these 2 decidua.
After trauma cervical spine injury will result in
mydriasis
accommodation
miosis
cataract
retinal detachment
C) Reason
Horner syndrome Sympathectomy of face:Ptosis (slight drooping of eyelid: superior tarsal muscle)Anhydrosis (absence of sweating) and flushing (rubor) of affected side of faceMiosis (pupil constriction)Associated with lesion of spinal cord above T1
primary afferent terminates in
medial leminiscus
spinothalamic tract
latral leminiscus
spinobulbar
rubrospinal
B) Reason
Anterolateral (spinothalamic tract) system:The anterolateral system carries pain, temperature, and crude touch sensations from the extremities and trunk.
cataract occur due long term use of which drug
rifampin
INH
pyrazenamide
chloroquin
ethambutol
D) Reason
Cataract:Painless, often bilateral, opacification of lens dec. in vision. Risk factors: incresing age, smoking, EtOH, excessive sunlight, drugs (prolonged corticosteroid use, chloroquin) classic galactosemia, galactokinase deficiency, diabetes (sorbitol), trauma, infection.
mood and emotions are brought about by which neurotransmitter?
epinephrine
Norepinephrine
serotonin
glutamate
Dopamine
E) Reason
Mood disorder is characterized by an abnormal range of moods or internal emotional states and loss of control over them. Caused by imbalance of Dopamine, neurotransmitter for mood.Severity of moods causes distress and impairment in social and occupational functioning.
left sided weakness with tongue deviation to right, lesion at medulla, artery involved..?
MMA
ACA
vertebral
PCA
posterior communicating
C) Reason
Contralateral hemiparesis—upper and lower limbs.sec. contralateral proprioception. Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally).Stroke commonly bilateral.Medial medullary syndrome— caused by infarct of paramedian branches of ASA and vertebral arteries
hormone released during stress?
LH
FSH
androgen
TSH
ACTH
E) Reason
Stress hormones are those that are secreted in in stressful conditions. These include ACTH, GH, Cortisol, epinephrine, Norepinephrine and glucagon.
In an old 57 year male, Oat cell CA causes what
Down syndrome
Carcinoid
asthma
cushing syndrome
Sarcoidosis
D) Reason
Small cell (oat cell) carcinoma:Central location, Undifferentiated and very aggressive.May produce ACTH (Cushing syndromeg) , ADH, or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome).
Hemostasis begins with?
platelet activation
vasoconstriction
Vasodilation
thrombus formation
clotting
B) Reason
Whenever there is an injury that would stimulate the endothelium, then vasoconstriction is the 1st response for the Hemostasis.
stony dull percusion is character of
air in plueral cavity
fluid in pleural cavity
fibrosis
Pneumoniae
COPD
B) Reason
Whenever there is a fluid in the the pleural cavity, the percussion note will be dull,normal note is tympanic in presence of normal pleural cavity.
A man sweats 2L, then drinks 2L pure water, what will happen/
inc. both
inc. ICF Osmolarity
inc. ECF
causes dehydration
inc. ICF
E) Reason
There will be increase in ICF.
all will cause edema except
dec. proteins
Vasodilation
CRF
vasoconstriction
inc. oncotic pressure
E) Reason
increase oncotic pressure is most correct option here.
anatomical snuff box injury leads to damage of?
radial nerve
ulner nerve
radial artery
ulnar artery
median nerve
C) Reason
The cephalic vein can be seen in the proximal roof of the snuffbox, and the pulsation of the radial arterycan be felt in its depth. The snuffbox is bounded on the radial side by the tendons of abductor pollicislongus laterally and extensor pollicis brevis medially; these tendons lie close to each other
pap smear of a 39 year old lady show hyperchromasia and koilocytes, Dx..?
anaplasia
dysplasia
Metaplasia
hyperplasia
hypertrophy
B) Reason
Dysplasia and carcinoma in situDisordered epithelial growth; begins at basal layer of squamocolumnar junction (transition zone) and extends outward. Classified as CIN 1, CIN 2, or CIN 3 (severe dysplasia or carcinoma in situ), depending on extent of dysplasia. Associated with HPV 16 and HPV 18, which produce both the E6 gene product (inhibits p53 suppressor gene) and E7 gene product (inhibits RB suppressor gene).
p53 mutation causes cancer by which mechanism
inc. cell survival
inc. apoptosis
sec. necrosis
dec. replication
inc. replication
A) Reason
Tumor suppressors: p53 and hypophosphorylated Rb normally inhibit G1-to-S progression; mutations in these genes result in unrestrained cell division and increased cell survival(e.g., Li-Fraumani syndrome).
artery arising from posterior of bifurcation of aorta
median sacral
lateral sacral
pudendal
ureteric
vesical
A) Reason
Three terminal arteries: two common iliac arteries and themedian sacral artery. Two are the continuation and third originates from posterior of the bifurcation of aorta
role of renin?
alpha 1
alpha 2
beta 2
β 1
M2
D) Reason
Renin Secreted by JG cells in response to inc. renal arterial pressure and inc. renal sympathetic discharge (β1 effect).
measurment of renal plasma flow is by?
Inulin
PABA
Creatinine
Hipporate
urea
D) Reason
Measurement of renal plasma flow (RPF)—by clearance of para-aminohippuric acid (PAH)■ PAH is filtered and secreted by the renal tubules.■ Clearance of PAH is used to measure RPF.■ Clearance of PAH measures effective RPF and underestimates true RPF by 10%.
Regarding plasma K what is true?
Major ECF cation
usually moves out
usually moves in
98% in ECF
98% in ICF
E) Reason
Intracellular fluid (ICF)■ is two-thirds of TBW.■ The major cations of ICF are K+ and Mg2+.■ The major anions of ICF are protein and organic phosphates
A ptient presents with malnutrition, edema, and dec. albumin, clinical condition is called as?
marasmus
kwashirkow
nephrotic syndrome
Down syndrome
patau syndrome
B) Reason
Kwashiorkor:Protein malnutrition resulting in skin lesions, edema, liver malfunction (fatty change due to decreased apolipoprotein synthesis). Clinical picture is small child with swollen belly
pelvic splanchnic nerves are
parasympathetic
sympathetic
pelvic
somatic
involuntary
A) Reason
The preganglionic cell bodies of the parasympathetic nervous system are found in the CNS in one of 2 places: • Gray matter of brain stem associated with cranial nerves III, VII, IX, and X, or • Spinal cord gray in sacral segments S2 3, and 4 (pelvic splanchnics)
where does entry of glucose is increased with insulin?
muscles
adipose tissue
muscle & adipose tissue
lense
Myocytes
C) Reason
Anabolic effects of insulin:inc. glucose transport in skeletal muscle and adipose tissueinc. glycogen synthesis and storageinc. triglyceride synthesisinc. Na+ retention (kidneys)
which is necessary for development of Seminiferous tubules
FSH
LH
androgen
FSH & androgen
testosterone
D) Reason
Within each lobule are 1 -4 tubes, seminiferous tubules (developed under the action of FSH and androgen), where spermatozoa are produced. Each tubule is a coiled, non-branching closed loop that is 1 50-200 µm in diameter and 30-70 cm in length.
enzyme act by
dec. Ea
inc. temperature
inc. pH
inc. Ea
inc. rate of reaction
A) Reason
Enzymes are the specific type of the functional proteins that speed up the reaction by decreasing the acitivation energy.
hypothalamus releases inhibitory factor to control which hormone?
ACTH
Prolactin
LH
FSH
TSH
B) Reason
REGULATION Prolactin secretion from anterior pituitary is tonically inhibited by dopamine from hypothalamus. Prolactin in turn inhibits its own secretion by dec. dopamine synthesis and secretion from hypothalamus. TRH inc.prolactin secretion.
Dicrotic notch is formed because of
aortic diastole
atrial systole
atrial diastole
aortic systole
aortic closure
E) Reason
The “blip” in the aortic pressure tracing occurs during aortic cystole after closure of the aortic valve and is called the dicrotic notch, or incisura.
decrease in surfactant in lungs will result in?
dec. complience
dec. CO affinity
inc. O2 affinity
inc. complience
cause Hypoxia
A) Reason
Surfactant deficiency inc. surface tension decreases lung compliance and increased chances of alveolar collapse. A lecithin:sphingomyelin ratio < 1.5 in amniotic fluid is predictive of neonatal respiratory distress syndrome.
Sample from 51 yearcold male with lymphadenopathy, epitheloid cells in TB granuloma are derived from
lymphocytes
NK cells
monocytes
macrophages
monocytes
C) Reason
Granuloma: nodular collections of epithelioidmacrophages (derived from monocytes) and giant cells. Outcomes include scarring and amyloidosis.
A 58 year old male with DM for last 23 year, most common complication of DM in eye
cataract
Cilliary spasm
keratitis
retinopathy
conjunctival redness
D) Reason
Small vessel disease (diffuse thickening of basement membrane) retinopathy (hemorrhage, exudates, microaneurysms, vessel proliferation) , glaucoma, nephropathy (nodular sclerosis, progressive proteinuria, chronic renal failure, arteriolosclerosis leading to hypertension, Kimmelstiel-Wilson nodules)
which one of these is part of innate immunity only?
NK cells
lymphocytes
monocytes
mast cells
macrophages
A) Reason
Natural killer cells Use perforin and granzymes to induce apoptosis of virally infected cells and tumor cells.Activity enhanced by IL-2, IL-12, IFN-β, and IFN-α.
chief parameter for measuring GFR
PAH
PABA
urea
Inulin clearance
Creatinine
D) Reason
Measurement of GFR—clearance of inulin■ Inulin is filtered, but not reabsorbed or secreted by the renal tubules.■ The clearance of inulin is used to measure GFR
cause of dysphagia to liquids?
LMN LESION
UMN LESION
cerebellar lesion
frontal lesion
NM disorder
E) Reason
liquids don”t have any physical hinderence to the swallowing, if there is Neuromuscular disorders that cause dysphagia to liquids as well.
which epithelium has no basement membrane
simple cuboidal
urothelium
simple columner
simple squamous
stratified columner
B) Reason
The urethra extends from the urinary bladder to the tip of the penis. The prostatic urethra is composed of transitional epithelium or Urothelium and the distal urethra of stratified epithelium. It has no basement membrane.
A 56 year old male with Hx of hypertensive with family history of Medullary CA thyroid, Dx..?
aortic stenosis
pheochromocytoma
renal stenosis
Cushing syndrome
conn syndrome
B) Reason
Medullary carcinoma From parafollicular “C cells”; produces calcitonin, sheets of cells in an amyloid stroma B. Associated with MEN 2A (especially phaeochromocytoma) and 2B (RET mutations).
Maong the following, infection common in 3rd trimester in a low socioeconomic lady
P. carinii
aspergilus
A. histolytica
candida
Histoplasma
D) Reason
Candida albicans: alba = white.Systemic or superficial fungal infection. Oral and esophageal thrush in immunocompromised (neonates, steroids, pregnancy especially 3rd trimester, diabetes, AIDS), vulvovaginitis (diabetes, use of antibiotics), diaper rash, endocarditis in IV drug users, disseminated candidiasis (to any organ), chronic mucocutaneous candidiasis.
Which nerve supplies middle of face?
ophthalmic nerve
mandibular nerve
maxillary nerve
facial nerve
Trigeminal nerve
C) Reason
Face is supplied by the Trigeminal nerve. Upper 3rd of face is supplied by the Ophthalmic nerve, middle by Maxillary nerve, and lower 3rd by the mandibular division of Trigeminal nerve.
drug given for short term anesthesia of episiotomy
lignocain
prilocain
bupivacain
ropivacain
procain
E) Reason
CLINICAL USE: Minor surgical procedures especially procain, spinal anesthesia. If allergic to esters, give amides.TOXICITY:CNS excitation, severe cardiovascular toxicity (bupivacaine), hypertension, hypotension, and arrhythmias (cocaine).
A 43 year old male has cecal mass, true about it
RET MUTATION
K-RAS mutation
Rb mutation
PAS mutation
gene loss
B) Reason
When APC gene is detected. the colon will be at risk of tumor formation. Further when K-RAS is mutated, there is risk of adenoma (as in this scenario) and finally p53 mutation causes cancer (molecular progression)
forceful expiration is a feature of
quadratus lumborum
rectus sheet
rectus abdominis
external oblique
internal oblique
C) Reason
Forced ExpirationForced expiration is an active process accomplished bycontraction of the muscles of the anterior abdominal wall i.e. the transversus abdominis(forcing the relaxed diaphragm upward by raising intraabdominal pressure) and contraction of the quadratuslumborum (pulling the twelfth rib downward).
What stabilizes TM joint
quadrate ligament
mandibular ligament
stylomandibular Ligament
hyoid ligament
condilyoid ligament
C) Reason
Stylomandibular Ligament:The stylomandibular ligament is the main support of the TM joint, it is attached to the styloid process above and to the angle of the mandible below.
A 45 years old male with malignant melanoma, patient”s biopsy will show which cells
monocytes
lymphocytes
macrophages
leukocytes
NK cells
E) Reason
Malignant Melanoma: Common tumor with significant risk of metastasis. S-100 tumor marker and NK cells on histology. Associated with sunlight exposure; fair-skinned persons are at risk. Depth of tumor correlates with risk of metastasis.
cell with large dark nucleus
eosinophils
monocytes
Basophils
lymphocytes
mast cells
C) Reason
Basophils: Mediates allergic reaction. Densely (dark)basophilic granules A containing heparin (anticoagulant), histamine (vasodilator), and leukotrienes.
How is hip flexed over a long range?
rectus femoris
quadricep femoris
sartorius
adductor longus
poplieus
A) Reason
MOVEMENTThe hip joint has a wide range of movement.• Flexion: Iliopsoas, rectus femoris (strongest of flexors), sartorius, and adductormuscles.• Extension (posterior movement of the flexed thigh):Gluteus maximus and hamstring muscles
Planter flexion lost, nerve responsible is/
tibial
common peroneal
sural
great Saphinus
fibular
A) Reason
Plantar flexion: (toes pointing downward): affected by tibial nerve lesion. Muscle causing movements are Gastrocnemius, soleus, plantaris, peroneus longus, peroneus brevis,tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles.
Supply of dura of middle cranial fossa
CN VIII
CN VII
CN VIII
CN IX
CN V
E) Reason
The trigeminal nerve is the largest cranial nerve .It leaves the anterior aspect of the pons as a small motor rootand a large sensory root, and it passes forward, out of theposterior cranial fossa, to reach the middle cranial fossa, where it gives meningeal branches to its dura.
fibrin clot is stabilized by?
factor 8
factor 9
factor 10
factor 13
factor 11
D) Reason
Factor X Stuart factor; Stuart-Prower factorFactor XI Plasma thromboplastin antecedent (PTA); antihemophilic factor CFactor XII Hageman factorFactor XIII Fibrin-stabilizing factorPrekallikrein Fletcher factor
A 54 year old man travel to Pakistan 1st time, developed high grade fever and chills, later he lost conscious level, Dx..?
CVA
Rikketsia
P. malarie
P. vivax
falciparum malaria
E) Reason
P. falciparum—severe; irregular and high gradefever patterns; parasitized RBCs occlude capillaries in brain (cerebral malaria), kidneys, lungs.
intracellular proteins that maintain protein folding are
elastins
Proreasomes
chaperons
reticulins
fibrins
C) Reason
Chaperone protein: Intracellular protein involved in facilitating and/or maintaining protein folding. In yeast, some are heat shock proteins (e.g., Hsp60) that are expressed at high temperatures to prevent protein denaturing/misfolding
water is impermeable at which segment of nephron?
PCT
DCT
loop of Henle
thick ascending limb
collecting ducts
D) Reason
■ Thick ascending limb of loop of Henle is impermeable to water. Thus, NaCl is reabsorbed without water. As a result, tubular fluid [Na+] and tubular fluid osmolarity decrease to less than their concentrations in plasma (i.e., TF/PNa+ and TF/Posm < 1.0). This segment, therefore, is called the diluting segment.
how many ATPs are produced in 1 cycle of TCA by 1 acetyl CoA
2
4
6
10
12
D) Reason
The TCA cycle produces 3 NADH, 1 FADH2, 2 CO2, 1 GTP per acetyl-CoA = 10 ATP/acetyl-CoA (2× everything per glucose). TCA cycle reactions occur in the mitochondria.α-ketoglutarate dehydrogenase complex requires the same cofactors as the pyruvate dehydrogenase complex (B1, B2, B3, B5, lipoic acid).
contraindication to systemic antifungal
vaginal thrush
systemic candidiasis
oral candidiasis
aspergilosis
Histoplasmosis
C) Reason
Treatment: topical azole for vaginal; fluconazole or caspofungin for oral/esophageal; fluconazole, amphotericin B, or caspofungin for systemic.
Regarding appendix what is true?
short vessels
anterior position
opens to colon
own Mesentary
has no Mesentary
D) Reason
It has a completeperitoneal covering, which is attached to the mesentery ofthe small intestine by a short mesentery of its own called the mesoappendix. The mesoappendix contains the appendicular vessels and nerves.
Which lesion will result in loss of bladder control?
lumber plexus
sacral plexus
pelvic nerve
L5-S1 lesion
S2-4 lesion
E) Reason
The afferent impulses enter the second, third, and fourthsacral segments of the spinal cord, these control the bladder tone.Efferent impulses leavethe cord from the same segments and pass via the parasympathetic preganglionic nerve fibers in the hypogastricplexuses to the bladder wall, where they synapse with postganglionic neurons.
A pt complain of water discharge from eye while eating. Which nerve is compromised
CN V
CN VIII
CN VII
CN IX
CN VI
C) Reason
Crocodile tears (gustatory lacrimation). There is unil ateral lacrimation with mastication. This is due to faulty regeneration of parasympathetic fibres of facial nerve which now supply lacrimal gland instead of the salivary glands.
which muscle will not be damaged if left little finger is damaged?
extensor digitorum
extensor indicis
extensor hallucis
dorsal interossei
flexor digitorum profundus
D) Reason
It spares during injury of little finger.
In a blood bank which anticoagulant is best to store blood?
CPDA
citrate
heparin
warfarin
Clopidogrel
A) Reason
Any substance that deionizes the blood calcium willprevent coagulation.The negatively charged citrate ionis especially valuable for this purpose, mixed withblood usually in the form of sodium, ammonium, orpotassium citrate (CPDA). The citrate ion combines withcalcium in the blood to cause an un-ionized calciumcompound, and the lack of ionic calcium preventscoagulation
Rickettsia takes which stain
Gram staining
ZN staining
Geimsa
silver stain
sudan red
C) Reason
Giemsa:stains Chlamydia, Borrelia, Rickettsiae, Trypanosomes, Plasmodium.
In kids which structure will be injured while passing IV line?
femoral vein
saphenous nerve
anterior tibial artery
great saphenous vein
great saphenous artery
B) Reason
Saphenous nerve, which descends through thefemoral triangle and the adductor canal and crosses thefemoral artery. The nerve emerges on the medial side ofthe knee joint between the tendons of the sartorius and thegracilis muscles, and it accompanies the great saphenousvein down the medial side of the leg and in front of the medial malleolus. It passes along the medial border of thefoot as far as the ball of the big toe. It is the commonally injured nerve in venopunture of children.
What structure plays a role of station during labor?
Ischial spine
ischium
pubis
pubic tubercle
true pelvis
A) Reason
The ischiorectal fossa and the ischial spines can bepalpated laterally in the pelvis, Ischial spine palpated here is the station for fetus descent in labour
hyperosmolar over hydration
Cushing syndrome
conn syndrome
phaechromocytoma
acute bronchitis
acute dirrohea
A) Reason
FINDINGS of Cushing syndrome: Hypertension due to hyperosmolar over hydration leading to inv. volume), weight gain, moon facies, truncal obesity B, buffalo hump, hyperglycemia (insulin resistance), skin changes (thinning, striae), osteoporosis, amenorrhea, and immune suppression.
effect of Acetazolamide
osmotic diuresis
NaCl loss
K loss
Ca loss
NaCO3 diuresis
E) Reason
AcetazolamideMECHANISM Carbonic anhydrase inhibitor. Causes self limited NaHCO3 diuresis and dec. total-body HCO3- stores.
2nd part of dudenum has anterior relation of
appendix
hepatic flexor
mesocolon
right suprarenal
spleenic vein
C) Reason
TRANSVERSE COLONThe transverse colon is approximately 15 in. (38 cm) inlength and passes across the abdomen, occupying the umbilical and the hypogastric region. It begins atthe right colic flexure below the right lobe of the liver andhangs downward, suspended by the transverse mesocolonfrom the pancreas. It then ascends from anterior to the dudenum to the left colic flexurebelow the spleen.
Which cells migrate to epidermis during 3rd month of gestation.?
fibroelasts
lymphocytes
keratinocytes
melanocytes
mast cells
D) Reason
In pregnancy, anterior pituitary hormones including MSH are increased. In 3rd trimester, these excessive melanocytes come under the eidermis and are reason for the increased pigmentation during pregnancy.
histology of macula densa
no basal lamina
no basement membrane
no basal layer
deep basal cells
deep basal lamina
E) Reason
The macula densa is formed by tall cuboidal cells with deep basal lamina in the wall of the DCT which detect sodium levels in the tubular fluid.
extra embrionic coelom develops from
hypoblast
epiblast
mesoblast
yolk sac
Mesoderm
A) Reason
The inner cell mass of the first week differentiates into the epiblast and hypoblast cells and forms a bilaminar embryonic disk. An amniotic cavity develops from the epiblast and the primary yolk sac replaces the blastocyst cavity. Hypoblast then forms the embrionic coelom.
A patient presents with bone mass, Giant cell tumor appearance on X-ray
soap bubbles
starry sky
onion peel
Reticular
apple core
A) Reason
Giant cell tumor:20–40 years old.Epiphyseal end of long bones.Locally aggressive benign tumor often around knee.“Soap bubble” appearance on x-ray.Has multinucleated giant cells.
carcinoma has following intermediate filaments
elastin
caspase
fibrin
collegen II
keratin
E) Reason
Carcinomas have keratin in their structure. First step in the invasion of malignant cells through an epithelium results from a loss of expression of cadherins that weakens the epithelium.
supply of bronchopulmonary segment
primary bronchus
secondary bronchus
tertiary bronchus
terminal bronchioles
alveolar sacs
D) Reason
BRONCHOPULMONARY SEGMENTSBronchopulmonary segments are the anatomic, functional,and surgical units of the lungs. Each lobar (secondary)bronchus, which passes to a lobe of the lung, gives offbranches called segmental (tertiary) bronchi .
In a burn patient, most common post burn non bacterial infection
Histoplasma
aspergilus
S. hematobium
candida
S.mansoni
D) Reason
Candida albicans: alba = white.Systemic or superficial fungal infection. Oral and esophageal thrush in immunocompromised (neonates, Burns , steroids, diabetes, AIDS), vulvovaginitis (diabetes, use of antibiotics), diaper rash, endocarditis in IV drug users, disseminated candidiasis (to any organ), chronic mucocutaneous candidiasis.
which of following is intraarticular tendon
sartorius
popliteus
adductor logus
gastrocnemius
soleus
B) Reason
Oblique Popliteal LigamentThe oblique popliteal ligament is a tendinous expansion ofthe semimembranosus muscle. It strengthens the backof the capsule.
MCP joints are flexed mainly via
lumbricals
extensor digitorum
flexor digitorum
extensor hallucis
extensor indicis
A) Reason
• Flexion: Lumbricals and interossei muscles, assisted byflexor digitorum superficialis and profundus muscles.• Extension: Extensor digitorum, extensor indicis, and extensor digiti minimi muscles.
which segment of nephron absorbs bicarbonate?
loop of Henle
DCT
thick ascending limb
collecting duct
PCT
E) Reason
Early proximal convoluted tubule (PCT)—contains brush border. Reabsorbs all of the glucose and amino acids and most of the HCO3–, Na+, Cl–, PO43–, K+, and H2O. Isotonic absorption. Generates and secretes NH3, which acts as a buffer for secreted H+.
Among the following, the most Radiosensitive tumor
astrocytoma
glioma
schanoma
meningeoma
medulloblastoma
E) Reason
meduloblastoma are most radiosensitive tumors and glioblastoma are least radiosensitive.
74 year old man with symptoms of urinary obstruction and frequency, has firm mass on DRE, PSA is 19, Dx..?
BPH
CA colon
CA rectum
Adenocarcinoma prostate
hemoroids
D) Reason
Prostatic adenocarcinoma:Common in men > 50 years old. Arises most often from the posterior lobe (peripheral zone) of the prostate gland and is most frequently diagnosed by inc. PSA and subsequent needle core biopsies. Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (inc. total PSA, with inc. fraction of free PSA).
laterally bladder has a posterior relation with
ureter
seminiferous tubules
seminal vesicle
prostate
Pudendal nerve
C) Reason
SEMINAL VESICLESThe seminal vesicles are paired organs that lie on the posterior surface of the bladder and lateral to the terminal part of the vas deferens.
A 48 year old male has dec. range of motion of upper limb, has normal CBC and other baseline with Ca 7.8 and PO4 6.4, albumin 6.2, Creatinine 7.8, Dx..?
parathyroid adenoma
CA parathyroid
excess vit. D
renal failure
parathyroid hyperplasia
E) Reason
Secondary Hyperparathyroidism: 2° hyperplasia due to decreased gut Ca2+ absorption and increased PO43-, most often in chronic renal disease (causes hypovitaminosis D decreased Ca2+ absorption).
cyclosporine MOA in transplant patients
inhibit B cells
inhibit T cell differentiation
inhibit NK cells
inhibit lymphocytes
inhibit monocytes
B) Reason
Cyclosporine: MoA, Calcineurin inhibitor; binds cyclophilin. Blocks T cell activation by preventing IL-2 transcription.Uses: Transplant rejection prophylaxis, psoriasis, rheumatoid arthritis.
A 28 year old male patient comes to you, his laparotomy scar is raised and hard, Dx..?
keloids
hernia
excessive elastin
Hypertonic scar
burst abdomen
D) Reason
Scar formation 70–80% of tensile strength returns at 3 months following wound; little additional tensile strength will be regained. Abnormally thick and tough struture formed by excessive scarring is the Hypertrophic scar.
While performing cubital venesectiom which nerve is likely to be damaged?
radial
ulner nerve
axillary artery
radial artery
median
E) Reason
From medial to lateral, the cubital fossa contains the median nerve, the bifurcation of the brachial artery into the ulnar and the radial arteries, the tendon of the biceps muscle,and the radial nerve and its deep branch. Median nerve is the most commonly damaged during venopunture in cubital fossa.
Regarding neoplasia, radiation cause protein damage that cause carcinogenesis by
bcr
abl
Rb
TET
BCl2
E) Reason
Bcl-2 prevents cytochrome c release by binding to and inhibiting Apaf-1. Apaf-1 normally induces the activation of caspases. If Bcl-2 is overexpressed (e.g., follicular lymphoma), then Apaf-1 is overly inhibited, leading to inc. caspase activation and tumorigenesis.
which renal function is determined with specific gravity of urine?
secretion
filtration
absorption
concentration
excretion
D) Reason
Specific gravity of urine is the measurement of the concentration of solutes in urine. As the concentrating ability of the kidney is impaired, the specific gravity changes.
lab. measurement of vit.D involves which metabolite
1 hydroxy vit.D
vit. D1
vit. D2
25 dihydroxy vit D
1,25 dihydroxy vit. D
D) Reason
Vitamin D D2 = ergocalciferol—ingested from plants.D3 = cholecalciferol—consumed in milk, formed in sun-exposed skin (stratum basale).25-OH D3 = storage form. 1,25-(OH)2 D3 (calcitriol) = active form
Pudendal nerve roots
S1
S2-3
S1-2
S2-4
S3-4
D) Reason
The pudendal nerve (S2, 3, and 4) leaves the pelvisthrough the greater sciatic foramen and enters the perineum through the lesser sciatic foramen.• Nerves to the piriformis muscle.
most common risk of giving systemic steroids to diabetic
delayed healing
poor sugrar control
obesity
edema
wheezing
B) Reason
TOXICITY Iatrogenic Cushing syndrome—buffalo hump, moon facies, truncal obesity, muscle wasting, thin skin, easy bruisability, osteoporosis (treat with bisphosphonates), poor sugrar control in diabetics, adrenocortical atrophy, peptic ulcers, diabetes (if chronic).Adrenal insufficiency when drug stopped abruptly after chronic use.
Rheumatic fever is the example of which type of HSR
delayed response
type 1 HSR
type 3 HSR
type 4 HSR
type 2
E) Reason
Type II: Autoimmune hemolytic anemiaPernicious anemiaIdiopathic thrombocytopenic purpuraErythroblastosis fetalisAcute hemolytic transfusion reactionsRheumatic feverGoodpasture syndromeBullous pemphigoidPemphigus vulgaris
vulva has nerve supply of?
femoral
Obturator
sacral plexus
lumber plexus
pudendal
E) Reason
Muscles of the perineum, including the external analsphincter, mucous membrane of the lower half of theanal canal, perianal skin, skin of the penis, scrotum,clitoris, and labia majora and minora (vulva).
inhaled anesthetic is given with Ca channel bloker, it will cause
headache
bleeding
hypertension
hypotension
rapid onset
D) Reason
Ca channel blockers are the Vasodilators that are used along with the volatile anesthetics. Their Vasodilation property is the cause of hypotension.
A pt”s labs show normal PT & deranged APTT. what is most likely cause?
aspirin
factor 8 inhibition
Clopidogrel
heparin
warfarin
B) Reason
It is clear that wheneither Factor VIII or platelets are in short supply,this step is deficient. Factor VIII is the factor thatis missing in a person who has classic hemophilia (darranged PTT and normal PT),for which reason it is called antihemophilic factor.Platelets are the clotting factor that is lacking inthe bleeding disease called thrombocytopenia
correct regarding xenograft
twins
same specie
from siblings
other species
same person
D) Reason
Autograft From self.Syngeneic graft From identical twin or clone.Allograft From nonidentical individual of same species.Xenograft From different species.
In a 29 year old women with sudden onset of bleeding disorder, here suspected DIC, diagnostic test
inc. PT
inc. PTT
D dimers
inc. fibrin
inc. thrombin
C) Reason
Labs: schistocytes, increased fibrin split products (d-dimers), decreased fibrinogen, decreased factors V and VIII
round ligament of liver is remnant of
umbilical artery
yolk sac
umbilical vein
foramin ovale
ductus venosus
C) Reason
Falciform Ligament Connects Liver to anterior abdominal wallIt contains Ligamentum teres hepatis/ Round ligament(derivative of fetal umbilical vein)
1 yr old boy has reccurent URTI and cough and chronic dirrohea, test for diagnosis
stool culture
suputum culture
jejunal biopsy
colonoscopy
chest HRCT
C) Reason
Celiac Disease: Autoimmune-mediated intolerance of gliadin (wheat) leading to malabsorption and steatorrhea. Associated with HLA-DQ2, HLA-DQ8, and northern European descent. Findings include anti-endomysial, anti-tissue transglutaminase, and anti-gliadin antibodies; blunting of villi; and lymphocytes in the lamina propria. decreased mucosal absorption that primarily affects distal duodenum and/or proximal jejunum. Jejunal biopsy is the diagnostic evaluation.
which structure forms roof of ischiorectal fossa?
perineal membrane
levator ani
perineal muscles
bulbourethral gland
bulbospongeosus
B) Reason
Ischiorectal FossaThe ischiorectal fossa is a wedge-shaped space on each sideof the anal canal . The base of the wedge is superficial and is formed by the skin. The edge of the wedge isformed by the junction of the medial and the lateral walls.The medial wall and roof is formed by the sloping levator ani muscleand the anal canal; the lateral wall is formed by the lower part of Obturator internus muscle.
blood is stored mostly with citrate. why?
bind to heparin
binds to Ca
bind to platelet
bind to fibrinogen
bind to fibrin
B) Reason
The citrate ion combines withcalcium in the blood to cause an un-ionized calciumcompound, and the lack of ionic calcium preventscoagulation. Citrate anticoagulants have an importantadvantage over the oxalate anticoagulants becauseoxalate is toxic to the body
cervix lymphatic drains into
internal iliac
external iliac
epigastric
deep inguinal
pelvic
A) Reason
Lymph DrainageFrom the fundus, the lymph vessels follow the ovarian arteryto the para-aortic nodes at the level of the first lumbar vertebra. From the body and the cervix, the lymph vessels draininto the internal and the external iliac nodes.
level of left kidney”s hilum
L3
L2
L4
L5
L2-4
B) Reason
The right kidney (L3) is slightly lower than the left kidney (L2) because of the large sizeof the right lobe of the liver.
bulbourethral gland is located at
pelvic pouch
pouch duglis
true pelvis
deep perineal pouch
false pelvis
D) Reason
CONTENTS OF THE DEEP PERINEAL POUCHIn males, the deep perineal pouch contains the following:• The membranous part of the urethra.• The sphincter urethrae.• The bulbourethral glands.• The deep transverse perineal muscles.• The internal pudendal vessels.• The dorsal nerves of the penis
eversion of foot is action of
sartorius
adductor longus
peroneus longus
soleus
gastrocnemius
C) Reason
Inversion (movement of the foot so that the sole facesmedially): Tibialis anterior, extensor hallucis longus, medial tendons of extensor digitorum longus, and tibialis posterior muscles.• Eversion (opposite movement of the foot so that the solefaces laterally): Peroneus longus, peroneus brevis, peroneus tertius, and lateral tendons of extensor digitorumlongus muscles.
Cardiolipin is present in
RER
SER
nucleus
cell membrane
mitochondria
E) Reason
The inner membrane is impermeable to most small ions (Na+, K+, H+) and small molecules (ATP, adenosine diphosphate, pyruvate). The impermeability is likely related to the high content of the lipid cardiolipin
Pt. with dirrohea, pH 7.3 , HCO3 22, CO2 35, normal anion gap, Diagnosis?
respiratory acidosis
renal tubular acidosis
metabolic acidosis
respiratory alkalosis
Barter syndrome
B) Reason
Normal anion gap (8−12 mEq/L):HARD-ASS:HyperalimentationAddison diseaseRenal tubular acidosisDiarrheaAcetazolamideSpironolactoneSaline infusion
Marked leucocytosis is indicative of?
plymghocytosis
inc. monocytes
inc. mast cells
neutrophilia
inc. Basophils
D) Reason
Acute appendicitis is an example of the acute inflammatory process, and cells that mediate an acute inflammation are neutrophils, while lymphocytes mediate the chronic inflamation.
near gall bladder, anterior relation of portal vein
epiploic foramin
callot”s triangle
lesser sac
greater sac
lesser omentum
A) Reason
BOUNDARIES OF THE EPIPLOIC FORAMEN• Anteriorly: Free border of the lesser omentum, the bileduct, the hepatic artery, and the portal vein.• Posteriorly: Inferior vena cava.• Superiorly: Caudate process of the caudate lobe of theliver.• Inferiorly: First part of the duodenum.
Pain in chest which agravates with respiration ,Reason?
myocardium
endocardium
pericardium
infarct
Pneumonia
C) Reason
Acute pericarditis Commonly presents with sharp pain, aggravated by inspiration, and relieved by sitting up and leaning forward. Presents with friction rub. ECG changes include widespread ST-segment elevation and/or PR depression.
diabetic pt. on diuretics presents with hyperkalemia, cause?
thiazide
spironolactone
furosemide
manitol
Acetazolamide
B) Reason
TOXICITY Hyperkalemia (can lead to arrhythmias), endocrine effects with spironolactone (e.g., gynecomastia, antiandrogen effects.
sesamoid bone is found in
femor
rectus femoris
Sartorius
psiform
thenar eminence
D) Reason
They are related to an articular or nonarticular bony surface, and the surfaces of contact are covered with hyaline cartilage and lubricated by a bursa or synovial membrane. Examples: patella, pisiform, fabella.
Supply of flexor carpi ulnaris is
median
radial
axillary
posterior interossius
ulnar
E) Reason
It is supplied by muscular branches of ulnar nerve.
Regarding immunology, ASO titer is used for the diagnosis of
Endocarditis
rheumatic fever
Myasthenia gravis
tyohioid fever
HIV
B) Reason
Associated with Aschoff bodies (granuloma with giant cells [blue arrows in A]), Anitschkow cells (enlarged macrophages with ovoid, wavy, rod-like nucleus, inc. ASO titers.Immune mediated (type II hypersensitivity); not a direct effect of bacteria. Antibodies to M protein cross-react with self antigens.
which of following is result of parasympthatic activity?
dec. motility
dec. gut secretion
dec. sphincter
inc. glandular secretion
closed sphincter
D) Reason
Parasympathetic system is characterized by the rest and digest, at GIT it causes opening of sphincters, increase gut motility and increases gut secretions
which anticoagulant is natural product?
warfarin
cumaidin
heparin
Clopidogrel
anti thrombin
C) Reason
Heparin: Heparin is a natural powerful anticoagulant,but its concentration in the blood is normally low, sothat only under special physiologic conditions does it have significant anticoagulant effects
People with fish and meat diet with no fruit, will have deficiency of
vit. D
vit. C
B1
B6
B12
B) Reason
Vitamin C is found in fruits and vegetables. DEFICIENCY Scurvy—swollen gums, bruising, hemarthrosis, anemia, poor wound healing, perifollicular and subperiosteal hemorrhages, “corkscrew” hair. Weakened immune response.
foramen for passage of accessory nerve
rotundum
jugular
spinosum
magnum
ophthalmic
B) Reason
The jugular foramen lies between the petrous part ofthe temporal bone and the condylar part of the occipitalbone. It transmits the glossopharyngeal, the vagus, and theaccessory nerves
lesser omentum is attached to
pancreas
spleen
stomach
mesocolon
caudate lobe
E) Reason
The lesser omentum suspends the lesser curvature ofthe stomach to the fissure for the ligamentum venosum andthe porta hepatis and caudate lobe of the liver. The gastrosplenic omentum (ligament) connects the stomach tothe hilus of the spleen.
Thrombus in which artery will result in infarct in visual centre?
anterior cerebral
posterior cerebral
vertebral
anterior communicating
middle meningeal
B) Reason
Visual cortex is located in the occipital lobe that is located in posterior cranial fossa supplied by the posterior cerebral artery.
How is GFR measured in CKD pt.?
inulin
urea
PAH
PABA
Creatinine clearance
E) Reason
Estimates of GFR with blood urea nitrogen (BUN) and serum [creatinine]:■ Both BUN and serum [creatinine] increase when GFR decreases.Serum Creatinine clearance is used to measure GFR in chronic renal disease.■ In prerenal azotemia (hypovolemia), BUN increases more than serum creatinine and there is an increased BUN/creatinine ratio (>20:1).■ GFR decreases with age, although serum [creatinine] remains constant because of decreased muscle mass.
Levator scapulae is innervated by?
C2
C4-5
C5-6
C1-3
C3-4
E) Reason
Levator scapulae is supplied by the spinal roots of the 3rd and 4th cervical nerves, Its function is to Raises the medial borderof the scapula.
primary heart tube is developed at
4th week
5th week
7th week
8th week
10th week
A) Reason
Cardiac looping Primary heart tube loops to establish left-right polarity; begins in week 4 of gestation
end product of purine metabolism
uric acid
urea
Creatinine
ammonia
CO2 and H2O
A) Reason
Lesch-Nyhan syndromeDefective purine salvage due to absent HGPRT, which converts hypoxanthine to IMP and guanine to GMP. Results in excess uric acid (end product of purine metabolism)production and de novo purine synthesis. X-linked recessive
Small cell CA lung is associated with which of following
no basement membrane
no basal lamina
keratin nests
more elastin
more fibrin
C) Reason
Undifferentiated and very aggressive.Has keratin pearls on histology.May produce ACTH, ADH, or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome). Amplification of myconcogenes common. Inoperable; treat with chemotherap
derivative of 2nd pharyngeal arch
hyoid bone
parathyroid
thyroid
thymus
stylohoid ligament
E) Reason
Derivatives of 2nd pharyngeal Arch: Muscles of facial expression: Stapes Plus: Styloid process Digastric (posterior belly) Lesser horn and UJ:Stylohyoid body of hyoid bone Stapedius.
Which nerve damage will result in loss of lateral eye movement?
CN V
CN VIII
CN VI
CN VII
CN IV
C) Reason
It supplies the lateralrectus muscle. The abducent nerve is therefore responsiblefor turning the eye laterally.
failure to rotate the anterior bud to the duodenum will result into
horseshoe kidney
pancreatic atresia
duodenal atresia
jejunal atresia
annular pancreas
E) Reason
A defect in the rotation and fusion of the ventral and dorsal buds results in an annular pancreas which can constrict or obstruct the duodenum and result in polyhydramnios.
abnormal histological findings on 3.5cm above gastro-esophageal junction is
adeno CA
lymphoma
dysplasia
achlasia
Barret esophagus
E) Reason
Barrett esophagus Glandular metaplasia—replacement of nonkeratinized (stratified) squamous epithelium with intestinal epithelium (nonciliated columnar with goblets cells) in the distal esophagus. Due to chronic acid reflux (GERD).
What should be V/Q for physiological shunt?
infinite
1
zero
2
maximum
C) Reason
V/Q =0 = airway obstruction (shunt). In shunt, 100% O2 does not improve Po2.V/Q =∞ = blood flow obstruction (physiologic dead space). Assuming < 100% dead space, 100% O2 improves Po2
vulva is lined by which epithelium
simple cuboidal
stratified squamous
simple columner
simple squamous
keratinized
B) Reason
Stratified squamous epithelium is found in the oral cavity, Vulva pharynx, and esophagus (non-keratinized) and in the skin (keratinizing).
Pt. sustains injury to nerve in axilla resulting in slight supination & flexion. Nerve damaged is?
radial
ulnar
axillary
muskulocutaneus
median
D) Reason
Musculocutaneous Nerve: Coracobrachialis, biceps brachii, and brachialis muscles; supplies the skin along the lateral border of forearm when it becomes the lateral cutaneous nerve of the forearm
A 4 month ill looking and Lethargic child in ER with Na 145 and K 2.5, Dx..?
alkalosis
respiratory acidosis
ATN
renal tubular necrosis
ARF
D) Reason
Key finding: granular (“muddy brown”) casts A.3 stages:1. Inciting event2. Maintenance phase—oliguric; lasts 1–3 weeks; risk of hyperkalemia, metabolic acidosis3. Recovery phase—polyuric; BUN and serum creatinine fall; risk of hypokalemiaCan be caused by ischemic or nephrotoxic injury.
Which nerve will be damaged in order to affect mass movement of intestine?
sympathetic
myenteric
parasympathetic
splanchnic nerves
aurbach plexus
E) Reason
Submucosa—includes Submucosal nerve plexus (Meissner)- secretionsMuscularis externa—includes Myenteric nerve plexus (Auerbach)- gut motility.
anterior superior iliac spine is fractured. which muscle is avulsed?
adductor longus
soleus
gastrocnemius
sartorius
rectus femoris
D) Reason
Sartoriua is long and strong muscle and it takes origin from the anterior superior Iliac spine (ASIS). Its avulsion can cause fracture of ASIS.
Due to trauma to temple region pt. suffered headache & loss of vision. Lesion is at?
anterior meningeal artery
middle miningeal artry
vertebral artery
posterior cerebral
anterior communicating
B) Reason
The middle meningeal artery ascends between theroots of the auriculotemporal nerve to enter the skull throughthe foramen spinosum. It runs laterally within the skull anddivides into anterior and posterior branches. The anteriorbranch is particularly important, because it lies close to themotor area of the cerebral cortex. It injury can cause loss of vision.
boy fell outstretched hands, can”t abduct arm upto 40 degree, but assisted to 40 then he can abduct overhead, muscle involved is
bicep
deltioid
brachialis
supraspinatus
tricep
D) Reason
Abduction: Middle fibers of the deltoid muscle, assistedby the supraspinatus muscle (overhead abduction).
Anterior relation of CBD to duodenum
2nd
3rd
4th
1st
head of pancreas
D) Reason
It descends in front of theopening into the lesser sac and passes behind the first partof the duodenum and then the head of the pancreas. Thebile duct ends below by piercing the medial wall of the duodenum approximately halfway down its length. Itis usually joined by the main pancreatic duct, and, together,they open into a small ampulla in the duodenal wall calledthe ampulla of Vater
dilated vessel around umbilicus, vessel compromised?
portal vein
spleenic vein
pancreatic vein
epigastric vein
umbilical vein
D) Reason
Clinically, theenlarged subcutaneous anastomosis between the lateral thoracic vein, a tributary of the axillary vein, andthe superficial epigastric vein, a tributary of thefemoral vein, may be seen on the thoracoabdominalwall.
Absorbance of csf is carried out at?
Arachnoid plexus
subdural place
Arachnoid villi
epidural space
sub Arachnoid space
C) Reason
Choroid plexus secretes CSF into all ventricles. Arachnoid granulations (Arachnoid villi) are sites of CSF resorption
median nerve damaged before flexor retinaculum, there is sensory loss at thenar, what other loss will be found?
opposition of thumb
flexion of thumb
extension of thumb
addiction of thumb
abduction of thumb
A) Reason
MEDIAN NERVE AND RESTRICTED SPACEIn the carpal tunnel the median nerve lies in a restricted space between the flexor digitorum superficialis and the flexor carpi radialis muscles. It may become compressed at this site. Manifests as loss of sensation of thenar eminence and loss of opposition of thumb.
Which nerve damage results in adduction & lateral rotation of thumb?
radial
ulnar
median
musculocutaneus
median
E) Reason
Anterior interosseousbranch of themedian nerve supplies the flexor pollisus longus, its damage can cause addiction and lateral rotation of thumb.
which nerve emerges from pons
CN V
CN V-VII
CN V-VI
CN 6-8
CN 5-8
E) Reason
Nerves originating from Pons are: V. The trigeminal (mixed).VI. The abducent (motor).VII. The facial (mixed).VIII. The vestibulocochlear (sensory).
Smudge cells are characteristics of
ALL
CML
ALL
CLL
multiple myeloma
D) Reason
CLL: Age: > 60 years. CD20+, CD5+ B-cell neoplasm. Often asymptomatic, progresses slowly; smudge cells in peripheral blood smear; autoimmune hemolytic anemia.
What must be depleted for thirst derive?
ICF fluid
ECF fluid
dec. ECF Osmolarity
inc. ICF Osmolarity
hypertension
B) Reason
When there is decreased Blood volume or ECF and in case of increased ECF Osmolarity, thirst center is actived in order to take ECF Osmolarity and ECF volume towards normal.
if anterior cruciate ligament is damaged lateral condyle of femur & tibia will move to?
anteroposterior
posterior
lateral
anterolateral
anterior
E) Reason
The anterior cruciate ligament is attached below tothe anterior intercondylar area of the tibia, and itpasses upward, backward, and laterally to be attached to thelateral femoral condyle.
supply of cremasteric reflex is
ilioinguinal
genitofemoral
pudendal
cremasteric
pelvic
B) Reason
Genitofemoral: Cremaster muscle in scrotum in male;nerve (L1, 2) skin over anterior surface of thigh;nervous pathway forcremasteric reflex
Supply of root of tongue is
tractus solitarius
vagus
CN IX
CN VII
CN VIII
A) Reason
SENSORY INNERVATION• Anterior two thirds: The lingual nerve (general sensation) and chorda tympani (taste).• Posterior third: The glossopharyngeal nerve, tractus solitarius nucleus(general sensation and taste).
which nerve is bound to submandibular gland?
mandibular nerve
maxillary nerve
ophthalmic nerve
lingual nerve
facial nerve
D) Reason
The submandibular ganglion is a parasympathetic ganglionthat lies deep to the submandibular salivary gland and is attached to the lingual nerve by small nerves.
A 29 year old male is treated for fever, now presented with jaundice and painful legs, Diagnosis?
Hemolytic crisis
Aplastic crisis
CML
ALL
CLL
A) Reason
Most common enzymatic disorder of RBCs.X-linked recessive.Defect in G6PD: dec. glutathione inc. RBC susceptibility to oxidant stress. Hemolytic anemia following oxidant stress (classic causes: sulfa drugs, antimalarials, infections, fava beans)
histology of tissue with less smooth muscles
cervix
uterus
Fallopian tube
ovary
vulva
A) Reason
Ectocervix Stratified squamous epithelium, nonkeratinizedEndocervix Simple columnar epithelium-less smooth muscles.Transformation zone Squamocolumnar junction (most common area for cervical cancer)
which is important during 2nd stage of labor
dilatation
effacement
descent
contraction
involution
D) Reason
During 1st stage, cervical dilatation and effacement is important. During 2nd stage, utrine contraction is important. While during 3rd stage utrine contraction and involution is important.
is developed in which week
3rd
4th
2nd
5th
6th
A) Reason
Third week: Gastrulation and early development of nervous and cardiovascular systems; corresponds to first missed period.
respiration is directly proportional to
alveoli
alveolar ducts
alveoli sac
surfactant
alveoli surface area
E) Reason
Diffusion: Vgas = A/T × Dk(P1 – P2) where A = area, T = thickness, and Dk(P1 – P2) ≈difference in partial pressures: A dec. in emphysema. T inc. in pulmonary fibrosis.
If adductor canal is compressed which structure will be damaged?
femoral
fibular
peroneal
deep femoral artery
superficial femoral artry
E) Reason
Theartery descends through the femoral triangle andthe adductor canal (can be damaged by compression over the canal), and it leaves the front of the thigh by passing through the opening in the adductor magnus and then entering the popliteal space as the popliteal artery.
urine conc. is 100, urine flow rate 2 and plasma conc. is 10, find renal clearance?
2
10
50
2000
20
E) Reason
Renal clearance Cx = UxV/Px = volume of plasma from which the substance is completely cleared per unit time. = 100 x 2 / 10= 20.
which is site of secretary proteins synthesis
SER
mitochondria
golgi complex
nucleus
RER
E) Reason
Rough endoplasmic reticulum:Site of synthesis of secretory (exported) proteins and of N-linked oligosaccharide addition to many proteins.
inc. conductance in ventricles have increased conductance because of?
less muscles
more muscle
purkinji fibers
less fibrin
more fibrin
C) Reason
Speed of conduction—Purkinje > atria > ventricles > AV node.Pacemakers—SA > AV > bundle of His/Purkinje/ventricles
IL1 cause fever. How?
TNF
proatacyclin
fibrin
prostagladins
elastin
D) Reason
Fever1. Pyrogens increase the production of interleukin-1 (IL-1) in phagocytic cells. ■ IL-1 acts on the anterior hypothalamus to increase the production of prostaglandins. Prostaglandins increase the set-point temperature, setting in motion the heat-generating mechanisms that increase body temperature and produce fever.
which muscle does no part in wrist?
brachialis
bracheoradialis
supinator
bicep
flexer carpi radialis
B) Reason
Brachioradialis is supplied by Radial nerve. It Flexes the forearm at theelbow joint, rotates theforearm to the midproneposition
active thyroid hormone is
T3
T4
free form
protein bound
fat bound
C) Reason
T4 is major thyroid product; converted to T3 in peripheral tissue by 5”-deiodinase.Free form of T3 (active form) binds receptors with greater affinity than T4.Peroxidase is enzyme responsible for oxidation and organification of iodide as well as coupling of monoiodotyrosine (MIT) and diiodotyrosine (DIT).
Thrombus in which vessel will result in infarct of lower segment of heart?
RCA
LXA
posterior branch
LCA
marginal branch
D) Reason
Left anterior descending artery (LAD) Branch of LCA—supplies anterior 2/3 of interventricular septum, anterior papillarymuscle, and anterior surface of left ventricle
blood supply of lungs
pulmonary artery
bronchial arteries
alveolar artry
splanchnic artery
pleural artery
B) Reason
BLOOD SUPPLY OF THE LUNGSThe bronchi, connective tissue, and visceral pleura are supplied by the bronchial arteries
Prostagladins D2, E2 and F2 features are
Vasodilation
vasoconstriction
mediate inflammation
clear debris
for pain
A) Reason
LTC4, D4, and E4 function in bronchoconstriction, vasoconstriction, contraction of smooth muscle, and inc. vascular permeability.PGI2 inhibits platelet aggregation and promotes vasodilation
syndemosis is present in
at sutures
teeth
vertebrae
knee joint
b/w radius & ulna
E) Reason
The bones are connected by the interossesous ligament . Example includes radioulnar joint and inferior tibiofibular joint.
Among the following, which of following has no graft rejection after transplant
HIV
CML
Aplastic crisis
Aplastic anemia
SCID
E) Reason
Severe combined immunodeficiency (SCID): Failure to thrive, chronic diarrhea, thrush. Recurrent viral, bacterial, fungal, and protozoal infections.Treatment: bone marrow transplant (no concern for rejection).
internal jugular vein on emerging from jugular foramen is related anteriorly to?
hypoglossal
axillary nerve
acessary nerve
axillary artery
Subclavian vein
C) Reason
The internal jugular vein is a large vein that drains bloodfrom the brain, face, scalp, and neck. It starts as acontinuation of the sigmoid venous sinus and leaves theskull through the jugular foramen. It then descends throughthe neck in the carotid sheath lateral to the vagus nerve andanterior to the acessary nerve and the internal and the common carotid arteries.
acid production activity is done by?
H2 receptor
H1 receptor
gastrin
parietal mucosa
sympathetic nerve
A) Reason
■ stimulates H+ secretion by activating H2 receptors on the parietal cell membrane.■ The H2 receptor is coupled to adenylyl cyclase via a Gs protein.■ The second messenger for histamine is cAMP.■ H2 receptor–blocking drugs, such as cimetidine, inhibit H+ secretion by blocking the stimulatory effect of histamine
Patient in ICU has to shift on vent. what is necessary to tell to patient/attendant
detail of procedure
consent
keep them in ICU
take to home
do what is necessary without communicating
A) Reason
In order to ensure the best communication between the Dr. and Patients, it is necessary to explain the procedure.
After surgery of a 37 year old male HIV patient, how to clean the theater
alcohol
formaldehyde
UV light
gamma rays
2 % glutraldehyde
E) Reason
Glutaraldehyde, which has two reactive aldehyde groups, is 10times more effective than formaldehyde and is less toxic. In hospitals, it is used tosterilize respiratory therapy equipment, HIV and HBV used instruments, endoscopes, and hemodialysis equipment.
spinal nerves are
sensory
motor
double supply
no ganglion
mixed
E) Reason
Spinal nerves: There are mixed nerves, 31 nerves in total: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal.Nerves C1–C7 exit above the corresponding vertebra. All other nerves exit below (e.g., C3 exits above the 3rd cervical vertebra; L2 exits below the 2nd lumbar vertebra).
external carotid artery terminates at
parotid gland
Submandibular gland
Sublingual gland
mandibular angle
mandibular body
A) Reason
External Carotid ArteryThe external carotid artery begins at the level of the upperborder of the thyroid cartilage as one of the terminalbranches of the common carotid artery. It ascendsto terminate in the parotid salivary gland behind the neck ofthe mandible, where it divides into the superficial temporaland the maxillary arteries.
carcinoma compressing optic tract causes
unilateral blindness
ipsilatral blindness
homonymous hemianopia
bitemporal hemianopia
contralatral loss
C) Reason
Visual field defects: 1. Ipsilatral anopia (optic nerve).2. Bitemporal hemianopia (pituitary lesion, chiasm)3. contralatral omonymous hemianopia ( optic tract lesiong
level of body of hyoid bone
C1
C3
C2
C4
C3-5
B) Reason
The hyoid bone may be felt a few centimetres below and behind the chin, especially if the neck isextended. It may be palpated between finger and thumb and moved from side to side. The hyoid bone liesapproximately at the level of the third cervical vertebra.
most abundant cells in respiratory tree
type 2 cells
clara cells
Type 1 cells
squamous cells
cuboidal cells
C) Reason
Type I cells 97% of alveolar surfaces. Line the alveoli. Squamous; thin for optimal gas diffusion
which Hb is absent in fetal blood
alpha chain
gamma chain
delta chain
beta chain
theta chain
D) Reason
Hemoglobin development:Fetal hemoglobin (HbF) = α2γ2.Adult hemoglobin (HbA) = α2β2.HbF has higher affinity for oxygen due to less avid binding of 2,3-BPG. This allows HbF to extract oxygen from (HbA) maternal hemoglobin across the placenta.
No. of lactiferous ducts are found in mammary gland?
13-15
15-20
18-20
20-25
25-30
B) Reason
Each gland consists of 15 to 20 lectiferous ducts that radiate outward from the nipple. There is no capsule. Each lobe is separated from its neighbor by connective tissue septa that extend from the skin to the deep fascia and that serve assuspensory ligaments. Th
visible intercostal pulsation with notching on X-ray is found. Diagnosis
pneumonia
pericarditis
aortic arch aneurysm
mitral stenosis
aortic stenosis
C) Reason
Associated with cystic medial degeneration due to hypertension (older patients) or Marfan syndrome (younger patients). Presents with intercostal pulsation with notching on X-ray chest. Also historically associated with 3° syphilis (obliterative endarteritis of the vasa vasorum).
pulmonary pressure and volume curve shows
ventilation
compliance
perfusion
circulation
pressure
B) Reason
Compliance—change in lung volume for a given change in pressure; dec. in pulmonary fibrosis, pneumonia, and pulmonary edema; inc. in emphysema and normal aging
cremesteric fascia is derived from
transversus abdominis
external oblique
transversalis facia
internal oblique
conjoint tendon
D) Reason
Covering layers of the spermatic cord are from anterior abdominal wall:• External spermatic fascia derived from the externaloblique muscle and attached to the margins of the superficial inguinal ring.• Cremasteric fascia derived from the internal obliquemuscle.• Internal spermatic fascia derived from the fasciatransversalis and attached to the margins of the deep inguinal ring.
Relation of uterine artery, after arising from internal iliac
ureter
Fallopian tube
ovary
femoral artery
Pudendal nerve
A) Reason
Uterine artery: This artery runs medially on the floor ofthe pelvis and crosses the ureter superiorly. Itpasses above the lateral fornix of the vagina to reach theuterus, where it ascends between the layers of the broadligament along the lateral margin of the uterus.
cervical smear is showing stratified squamous epithelium, cause
anaplasia
Metaplasia
dysplasia
hyperplasia
hypoplasia
B) Reason
Disordered epithelial growth; begins at basal layer of squamocolumnar junction (transition zone) and extends outward. Classified as CIN 1, CIN 2, or CIN 3 (severe dysplasia or carcinoma in situ), depending on extent of dysplasia. Associated with HPV 16 and HPV 18, which produce both the E6 gene product (inhibits p53 suppressor gene) and E7 gene product (inhibits RB suppressor gene)
Tyoe of joint between intervertebral discs
amphiarthrosis
syndemosis
gomphosis
symarthrosis
chondrosis
A) Reason
Amphiarthroses are joints at which slight movement is possible. A pad of cartilage lies between the bone surfaces, and there are fibrous ligaments to hold the bones and cartilage in place. The cartilages of such joints also act as shock absorbers, e.g. the intervertebral discs
In patient with chronic recurrent typhoid relapses, Typhoid carrier stage is
obstructive
jaundice
gall stones
cholangitis
asymptomatic
E) Reason
Carrier state of S. typhi resides in gall bladder, and is asymptomatic state of the typhoid fever.
dermatome of thumb
C1
C2
C6
C7
C8
C) Reason
C2—posterior half of a skull “cap.”C3—high turtleneck shirt.C4—low-collar shirt. C5–deltoid, C6–lateral one and half digits.
adduction of wrist is combined effort of flexor carpi ulnaris and
flexor carpi radialis
extensor pollicis
extensor indicis
brachialis
extensor carpi ulnaris
E) Reason
Abduction: Flexor carpi radialis, extensor carpi radialislongus and brevis, abductor pollicis longus, and extensorpollicis longus and brevis muscles.• Adduction: Flexor and extensor carpi ulnaris muscles.
In Pathogenesis of Atherosclerosis, 1st gross sign of atheroma
platelet adhesion
platelet plug
embolism
endothelial injury
fatty streaks
E) Reason
The atheromas can develop from the fatty streak, a lesion that is characterized by focal accumulations in the intima of lipid-laden foam cells that may appear as early as the first year of life and that is present in the aorta of most older children.
In a 27 year old male patient, which is first step related to thrombin generation
platelet plug
fibrin clots
Elastin fibers
platelet adhesion
macrophages deposits
D) Reason
Adhesion (a) Vessel injury exposes subendothelial collagen, leading to platelet adhesion (adherence to the subendothelial surface) . (b) Interaction of specific platelet-surface glycoprotein receptors and subendothelial collagen is mediated by von Willebrand factor.
2 posterior cerebral artery are derived from
middle meningeal
anterior cerebral
occipital
basilar artry
vertebral artery
D) Reason
The basilar artery ascends in a groove on theanterior surface of the pons. It gives off branches to thepons, the cerebellum, and the internal ear. It finally dividesinto the two posterior cerebral arteries.
muscle which remains intact on little finger injury
lumbricals
extensor indicis
dorsal interossous
flexor carpi ulnaris
extensor carpi radialis
C) Reason
Anatomically, there are only four dorsal interossi from 1st digit to the 4th one. Hence dorsal interossous will not be affected in little finger (5th digit) injury.
deep cervical artey is branch of
internal thoracic
costocervical
vertebral
internal memory
Subclavian
B) Reason
The costocervical trunk runs backward over the dome ofthe pleura and divides into the superior intercostalartery, which supplies the first and the second intercostalspaces, and the deep cervical artery, which supplies thedeep muscles of the neck.
Among the following, foam cells are seen in
fatty streaks
atheroma
embolism
thrombi
thrombosis
B) Reason
The atheromas can develop from the fatty streak, a lesion that is characterized by focal accumulations in the intima of lipid-laden foam cells that may appear as early as the first year of life and that is present in the aorta of most older children
fracture of sub occipital bone, artery involved
basilar
occipital
vertebral
posterior cerebral
post. communicating
C) Reason
The vertebral artery ascends in the neck through theforamina in the transverse processes of the upper six cervical vertebrae . It supplies the occipital lobe.
strongest ligament of body
genitofemoral
quadrate ligament
iliofemoral
broad ligament
Ligamentum teres
C) Reason
Iliofemoral LigamentThe iliofemoral ligament is the strongest and most importantligament of the hip joint . It is shaped like an inverted Y. Its base is attached to the anteroinferior iliac spineabove, and the two limbs of the Y are attached to the upperand the lower parts of the intertrochanteric line of the femur
A 15 yr old boy died of Acute rheumatic fever, cause of death is due to
pericarditis
Endocarditis
valvular damage
autoimmune disorder
myocarditis
E) Reason
Rheumatic fever:A consequence of pharyngeal infection with group A β-hemolytic streptococci. Early deaths due to myocarditis. Late sequelae include rheumatic heart disease, which affects heart valves—mitral > aortic»_space; tricuspid (high-pressure valves affected most).
A 48 year old male is suspected to have GB syndrome, type of hypersensitivity in GB syndrome
type 3
type 4
delayed response
type 1
type 2
B) Reason
Type IV: Multiple sclerosisGuillain-Barré syndromeGraft-versus-host diseasePPD (test for M. tuberculosis)Contact dermatitis (e.g., poison ivy, nickel allergy)
pain fibers to uterus travel via
Cruciate ligament
Ligamentum teres
uterine ligament
broad ligament
quadrate ligament
D) Reason
Each ovary is attached to the back of the broad ligament bythe mesovarium . The ovarian vessels and nerves(through the broad ligament)enter the ovary at the hilum
right sided hemiplegia with left sided mouth deviation, lesion
medulla
Midbrain
basal ganglia
uncus
pons
E) Reason
Facial nerve nucleus arises from the Pons, in lesions of the Pons the will be hemiplegia and the facial nerve palsy of the other side.
In a 39 year old lady with bile obstruction, after cholecystectomy, which is raised
AST
ALT
ALP
bilirubin
amylase
C) Reason
In an any Inflammatory or the obstruction of the billiary tract, there is raised level of the ALP, like in choledocholithiasis, cholangitis and obstruction.
unable to extend MCP joint and abduct thumb but sensation intact, nerve damaged
ulnar
median
musculocutanous
deep radial
Posterior interossious branch of radial nerve
E) Reason
Extensor pollicis longus Extends the distal phalanxof the thumbExtensor indicis Extends the metacarpophalangeal joint of theindex finger, Both are supplied by deep branch of radial nerve.
If left lower lobe of thyroid is excised, nerve damage
external laryngeal
recurrent laryngeal
superior laryngeal
inferior laryngeal
vagus
A) Reason
The external laryngeal nerve is motor; it is located closeto the superior thyroid artery and supplies the cricothyroidmuscle. It is mostly injured in lower lobe thyroid surgery.
foramen ovale & otic ganglion are related as
superior
lateral
anterior
below
posterior
D) Reason
Otic GanglionThe otic ganglion is a parasympathetic ganglion that is located medial to the mandibular nerve just below the skull,and it is inferior to the foramen ovale and adherent to the medial pterygoid muscle.
A 35 years old male history of with fever and lymphadenopathy, H/O sleeping outside and bitten by flies, Dx..?
malaria
giardiasis
onchocercosis
yellow fever
kalazar
E) Reason
Leishmania donovani: Transmitted by Sandfly, causes Visceral leishmaniasis (kala-azar): spiking fevers, lymphadenopathy,hepatosplenomegaly, pancytopenia.
student observed a cell with its organelle in dividing phase, this is
RER
SER
mitochondria
ribosome
peroxisome
C) Reason
Mitochondria are the cellular organelle that have their own DNA as their genetic material and hence can replicate their own.
left renal vein is related to
posterior to aorta
anterior to aorta
anterior to IVC
posterior to IVC
lateral to aorta
B) Reason
Vein:The renal vein, right one is slightly higher and just anterior to aorta, drains into the inferior vena cava.
Pt. with CA rectum, pain radiates to posterior of thigh, nerve involved
lumbar plexus
Pudendal nerve
sacral plexus
pelvic nerve
Obturator nerve
C) Reason
Branches of Sacral plexus: The sciatic nerve (L4 and 5; S1, 2, and 3) is the largestnerve in the body and the largest branch of the sacralplexus.• The superior gluteal nerve supplies the gluteus medius,the gluteus minimus, and the tensor fasciae latae muscles.• The inferior gluteal nerve supplies the gluteus maximusmuscle.• The nerve to the quadratus femoris muscle also supplies the inferior gemellus muscle.• The nerve to the obturator internus muscle also supplies the superior gemellus muscle.• The posterior cutaneous nerve of the thigh suppliesthe skin of the buttock and the back of the thigh.
which is COX-2 inhibitor
aspirin
Ketorolac
phenylbutone
endomethicin
celecoxib
E) Reason
COX-2 inhibitors (celecoxib)MECHANISM: Reversibly inhibit specifically the cyclooxygenase (COX) isoform 2, which is found in inflammatory cells and vascular endothelium and mediates inflammation and pain; spares COX-1, which helps maintain the gastric mucosa.
loop diuretics act on
PCT
DCT
loop of Henle
descending limb
ascending limb
E) Reason
MECHANISM: Sulfonamide loop diuretic. Inhibits cotransport system (Na+/K+/2 Cl-) of thick ascending limb of loop of Henle. Abolishes hypertonicity of medulla, preventing concentration of urine. Stimulates PGE release (vasodilatory effect on afferent arteriole); inhibited by NSAIDs.
what to check to assess nutritional status
protein content
body fats
carbohydrates
liver size
adipose tissue
A) Reason
Proteins are nuitrional constituents that are present in different parts of the body and are the essential part of the balanced diet. Nuitrional assessment is checked by body proteins contents (kwashirkow etc)
true about nucleolus
no RNA
least RNA
more proteins
high conc. of RNA
no DNA
D) Reason
Nucleolus: The nucleolus is responsible for ribosomal RNA (rRNA) synthesis and ribosome assembly. It contains high concentration of the RNA.
Among the following, the most reliable sign of irreversible cell injury
hyperemia
Apoptosis
nuclear atypia
Hypoxia
autophagy
E) Reason
Autophagy of cellular components involves generation of autophagic vacuoles. These vacuoles fuse with lysosomes whose hydrolytic enzymes breakdown cellular components. It is an irreversible cell injury.
which anterior pituitary hormone is inhibited by somatostatin?
LH
calcitonin
GH
TSH
MSH
C) Reason
REGULATION Released in pulses in response to growth hormone–releasing hormone (GHRH). Secretion inc. during exercise and sleep. Secretion inhibited by glucose and somatostatin.
renal column consists of
lobular artery
glomerulus
interlobar artery
peritubular capillaries
perilobar capillaries
C) Reason
Blood Circulation The renal artery enters the kidney at the hilum, near the ureter. The artery branches into interlobar arteries, which travel to the medulla-cortex border remaining outside the medullary pyramids.
head of pancreas is related posteriorly to?
aorta
hilum
colon
IVC
dudenum
D) Reason
The head is disc shaped and lies withinthe concavity of the C-shaped duodenum just posterior to the IVC.
Regarding neoplasms, which form of carcinoma uses metalloproteinases
early
advance
metastasis
invasive
pleomorphism
D) Reason
Invasive carcinoma• Cells have invaded basement membrane using collagenases and hydrolases (metalloproteinases)• Can metastasize if they reach a blood or lymphatic vessel
at Mcburny incision which nerve is likely to be compromised?
genitofemoral
iliohypogastric
ilioinguinal
Pudendal
sacral plexus
B) Reason
Iliohypogastric Nerve (L1) External oblique, internal oblique,transversus abdominis musclesof anterior abdominal wall;skin over lower anteriorabdominal wall over the ileac fossa and buttock.
epiploic foramen is formed inferiorly by?
jejunum
ilium
colon
duodenum
pancreas
D) Reason
BOUNDARIES OF THE EPIPLOIC FORAMEN• Anteriorly: Free border of the lesser omentum, the bileduct, the hepatic artery, and the portal vein.• Posteriorly: Inferior vena cava.• Superiorly: Caudate process of the caudate lobe of theliver.• Inferiorly: First part of the duodenum.
In a 59 year old female, which LNs involved in cervical cancer stage IV
internal iliac
external illeic
superficial inguinal
deep inguinal
hypogastric
D) Reason
Lymph DrainageFrom the fundus, the lymph vessels follow the ovarian arteryto the para-aortic nodes at the level of the first lumbar vertebra. From the body and the cervix, the lymph vessels draininto the internal and the external iliac nodes. In addition, afew lymph vessels pass through the inguinal canal to the superficial and deep (especially in late stage of malignancy) inguinal nodes.
Pt has seizures and excitatory muscle contraction with Ca 6, glucose 120 and PTH 13, Diagnosis.?
hyperparathyriod
Hyperkalemia
tetany
hypoparathyroid
hypophosphtemia
C) Reason
hypocalcemia–Tetany:Chvostek sign—tapping of facial nerve (tap the Cheek) inc. contraction of facial muscles.Trousseau sign—occlusion of brachial artery with BP cuff (cuff the Triceps) lead yo carpal spasm
45% Hematocrit mean, 45 percent of blood volume is formed by
RBC
wbc
platelet
All blood cells
cell & proteins
D) Reason
Hematocrit Mean: is the percentage of blood volume that is consisted of the blood cellular corpuscles, largely contributed by RBCs.
extensor carpi ulnaris is innervated by
ulnar
radial
axillary
median
posterior interossous
E) Reason
interosseous nerve which is continuation of deep branch of radial nerve is the correct answer.
Which segment of nephron sense fluid load?
PCT
macula densa
DCT
loop of Henle
thick limb
B) Reason
Tubuloglomerular feedback, in which increased renal arterial pressure leads to increased delivery of fluid to the macula densa. The macula densa senses the increased load and causes constriction of the nearby afferent arteriole, increasing resistance to maintain constant blood flow
what phenomenon is carried out at dead space?
conduction
convection
radiation
ventilation
perfusion
A) Reason
physiologic dead space = anatomic dead space of conducting airways plus functional dead space in alveoli; apex of healthy lung is largest contributor of functional dead space. Volume of inspired air that does not take part in gas exchange.
poorly differentiated cells are associated with
pleomorphism
anaplasia
monomorphism
heteromorphism
dimorphism
A) Reason
Morphologic manifestations include disorderly maturation and spatial arrangement of cells; marked variability in nuclear size and shape (pleomorphism) ; and increased, often abnormal, mitosis.
platelet aggregation is inhibbited aggressively by?
PGE2
PGD2
PGA2
PGC4
PGI2
E) Reason
Anti-aggregation factors:PGI2 and NO (released by endothelial cells) ↑ blood flow ↓ platelet aggregation
about kidney fascia which is right?
covers its gland
deficient anteriorly
deficient lateraly
covers hilum
covers
A) Reason
Renal fascia: This is a condensation of areolar tissue outside the perirenal fat. It encloses the kidneys and thesuprarenal glands
portal hypertension involves which structure?
IVC
spleenic vein
hepatic vein
portal vein
mesenteric vein
D) Reason
Portal hypertension is characterized by the development of venous collaterals with varices in the submucosal veins of the esophagus, the hemorrhoidal plexus, and other sites. This condition is often classified by the site of portal venous obstruction
inferior wall MI is result of thrombus in which artery?
left marginal
right marginal
LAD
LCA
LXA
B) Reason
Acute marginal artery—is on the right side and is the branch of the RCA, itsupplies right ventricleand the inferior surface of the heart.
Only one parent is sufferer in which genetic trait
X-linked recessive
autosomal recessive
autosomal dominant
X-linked dominant
multifactorial
C) Reason
Autosomal dominant: Often due to defects in structural genes. One of the parents is affected to transfer the trait. Many generations, both male and female, affected.
In a 53 year old female with CA breast, grade 4 tumor mean which percent of undifferentiated cells
Metaplasia
dysplasia
atrophy
anaplasia
hypertrophy
D) Reason
Grade: Determined by degree of cellular differentiation and mitotic activity on histology. Usually graded 1–4; 1 = low grade, well differentiated; 4 = high grade, poorly differentiated, anaplastic.
In hot weather atmospheric temp exceeds body temp. heat loss by?
sweating
conduction
convection
radiation
exhausion
A) Reason
When the atmosphere temperature is greater than the body temperature, sympathetic system activation causes periphral Vasodilation and sweating to loose extra heat.
which vitamin Excess of which vitamin will result in renal calcium calculi
vit. E
vit. B2
vit. B3
vit. C
vit. D
E) Reason
Vitamin D. As 70%Stones are calcium stones so factor that will inc calcium will be responsible for it so vit D is correct answer.
which part of nephron is responsible for absorption of glucose & aminoacids?
DCT
loop of Henle
thick limb
collecting duct
PCT
E) Reason
Early proximal convoluted tubule (PCT)—contains brush border. Reabsorbs all of the glucose and amino acids and most of the HCO3–, Na+, Cl–, PO43–, K+, and H2O. Isotonic absorption.
Pt. is unable to rotate eye. Reason
sinus thrombus
optic chiasm fracture
pituitary tumor
sella Turcica fracture
cavernous sinus infection
E) Reason
It passes forward through the cavernoussinus (mostly affected by sinus infection) with the internal carotid artery, enters the orbitthrough the superior orbital fissure, and supplies the lateralrectus muscle. The abducent nerve is therefore responsiblefor turning the eye laterally.
polyarteritis nodosa is an example of
delayed response
type 1 HSR
type 2 HSR
type 4 HSR
type 3 HSR
E) Reason
Type III SLEPolyarteritis nodosaPoststreptococcal glomerulonephritisSerum sicknessArthus reaction (e.g., swelling and inflammation following tetanus vaccine).
features of SCC
Elastin
keratin
fibrin
Ca
Excess atypia
B) Reason
SCC: Hilar mass arising from bronchus; Cavitation; Cigarettes; hyperCalcemia (produces PTHrP).Keratin pearls and intercellular bridges
insulin is antagonized by
GH
LH
FSH
glucagon
Somatostatin
E) Reason
REGULATION Glucose is major regulator of insulin release. GH (causes insulin resistance inc. insulin release) and β2-agonists inc. insulin. One potent inhibitor of insulin is Somatostatin.
visceral layer of serous pericardium forms?
Endocarditis
pericardium
epicardium
pleura
tracheal
C) Reason
Layers of the Heart Wall:The heart wall is composed of 3 distinct layers: an outer epicardium, a middle myocardium and an inner endocardium. The epicardium, or visceral layer of serous pericardium, consists of a simple squamous epithelium (mesothelium) and its underlying connective tissue
inferior cervical ganglion combined with 1st thoracic ganglion to form?
otic
ciliary
optic
stellate
salivary
D) Reason
In most people, the inferior cervical ganglion is fused to thefirst thoracic ganglion to form the stellate ganglion. It is located between the transverse process of the seventh cervical vertebra and the neck of the first rib.
hippocampus injury causes what
memory loss
aphasia
agraphesthesia
asteriognosis
aphonia
A) Reason
Hippocampus (bilateral):Anterograde amnesia—inability to make new and short termmemories
Regarding genetics, most beneficial role of p53
prevent inflamation
anticoagulant
prevent overcrowding
anti TNF
anti inflammatory
C) Reason
p53 and hypophosphorylated Rb normally inhibit G1-to-S progression; mutations in these genes result in unrestrained cell division (e.g., Li-Fraumeni syndrome). p53 also prevents the overcrowding if the cells.
Of the following, which Non lymphoid lesion that can transform to AML
CML
AML
myelodysplastic
ALL
CLL
C) Reason
Myelodysplastic syndromesStem cell disorders involving ineffective hematopoiesis defects in cell maturation of all non-lymphoid lineages. Caused by de novo mutations or environmental exposure (e.g., radiation, benzene, chemotherapy). Risk of transformation to AML.
No. of parts of CBD is
1
3
5
4
2
D) Reason
CBD has four parts
no. of frontonasal prominances for face development
4
3
2
5
1
E) Reason
The face develops from 5 primordia of mesoderm (neural crest) of the first pharyngeal arch: a single frontonasal prominence, the pair of maxillary prominences, and the pair of mandibular prominences.
fixed splitting is characteristic of
VSD
ASD
PDA
TOF
TGA
B) Reason
Fixed splitting: Seen in ASD. ASD leads toleft-to-right shunt inc. RA and RV volumes inc. flow through pulmonic valve such that, regardless of breath, pulmonic closure is greatly delayed.
Injury in axilla resulting in loss of supination & flexion of arm. Nerve involved?
Musculocutaneous
radial
ulnar
axillary
median
A) Reason
Musculocutaneous Nerve Supplies: Coracobrachialis, biceps brachii, and brachialis muscles; supplies the skin along the lateral border of forearm when it becomes the lateral cutaneous nerve of the forearm.
baroreceptors act & decrease compliance of what?
arteries
venules
arterioles
muscle
veins
E) Reason
baroreceptors respond to the decrease in arterial pressure by decreasing the firing rate of the carotid sinus nerves. A coordinated response from the vasomotor center then increases sympathetic outflow to the heart and blood vessels and decreases parasympathetic outflow to the heart. As a result, heart rate, contractility, decreased venous complience, TPR, and venous return increase, and blood pressure increases toward normal.
tibialis anterior and posterior are damaged, which movement is compromised
rotation
dorsiflexion
Planterflexion
inversion
eversion
D) Reason
Inversion (movement of the foot so that the sole facesmedially): Tibialis anterior, extensor hallucis longus, medial tendons of extensor digitorum longus, and tibialis posterior muscles.
which clotting factors are detected wit PT?
1,2,5,7
1,2,5,7,10
2,7,9
2,7,9,10
7,9,10
B) Reason
PT—tests function of common and extrinsic pathway (factors I, II, V, VII, and X). Defect increases PT. PTT—tests function of common and intrinsic pathway (all factors except VII and XIII). Defect increases PTT.
pterigomandibular ligament is attached to
mandible angle
body of mandible
pterygoid
ala of nose
buccinator
E) Reason
Pterygomandibular Ligament: Connects the hamularprocess of the medial pterygoid plate to the posterior end ofthe mylohyoid line of the mandible. It also gives attachmentto the superior constrictor and the buccinator muscles.
Pt has inability to evert foot, muscle damaged
peroneus longus
adductor longus
tibialis
soleus
gastrocanemius
A) Reason
Eversion (opposite movement of the foot so that the solefaces laterally): Peroneus longus, peroneus brevis, peroneus tertius, and lateral tendons of extensor digitorumlongus muscles.
lateral thoracic artery supplies which structure?
breast
pec. major
pec. minor
pleura
thymus
A) Reason
ARTERIESLateral thoracic and thoracoacromial arteries, branches ofthe axillary artery, and perforating branches of the internalthoracic and intercostal arteries supply the breast.
adrenal medulla gets pre-ganglionic fibers from
sacral plexus
lumber plexus
renal plexus
sacral splanchnic
lumber splanchnic
C) Reason
Chromaffin cells are neural crest cells, which migrate into the adrenal medulla to form postganglionic sympathetic neurons. That reaches the gland through renal plexus.
while observing surgery for 1st time a med student falls on floor, BP 90/60, reason?
dec. tone
inc. tone
dec. TPR
inc. TPR
vasoconstriction
C) Reason
Sympathetic system is characterized by fight and flight, here the student”s sympathetic system was activated due to stress laeding to sec. TPR and cuase hypotension and syncope.
For physiological shunt to occur V/Q must be?
infinite
zero
1
2
10
B) Reason
V/Q is 0 = airway obstruction (shunt). In shunt, 100% O2 does not improve Po2.V/Q is ∞ = blood flow obstruction (physiologic dead space). Assuming < 100% dead space, 100% O2 improves Po2.
acessary meningeal artery passes through which foramen?
rotundum
spinosum
jugular
magnum
ovale
E) Reason
The foramen ovale lies posterolateral to the foramen rotundum. It perforates the greater wing of the sphenoid, and it transmits the acessary meningeal artery, the sensory and the motor roots of themandibular division of the trigeminal nerve. It also transmitsthe lesser petrosal nerve (p. 232).
hyaline cartilage is present in between which joint
syndemosis
gomphosis
secondary cartilaginous
tertiary Cartilagenous
primary Cartilagenous
E) Reason
Primary cartilaginous joints (synchondrosis, or hyaline cartilage joints): The bones are united by a plate of hyaline cartilage so that the joint is immovable and strong.
Pattern of Duchene muscular dystrophy
X-linked dominant
autosomal dominant
X-linked recessive
autosomal recessive
Y linked
C) Reason
Muscular dystrophy (most commonly Duchenne): X-linked recessive deletion of dystrophin gene.
Which facial bone fracture is most prevalent?
nasal
ethmoid
zygomatic
frontal
parietal
A) Reason
FRACTURES OF THE FACIAL BONESNasal fractures, because of the prominence of thenose are the most common facial fractures. Fracturesof the maxilla are common and usually result from adirect anteroposterior blow to the face
ketones production is found elevated. which hormone is responsible?
glucagon
insulin
Somatostatin
GH
calcitonin
A) Reason
FUNCTION Catabolic effects of glucagon:Glycogenolysis, gluconeogenesisLipolysis and ketone production
A 56 year old male with central chest pain, the most initial raise in MI
trop I
trop T
Myoglobin
CKMB
CPK
D) Reason
CK-MB is predominantly found in myocardium but can also be released from skeletal muscle. Useful in diagnosing reinfarction following acute MI because levels return to normal after 48 hours.
what will happen if sympathetic nervous system activates?
accomodation
pupil constriction
edema
hypremia
pupil dilation
E) Reason
Sympathetic system is characterized by fight and flight, It causes puplillary dilatation while parasympathetic stimulation causes pupillary construction.
what causes increased gastrin secretion?
HCL
secretin
amylase
phenylalanine
lipase
D) Reason
Stimuli for secretion of gastrin■ Gastrin is secreted from the G cells of the gastric antrum in response to a meal.■ Gastrin is secreted in response to the following:(1) Small peptides and amino acids in the lumen of the stomach ■ The most potent stimuli for gastrin secretion are phenylalanine and tryptophan.
anterior and posterior longitudinal ligament stabilize which structure
spinous process
spines
lateral wings
canal
vertebral bodies
E) Reason
The anterior and posterior longitudinal ligaments runas continuous bands down the anterior and the posteriorsurfaces of the vertebral column from the skull to thesacrum and provide stability to vertebral bodies.
tumor right temporal lobe compresses optic tract, will cause
right Homonimous hemianopia
Left homonimous hemianopia
right total loss
left total loss
quadrinopia
B) Reason
Optic tract lesion causes contralatral Homonemous hemianopia, hence in rigjt optic tract lesion, left homonymous hemianopia will be the manifestation.
Broca area damage will cause which aphasia
motor
sensory
mixed
global
frontal
A) Reason
Broca: Nonfluent motor aphasia with intact comprehension.Broca area—inferior frontal gyrus of frontal lobe
during menstruation and parturation which layer sheds off?
basalis
parietalis
endometrial
myometrial
functionalis
E) Reason
The functionalis is the part that is sloughed off at menstruation and parturation then replaced during each menstrual cycle, and the basalis is the portion retained after menstruation that subsequently proliferates and provides a new epithelium and lamina propria.
pain from visceral pleura is carried via
parasympathetic fibers
bronchial unit
vagus
sympathetic nerve
pulmonary plexus
E) Reason
Parietal PleuraThe parietal pleura is sensitive to pain, temperature, touch,and pressure. The costal pleura is supplied by the intercostal nerves, the mediastinal pleura by the phrenic nerve,and the diaphragmatic pleura over the domes by thephrenic nerve and around the periphery by the lower intercostal nerves.Visceral PleuraThe visceral pleura receives an autonomic nerve (sympathetic ) supplyfrom the pulmonary plexus. It is sensitive only to stretching.
On ECG ST segment in v4 is elevated. which artery is responsible?
LXA
RCA
posterior Interventricular
anterior Interventricular
LAD
E) Reason
V4 is one of the anteriorolateral chest lead, Left anterior descending artery (LAD)—supplies anterior 2/3 of interventricular septum, anterior papillarymuscle, and anterior surface of left ventricle.
A 26 year old lady with 2 weeks of H/O fever, chest pain not affected by respiration, cause
endocardium
epicardium
pleura
myocardium
pericardium
D) Reason
pain in myocarditis is not affected by respiration.
Posterior 1/3 of tongue is innervated by?
acessary nerve
tractus solitarius
nucleus ambiguous
amygdala
glossopharyngeal
B) Reason
SENSORY INNERVATION• Anterior two thirds: The lingual nerve (general sensation) and chorda tympani (taste).• Posterior third: The glossopharyngeal nerve (nucleus of tractus solitarius, general sensation and taste).
A 54 year old male Patient with cough and bronchial spasm, cause
IgE
IgD
IgA
IgM
IgG
A) Reason
IgE: Binds mast cells and basophils; cross-links when exposed to allergen, mediating immediate (type I) hypersensitivity through release of inflammatory mediators such as histamine. Mediates immunity to worms by activating eosinophils. Lowest concentration in serum
A baby died of severe Hemolytic anemia after few days of birth, most affected post mortem part of baby died of Rh incompatiblility
uncus
Pons
medulla
midbrain
basal ganglia
E) Reason
In severe form of the Rh incompatiblility as in subsequent pregnancies, the excessive level of bilurubin also deposits in brain (basal ganglia) causing CNS symptoms known as Kernecterus.
relaxing protein in muscle
troponin
elastin
myosin
tropomyosin
actin
D) Reason
Relaxation occurs when Ca2+ is reaccumulated by the SR Ca2+-ATPase (SERCA). Intracellular Ca2+ concentration decreases, Ca2+ is released from troponin C, and tropomyosin again blocks the myosin-binding site on actin. As long as intracellular Ca2+ concentration is low, cross-bridge cycling cannot occur
which muscle has no role at wrist
flexor carpi ulnaris
flexor carpi radialis
palmaris
Brachioradialis
crocobrachialis
D) Reason
Brachioradialis is Supplied by Radial nerve, it Flexes the forearm at theelbow joint, rotates theforearm to the midproneposition
In a 58 year old male patient of CKD, how to figure out either to do dialysis or transplant
urea
uric acid
Creatinine clearance
GFR
renal blood flow
C) Reason
Creatinine is raised in patients with chronic renal failure, its level in serum indicate the effectiveness of the therapy. So less effective control indicate the renal transplantation option.
which one is parasympathetic component
thoracic splanchnic
lumber splanchnic
sacral splanchnic
lumber plexus
sciatic
C) Reason
Parasympathetic system is the CranioSacral outflow while Sympathetic System is the ThoracoLumber outflow.
TPR dec. in exercising muscles. why?
sympathetic
local metabolites
parasympathetic
O2
somatic
B) Reason
■ During exercise, when demand is high, these local metabolic mechanisms are dominant.■ The local vasodilator substances are lactate, adenosine, and K+ that dec. TPR and increase blood flow.
adduction and lateral rotation of thumb, nerve damaged?
ulnar
radial
axillary
median
Musculocutaneous
D) Reason
Branches of the Median Nerve in the Forearm• Muscular branches: Pronator teres, flexor carpi radialis,palmaris longus, and flexor digitorum superficialis muscles.• Articular branches: Elbow joint
nerve to Obturator internus and gemellus is branch of…division of sacral plexus???
anterior
superior
lateral
posterior
inferior
D) Reason
Posterior division of Sacral plexus: The nerve to the quadratus femoris muscle also supplies the inferior gemellus muscle.• The nerve to the obturator internus muscle also supplies the superior gemellus muscle.
which diuretic acts on smooth muscles
thiazide
furosemide
spironolactone
Acetazolamide
manitol
B) Reason
FurosemideMECHANISM Sulfonamide loop diuretic. Inhibits cotransport system (Na+/K+/2 Cl-) of thick ascending limb of loop of Henle. Abolishes hypertonicity of medulla, preventing concentration of urine. Stimulates PGE release (vasodilatory effect on smooth muscles on afferent arteriole); inhibited by NSAIDs.
external carotid artery begins at
cricothyroid muscle
cricoid cartilage
thyroid cartilage
jugular foramen
isthmus
C) Reason
External Carotid ArteryThe external carotid artery begins at the level of the upperborder of the thyroid cartilage as one of the terminalbranches of the common carotid artery.
coagulation pathway is on going. what is most valuable step
thrombin
platelets adhesion
platelet aggregation
fibrin formation
clot formation
D) Reason
Most important step in coagulation pathway is the formation of the fibrin from Fibrinogen. then Fibrin mesh acts tostabilize platelet plug
To increase pulse pressure what must change
inc. rate
inc. output
inc. stroke volume
inc. diastolic pressure
dec. diastolic pressure
C) Reason
■ is the difference between the systolic and diastolic pressures.■ The most important determinant of pulse pressure is stroke volume. As blood is ejected from the left ventricle into the arterial system, arterial pressure increases because of the relatively low capacitance of the arteries. Because diastolic pressure remains unchanged during ventricular systole, the pulse pressure increases to the same extent as the systolic pressure
what is the reason heart muscle act as synctium.
gap junction
desmosome
less myofibrils
more neurofibers
no gap junctions
A) Reason
Gap junctions■ are present at the intercalated disks.■ are low-resistance paths between cells that allow for rapid electrical spread of action potentials.■ account for the observation that the heart behaves as an electrical syncytium.
slow pain fibers responsible for slow pain detection are
C fibers
A fibers
D fibers
delta fiber
gamma fibers
A) Reason
■ Fast pain is carried by group III fibers. It has a rapid onset and offset, and is localized.■ Slow pain is carried by C fibers. It is characterized as aching, burning, or throbbing that is poorly localized
who carries more total body water
female
adult male
new born
old age
obese people
C) Reason
■ Total body water (TBW) is approximately 60% of body weight.■ The percentage of TBW is highest in newborns and adult males and lowest in adult femalesand in adults with a large amount of adipose tissue.
A 35 years old woman with warty lesion in vulva, poikilocytosis on smear, Dx..?
SCC
BCC
condylomata acumulata
lymphoma
granuloma
C) Reason
Condylomata acuminata: Caused by HPV 6 and 11.Genital warts, koilocytes.
with moderate excercise what organ has unaffected blood flow
coronary
cerebral
pleural
pulmonary
ophthalmic
B) Reason
Constriction of arterioles causes intense peripheral vasoconstriction and increased TPR. Blood flow to other organs (e.g., kidneys) is significantly reduced in an attempt to preserve blood flow to the brain.
A 54 year old diabetic lady with blurr vision and clouding, fundoscopy and ICP normal, Cause
retinal detachment
glaucoma
retinopathy
occulopathy
cataract
E) Reason
Osmotic damage (sorbitol accumulation in organs with aldose reductase and decrease or absent sorbitol dehydrogenase):Neuropathy (motor, sensory, and autonomic degeneration)Cataracts by accumulation of sorbitol.
A 28 year old female with pruritis, ALP 1600, ALT 75, AST 250, direct bilurubin 15, cause
cirrhosis
extra hepatic cholestasis
fibrosis
cholelithiasis
hepatitis
B) Reason
ALP is raised in any obstructive cases of the billiary tract, moreover the direct bilurubin raised indicate the extra hepatic stasis of the billiary tract.
A boy with blue sclera and H/O multiple fractures by minor trauma, pattern of inheritance
X-linked recessive
X-linked dominant
autosomal dominant
autosomal recessive
multifactorial
C) Reason
Osteogenesis imperfecta:Genetic bone disorder (brittle bone disease ) caused by a variety of gene defects.Most common form is autosomal dominant with dec. production of otherwise normal type I collagen. OI manifestations can include:Multiple fractures with minimal trauma; may occur during the birth processBlue sclerae due to the translucency of the connective tissue over the choroidal veins.
Type of cartilage present in between discs of joints
hyaline
articular cartilage
chondroitin
mixed
fibrocartilage
E) Reason
Intra-articular fibrocartilages, articular discs or menisci, complete or incomplete, help in spreading the synovial fluid throughout the joint cavity, but particularly between the articular surfaces, e.g. temporomandibular joint.
which anti-epileptic cause Steven johson syndrome.
valproate
ethosuxamide
dormicum
phenytion
benzodiazapine
D) Reason
Nystagmus, diplopia, ataxia, sedation, gingival hyperplasia, hirsutism, peripheral neuropathy, megaloblastic anemia, teratogenesis (fetal hydantoin syndrome) SLE-like syndrome, induction of cytochrome P-450, lymphadenopathy, Stevens Johnson syndrome, osteopenia.
Stagnant hypoxia is result of
anemia
polycythemia
Thrombocytopenia
CML
ALL
B) Reason
Polycythemia often presents as intense itching after hot shower. Rare but classic symptom is erythromelalgia (severe, burning pain and reddish or bluish coloration) due to episodic blood clots due to hyperviscosity in vessels of the extremities. Hyperviscosity and clots in vessels is the cause of stagnant Hypoxia.
Which ligament injury will lead to eversion loss?
Cruciate
anterior ligament
deltoid
suspensory
short
C) Reason
Medial (Deltoid) LigamentThe medial ligament is very strong and is attached by itsapex to the tip of the medial malleolus. Its injury results in loss of eversion.
A 46 year old female with pruritis and hepatospleenomegaly, investigation to confirm
USG
ERCP
CT abdomen
CBC
ESR
C) Reason
Primary billiary cirrhosis, PRESENTATION: Pruritus, jaundice, dark urine, light stools, hepatosplenomegaly. Confirmed by CT and MRCP.
in adults level of tracheostomy?
C1
C2
C3
C2-3
C3-4
D) Reason
The isthmuscrosses the midline in front of the second, the third, andthe fourth rings of the trachea. Tracheostomy is done at C2-3 and save the isthmus injury.
supply of head of femor
Obturator artery
femoral artry
Pudendal artery
uterine artery
genital artery
A) Reason
In the young, the epiphysis of the head is supplied bya small branch of the obturator artery, which passes tothe head along the ligament to the femoral head
supply of head of femor
Obturator artery
femoral artry
Pudendal artery
uterine artery
genital artery
A) Reason
In the young, the epiphysis of the head is supplied bya small branch of the obturator artery, which passes tothe head along the ligament to the femoral head
transpyloric plain is at level of lower border of which of these?
L2
L3
L1
L4
L5
C) Reason
The pylorus lies on the transpyloric plane at thelevel of the first lumbar vertebra
Protamin sulphate anatagonize heparin is an example of which interaction
drug-receptor
drug-drug
cell-drug
drug-antidote
drug-serum
A) Reason
Protamine can lessen the risk of serious bleeding that canresult from excessive unfractionated heparin by occupying its receptor site. Protamine only partially reverses the effects of LMWheparins
natural defense against tumor
necrosis
Apoptosis
Hypoxia
hypotrophy
anaplasia
B) Reason
Natural killer cells Use perforin and granzymes to induce apoptosis of virally infected cells and tumor cells.Only lymphocyte member of innate immune system
atlanto-axial joint movement is known as
Flexion
extension
adduction
rotation
abduction
D) Reason
MOVEMENTSRotation of the atlas with the head on the axis is possible.
which nerve damage will result in claw hand?
lower trunk
radial
median
axillary
Musculocutaneous
A) Reason
LOWER TRUNK LESIONS OF THE BRACHIALPLEXUS (KLUMPKE PALSY)Lower trunk lesions of the brachial plexus result fromtraction injury, as in excessive abduction of the arm.The first thoracic nerve is usually torn, all the smallmuscles of the hand are paralyzed, and the patient develops a claw hand
thirst is relieved by
gut reflux
least secretions
dec. Osmolarity
gut distention
more ECF volume
D) Reason
Autonomic center of Hypothalamus■ Temperature regulation centerthrough central and periphral mechanisms.■ Thirst and food intake regulatory centers as gut distention is associated with increased serum Osmolarity and causes thirst stimulation.
RCA blocked by thrombus before origin of marginal artery, site affectd is?
SA node
AV node
Purkinje fibers
bundle of His
atrial fibers
A) Reason
SA and AV nodes are usually supplied by RCA before the origin of the marginal branch. Infarct may cause nodal dysfunction (bradycardia or heart block).
vol. expansion alongwith hypokalemic metabolic alkalosis is due to
Cushing syndrome
klinefilter syndrome
WPS syndrome
primary hypertension
Conn syndrome
E) Reason
aldosterone-secreting adrenal adenoma (Conn syndrome), resulting in hypertension, hypokalemia, metabolic alkalosis, and lowplasma renin. Normal Na+ due to aldosterone escape = no edema due to aldosterone escape mechanism. May be bilateral or unilateral.
external oblique at its origin interdigitate with which muscle?
trapezius
serratus posterior
latismus dorsi
quadratus lumborum
serratus anterior
E) Reason
External oblique Originate from Lower right ribs where it interdigitate with serratus anterior. It is inserted into the Xiphoid process, linea alba, pubic crest, pubic tubercle, iliac crest.
most suitable pain killar in pancreatitis
morphine
Ketorolac
endomethacin
pethidine
NSAID
D) Reason
Pathedine is a synthetic analgesic with anti-spamodic action as well. That is the reason, it can be used in severe pain of the pancreatitis.
time taken for spread of potential from sub-endocardium to epicardium
T wave
p wave
QRS complex
ST segment
PR interval
C) Reason
QRS complex—ventricular depolarization (normally < 120 msec). It the time taken by conductive system to conduct electric potential from sub-endocardium (the conductive system) to the ventricle (including its pericardium).
in mediolateral episiotomy which of these is likely to be injured?
perineal muscles
perineal pouch
bulbospongiosus
perineal membrane
bulbourethral
C) Reason
Bulb of the vagina is attached to the undersurface of the urogenital diaphragm and is covered by thebulbospongiosus muscles. It is the most commonly damaged muscle during mediolateral episiotomy.
receptor act as transducer because of?
modulater
necessary
physical stimuli
augment stimuli
chemical stimuli
D) Reason
Receptors are the specific type of molecules usually proteins that are present at cell surface (usually) inside cell. Receptors mediate the function of a ligand molecule or stimulus.
Which of these replaces transplanted bone?
cartilage
endostium
periosteum
osteoclasts
tendon
C) Reason
Mature long bones are covered on all surfaces by dense cortical bone with an outer periosteum, with the exception of articular surfaces, which are covered by hyaline articular cartilage. Transplanted bones are replaced by this periostium.
Dynamic chemotactic agent
LTB1
LTB4
LTC4
LTE4
PGI2
B) Reason
Chemotactic products released in response to bacteria: C5a, IL-8, LTB4, kallikrein, platelet-activating factor
measurment of renal plasma flow is by?
Urea
Inulin
PABA
Creatinine
PAH
E) Reason
Measurement of renal plasma flow (RPF)—clearance of para-aminohippuric acid (PAH)■ PAH is filtered and secreted by the renal tubules.■ Clearance of PAH is used to measure RPF.
A 23 year old male with Hb 8, WBC 3k and platelet 30k, and skin pigmentation, cause
folate
B12 deficiency
CML
ALL
CLL
B) Reason
Hypersegmented neutrophils, pancytopenia, glossitis, dec. B12, inc. homocysteine, inc. methylmalonic acid.Neurologic symptoms: subacute combined degeneration (due to involvement of B12 in fatty acid pathways and myelin synthesis):
normal saline is
9g in 1000ml
9g in 1000ml
0.9g in 1000ml
1g in 91ml
9g in 100ml
A) Reason
Normal saline is with NaCl concentration of 0.9 percent, That means 0.9g in 100ml and 9g in 1000ml.
following is true about mean > median > mode.
sensitivity
specificity
negative skew
positive skew
PPV
D) Reason
Positive skew Typically, mean > median > mode. Asymmetry with longer tail on right. Negative skew: Typically, mean < median < mode.
“what is actually happening” is studied in which type
cohort
observational
rertrospective
cross control
experimental
D) Reason
Cross-sectional study:Collects data from a group of people to assess frequency of disease (and related risk factors) at a particular point in time.Asks, “What is happening?”
superficial plexus is located below?
beneath chest wall
parietal pleura
lung surface
endothelium
visceral pleura
E) Reason
superficial plexus lies beneath the visceral pleura anddrains over the surface of the lung toward the hilum, wherethe lymph vessels enter the bronchopulmonary nodes.
longest erythrocytic shizgony phase is of
P. falciparum
P. vivax
P. malarie
P. ovale
toxaoplama
C) Reason
P. malarie is a specie of the Plasmodium that is known as quatran malaria (fever spikes on fourth day) due to its long duration of about 48-72 hours of erythrocytic shizgony phase. While other species cuase tertiary malaria (fever spikes on 3rd day) due to relatively short erythrocytic shizgony phase.
lung cancer spread through
Hematogenous
direct invasion
nerve plexus
chemokines
lymphatics
E) Reason
In the lung, metastases (usually multiple lesions) are more common than 1° neoplasms. Most often from breast, colon, prostate, and bladder cancer. Lung cancer metastases through lymphatics to—adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly).
RBCs are most suitable to do
viscosity
Hb
immunity
clotting
gases exchange
E) Reason
Erythrocytes: Carries O2 to tissues and CO2 to lungs. Anucleate and biconcave, with large surface area-to-volume ratio for rapid gas exchange. Life span of 120 days.
In a 74 year old man with CA prostate, which nodes will be affected in prostate ca.
Pudendal
deep inguinal
superficial inguinal
external iliac
internal iliac
E) Reason
Lymph DrainageThe lymph drains into the internal iliac nodes.Nerve SupplyInferior hypogastric plexuses supply the prostate.
sensory nerve supply of larynx above vocal chords
internal laryngeal
reccurent laryngeal
external laryngeal
vagus
auricular
A) Reason
NERVE SUPPLYSensory Nerves• Above the vocal folds: The internal laryngeal nerve.• Below the vocal folds: The recurrent laryngeal nerve.
Resection of vagal trunk results in
no acid reflux
delayed gastric emptying
bile gastritis
pancreatic cancer
abscess
B) Reason
Truncal vagotomy also causes disturbed motility of the antrum and pylorus of stomach besides the sec. acid secretion. That is why, truncal vagotomy causes delayed gastric emptying, and now selective vagotomy is in practice to avoid this side effect.
which cell has different origin
osteoblasts
osteocytes
Chondrocytes
osteoclasts
fibroelasts
D) Reason
Macrophage rank binds to osteoblast RAN KL and macrophage becomes an osteoclast. While osteoblasts and osteocytes are the bone forming cells.
classical example of multifactorial involvement
Down syndrome
DM
osteoarthritis
infective Endocarditis
rheumatic fever
B) Reason
DM is a multifactorial trait that presents with Polydipsia, polyuria, polyphagia, weight loss, DKA (type 1), hyperosmolar coma (type 2).Rarely, can be caused by unopposed secretion of GH and epinephrine.
In portal hypertension, veins are engorged. which are?
lower esophagus
abdomen
upper esophagus
gastric
spleenic
A) Reason
Esophageal varices Painless bleeding of dilated submucosal veins in lower 1 ⁄3 of esophagus 2° to portal hypertension
cervical branch of facial nerve supplies?
trapezius
cricothyroid
platysma
omohyoid
latismus dorsi
C) Reason
Platysma Muscle is supplied by the spinal part of the facial nerve, It Depresses themandible and angleof the mouth
treatment of feverish(febrile) feeling after blood transfusion
adrenaline
antihistamine
IV fluids
anti serum
antipyretics
E) Reason
Blood reaction that doesn”t involve the severe manifestations of the anaphylactic shock, is a simple febrile reaction and is easily managed by antioyretics and close monitoring.
long term prophylaxis for Rheumatic fever with Endocarditis
benzathene penicillin
gentamicin
penicillin
benzyl penicillin
metronidazole
A) Reason
benzathine penicillin once each month for several years) in persons who have hadrheumatic fever is important to prevent recurrence of the disease. There is noevidence that patients who have had AGN require similar penicillin prophylaxis
zona glomerulosa is mainly controlled by
Angiotensin-II
LH
GH
FSH
cortisol
A) Reason
Zona glomerulosa is the part of the adrenal cortex that secrets Aldosterone in an influence of renin-Angiotensin-aldosterone system of blood pressure control.
which is delayed allergy mediator
chemokine
prostagladins
ILs
TNF
lymphokines
E) Reason
Type IV Delayed (T-cell-mediated) type—sensitized T lymphocytes encounter antigen and then release lymphokines (leads to macrophage activation; no antibody involved).
what is absent at L4 spinal cord
anterior horn
posterior horn
lateral horn
spine
column
C) Reason
Preganglionic neurons of the sympathetic nervous system originate in spinal cord from lateral horns of the segments T1–L3 or the thoracolumbar region. So, there is no lateral horn bellow L3.
ECF vol. is raised by which fluid
Hypertonic saline
hypotonic saline
5 percent dextrose
more water
less Osmolarity
A) Reason
Hypertonic solution causes the shrinkage of the cells and outflow of fluids outside the cell leading to increased ECF volume.
which causes hyperchloremic metabolic acidosis
furosemide
Acetazolamide
spironolactone
mannitol
thiazide
B) Reason
TOXICITY: Hyperchloremic metabolic acidosis, paresthesias, NH3 toxicity, sulfa allergy
while performing surgery ovary is adherent to fossa, which artery will be injured?
ovarian
Fallopian
pelvic
uterine
internal iliac
E) Reason
Internal iliac artery is damaged.
which fascia is of thyroid gland?
superficial
pre tracheal
para tracheal
membranous
deep cervical
B) Reason
Pretracheal LayerThe pretracheal layer is a thin layer that is attached above tothe laryngeal cartilages. It surrounds the thyroid gland.
thymus is supplied by?
superior thyroid
thymic artery
pleural artery
internal carotid
inferior thyroid artery
E) Reason
The inferior thyroid artery ascends to reach the posterior surface of the thyroid gland, where it is closely relatedto the recurrent laryngeal nerve. The inferior thyroidartery supplies the thyroid, thymus and the inferior parathyroidglands.
toxoplamosis is caused by
fungi
bacteria
virus
parasite
antigen
D) Reason
Toxoplasma gondii, a protozoa:Brain abscess in HIV (seen as ring-enhancing brain lesions on CT/MRI); congenital toxoplasmosis = “classic triad” of chorioretinitis, hydrocephalus, and intracranial calcifications
area at node of ranvier has
more myelination
least myelination
fast fibers
less myelination
no mylen
E) Reason
In myelinated neurons, the area in between the myelinated parts is called the node of ranvier where there is no myelin. It is responsible for rapid conduction, the saltatory conduction.
insulin dependent uptake in
RBC
brain
cornea
exercising muscle
kidney
D) Reason
Insulin-dependent glucose transporters:GLUT-4: adipose tissue, skeletal muscleInsulin-independent transporters:GLUT-1: RBCs, brain, corneaGLUT-5 (fructose): spermatocytes, GI tractGLUT-2 (bidirectional): β islet cells, liver, kidney, small intestine
common cause of inc. bleeding time
hemophilia
rifampin toxicity
pyrizinamide side effects
aspirin toxicity
Clopidogrel
D) Reason
Aspirin is commonly used drug for pain killers and other purposes. TOXICITY of Aspirin: Gastric ulceration, tinnitus (CN VIII). Chronic use can lead to acute renal failure, interstitial nephritis, increased bleeding time, and upper GI bleeding.
Drainage of medial quadrant of
axillary nodes
apical nodes
internal memory
external memory
internal thoracic LNs
E) Reason
Lymphatic DrainageThe lateral quadrants of the breast drain into the anterior axillary or the pectoral nodes. The medial quadrantsdrain into the internal thoracic nodes. A few lymph vesselsalso drain posteriorly into the posterior intercostal nodes,and some communicate with the lymphatic vessels of theopposite breast and with those of the anterior abdominalwall.
if radial groove is injured what will be most likely damaged?
radialis
flexor carpi ulnaris
extensor hallucis
extensor of wrist
Brachioradialis
D) Reason
NERVE SUPPLYAnterior interosseous nerve (flexor and adductor of wrist) from the median and the deepbranches of the radial (extensor of wrist) and the ulnar nerves supply the wristjoint
Pain of parotid swelling is due to compression of which nerve?
auriculotemporal
fascial
mandibular
maxillary
nasal
A) Reason
The postganglionic secretomotorfibers reach the parotid salivary gland via the auriculotemporal nerve. Its compression is the main cause of parotid gland pain.
A 7 year old boy have soft tissue tumor with vimentin positive, Dx..?
carcinoma
leukemoid reaction
lymphoma
rhabdomyosarcoma
leukemia
D) Reason
Staining for different tissue tumors, Vimentin: Connective tissueDesMin: MuscleCytokeratin: Epithelial cellsGFAP: NeuroGliaNeurofilaments: Neurons
Diplopia on going downstairs, which nerve is damaged?
CN6
CN 5
CN 7
CN 3
CN 4
E) Reason
4th cranial nerve supplies the superior oblique muscle which is involved in looking downwards and medially.
femoral hernia descends behind
inguinal ligament
inguinal canal
inguinal ring
femoral artry
femoral nerve
A) Reason
The neck of the femoral hernial sac lies at the femoral ringand is related anteriorly to the inguinal ligament,posteriorly to the pectineal ligament, laterally to thefemoral vein, and medially to the sharp, free edge ofthe lacunar ligamen
Which test is most relevant for pulmonar function to check obstructve vs restrictive diseases
ventilation
RV
FEV1/ FVC
FVC
RC
C) Reason
Obstructive lung diseases:Obstruction of air flow resulting in air trapping in the lungs. Airways close prematurely at high lung volumes inc. RV and dec. FVC. PFTs: decreased FEV1/FVC ratio (hallmark),
pulmonary embolism of pulmonary artery will result in
zero V/Q
V/Q is 1
no ventilation
Hypoxia
inc. V/Q
E) Reason
Pulmonary emboli:V/Q mismatch leads to hypoxemia and respiratory alkalosis. Sudden-onset dyspnea, chest pain, tachypnea. May present as sudden death.Types: Fat, Air, Thrombus, Bacteria, Amniotic.
anterior dislocated shoulder will result in which artery damage?
acromial
axillary
Anterior circumflex
posterior circumflex
clavicular
C) Reason
Collateral circulation around the shoulder joint wouldinvolve the following:A. The subscapular arteryB. The superficial cervical arteryC. The suprascapular arteryD. The anterior circumflex humeral artery, most commonly injured in anterior dislocation.
A 15 years old boy with reddish nodule for many years and change in size, Dx..?
mole
nevus
birth mark
myoma
hemangioma
E) Reason
Strawberry hemangioma:Benign capillary hemangioma of infancy. Appears in first few weeks of life (1/200 births); grows rapidly and regresses spontaneously at 5–8 years old.Cherry hemangioma: Benign capillary hemangioma of the elderly. Does not regress. Frequency inc. with age.
left gastric vein drains into
portal vein
spleenic vein
IVC
mesenteric vein
hepatic vein
A) Reason
Veins:The veins drain into the portal circulation. The right and leftgastric veins drain into the portal vein. Left gastric vein drain directly into the portal vein. The short gastric and the left gastroepiploic veins drain into the splenic vein,and the right gastroepiploic vein drains into the superiormesenteric vein.
Cushing reflex is character of
brain Ischemia
more ECF Osmolarity
more ECF volume
vol. contraction
red reflex
A) Reason
The Cushing reaction is an example of the response to cerebral ischemia. Increases in intracranial pressure cause compression of the cerebral blood vessels, leading to cerebral ischemia and increased cerebral Pco2. The vasomotor center directs an increase in sympathetic outflow to the heart and blood vessels, which causes a profound increase in arterial pressure.
A 12 year old girl with tumor of vermis with rosettes present, Dx..?
SCC
myxoma
astrocytoma
ependymoma
medulloblastoma
D) Reason
Characteristic perivascular rosettes seen in Ependymoma. Rodshaped blepharoplasts (basal ciliary bodies) found near nucleus.
Which of these are false ribs?
8th-10th
1st 3
last 3
7th-9th
9th-11th
A) Reason
False ribs: The eighth, ninth, and tenth pairs are attachedanteriorly to each other and to the seventh rib by theircostal cartilages and small synovial joints.
superficial external Pudendal artery emerges through what?
femoral ring
inguinal ring
inguinal canal
saphenus opening
adductor canal
D) Reason
The saphenous opening is a gap in the deep fascia in thefront of the thigh and just below the inguinal ligament. It allows passage of the great saphenous vein, some smallbranches of the femoral artery, and lymph vessels.
superficial epigastric artery passes through which opening?
saphenus opening
inguinal canal
inguinal ring
femoral canal
femoral ring
A) Reason
The saphenous opening is a gap in the deep fascia in thefront of the thigh and just below the inguinal ligament. It allows passage of the great saphenous vein, some smallbranches of the femoral artery, and lymph vessels.
Effect of alpha adrenergic receptor activation
hypotension
pupil construction
pupil dilation
accomodation
inc. ICP
C) Reason
Adrenergic stimulation of α1: Hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)
90 percent of anthrax pt has which finding
lung involved
saddle nose
from mammals
brain lesions
skin lesion
E) Reason
Cutaneous anthrax: most common presentation, Boil-like lesion and ulcer with black eschar (painless, necrotic) causes uncommonly progresses to bacteremia and death.Pulmonary anthrax: Inhalation of spores causes flu-like symptoms that rapidly progress to fever, pulmonary hemorrhage, mediastinitis, and shock.
1st sign of deficiency of vitamin A
chelosis
corneal degeneration
corneal vascolurization
pancytopenia
night blindness
E) Reason
DEFICIENCY Night blindness (nyctalopia); dry, scaly skin (xerosis cutis); alopecia; corneal degeneration (keratomalacia); immune suppression.
A 46 year old female has ovarian tumor with inhibin positive, Dx..?
adeno ca
germ cell tumors
yolk sac tumor
granulosa cell tumor
theca cell tumor
D) Reason
Granulosa cell tumor Most common sex cord stromal tumor. Predominantly women in their 50s. These are the inhibin positive tumors. Often produce estrogen and/or progesterone and present with abnormal uterine bleeding, sexual precocity (in preadolescents), breast tenderness
Chief investigation for hemophilia
platelet count
PT
Electrophoresis
periphral smear
APTT
E) Reason
Hemophilia A: deficiency of factor VIII.Hemophilia B: deficiency of factor IX. These are the factors of intrinsic pathway and can be assessed by PTT.
best advice for increasing vitamin intake
more liver foods
more meats
more pulses
inc. vegetables
inc. egg
D) Reason
Vitamins are abundant in vegetables and fruits. Moreover it ia an easy and cheap source of vitamins.
which organ uses glucose solely as energy source
liver
kidney
heart
skeletal muscle
brain
E) Reason
Carbohydrates are the main sources of energyin the body. Brain cells and RBCs are almostwholly dependent on carbohydrates as theenergy source.
level of lumbar puncture is between
L1
L2-3
L3-4
L4-5
L5
D) Reason
A lumbar puncture is used to inject anesthetic material in the epidural space or to withdraw CSF from the subarachnoid space. • A spinal tap is typically performed at the L4 and L5 interspace.
in muscles, ATPase activity is shown by
myosin
actin
troponin
sarcoplasm
tropomyosin
A) Reason
Myosin has 3 different biological activities:a. Myosin molecules assemble into filaments.b. Myosin acts as the enzyme ATPase.c. Myosin binds to actin polymer which is the majorcomponent of the thin filaments
gastric emptying is inhibited by?
gastrin
secretin
CCK
enterokinase
bile
C) Reason
Increases pancreatic secretionIncreases gallbladder contractionDecreases gastric emptyingIncreases phincter of Oddi relaxation
Young girl with ambiguous genitalia and 46 XY, Diagnosis?
true hermaphrodite
false hermaphrodite
klinefilter syndrome
Patau syndrome
CAH
E) Reason
Due to excessive and inappropriate exposure to androgenic steroids during early gestation (e.g., congenital adrenal hyperplasia or exogenous administration of androgens during pregnancy.
accessory muscle of expiration is?
trapezius
platysma
rectus abdominis
external oblique
transversus abdominus
C) Reason
Forced expiration is an active process accomplished bycontraction of the muscles of the anterior abdominal wall, rectus abdominus(forcing the relaxed diaphragm upward by raising intraabdominal pressure)
damage of tibial nerve spares which muscle so that flexion exists ??
peroneus longus
peroneus brevis
poplitius
Sartorius
short head of bicep femoris
E) Reason
Flexion: Biceps femoris, semitendinosus, and semimembranosus muscles. Bicep femoris is supplied by sciatic nerve that is why in tibial nerve lesion, bicep femoris cause some Flexion of knee.
A 43 year old male patient died of MI, on autopsy, coagulative necrosis with neutrophils found, age of lesion
1-2 hrs
4 hrs
6 hrs
6-12 hrs
24 hrs
E) Reason
12- 24 hr:Occluded artery InfarctDark mottling; pale with tetrazolium stainEarly coagulative necrosis, neutrophils and release of necrotic cell contents into blood; edema, hemorrhage, wavy fibers.
GnRH is inhibited during lactation by
Prolactin
LH
FSH
GH
TSH
A) Reason
FUNCTION Stimulates milk production in breast; inhibits ovulation in females and spermatogenesis in males by inhibiting GnRH synthesis and release.
metabolic acidosis with normal anion gap is in
coma
diarrohea
hyperventilation
vomiting
fever
B) Reason
Metabolic acidosis with Normal anion gap (8−12 mEq/L):HyperalimentationAddison diseaseRenal tubular acidosisDiarrheaAcetazolamideSpironolactoneSaline infusion
a lady is taking only ferrous sulphate, she will have deficiency of
Ca
B12
K
Na
folate
E) Reason
Folate deficiency Causes: malnutrition (e.g., alcoholics), malabsorption, antifolates (e.g., methotrexate, trimethoprim, phenytoin), increased requirement (e.g., hemolytic anemia, only iron intake, pregnancy).
heat loss of an intubated individual is by
conduction
evaporation
convection
radiation
hyperventilation
B) Reason
Tracheostomy is an artificial mean of opening the airway through the trachea. As it is an artificial opening and it is always open, and causes heat and vapors loss continually.
Which of these is membrano-cartilagenous bone
femor
tibia
clavicle
fibula
humerus
C) Reason
Membrano-cartilaginous bones ossify partly in membrane and partly in cartilage. Examples: clavicle, mandible, occipital, temporal, sphenoid.
HLA matching is best detected by
RBC
platelet
WBCs
eosinophils
liver cells
C) Reason
HLA (Human Leukocytic Antigen) are the specific type of antigens present on Leukocytes that have specific antigenicity and that is why used for tissue matching.
osmosis is result of the movement of following molecules across cell membrane
CO2
liquids
solvents
water
solutes
D) Reason
■ Osmosis is the flow of water across a semipermeable membrane from a solution with low solute concentration to a solution with high solute concentration.
CN 5,6 & 7 damaged, which area involved
pons
Midbrain
medulla
cortex
spinal cord
A) Reason
Midbrain—nuclei of CN III, IVPons—nuclei of CN V, VI, VII, VIIIMedulla—nuclei of CN IX, X, XIISpinal cord—nucleus of CN XI
drugs are inactive in plasma, reason
free
protein bound
in liver
in adipose tissue
in gut
B) Reason
In plasma, protein bound drugs are inactive form of the drugs while free form of the drugs that are not bound to plasma proteins are the active form of the drugs.
which descending tract has function related to lateral spinothalamic tract
tactospinal
thalamospinal
limbospinal
rubrospinal
reticulospinal
D) Reason
Lateral corticospinal tract(voluntary motor). Rubrospinal tract■ originates in the red nucleus and projects to interneurons in the lateral spinal cord.■ Stimulation of the red nucleus produces stimulation of flexors and inhibition of extensors
Reason of hyperventilation if breathing in paper bag
inc. pH
inc. HCO3
inc. K
dec. H
inc. CO2
E) Reason
If a person is breathing in a paper bag, there will be increased level of CO2 accumulation that will be washed out by hyperventilation.
collagen type related to wound strength
type 4
type 3
type 1
type 2
type 5
C) Reason
Type I Collagen: Most common (90%)—Bone (made by osteoblasts), Skin, Tendon, dentin, fascia, cornea, late wound repair (deficiency causes delayed and less strong wound healing).
Neurotransmitter of Parkinson disease
GABA
gluatamate
Aspartate
Dopamine
glycine
A) Reason
Parkinson disease Degenerative disorder of CNS associated with Lewy bodies (composed of α-synuclein—intracellular eosinophilic inclusion) and loss of dopaminergic neurons (i.e., depigmentation) of the substantia nigra pars compacta. While GABA related CNS disorder is the Huntington disease.
chelosis, sebhoric dermatitis and corneal vascularizatio, vitamin deficiency..?
B1
B2
B3
B6
B12
B) Reason
DEFICIENCY Cheilosis (inflammation of lips, scaling and fissures at the corners of the mouth), Corneal vascularization.
all organ systems of fetus are formed by following week
8
3
4
6
10
A) Reason
All major organ systems begin to develop during the embryonic period (weeks 3-8). By the end of this period, the embryo begins to look human.
nuclei vanish during which phase of erythrocyte development
early normoblast
late normoblast
erythroid cells
progenitor cells
in marrow
B) Reason
In the process of erythropoisis, red blood cells have their nuclei but as they mature their nuclei disappear in late stages of development and ultimately mature rbcs have no nuclei.
superior mesenteric artery infarction will not affect?
stomach
duodenum
descending colon
pancreas
spleen
C) Reason
All the organs except descecding colon given in scenario”s option are derivatives of foregut supplied by Superior mesenteric artery, and descending colon is supplied by inferior mesenteric artery.
uterine prolapse is due to chronic cervicitis with
squamous metaplasia
columner Metaplasia
damaged ligaments
damaged pelvis
nulliparus
A) Reason
Damage supporting structures during childbirthor chronic Metaplasiaor as a result of general poor body muscular tone mayresult in downward displacement of the uterus, calleduterine prolapse
protein that binds to hemoglobin
haptoglobin
Myoglobin
ferritin
thyroglobin
albumin
A) Reason
HaptoglobinIt is synthesized in the liver. It transports free hemoglobin inthe plasma to reticulo endothelial system.
which nerve is related to Superior thyroid artery?
reccurent laryngeal
external laryngeal
vagus
Superior laryngeal
hypoglossal
B) Reason
The superior thyroid artery curves downward to the upperpole of the thyroid gland. It is accompanied by the external laryngeal nerve, which supplies thecricothyroid muscle.
bilateral damage of which nerve causes death
Trigeminal
vagus
hypoglossal
acessary
facial
B) Reason
Bilateral damage of the vagus nerve will lead to totally lost inervation of the heart leading to cardiac arrest and death.
which hormone always acts through adenylate cyclate
GH
LH
TSH
insulin
glucagon
C) Reason
TSH increases both the synthesis and the secretion of thyroid hormones by the follicular cells via an adenylate cyclase–cAMP mechanism.■ Chronic elevation of TSH causes hypertrophy of the thyroid gland
A 9 year old boy with nasal lesion with lymphadenopathy and AFB positive, Dx..?
TB
leprosy
skin TB
anthrax
Sarcoidosis
B) Reason
Leprosy (Hansen disease):Caused by Mycobacterium leprae, an acid-fast bacillus that likes cool temperatures (infects skin and superficial nerves—“glove and stocking” loss of sensation) and cannot be grown in vitro. Causes lymphadenopathy and typical lepromatous nose lesion.
A person lives in deserted land n drinks, from where does maximum absorption takes place
DCT
loop of Henle
PCT
thick limb
collecting ducts
C) Reason
Early proximal convoluted tubule (PCT)—contains brush border. Reabsorbs all of the glucose and amino acids and most of the HCO3–, Na+, Cl–, PO43–, K+, and H2O. About 65-80 percent of these substances are reabsorbed from PCT.
