Jammu Paper Part - 1

JAMMU MD
2008
PAPER PART -
I
Dreamz Learning Page 1
1. The following are risk factors for cancer of cervix,
except:
B. Genital warts
C. Early marriage
D. Oral contraceptive pill use
E. Higher socioeconomic group
Ans d

• Oral contraceptives (birth control pills):
– There is evidence that taking oral contraceptives
(OCs) for a long time increases the risk of
cancer of the cervix. Research suggests that the
risk of cervical cancer goes up the longer a
woman takes OCs, but the risk goes back down
again after the OCs are stopped. In a recent
study, the risk of cervical cancer was doubled in
women who took birth control pills longer than 5
years, but the risk returned to normal 10 years
after they were stopped.

• Low socioeconomic status: Poverty is
also a risk factor for cervical cancer.
Many women with low incomes do not
have ready access to adequate health
care services, including Pap tests. This
means they may not get screened or
treated for pre-cancerous cervical
disease.

• Multiple pregnancies: Women who have
had many full-term pregnancies have an
increased risk of developing cervical cancer.
No one really knows why this is true. One
theory is this may be because some of the
women may have been exposed more to
HPV through un-protected sexual contact.
Also, studies have pointed to hormonal
changes during pregnancy as possibly
making women more susceptible to HPV
infection or cancer growth.
• Human papilloma virus infection: The
most important risk factor for cervical cancer
is infection by the human papilloma virus
(HPV).
• Certain types of HPV are called "high-risk"
types because they are often the cause of
cancer of the cervix. These types include
HPV 16, HPV 18, HPV 31, HPV 33, and HPV
45, as well as some others.
• About two-thirds of all cervical cancers are
caused by HPV 16 and 18.
2. Modified plan of operation for Malaria is based on this indicator:
B. Annual parasite incidence
C. Annual blood examination rate
D. Slide falciparum rate
E. Spleen rate
Ans b

• In India, with the implementation of Modified Plan
of Operation (MPO) in 1977, the upsurge of malaria
cases dropped down from 6.74 million cases in 1976
to 2.1 million cases in 1984
• The WHO Expert Committee on Malaria in 1964
recommended that the monthly number of slides
examined should amount to at least 1 per cent of the
population.
• In the Modified Plan of Operation, the minimum
prescribed is 10 per cent of the population in a
year.
• AEBR is an index of operational efficiency

3. India has entered the following
demographic stage:
B. High stationary
C. Early expanding
D. Late expanding
E. Low stationary
Ans c

(1) FIRST STAGE (High stationary)
This stage is characterised by a high birth rate and a high death rate
which cancel each other and the population remains stationary.
India was in this stage till 1920.
(2) SECOND STAGE (Early expanding)

The death rate begins to decline, while the birth rate remains
unchanged. Many countries in South Asia and Africa are in this
phase. Birth rates have increased in some of these countries
possibly as a result of improved health conditions, and shortening
periods of breast feeding (1).

(3) THIRD STAGE (Late expanding)
The death rate declines still further, and
the birth rate tends to fall. The
population continues to
grow because births exceed
deaths
India has entered this
phase. In a number of developing
countries(e. g china Singapore) birth
rates have declined rapidly.

(4) FOURTH STAGE (Low stationary)
This stage is characterised by a low birth and low death rate
with the result the population becomes stationary. Zero
population growth has already been recorded in Austria
during 1980-85. Growth rates as little as 0.1 were
recorded in UK, Denmark, Sweden and Belgium during
1980-85. In short, most industrialized countries have
undergone a demographic transition shifting from a high
birth and high death rates to low birth and low death rates.
(5) FIFTH STAGE: (Declining)
The population begins to decline because birth rate is lower
than the death rate. Some East European countries,
notably Germany and Hungary are experiencing this stage.

4. Normal curve is:
B. Linear
C. Symmetrical
D. Parabolic
E. Curvilinear
Ans b

• Standard normal curve
Although there is an infinite number of normal curves
depending upon the mean and standard deviation, there is
only one standardized normal curve, which has been
devised by statisticians to estimate easily the area under the
normal curve, between any two ordinates.
The standard normal curve is a smooth, bell-shaped,
perfectly symmetrical curve, based on an infinitely large
number of observations. The total area of the curve is 1;
its mean is zero; and its standard deviation is 1.
The mean, median and mode all coincide.
The distance of a value (x) from the mean (x) of the curve in
units of standard deviation is called “relative deviate or
standard normal variate” and is usually denoted by Z.

5. Approximate magnitude of completed
family size is given by:
B. General fertility rate
C. Total fertility rate
D. Net reproduction rate
E. Pregnancy rate
Ans b

• While in common parlance,
family size refers to the
total number of persons in a
family, in demography,
family size means the total
number of children a
woman has borne at a point
in time
• The completed family size
indicates the total number of
children borne by a woman
during her child-bearing
age, which is generally
assumed to be between 15
and 45 years.
– The total fertility rate gives
the approximate magnitude of
completed family size.

6. 100 ml Breast milk provides:
B. 50 calories
C. 70 calories
D. 100 calories
E. 140 calories
Ans b

• Longitudinal and cross-sectional studies indicate
that poor Indian women secrete as much as 400
to 600 ml of milk per day during the first year
• No other food is required to be given until 4 to 5
months after birth. At the age of 4 to 5 months,
breast milk should be supplemented by additional
foods rich in protein and other nutrients (e.g.,
animal milk, soft-cooked mashed vegetables,
etc.).

• Under any circumstances, breast milk is the
ideal food for the infant. No other food is
required by the baby until 4-5 months after
birth.
• Under normal conditions, Indian mothers
secrete 450 to 600 ml of milk daily with 1.2 g
per cent protein.
• The energy value of human
milk is 70 kcals per 100 ml.

7. The precursors of prostaglandins are:
B. Essential amino acids
C. Mono unsaturated fatty acids
D. Poly unsaturated fatty acids
E. Saturated fatty acids
Ans c

Polyunsaturated fatty acids are
precursors of prostaglandins - a group of
compounds, now recognised as “local
hormones”; they play a major role in
controlling many of the physiological
functions of the body such as vascular
homeostasis, kidney function, acid secretion
in stomach, gastro-intestinal motility, lung
physiology and reproduction

8. The following substance is called as kidney
hormone:
B. Vitamin A
C. Vitamin D
D. Calcium
E. Phosphorus
Ans b

Vitamin D: Kidney hormone
• Major advances have been made in recent years in our
understanding of the metabolism of vitamin D in the body (36). It
is now known that vitamin D, by itself, is metabolically inactive
unless it undergoes endogenous transformation into several
active metabolites (e.g., 25, HCC; 1:25 DHCC) first in the liver
and later in the kidney. These metabolites are bound to specific
transport proteins and are carried to the target tissues -bone and
intestine. It has been proposed that vitamin D should be regarded
as a kidney hormone because it does not meet the classic
definition of a vitamin, that is, a substance which must be
obtained by dietary means because of a lack of capacity in the
human body to synthesize it. In fact, vitamin D3 is not a dietary
requirement at all in conditions of adequate sunlight. It can be
synthesized in the body in adequate amounts by simple exposure
toDreamz
sunlight even for 5 minutes per day.
Learning Page 24
9. Major components of Socioeconomic status
include all, except:
B. Family type
C. Income
D. Occupation
E. Education
Ans a

• Socio-economic status scale
Socio-economic status has been defined as the position
that an individual or family occupies with reference
to the prevailing average standards of cultural and
material possessions, income, and participation in
group activity of the community. The social status
may be inherited, but in modern society, it is
achieved on the basis of occupation, income, type of
housing and neighbourhood, membership of certain
associations and organizations, material possessions,
etc.
•

• There have been many attempts at developing
scales for measuring socio-economic status.
Hollingshed in USA employed three variables, viz
education, occupation and residential address for
measuring socioeconomic status
• Kuppuswamy - in India prepared a scale based
on education, occupation and income which are the
three major variables contributing to
socioeconomic status in urban areas.
• Similar scales have also been prepared by Pareek
and Kulshrestha for use in rural and urban
areas. Kuppuswamy’s scale is fairly widely known.

10. Minimum recommended concentration of
free Chlorine level in Drinking water is:
B. 0.1 mg/Litre
C. 0.5 mg/Litre
D. 0.1 gm/Litre
E. 0.5 gm/Litre
Ans b

• It is good practice to test for residual
chlorine at the end of one hour contact. If
the “free” residual chlorine level is less than
0.5 mg/litre, the chlorination, procedure
should be repeated before any water is
drawn.

11. The method of disposal of discarded
medicines and cytotoxic drugs is:
B. Microwaving
C. Autoclaving
D. Chemical treatment
E. Secured land fill
Ans d

12. The duration of Maternity benefit for
sickness arising out of confinement is:
B. 30 days
C. 6 weeks
D. 12 weeks
E. 6 months
Ans a

BENEFITS TO EMPLOYEES under ESI Act:
• The Act has made provision for the following
benefits to insured persons or, to other
dependants as the case may be:
(1) Medical benefit
(2) Sickness benefit
(3) Maternity benefit
(4) Disablement benefit
(5) Dependant’s benefit
(6) Funeral expenses
(7) Rehabilitation allowance
• Maternity benefit
• The benefit is payable in cash to an insured
woman for confinement/miscarriage or
sickness arising out of pregnancy/ confinement
or premature birth of child or miscarriage. For
confinement, the duration of benefit is 12
weeks, for miscarriage 6 weeks and for
sickness arising out of confinement etc. 30
days.
– The benefit is allowed at about full wages.

13. The Chairman of Healthy survey and
planning committee is:
B. Sir Joseph Bhore
C. Dr. A.L. Mudaliar
D. Dr. M.S. Chadah
E. Dr. N. Jungalwalla
Ans b

• Mudaliar committee, 1962
• By the close of the Second Five Year Plan (1956-61), a fresh look at the
health needs and resources was called for to provide guidelines for
national health planning in the context of the Five year Plans. In 1959,
the Government of India appointed another Committee known as
“Health Survey and Planning Committee”, popularly known as the
Mudaliar Committee (after the name of its Chairman, Dr. A.L.
Mudaliar) to survey the progress made in the field of health since
submission of the Bhore Committee’s Report and to make
recommendations for future development and expansion of health
services.
•
• The Mudaliar Committee found the quality of services provided by the
primary health centres inadequate, and advised strengthening of the
existing primary health centres before new centres were established. It
also advised strengthening of subdivisional and district hospitals so that
they may effectively function as referral centres.
•

• The main recommendations of the Mudaliar Committee
were:
– (l)consolidation of advances made in the first two five year plans;
– (2)strengthening of the district hospital with specialist services to
serve as central base of regional services;
– (3) regional organizations in each state between the headquarters
organization and the district in charge of a Regional Deputy or
Assistant Directors - each to supervise 2 or 3 district medical and
health officers;
– (4) each primary health centre not to serve more than 40,000
population;
– (5) to improve the quality of health care provided by the primary
health centres
– (6) integration of medical and health services as recommended by
the Bhore Committee; and
– (7) constitution of an All India Health Service on the pattern of
Indian Administrative Service.

14. First pass metabolism in undesirable in
clinical practice because of the following
except:
B. Large dose per oral is needed
C. Unpredictable pharmacodynamics
D. Poor bioavailability
E. Tachyphylaxis
Ans d

• The first-pass effect (also known as first-pass
metabolism or presystemic metabolism) is a
phenomenon of drug metabolism whereby the
concentration of a drug is greatly reduced before it
reaches the systemic circulation.
• After a drug is swallowed, it is absorbed by the
digestive system and enters the hepatic portal
system. It is carried through the portal vein into the
liver before it reaches the rest of the body. The liver
metabolizes many drugs, sometimes to such an
extent that only a small amount of active drug
emerges from the liver to the rest of the circulatory
system. This first pass through the liver thus
greatly reduces the bioavailability of the drug.
Tachyphylaxis - a rapidly decreasing response to a drug
following administration of the initial doses.
Examples of tachyphylaxis are the following :
• Nitroglycerine demonstrates tachyphylaxis, requiring drug-free
intervals when administered transdermally
• Repeated doses of ephedrine may display tachyphylaxis, since it is
an indirectly acting sympathomimetic amine which will deplete
noradrenaline from the nerve terminal. Thus repeated doses result in
less noradrenaline being released than the initial dose.
• Nicotine may also show tachyphylaxis over the course of a day,
although the mechanism of this action is unclear.

• Hydralazine displays tachyphylaxis if given as a monotherapy
for antihypertensive treament. It is administered with a beta-
blocker with or without a diuretic.
• Metoclopramide is another example.
• Dobutamine, a direct-acting beta agonist used in congestive
heart failure, also demonstrate tachyphylaxis.
• Desmopressin used in the treatment of type 1 von Willebrand
disease is generally given every 12-24 hours in limited numbers
due to its tachyphylactic properties.
• Hormone replacement when used in menopausal women in the
form of oestrogen and progesterone implants is cited as
potentially leading to tachyphylaxis, but that citation is based on
a single study done in 1990 and no followup research is
available to support this interpretation.

15. Targets for drug action:
B. Receptors
C. Ion channels
D. Enzymes
E. All of these
Ans d

16. Therapeutic index is calculated as:
B. ED 50/LD 50
C. LD 50/ED 50
D. C max/V d
E. C max/t ½
Ans b

• The therapeutic index (also known as
therapeutic ratio), is a comparison of the
amount of a therapeutic agent that causes
the therapeutic effect to the amount that
causes toxic effects. Quantitatively, it is the
ratio given by the toxic dose divided by the
therapeutic dose.

• A commonly used measure of therapeutic
index is the lethal dose of a drug for 50% of
the population (LD50) divided by the
minimum effective dose for 50% of the
population (ED50).

17. All of the following drugs are useful in
glaucoma, except:
B. Physostigmine
C. Timolol
D. Acetazolamide
E. Atropine
Ans d

18. Which of the following drugs would be
most suitable in treating orthostatic
hypotension secondary to spinal
anaesthesia:
B. Epinephrine
C. Isoproterenol
D. Atropine
E. Ephedrine
Ans d

• Drugs Used in Treating Shock
• Alpha receptor agonists: increase peripheral vascular
resistance which may be valuable in managing hypotensive
states associated with shock
• Norepinephrine, phenylephrine , metaraminol ,
mephentermine \and methoxamine \may be used to maintain
blood pressure in severe hypotension.
• The objective is to ensure adequate CNS perfusion
• The use of these agents may be indicated if the
hypotensive state is due to sympathetic failure, such as
possibly occurring following spinal anesthesia or injury
• In shock due to other causes, reflex vasoconstriction is
typically intense; adding a agonists may be harmful by
further compromising organ (e.g. renal) perfusion.

ß- agonists: increase heart rate and
contractility
• Increasing heart rate and contractility by
isoproterenol , epinephrine or
norepinephrine \may adversely affect cardiac
performance in damaged myocardium
• These agents increase myocardial oxygen
requirements and may induce arrhythmias
• Norepinephrine by increasing afterload
(alpha receptor activation) may worsen
myocardial performance
• Orthostatic hypotension is indicated if there
is a drop in 20 mmHg of systolic pressure
(and a 10 mmHg drop in diastolic
pressure in some facilities) and a 20 bpm
increase in heart rate.

• Ephedrine has been advocated as the
vasopressor of choice for treating
maternal hypotension during regional
anaesthesia

19. Bromocriptine is useful in the treatment of
Parkinsonism as it has:
B. Dopaminergic agonistic action
C. Dopa decarboxylase enzyme inhibitor
D. Anticholinergic action
E. MAO-B inhibitor action
Ans a

Bromocriptine , an ergoline derivative, is a
dopamine agonist that is used in the
treatment of pituitary tumors and
Parkinson's disease.
Parkinson's disease
• Bromocriptine is an agonist of D2 dopamine
receptors and has therefore been used as a
treatment for Parkinson's disease.

20. Which of the following drug is most likely
to result in hypokalemia?
B. Captopril
C. Digoxin
D. Furosemide
E. Diltiazem
Ans c

Drug induced causes of hypokalemia
Osmotic diuresis:
Mannitol and hyperglycemia can cause osmotic
diuresis.
Diuretics
(carbonic anhydrase inhibitors, loop diuretics,
thiazide diuretics):
Some penicillins
Exogenous bicarbonate ingestion
Amphotericin B
Gentamicin
Cisplatin

21. Dronabinol is used as:
B. Appetite stimulant
C. Anti-emetic
D. Both (A) and (B)
E. None of these
Ans c

• Dronabinol, which is the INN of Δ9-
tetrahydrocannabinol (THC).
• THC is a naturally occurring component
in cannabis.

• Dronabinol is FDA-approved cannabinoid
and is prescribed as an appetite stimulant,
primarily for AIDS, chemotherapy and
gastric bypass patients.
• Dronabinol was also FDA approved as an
anti-nauseant, in order to better address the
nausea experienced after chemotherapy
treatments
• Dronabinol can serve as an anti-emetic and
appetite booster, its immunomodulative
effect should be taken into account in the
treatment of any compromised immune
condition

22. One of the following drugs in use as broad
spectrum antiepileptic:
B. Gabapentin
C. Topiramate
D. Sodium Valproate
E. Phenytoin sodium
Ans c

• Many new antiepileptic drugs exhibit a
broad spectrum of activity while only
one of the older ones (valproate) has a
broad-spectrum profile

• Sodium valproate is a broad-spectrum
antiepileptic that has proven efficacy against
all seizure types, which makes it a useful
antiepileptic when exact seizure classification
is unknown or multiple seizure type exists.
• The patients who do not respond to first line
antiepileptics or develop side effects to them are
invariably prescribed alternative drugs.
Clobazam, a long acting benzodiazepine, is one
such drug that is given as an adjunctive therapy in
these patients
• Phenobarbital
• This is the most commonly prescribed AED of the 20th
century. It is a very potent anticonvulsant with a
broad spectrum of action. Currently, its use is
limited because of its adverse effects. It is a free
acid, relatively insoluble in water. The sodium salt is
soluble in water but unstable in solution. It has a direct
action on GABA-A receptors by binding to the
barbiturate-binding site that prolongs the duration of
chloride channel opening. It also reduces sodium and
potassium conductance and calcium influx and
depresses glutamate excitability.

• Newer Antiepileptic Drugs:
Gabapentin, Lamotrigine, Felbamate,
Topiramate and Fosphenytoin

• Lamotrigine does not impair cognition
and has a relatively broad spectrum of
activity against multiple types of
seizures. Three multicenter clinical studies have
demonstrated its efficacy as adjunctive therapy in adults
with refractory partial seizures.2
• The only contraindication to lamotrigine is
hypersensitivity to the drug. The need for monitoring
drug levels has not been established. The most
frequently encountered adverse reactions include
dizziness, ataxia, somnolence, headache, blurred vision,
nausea, vomiting and rash. Up to 10 percent of patients
discontinue lamotrigine therapy because of side effects.
One case of acute hepatic failure has been reported.
Because lamotrigine depresses the central nervous
system, patients who are taking it should be cautioned
about driving or operating complex machinery.

23. Which of the following is a nontropic
agent:
B. Levtiracetam
C. Piracetam
D. Rivastigmine
E. Vit E
Ans b

• piracetam, a nontropic agent
– cognition-enhancing agent (i.e., a
nontropic drug)

• Piracetam is a nootropic.
– It is a dietary supplement which is claimed to
enhance cognition and memory, slow down
brain aging, increase blood flow and oxygen to
the brain, aid stroke recovery, and improve
Alzheimer's, Down syndrome, dementia, and
dyslexia, among others.

• piracetam increases performance on a variety of
cognitive tasks among dyslexic children, though
this may reflect its enhancement of cross-
hemispheric communication and of cognitive
function in general, rather than a specific
improvement in whatever causes dyslexia.
Piracetam also seems to inhibit brain damage
caused by a variety of factors including hypoxia
and excessive alcohol consumption

• Mechanisms of action
– The mechanism of action of piracetam is not
known, although it is hypothesized to act on ion
channels or ion carriers, thus leading to non-
specific increased neuron excitability, while
explaining its lack of agonistic or inhibitory effect
on synaptic action (quite unlike most
neurotransmitters), and its low toxicity
• It has been found to increase blood flow and
oxygen consumption in parts of the brain\

• Piracetam improves the function of the neurotransmitter
acetylcholine via muscarinic cholinergic (ACh) receptors which
are implicated in memory processes
• Furthermore, Piracetam may have an effect on NMDA glutamate
receptors which are involved with learning and memory processes.
Piracetam is thought to increase cell membrane permeability
• Piracetam may exert its global effect on brain neurotransmission via
modulation of ion channels (i.e., Ca2+, K+).[10] It has been found to
increase oxygen consumption in the brain, apparently in connection
to ATP metabolism, and increases the activity of adenylate kinase in
rat brain
• Piracetam appears to increase the synthesis of cytochrome b5
– which is a part of the electron transport mechanism in mitochondria. It also
increases the permeability of the mitochondria of some intermediaries of the
Krebs cycle

• Levtiracetam -antiepileptic
– is available in liquid, tablet, and intravenous
forms, and is usually taken twice per day.
– Blood testing may be performed to monitor
drug levels.
– The most common side effects include fatigue,
dizziness, and aggressive behavior and
irritability.

24. Drug of choice in paroxysmal
supraventricular tachycardia:
B. Procainamide
C. Mexiletine
D. Adenosine
E. Sodium nitroprusside
Ans c

• When administered intravenously, adenosine causes
transient heart block in the AV node. This is mediated
via the A1 receptor, inhibiting adenyl cyclase, reducing
cAMP and so causing cell hyperpolarization by
increasing outward K+ flux.
• It also causes endothelial dependent relaxation of smooth
muscle as is found inside the artery walls. This causes
dilatation of the "normal" segments of arteries, i.e. where
the endothelium is not separated from the tunica media by
atherosclerotic plaque. This feature allows physicians to use
adenosine to test for blockages in the coronary arteries, by
exaggerating the difference between the normal and
abnormal segments.

• In individuals suspected of suffering from a
supraventricular tachycardia (SVT), adenosine is used
to help identify the rhythm.
– Certain SVTs can be successfully
terminated with adenosine. This includes
any re-entrant arrhythmias that require
the AV node for the re-entry (e.g., AV
reentrant tachycardia (AVRT), AV nodal
reentrant tachycardia (AVNRT). In
addition, atrial tachycardia can sometimes
be terminated with adenosine.

• Adenosine has an indirect effect on atrial tissue causing
a shortening of the refractory period. When administered
via a central lumen catheter, adenosine has been shown
to initiate atrial fibrillation because of its effect on atrial
tissue. In individuals with accessory pathways, the onset
of atrial fibrillation can lead to a life threatening
ventricular fibrillation.

• Fast rhythms of the heart that are confined to the atria
(e.g., atrial fibrillation, atrial flutter) or ventricles (e.g.,
monomorphic ventricular tachycardia) and do not
involve the AV node as part of the re-entrant circuit are
not typically converted by adenosine. However, the
ventricular response rate is temporarily slowed with
adenosine in such cases.

• Because of the effects of adenosine on AV
node-dependent SVTs, adenosine is
considered a class V antiarrhythmic agent.
When adenosine is used to cardiovert an
abnormal rhythm, it is normal for the heart
to enter ventricular asystole for a few
seconds. This can be disconcerting to a
normally conscious patient, and is
associated with angina-like sensations in the
chest.[
25. Bicalutamide is:
B. Antioestrogen
C. Antiandrogen
D. Anti-arrhythmic
E. None of these
Ans b

• Bicalutamide
– is an oral non-steroidal anti-androgen for
prostate cancer

• Indications and use
– For the treatment of stage D2 metastatic
prostate cancer in combination with a
luteinizing hormone-releasing hormone
analogue or as a monotherapy.

• Adverse reactions
– Adverse reactions include reproductive system
and breast disorders, breast tenderness,
gynaecomastia, hot flushes, gastrointestinal
disorders, diarrhoea, nausea, hepatic changes
(elevated levels of transaminases, jaundice),
asthenia and pruritus.

• An antiandrogen, or androgen antagonist, is
any of a group of hormone receptor antagonist
compounds that are capable of preventing or
inhibiting the biologic effects of androgens,
male sex hormones, on normally responsive
tissues in the body
• Antiandrogens usually work by blocking the
appropriate receptors, competing for
binding sites on the cell's surface,
obstructing the androgens' pathway.

Antiandrogen drugs (brand names in parentheses) include:
• Spironolactone , a synthetic 17-spirolactone
corticosteroid, which is a renal competitive
aldosterone antagonist in a class of pharmaceuticals
called potassium-sparing diuretics, used primarily to
treat low-renin hypertension, hypokalemia, and Conn's
syndrome.
• Cyproterone acetate , a synthetic steroid, a potent
antiandrogen that also possesses progestational
properties.
• Flutamide , nilutamide and bicalutamide
nonsteroidal, pure antiandrogens.

• Ketoconazole ,an imidazole derivative used as a
broad-spectrum antifungal agent effective against a
variety of fungal infections, side effects include
serious liver damage and reduced levels of androgen
from both the testicles and adrenal glands.
Ketoconazole is a relatively weak antiandrogen.
• Finasteride and dutasteride ,inhibitors of the 5-α-
reductase enzyme that prevent the conversion of
testosterone into dihydrotestosterone (DHT).
Finasteride blocks only 5-α-reductase type II,
dutasteride also blocks type I. They are not general
antiandrogens in that they don't counteract the effects or
production of other androgens than DHT.

26. Leukotriene receptor antagonist used in
bronchial asthma:
B. Zileuton
C. Monteleukast
D. Fluticosone
E. Sodium cromoglycate
Ans b

• Zileuton (INN) is an asthma drug. It blocks
leukotriene synthesis by inhibiting 5-
lipoxygenase, an enzyme of the eicosanoid
synthesis pathway.

• Montelukast is a leukotriene receptor antagonist
(LTRA) used for the maintenance treatment of asthma and
to relieve symptoms of seasonal allergies
• It is usually administered orally.
• Montelukast blocks the action of leukotriene
D4 on the cysteinyl leukotriene receptor
CysLT1 in the lungs and bronchial tubes by
binding to it. This reduces the bronchoconstriction
otherwise caused by the leukotriene, and results in less
inflammation. Because of its method of operation, it is not
useful for the treatment of acute asthma attacks. Again
because of its very specific focus of operation, it does not
interact with other allergy medications such as theophylline.

• Side effects of Monteluekast include
gastrointestinal disturbances,
hypersensitivity reactions, sleep disorders
and increased bleeding tendency, aside from
many other generic adverse reactions. Its use
is associated with a higher incidence of
Churg-Strauss syndrome

27. Desmopressin is used:
B. Diabetes insipidus
C. Gastrointestinal bleeding
D. Nocturnal eneuresis
E. All of these
Ans d

• Desmopressin is also used to reduce urine
production in central diabetes insipidus
patients and to promote the release of von
Willebrand factor and factor VIII in patients
with coagulation disorders such as type I
von Willebrand disease, mild hemophilia A,
and thrombocytopenia.

• Desmopressin is used frequently for
treatment of bedwetting.It is usually in the
form of Desmopressin acetate, DDAVP.
Patients taking DDAVP are 4.5 times more
likely to stay dry than those taking a placebo

28. Telithromycin is a:
B. Aminoglycoside
C. Fluroquinolone
D. Macrolide antibiotic
E. Beta Lactam antibiotic
Ans c

• Telithromycin is the first ketolide antibiotic
to enter clinical use. It is used to treat mild
to moderate respiratory infections.
• Telithromycin is a semi-synthetic
erythromycin derivative. It is created by
substituting the cladinose sugar with a
ketogroup and adding a carbamate ring in
the lactone ring
• Telithromycin prevents bacteria from growing, by
interfering with their protein synthesis. Telithromycin
binds to the subunit 50S of the bacterial ribosome, and
blocks the progression of the growing polypeptide chain.
Telithromycin has over 10 times higher affinity to the
subunit 50S than erythromycin. In addition,
telithromycin binds simultaneously to two domains of
23S RNA of the 50 S ribosomal subunit, where older
macrolides bind only to one. Telithromycin can also
inhibit the formation of ribosomal subunits 50S and 30S.

• Unlike erythromycin, telithromycin is acid-
stable and can therefore be taken orally
while being protected from gastric acids. It
is fairly rapidly absorbed, and diffused into
most tissues and phagocytes. Due to the high
concentration in phagocytes, telithromycin is
actively transported to the site of infection.
During active phagocytosis, large
concentrations of telithromycin is released.
The concentration of telithromycin in the
tissues is much higher than in plasma.
29. Imatinib is:
B. Protein tyrokinase inhibitor
C. Used in chronic myelogenous leukemia
D. Monoclonal antibody
E. A and B
Ans d

• It is the first member of a new class of agents that
act by inhibiting particular tyrosine kinase
enzymes, instead of non-specifically inhibiting
rapidly dividing cells
• ). It is used in treating chronic myelogenous
leukemia (CML), gastrointestinal stromal tumors
(GISTs) and a number of other malignancies.
• .

• There are a large number of TK enzymes in
the body, including the insulin receptor.
Imatinib is specific for the TK domain in abl
(the Abelson proto-oncogene), c-kit and
PDGF-R (platelet-derived growth factor
receptor).

• In chronic myelogenous leukemia, the
Philadelphia chromosome leads to a fusion
protein of abl with bcr (breakpoint cluster
region), termed bcr-abl. As this is now a
continuously active tyrosine kinase, imatinib is
used to decrease bcr-abl activity.

• The active sites of tyrosine kinases each have a binding site for
ATP. The enzymatic activity catalyzed by a tyrosine kinase is the
transfer of the terminal phosphate from ATP to tyrosine residues on
its substrates, a process known as protein tyrosine phosphorylation.
Imatinib works by binding to the ATP binding site of bcr-abl and
inhibiting the enzyme activity of the protein competitively.
• Imatinib is quite selective for bcr-abl – it does also inhibit other

targets mentioned above (c-kit and PDGF-R), but no other known
tyrosine kinases. Imatinib also inhibits the abl protein of non-cancer
cells but cells normally have additional redundant tyrosine kinases
which allow them to continue to function even if abl tyrosine kinase
is inhibited. Some tumour cells, however, have a dependence on
bcr-abl.[1] Inhibition of the bcr-abl tyrosine kinase also stimulates
its entry in to the nucleus, where it is unable to perform any of its
normal anti-apoptopic functions

30. Thalidomide is used as:
B. Immunomodulator
C. In multiple myeloma
D. In erythema nodosum
E. All of these
Ans d

• On May 26, 2006, the U.S. Food and Drug
Administration granted accelerated
approval for thalidomide in combination
with dexamethasone for the treatment of
newly diagnosed multiple myeloma (MM)
patients."

• The drug has some bothersome side effects
such as neuropathy, constipation and
fatigue, but is likely more effective than
standard chemotherapy for multiple myeloma.
• Thalidomide, along with another new drug,
bortezomib, is changing multiple myeloma
treatment, such that dangerous stem cell
transplants may no longer be the standard
treatment for this incurable malignancy.

• Serious infections including sepsis and
tuberculosis cause the level of Tumor
necrosis factor-alpha (TNFα) to rise.
– TNFα is a chemical mediator in the body, and
it may enhance the wasting process in cancer
patients as well.
– Thalidomide may reduce the levels of TNFα,
and it is possible that the drug's effect on ENL
is caused by this mechanism

• Thalidomide also inhibits the growth of new
blood vessels (angiogenesis), which may be
useful in treating macular degeneration and other
diseases.
– This effect helps AIDS patients with Kaposi's
sarcoma, although there are better and cheaper drugs
to treat the condition. Thalidomide may be able to
fight painful, debilitating aphthous lesions in the
mouth and esophagus of AIDS patients which
prevent them from eating

31. Which of the following monoclonal
antibody is used in colorectal cancer?
B. Rituximab
C. Trastuzumab
D. Cetuximab
E. Alemtuzumab
Ans c

• Cetuximab
– is a chimeric monoclonal antibody, an
epidermal growth factor receptor (EGFR)
inhibitor, given by intravenous injection for
treatment of metastatic colorectal cancer and
head and neck cancer

Mode of action
• Cetuximab is believed to operate by binding
to the extracellular domain of the EGFR of
all cells that express EGFR, which includes
the subset "cancer cells", preventing ligand
binding and activation of the receptor.
– This blocks the downstream signaling of EGFR
resulting in impaired cell growth and
proliferation.
– Cetuximab has also been shown to mediate
antibody dependent cellular cytotoxicity
(ADCC).

Colorectal Cancer
• Cetuximab is used in metastatic colon
cancer and is given concurrently with the
chemotherapy drug irinotecan, a form
of chemotherapy that blocks the effect of
DNA topoisomerase I, resulting in fatal
damage to the DNA of affected cells

Head and neck cancer
• Cetuximab was approved by the FDA in March
2006[4] for use in combination with radiation
therapy for treating squamous cell carcinoma of
the head and neck (SCCHN) or as a single agent
in patients who have had prior platinum-based
therapy.
• One of the side effects of Cetuximab therapy is
the incidence of, possibly severe, acne-like rash.

32. Antibiotic to be avoided in liver disorder:
B. Pyrazinamide
C. Erythromycin estolate
D. Tetracycline
E. All of these
Ans d

• Tetracycline antibiotics should be avoided if
possible because they could be an initiating
cause of hepatic lipidosis.
• Erythromycin estolate is
contraindicated in persons with pre-
existing liver disease or dysfunction and
during pregnancy.

• Pyrazinamide - Avoid-idiosyncratic
hepatotoxicity more common
• Whenever possible, the use of
pyrazinamide should be avoided in
patients with preexisting hepatic.
impairment (ALT> 3 x ULN) due to the
risk of liver

33. Effective treatment of Mycobacterium
Avium Complex (MAC) includes:
B. INH + Ethambutol + Minocycline
C. Clarithromycin + Ethambutol
D. INH + Thioacetazone
E. INH + Amikacin
Ans b

• The drugs used most often for treatment of M
avium complex (MAC) include clarithromycin,
azithromycin, ethambutol, and rifabutin.
Amikacin is used for refractory cases.
Combination therapy is important to enhance
efficacy and prevent resistance. Duration of
treatment is not established. In general,
patients with MAC pulmonary infection
should be treated for a minimum of one year
or until 12 months after sputum has
converted to negative for MA
• Treatment of pulmonary MAC infection in non-
immunocompromised patients involves a
combination of a newer macrolide (azithromycin or
clarithromycin), ethambutol, and rifabutin. Clofazimine has
been successfully used in place of rifamycins with good
outcome. Streptomycin has also been used successfully in
combination with macrolides for the first 6-12 weeks in patients
with cavitary disease. A macrolide-containing regimen has
been shown to carry a cure rate of about 56%, including the
dropouts and relapses in the analysis. Macrolides carry high
rates of intolerance. Clarithromycin, a cytochrome P-450
inhibitor, interacts with many drugs metabolized in the liver.
Similarly, rifamycins are known to induce hepatic enzymes and
can alter metabolism of many drugs taken concomitantly.

• For treatment of patients with AIDS and disseminated MAC (DMAC)
infection, combination of a newer
macrolide antibiotic
(clarithromycin, azithromycin) with
ethambutol and rifabutin is probably the
most active regimen.
• Clear evidence demonstrates the efficacy of clarithromycin and
azithromycin, but monotherapy with only one agent can lead to resistance.
Published data suggest efficacy of azithromycin for MAC infection (55-60%
success). Ethambutol
appears to be the best
second choice to combine with a macrolide.
Rifabutin should be used as a third agent.
• A study that compared clarithromycin and ethambutol (dual-therapy) with
clarithromycin, ethambutol, and rifabutin (triple-therapy) showed improved
microbiological clearance and survival in the triple-therapy arm.
• A major problem with rifabutin is drug interactions. Higher doses of rifabutin
(600 mg/d) are associated with higher rates of uveitis. Higher doses of
clarithromycin (1000 mg bid) are associated with higher mortality rates

• Fever should improve within 2-4 weeks of
beginning therapy. If patients remain febrile
longer than expected, repeat blood cultures
and assess susceptibilities to antimicrobial
agents. If the isolate is susceptible to
macrolide and the infection is not responding
to therapy, consider adding other agents
such as a fluoroquinolone (eg, levofloxacin)
or amikacin.

• Chemoprophylaxis is recommended for
patients with HIV with a CD4+ lymphocyte
count of less than 50 cells/µL. The drug of
choice is either clarithromycin or
azithromycin.
• One study that compared clarithromycin with
placebo revealed an incidence of MAC
bacteremia of 5.6% in patients taking
clarithromycin and 15.5% in those taking
placebo. Patients taking clarithromycin also
had an improved survival rate. More than 50%
of patients taking clarithromycin who developed
bacteremia were infected with clarithromycin-
resistant isolates.
34. Treatment of Pneumocystis Carinii
includes:
B. Co-trimoxazole
C. Pentamidine
D. Clindamycin + Primaquine
E. All of these
Ans d

35. Actinic Keratosis (senile Keratosis) is caused by:
• Infection by actino mycosis
• Tumour Deposit
• Viral infection by Herpes zoster
• Exposure to ultraviolet spectrum of sunlight
Ans d

• Actinic keratosis (AK) is a UV light–
induced lesion of the skin that may
progress to invasive squamous cell
carcinoma. It is by far the most common
lesion with malignant potential to arise
on the skin. AK is seen in fair-skinned
persons in areas of long-term sun
exposure

• AKs arise on fair-skinned people in areas of long-term sun
exposure, such as the face, ears, bald scalp, forearms, and
backs of the hands. However, they may occur on any area
that is repeatedly exposed to the sun, such as the back,
the chest, and the legs. Long-term UV light exposure is
implicated as the cause from both epidemiologic
observations and molecular analysis of tumor cells. AK
frequency correlates with cumulative UV exposure.
Therefore, AK frequency increases with each decade of
life, is greater in residents of sunny countries closer to the
equator, and is greater in persons with outdoor occupations

• Clinically, AKs range from
barely perceptible rough spots
of skin to elevated,
hyperkeratotic plaques
several centimeters in
diameter. Most often, they
appear as multiple discrete,
flat or elevated, keratotic
lesions. Lesions typically
have an erythematous base
covered by scale
(hyperkeratosis).

• They are usually 3-10 mm in diameter and gradually
enlarge into broader, more elevated lesions. With time,
actinic keratoses may develop into invasive squamous cell
carcinoma. Development of actinic keratoses may occur as
early as the third or fourth decade of life in patients who
live in areas of high solar radiation, are fair-skinned, and do
not use sunscreen for photoprotection. Usually, patients
demonstrate a background of solar-damaged skin with
telangiectasias, elastosis, and pigmented lentigines.

36. Cellular Blue nervus can be distinguished
from malignant melanoma by:
B. Pushing margins in the latter and
peripheral inflammation in the latter
C. Lack of junctional activity in the former
D. Mitosis and prominent nucleoli in the latter
E. All of the above
Ans d

• o clinically recognized variants of blue
nevus exist: the common blue nevus
and the cellular blue nevus.

• The cellular blue nevus is a less common lesion but often
clinically similar to the common blue nevus. These lesions tend
to be large, usually measuring 1-3 cm in diameter. Lesions
are elevated, smooth-surfaced papules or plaques that are
gray-blue to bluish black in color. Lesions are usually
solitary and found on the buttocks, the sacral region, and
occasionally on the dorsal aspects of the hands and the feet.
• Blue nevi are most frequently noted in Asian populations,
where the prevalence is estimated to be 3-5% in adults

Common blue nevus on the scalp.

• A histologic continuum exists from common blue nevi to
cellular blue nevi.
• In common blue nevus, a vaguely nodular collection of poorly
melanized spindled melanocytes and deeply pigmented
dendritic melanocytes within thickened collagen bundles is
seen. Scattered melanophages are usually noted. No mitoses
are present.
• In cellular blue nevus, a well-demarcated nodule formed
by fascicles and nests of tightly packed, moderately
sized, spindled to oval melanocytes with scattered
melanophages is seen. The lesion is centered in the reticular
dermis; blunt-ended, bulbus extensions that extend into
the subcutaneous fat may be noted.
• Occasional mitoses may be present, but significant cytologic
atypia and areas of necrosis are absent. Often, a component
of common blue nevus is seen within these lesions.

• The term malignant blue nevus is
synonymous with malignant melanoma
arising in association with a cellular blue
nevus or growing in a histologic pattern
similar to that of a cellular blue nevus.
These lesions typically have a pronounced
cytologic atypia, hyperchromasia,
necrosis, an increased mitotic rate, and
an infiltrative growth pattern. Complete
excision with a margin of healthy skin
should be performed.
• In cellular blue nevus, a well-demarcated nodule
formed by fascicles and nests of tightly packed,
moderately sized, spindled to oval melanocytes
with scattered melanophages is seen.
• The lesion is centered in the reticular dermis; blunt-
ended, bulbus extensions that extend into the
subcutaneous fat may be noted. Occasional
mitoses may be present, but significant cytologic
atypia and areas of necrosis are absent. Often, a
component of common blue nevus is seen within
these lesions.

• Carney syndrome (complex)
– Carney syndrome (complex) is the rare
association of blue nevi with other cutaneous
and systemic findings. This condition is thought
to arise in an autosomal dominant fashion.
– Synonyms include lentigines, atrial myxomas,
mucocutaneous myxomas, and blue nevi
(LAMB) and nevi, atrial myxomas, myxoid
tumors (neurofibromas), and ephelides (NAME).

• Additional associations reported with
Carney syndrome (complex) include
myxoid fibroadenoma of the breast, growth
hormone producing pituitary adenoma
causing acromegaly, pheochromocytoma,
Sertoli cell tumor of the testes, myxoid
uterine leiomyomas, acoustic neuroma, blue
nevi, and psammomatous melanotic
schwannoma.

37. One of the following is a complication of
AIDS disease:
B. Angio keratoma
C. Kaposi sarcoma
D. Solar keratosis
E. Paget’s disease of bone
Ans b

38. Rhinoscleroma is a :
B. Malignant tumour of nose
C. Disease caused by Rabies virus
D. Caused by Klebsiella group of organism
E. Fungal infection by Rhinosporidium
seeberi
Ans c

• Rhinoscleroma is a chronic
granulomatous condition of the nose
and other structures of the upper
respiratory tract. Rhinoscleroma is a
result of infection by the bacterium
Klebsiella rhinoscleromatis

39. Which of the lesions is more commonly
coexistant?
B. Thymoma and Myesthenia gravis
C. Lymphoma of cervical lymphnode and
quadriplegia
D. Carcinoid of appendix and ovarian
granulose cell tumor
E. Hashimotos thyroiditis and gigantism
Ans a

40. Dequerven’s Thyroiditis consists of:
B. Inflammation and foreign body giant cell granuloma
around follicles
C. Papillary proliferation of follicular epithelium
D. Follicles crowded and surrounded by capsule
E. None of the above
Ans a

• The thyroid gland is moderately
enlarged and edematous in de Quervain
thyroiditis. It may be unilaterally or
bilaterally enlarged and has an intact
capsule.
• Affected areas are firm and yellow-white
and stand out from the more rubbery,
normal, brown thyroid substance.
• The changes are patchy and vary
with the stage of the disease.
• The early phase is the active
inflammatory phase and is
characterized by areas of entirely
disrupted follicles, which are
replaced by neutrophils, forming
microabscesses.

• In a later phase, the classic changes of
granulomatous thyroiditis develop. This is
characterized by aggregations of lymphocytes,
large histiocytes, and plasma cells among
damaged thyroid follicles. Multinucleated giant
cells enclose pools or fragments of colloid, from
which stems the designation giant cell
thyroiditis.
• Colloid is also found within the giant cells, following a
process called colloidophagy. In the final stages, the
areas of injury are replaced by a chronic inflammatory
infiltrate and fibrosis. Different histologic stages
sometimes are found in the same gland, suggesting
waves of destruction over a period of time.

• The inflammatory process has a distinctly
granulomatous pattern, characterized by the
presence of foreign-body-type giant cells
(multiple irregularly shaped nuclei in
abundant cytoplasm)

• cytomorphology of subacute granulomatous thyroiditis shows
loss of a uniform honeycomb cellular arrangement, variation in
size and decreased or shortened microvilli in follicular cells,
and the appearance of round or ovoid giant cells.

• The giant cells are closely associated with the
granulomas, and are CD68+, thyroglobulin
negative, and cytokeratin negative. The small
lymphocytes in the granulomas are CD3+,
CD8+, CD45RO+ cytotoxic T cells. In the
nongranulomatous lesions, the follicles are
infiltrated by CD8+ T lymphocytes,
plasmacytoid monocytes, and histiocytes,
resulting in disrupted basement membrane and
rupture of the follicles.
• These findings suggest that cellular immune
response may play an important role in the
pathogenesis of subacute thyroiditis.

• The histologic differential diagnosis
includes palpation thyroiditis (histiocytes,
lymphocytes, and no neutrophils),
lymphocytic thyroiditis (oxyphilic
[Hurthle, oncocytic] follicular epithelial
cell metaplasia with mature lymphocytes
and plasma cells arranged around germinal
centers), and Riedel's thyroiditis (vasculitis
and fibrosis).

41. Which one of the following is true regarding Meckel’s
Diverticulum?
• It is a result of persistence of proximal portion of
vittelline duct
• Is an abnormality of mesonephric duct
• Is an abnormality of 2nd bronchial pouch
• Is an abnormality of wolffian duct
Ans a

• Meckel diverticulum is the
most common form of
congenital abnormality of the
small intestine, resulting
from an incomplete
obliteration of the vitelline
duct (ie,
omphalomesenteric duct,
yolk stalk

• Early in embryonic life, the vitelline duct connects the midgut
to the yolk sac. Later on, the duct undergoes progressive
narrowing and usually disappears by the seventh gestational
week. When the duct fails to obliterate, different types of
vitelline duct anomalies appear.
• Examples of such anomalies include (1) a persistent
vitelline duct (appearing as a draining fistula at the
umbilicus), (2) a fibrous band connecting the ileum to the
inner surface of the umbilicus, (3) a patent vitelline sinus
beneath the umbilicus, (4) an obliterated bowel portion, and
(5) a vitelline duct cyst.
• Meckel diverticulum has been reported in 97% of the vitelline
duct anomalies. The tip of the diverticulum can be free in 75%
of cases and attached to the anterior abdominal wall or
another structure in the remainder.
• Enterocystomas, umbilical sinuses, and omphaloileal fistulas
are among the other congenital anomalies seen with Meckel
diverticulum.

42. The following are true, except:
B. Coeliac disease shows circulating
antibodies against gluten
C. Tropical sprue is caused by gluten
D. There will be villous atrophy in coeliac
disease
E. Tropical sprue responds to folic acid/ B 12
and tetracycline
Ans b

• Celiac sprue, also known as
celiac disease or gluten-
sensitive enteropathy, is a
chronic disease of the
digestive tract that interferes
with the digestion and
absorption of food nutrients.
• People with celiac sprue
cannot tolerate gluten, a
protein commonly found in
wheat, rye, and barley.

• Most patients with celiac disease tolerate oats,
but they should be monitored closely. When
people with celiac sprue ingest gluten, the
mucosa of their intestines is damaged by an
immunologically mediated inflammatory
response, resulting in maldigestion and
malabsorption. Patients can present with
failure to thrive and diarrhea (the classical
form). However, some patients have only
subtle symptoms (atypical celiac disease) or
are asymptomatic (silent celiac disease).
• Celiac sprue primarily involves the
mucosa of the small intestine.
– The submucosa, muscularis, and serosa are
usually not involved.
– The villi are atrophic or absent, and crypts
are elongated.
– The cellularity of the lamina propria is
increased with a proliferation of plasma cells
and lymphocytes.
– The increased number of intraepithelial
lymphocytes per unit length of absorptive
epithelium is increased.

• Serological analysis for immunoglobulin G
(IgG) and IgA antitissue transglutaminase
is the most widely used test to help diagnose
celiac sprue.
• The presence of serum IgA antibody to
endomysium in untreated celiac sprue has
higher sensitivity and higher specificity than
antigliadin antibodies. However, serum IgA
antiendomysial antibody often becomes
undetectable after 6-12 months of gluten
withdrawal
• Tropical sprue (TS) is a syndrome characterized by
acute or chronic diarrhea, weight loss, and
malabsorption of nutrients.
– It occurs in residents of or visitors to the tropics and
subtropics.
• The exact causative factor is unknown, but an
intestinal microbial infection is believed to be the
initiating insult. The infection results in enterocyte
injury, intestinal stasis, and possible bacteria
overgrowth. Villous destruction and demonstrable
nutrient malabsorption occur in varying degrees.
Folate, vitamin B-12, and iron deficiencies are the
most common nutrient deficiencies.

• Nutrient replacement to correct deficiencies
in patients with TS often includes folic acid,
vitamin B-12, and iron. Antibiotic therapy is
also helpful because early eradication of
bacterial pathogens can relieve continuing
injury to the gut.
• Empiric antimicrobial therapy with
tetracycline must be comprehensive and
should cover all likely pathogens

43. The commonest parasite seen in vermiform appendix
is:
B. Wucheraria Banchrofti
C. Enterobius Vermicularis
D. Trypanosoma Gambiense
E. Cysticercus cellulosae
Ans b

44. Tumour marker for prostate carcinoma is:
B. CEA
C. PSA
D. S-100
E. Philadelphia chromosome
Ans b

45. Carcinoma cervix is caused by:
B. HPV 16 and 18 viruses
C. HPV 11
D. HPV 6
E. HPV 1
Ans a

• About two-thirds of all cervical
cancers are caused by HPV 16 and
18.

46. Massive edema of the ovary:
B. Is a benign tumour of ovary
C. Malignant tumour of ovary in pregnant
women
D. Non-neoplastic lesion with Meig’s
syndrome
E. Caused by endometriosis of ovary
Ans c

Massive ovarian edema is a name tumonlike entity
chanactemized by marked enlargement of one on both
ovaries due to marked edema in the stroma.
This abnormality is thought to result from interference with
venous and lymphatic drainage due to pantial
or intermittent torsion of the ovary

58-year-old woman with palpable abdominopelvic
mass.
A, Pelvic sonogram shows ascites and huge mass
composed of solid and cystic portions.

B and C, Sagittal TI-weighted (B) and T2-
weighted (C) MR images show pelvic mass that
contains upper cystic and lower solid components.
D, CoronalTl-
Massive ovarian edema
defined the entity as “marked enlargement of one or both ovaries
by an accumulation of edema fluid in the stroma, separating normal
folliculam structure.”
The edema is thought to be the result of partial or intermittent
torsion of the ovary, causing venous and lymphatic
drainage
Most reported cases have occurred in patients in the second
and third decades of life
. Presenting symptoms are acute abdominal pain, a palpable adnexal
mass, and, less commonly, menstrual disturbances. Masculinization
of vanous degrees is sometimes present, clinically suggestive of
polycystic ovary syndrome
Meigs’ syndrome occasionally accompanies

massive ovarian edema
47. Phyllodes tumour is:
B. Stromal Tumour of Breast
C. Tumour arising from Filum Terminale
D. Tumor of Erector pili muscle
E. Malignant tumor of pylorus of stomach
Ans a

48. Littoral cell angioma is
B. Tumor of spleen
C. Angiomatous lesion of skin
D. Angioblastic tumor of Cerebellum
E. Congenital vascular anomaly at base of
brain
Ans a

• Littoral cell angioma, first described by
Falk et al is a tumor of vascular
proliferation unique to the spleen. This
neoplasm has characteristic morphologic
and immunophenotypic features that
distinguish it from other vascular splenic
tumors including hemangiomas,
lymphangiomas, hamartomas,
hemangioendotheliomas, and angiosarcomas

Case presentation
• A 59-year-old man was first diagnosed with
splenomegaly
– Treatment included a bone marrow biopsy that revealed
erythroid hyperplasia, although peripheral blood smear
was normal. Four years later, the patient complained
of persistent left upper abdominal pain and fullness.
His physical examination was again notable for
splenomegaly. Abnormal laboratory data included the
following: hemoglobin (11.8 g/dl), hematocrit (36.9%),
and platelet count (119 x 103 µl). A second bone marrow
biopsy showed normocellular marrow with a left-shifted
granulocytic maturation and no evidence of leukemia or
lymphoma.

• Sonogram
shows
mottled
echo
texture of
spleen.

• Early contrast-
enhanced helical CT
scan shows enlarged
spleen containing
innumerable small,
focal, low-density
lesions

Photograph of pathologic specimen shows exterior surface
of enlarged spleen as deformed and markedly nodular

Photomicrograph of histologic specimen reveals vascular
channels with benign-appearing lining cells (large
arrowheads) filled with macrophages (M) and blood cells
(small arrowheads).

• Vascular neoplasms are the most common
primary tumor of the spleen. Traditionally,
these tumors have been divided into benign
types such as hemangiomas, lymphangiomas,
and hamartomas; an intermediate type such as
hemangioendothelioma; and a malignant form
called angiosarcoma. A distinct subtype of
vascular splenic tumor distinguished by its
immunohistochemical properties has recently
been described. Termed littoral cell angioma,
this neoplasm expresses both vascular and
histiocytic antigens

49. M Band is diagnostic feature of:
B. Plasma cytoma/Myeloma
C. Sickle cell Anemia
D. Thalassemia
E. Congenital hyperlipidemia
Ans a

50. Trichinosis is:
B. Parasitic infestation of skeletal muscle fibres
C. Fungal infection of hair follicle
D. Benign tumor of Tibia Bone
E. Viral infection of Trachea
Ans a

51. The commonest polyp in the stomach is:
B. Hyperplastic polyp
C. Hamartomatous polyp
D. Adenomatous polyp
E. Adenocarcinoma
Ans a

• Hyperplastic polyp is the most common
polyp in the. stomach

52. All are true, except:
B. Ulcerative colitis always involves Rectum
C. There will be diffuse involvement in chrons
disease
D. Strictures are common in chrons disease
E. Skipped areas are absent in ulcerative
colitis
Ans b

• Ulcerative colitis is a chronic disease
characterized by diffuse mucosal
inflammation of the colon.
• Ulcerative colitis always involves the
rectum (i.e., proctitis), and it may extend
proximally in a contiguous pattern to
involve the sigmoid colon (i.e.,
proctosigmoiditis), the descending colon
(i.e., left-sided colitis), or the entire colon
(i.e., pancoliti

53. Mickulitiz disease is:
• Benign tumor of Salivary gland
• Malignant tumor of Thyroid gland
• Benign lymphoepithelial lesion of salivary gland
• Congenital anomaly of salivary gland
Ans c

• Mikulicz's syndrome" and later termed
Sjögren's syndrome
• A labial salivary gland biopsy (LGB)
can be an important diagnostic tool
in patients with suspected SS. The
biopsy should be taken from a
macroscopically normal, nontraumatized
part of the lower lip and should be large
enough to contain at least four lobules.
The key histologic feature is focal
collections of lymphocytes, often
beginning centrally within the lobule. The
most widely accepted grading system
records the number of foci of lymphoid
tissue, defined as collections of 50 or Page 189
Dreamz Learning
more lymphocytes per 4 mm2
54. Alagilles syndrome is:
B. Neonatal hepatic disorder caused by
intrahepatic cholestasis
C. Cirrhotic disease in childhood
D. Complication of hepatitis B infection
E. Complication of hepatitis C infection
ANS A

• Alagille syndrome (AS) is an autosomal
dominant disorder associated with
abnormalities of the liver, heart,
skeleton, eye, kidneys, and
characteristic facial appearance.
• Major contributors to morbidity arise
from bile duct paucity or cholestatic liver
disease, underlying cardiac disease,
and renal disease.
• Most children are evaluated when younger than
6 months for either neonatal jaundice (70%), or
cardiac murmurs and symptoms (17%).
Presentation is variable.
• Some patients are diagnosed after prolonged
neonatal jaundice or when liver biopsy
demonstrates paucity of intrahepatic bile
ducts.
• Others may be diagnosed during evaluation for
right-sided heart disease.
• Some individuals are diagnosed by careful
examination after an index case is identified in
the family.

Hepatic
• Hepatic disease is a key feature of AS.
• The majority of infants with AS present
with cholestatic jaundice.
• Hepatosplenomegaly is common.
• Elevations in serum bile acids often result in
severe pruritus and xanthomas
(hypercholesterolemia).
• Fat-soluble vitamin deficiencies, including
coagulopathies and rickets, are frequent.
• Hepatic complications arise from cholestasis and
cirrhosis. Infants may present with neonatal jaundice.
Either jaundice resolves by age 2 years or cholestasis
persists. Unrecognized deficiencies of fat-soluble vitamins
(A, D, E, K) can contribute to morbidity (eg, osteopenia,
hemolytic anemia) and mortality (eg, intracranial
hemorrhage, aberrant intracerebral vessels secondary to
abnormal notch or JAG1 expression) from bleeding events.
Severe intractable pruritus leaves many children with AS
miserable, prompting consideration for liver transplantation.
Several patients have developed hepatocellular carcinoma
in early adulthood

55. The tumor than can resemble Renal cell
Carcinoma histologically is:
B. Oncocytoma of kidney
C. Chronic pyelonephritis
D. Wilms Tumor
E. Angiomyolipoma
Ans a

Renal oncocytoma. The mahogany
appearance of the tumor contrast with the
white fibrous scar in the center of the mast.

Renal oncocytoma. Eosinophilic tumor cells with large granular
cytoplasm form small aggregates and tubules. Note the lack of
mitotic activity and cytologic atypia

Renal oncocytoma. The ultrastructural micrograph
shows numerous mitochondria filling the cytoplasm of
the tumor cell.

Oncocytoma
• The histologic features are very characteristic. Strongly
eosinophilic tumor cells forming islands and tubules dominate
throughout the tumor. Tumor cells exhibit large and finely
granular cytoplasm, uniform round nuclei, clumped chromatin
and small nucleoli \ Bizarre, enlarged nuclei may be scattered
throughout the tumor, but mitoses are rare. Oncocytomas
sometimes extend into the perinephric fat or into venous
sinuses without affecting the prognosis. These two features
are never observed grossly.
– The differential diagnosis with eosinophilic
chromophobe RCC would be difficult without Hale’s
colloidal iron stain, which is negative in
oncocytomas, or without electron microscopy (EM),
which in oncocytomas shows numerous
mitochondria filling the cytoplasm of the tumors
cells

• Clear cell RCC. Note
the variegated
appearance of the
tumor mass, which is
located in the upper
pole of the kidney.
The tumor combines
yellow solid areas
with red and cystic
areas of necrosis
and hemorrhage.

56. Adenocarcinoma of Cowper’s Glands
occurs in:
B. Fundic portion of stomach
C. Ampulla of vater
D. Prostate gland
E. Rectum
Ans c

• When there is florid mucinous
metaplasia, especially in an apical
location in Prostatic adenocarcinoma,
confusion with Cowper's (bulbourethral)
glands may occur

57. Brenner tumor is:
B. Ovarian tumor with stromal and glandular component
C. A germ cell tumor of ovary
D. A childhood tumor of liver
E. A malignant tumor of uterus
Ans a

• Brenner tumors are uncommon tumors that are
part of the surface epithelial-stromal tumor group
of ovarian neoplasms.
• The majority of these tumors are benign.

However, they can be malignant\
• They are most frequently found as incidental

findings on pelvic examination or at laparotomy.

• Histologically, there are nests of
transitional-type epithelial cells with
longitudinal nuclear grooves (coffee bean
nuclei) lying in abundant fibrous stroma.

• Epithelial-stromal tumors are classified on the
basis of the epithelial cell type, the relative
amounts of epithelium and stroma, the presence
of papillary processes, and the location of the
epithelial elements
– This group consists of serous, mucinous,
endometrioid, clear cell, and brenner (transitional
cell) tumors, though there are a few mixed,
undifferentiated and unclassified types.

58. Kikuchi’s fujimoto’s disease is:
B. Painless lymphadenopathy will paracortical
necrotizing lesions
C. A complication of HIV disease
D. Seen in post BCK vaccination
E. Other name for sarcoidosis of lymph node
Ans a

Kikuchi’s disease is a rare, benign
clinicopathological condition presenting with
fever and lymphadenopathy. Its association
with Systemic Lupus Erythematosus (SLE)
makes it necessary to be aware of this
condition and follow up these children.

Kikuchi-Fujimoto disease or
histiocytic necrotising lymphadenitis without
granulocytic infiltration
It is considered as a self-limiting benign
systemic lymphadenitis, especially
involving the cervical nodes of unknown
cause(

Biopsy of the lymphnode is diagnostic.
The pathological features of the
affected lymphnode are patchy or confluent
area of necrosis, varying amount of nuclear
debris in affected area, aggregates of
histiocytes, presence of medium - large sized
transformed lymphocytes (immunoblasts) and
plasmacytoid T cells, absence of neutrophils
and eosinophils(8). Cytoplasmic tubuloreticular
structures resembling viral particles or
aberrant organelle structures have been
identified by electron microscopy

59. All of the below are true, except:
B. Myeloblast has multiple nucleoli
C. Lymphoblast is identified by Auer rods
D. PAS positive granules are present in
lymphoblast
E. Myeloblasts are positive for
myeloperoxidase stain
Ans b

• Auer rods can be seen in the leukemic blasts of
Acute Myeloid Leukemia.
• Auer rods are clumps of azurophilic granular
material that form elongated needles seen in the
cytoplasm of leukemic blasts. They are composed of
fused lysosomes and contain peroxidase, lysosomal
enzymes, and large crystalline inclusions.
• Auer rods are classically seen in myeloid blasts of
M1, M2, M3, and M4 acute leukemias.
• They are also used to distinguish the pre-leukemia
Myelodysplastic Syndromes: Refractory Anemia
with Excess Blasts 2 (which has Auer rods) from
RAEB 1 (which does not).
Bone marrow aspirate showing acute myeloid
leukemia with Auer rods in several blasts

60. Which of the following courts can pass death sentence?
• Chief Judicial Magistrate
• Asstt. Sessions Judge
• Sessions Judge
• 1st Class Judicial Magistrate
Ans c

61. Dialated pupil is seen in the following
poisons, except:
B. Datura
C. Endrin
D. Alcohol
E. Opium
Ans b

• (a) organochlorine compounds: DDT,
benzene hexachloride (lindane, gammexane
BHC) aldrin (chlordane, dieldrin, heptachlor
epoxide, endrin)
• (b) organophosphorus insecticides:
chlorpyrifos, parathion, malathion,
dimethoate, dichlorvos, mevinphos

62. Which organ resists putrefaction for longer
time?
B. Heart
C. Lung
D. Prostate
E. Kidney

•
• In advanced putrefaction, sex can be
determined by identifying uterus or
prostate which resist putrefaction for a
long time.

63. Tailing of wound is seen in:
B. Abrasion
C. Laceration
D. Firearm injury
E. Incised wound
Ans d

• : Incised wounds are deeper at the
beginning, because more pressure is exerted
on the knife at this point. This is known as the
head of the wound. Towards the end of the
cut the wound becomes increasingly shallow,
till finally as the knife leaves the tissues the
skin alone is cut. This is known as the tailing
of the wound, and indicates the direction in
which the cut was made.

64. Whiplash injury is seen in which of the
following organ?
B. Brain
C. Intestines
D. Spinal cord
E. Lung
Ans c

• Whiplash injury is due to a violent acceleration or deceleration
force applied to the passenger, usually front seat occupant. When
the vehicle comes to a sudden stop due to head-on obstruction, the
heavy head continues to move forward (acute hyperflexion). When
the body comes to rest, or the head strikes an obstruction in front,
there is then a reactionary hyperextension as the head is thrown
backwards, this double movement being known as the
‘whiplash’.
• If a vehicle is hit violently from behind by another vehicle, then the
head is thrown violently backwards into hyperextension and then
comes forwards after body stops movement. In either case, this
violent extension-flexion movement can cause dislocation of the
upper cervical spine, or less commonly a fracture-dislocation in the
lower part of the spine at about C 5-6. Fatal contusion or
laceration of the spinal cord may occur without fracture of spine.
Fracture or dislocation can also occur in the, upper dorsal spine,
often around T5 to 7.

65. Punishment for dowry death is under:
B. Sec 304 A IPC
C. Sec 304 B IPC
D. Sec 375 IPC
E. Sec 320 IPC
Ans b

.304.B. I.P.C. (Dowry Death): Where the death’ ‘Ofa
woman is caused by any burn or bodily injury or occurs otherwise than
under normal circumstances within seven years of her marriage and it is
shown that soon before her death she was subjected to cruelty or
harassment by her husband or any relative of her husband for. or in
connection with, any demand for dowry, such death shall be called
“dowry death”, and such husband or relative shall be deemd to have
caused her death.
• S.49&-A, I.P.C.: Whoever being the husband or
the relatives of the husband of the woman,
subject such woman to cruelty shall be punished
with imprisonment for a term which may extend to three
years and shall also be liable to fine.
• S.113A and 113B, I.E.A., deal with presumption
as to abetment of suicide by a married woman,
and presumption as to dowry death.
66. Mechanism of Asphyxia in Café Coronary
is:
B. Gagging
C. Smothering
D. Choking
E. Mugging
Ans c

Choking is a form of asphyxia caused by an obstruction
within the air-passages.
• CAFE CORONARY : This is a condition in

which a healthy but grossly intoxicated person
(restaurant patron), who begins a meal, suddenly
turns blue, coughs violently, then collapses and
dies, without much fuss death appears to be due
to sudden heart attack. At autopsy, a large piece
of poorly chewed food (bolus or a piece of meat)
may be found obstructing the larynx. The clinical
signs n of choking are absent, because of the
high blood C alcohol content which
anaesthetises
Dreamz Learning the gag reflex. Page 227
67. Confirmatory test for semen is:
B. Haemochromogen crystal test
C. Marsh test
D. Acid phosphatase test
E. Diatoms test
Ans c

• The Acid Phosphatase Test prostatic secretion element of
seminal fluid contains a very much higher percentage of acid
phosphatase than any other body fluid. Human red cells semen
of higher apes, and juice of cauliflower have acid phosphatase
leval similar to that of human semen Undiluted semen has an acid
phosphatase activity of 340 to 360 Bodansky units per ml. The concentrati6n of acid
phosphatase graudually falls with time in vaginal secretions, and positive reactions are
found for periods of thirty six hours but is little changed if the body is refrigerated. Five
to ten ml. of normal saline solution is placed in the vagina with a syringe. The fluid is
then removed and placed in a sealed “tube and refrigerated for enzyme examination
Concentration in excess of hundred Bodansky units with or without motile sperms.
indicate that ejaculation occurred within twelve’ hours of examination. Dried seminal
stains which have not undergone putrefaction retain acid phosphatase activity for weeks
or months, although enzymatic activity decreases slowly with time. The concentration is
slowly reduced when the stain is left at room temperature and exposed to light. Heating
of the specimen to 60°C. or over destroys it within five minutes. In humans, acid
phosphatase content is greater than in animals. Thus test is conclusive in the absence of
demonstrable sperms or in aspermia.

Marsh’s Test , Reinsch’s Test for Arsenic
(1) Marsh’s Test : When the corn-Treatment consists in removing the patient except the
metai”andlts sulphides are from the source of exposure and administration or
hydrogen generator, arseniuretted hydro-o is liberated and may be burned in a jet
together with the escaping hydrogen The flame is bluish or greenish, violet suddenly
cooled as, e.g., by placing a piece of cold procelain In the flame, arsenic is deposited
as a blackish-brown stain of metallic lustre. This stain is soluble in a solution of
hypochlorite, while the addition of ammonium sulphide does not dissolve, but
detaches it from the procelain. This is a very delicate test and detects arsenic even up
to one thou-sandth of a milligramme.
•
• (2) Reinsch’s Test: The material suspected to contain arsenic is boiled for five to ten
minutes with about half of its volume of pure hydrochloric acid, and a small strip of
pure copper is introduced. If prsenic is present, the copper is coated steel-grey or
black. The copper foil is then washed with distilled Water, alcohol and ether, dried
and heated in a test tube. The arsenic deposit volatilises and forms a white deposit
further up in the cooler portions of the tube. Microscopically, the deposit consists of
octahedral crystals of arsenious acid with their apices broken.

68. Viperine snake bite symptoms are seen in
poisoning due to:
B. Abrus precatorius
C. Cocain
D. Strychnus nux vomica
E. Croton tiglium
Ans a

• ABRUS PRECATORIUS
• It is also known as jequirity,
indian liquorice (gunja or
rati). It is a slender, twining,
climbing plant, woody at
base and is found all over
India
• The seeds contain an
active principle abrin, a
toxalbumen, which is
similar to viperine snake
venom; also present are
abrine (N-
methyltryptophan), an
aminoacid, haemoglutinin
in the cotyledons; a lipolytic
enzyme, and abralin, a
glycosid
69. Universal Antidote consists of the
following, except:
B. Powdered animal charcoal
C. Copper sulphate
D. Magnesium oxide
E. Tannic acid
Ans b

• Universal Antidote: When the exact poison is not known,
or when a combination of two or more poisons had been
taken, universal antidote is given, which consists of
powdered animal charcoal (or burnt toast) two parts;
magnesium oxide one part; tannic acid (or strong tea)
one part.
• A tablespoonful is mixed in glassful of water and is given
by mouth. It may be repeated once or twice. Charcoal
adsorbs alkaloids; tannic acid precipitates alkaloids,
glucosides and many of the metals; magnesia neutralises
acids without gas formation It is a combination of physical
and chemical antidotes. Evacuation of the stomach should
be carried out at the same time.

70. A patient presents with severe colitis
associated with an overgrowth of
Clostridium diffcile in the lower bowel. The
most likely cause of this condition is:
B. Botulinum food poisoning
C. A compromised immune system
D. Antibiotic therapy
E. Mechanical blockage in large intestine
Ans c

71. Endotoxins belong to a class of biological
molecules called:
B. Mucopolysaccharides
C. Lipopolysaccharides
D. Nucleic acid
E. Peptidoglycan
Ans b

72. Which of the following most correctly describes
vaccine containing live, attenuated pathogen?
• Pathogen does not multiply in human host
• Provides extended sometimes lifelong immunity
• No possibility for reversion of pathogenic form
• Provides little cell mediated immunity
Ans b

73. A lysogenic bacterium:
B. Carries a prophage
C. Caused lysis of other bacteria on contact
D. Cannot support the reproduction of a
virulent phage
E. Is usually not capable of conjugal genetic
transfer
Ans a

Lysogenic bacterium
• A bacterium in the symbiotic condition in which its
genome includes the genome (probacteriophage) of
a temperate bacteriophage; in occasional instances
the probacteriophage dissociates from the bacterial
genome, develops into vegetative bacteriophage,
and then matures, causing lysis of the respective
host bacterium and release into the culture medium
of infective temperate bacteriophage, formerly, a
pseudolysogenic bacterial strain, i.e., a "carrier"
strain of bacteriophage of low infectivity.

74. Which of the following organism principally
infects the vascular endothelial cells?
B. Salmonella typhi
C. Rickettsia typhi
D. Haemophilus influenza
E. Coxiella burneti
Ans b

• The vascular endothelial cell (EC) is a
primary target of infection with Rickettsia
rickettsii, the etiologic agent of Rocky
Mountain spotted fever.
– Changes in gene transcription elicited by
intracellular infection, including EC expression
of the coagulation pathway initiator known as
tissue factor (TF), may contribute to the
vascular pathology observed during disease

75. An outbreak of sepsis caused by Staphylococcus
aureus has occurred in the newborn nursery. You are
called upon to investigate. According to your
knowledge of normal flora, which of the following is
the most likely source of organism?
B. Colon
C. Nose
D. Throat
E. Vagina
Ans b

• Staphylococcus aureus, or S. aureus,
is a common bacterium that lives on the
skin or in the nose

76. Anton test is positive in :
B. Erysipelothrix rhusiopathiaea
C. Streptobacillus moniliformes
D. Listeria monoctogenes
E. Calymmatobacterium granulomatis
Ans c

Anton test
• A test used in the
identification of Listeria
monocytogenes;
instillation of a culture
into the conjunctival sac
of a rabbit or guinea pig
causes severe
keratoconjunctivitis
within 24 hours.
77. Carrion’s disease is caused by :
B. Leptospira icterohaemorrhagic
C. Rickettsia mooseri
D. Bartonella bacilliformis
E. Acinetobacter
Ans c

• Oroya fever or Carrion's Disease is an
infectious disease produced by Bartonella
bacilliformis infection.

• Carrion's disease is found only in Peru,
Ecuador, and Colombia
– It is Endemic in some areas of Peru and is caused
by infection with the bacterium Bartonella
bacilliformis and transmitted by sandflies of
genus Lutzomyia

• Acute phase: (Carrion's disease) the
most common findings are fever (usually
sustained, but with temperature no greater
that 39ºC), pallor, malaise, nonpainful
hepatomegaly, jaundice,
lymphadenopathy, splenomegaly. This
phase is characterized by severe
hemolytic anemia and transient
immunosuppression
• Chronic phase:(Verruga Peruana or
Peruvian Wart) it is characterized by an
eruptive phase, in which the patients
develop a cutaneus rash produced by a
proliferation of endothelial cells and is
known as "peruvian warts" or "verruga
peruana".

78. Botryomycosis is :
B. Caused by true bacteria
C. Caused by Nocardia
D. Responds to antifungal treatment
E. Does not respond to treatment
Ans a

Botryomycosis caused by Staphylococcus aureus and
Pneumocystis carinii in a patient with acquired
immunodeficiency disease
• Botryomycosis; also known as bacterial

pseudomycosis is a rare chronic
granulomatous bacterial infection that
affects the skin, and sometimes the viscera.
• Cutaneous botryomycosis is differentiated by the
presence of basophilic granules that resemble the
sulfur granules of actinomyces at histologic
examination. Depressed immunity is also common
to cutaneous botryomycosis, as seen in acquired
immunodeficiency syndrome (AIDS).

• Botryomycosis usually requires
surgical intervention for cure. Major
surgery is often required for patients,
• Treatment with six weeks of. oral
dicloxacillin (500 mg q.i.d.

79. Which of the following fungi has not been
successfully cultured so far?
B. Rhinosporidium
C. Loboa loboi
D. Candida tropicalis
E. Histoplasma capsulation
Ans a

• Culture of this. organism,
Rhinosporidium seeberi, has been
tried in. practically all types of media, but
has not been suc-. cessfully cultivated

80. Atheletes foot is commonly caused by :
B. Trichophyton rubrum
C. Candida albicans
D. Aspergillus fumigates
E. Curvalaria
Ans a

Pale, flaky & split skin of athlete's foot in a toe web space
• It usually occurs
between the toes,
but in severely
lasting cases may
appear as an
extensive
"moccasin"
pattern on the
bottom and sides
of the foot

• Athlete's foot is a layman's description of a
skin fungal infection, and is medically
referred to as tinea pedis. It may be
associated with several different fungi,
including yeasts. The most common fungi
causing tinea pedis are Trichophyton rubrum
and T. mentagrophytes. Fungal infections of
the skin are called dermatophytos

81. A component of cell membrane of most
fungi is :
B. Cholesterol
C. Chitin
D. Ergosterol
E. Keratin
Ans c

• Ergosterol is the primary sterol in the
cell membranes of filamentous fungi

82. Which of the following protozoa primarily
infects macrophages?
B. Plasmodium vivax
C. Leishmania donovani
D. Trypanosoma cruzi
E. Trichomonas vaginalis
Ans d

83. River blindness is caused by:
B. Dranunculus medinensis
C. Loa loa
D. Onchocerca vulvulus
E. Toxocara canis
Ans c

• river blindness
(onchocerciasis

84. In malaria, the form of plasmodia that is
transmitted from mosquito to human is:
B. Sporozoite
C. Merozoite
D. Hypnozoite
E. Gametocyte
Ans a

• Some merozoites turn into male and female
gametocytes.
• If a mosquito pierces the skin of an infected
person, it potentially picks up gametocytes within
the blood. Fertilization and sexual recombination
of the parasite occurs in the mosquito's gut,
thereby defining the mosquito as the definitive
host of the disease.
• New sporozoites develop and travel to the
mosquito's salivary gland, completing the cycle
85. Each of the following statement regarding hepatitis C
virus (HCV) and hepatitis D virus (HDV) is correct,
except :
B. HCV is an important cause of post transfusion
hepatitis
C. HDV is a defective virus with an RNA genome
D. HDV is primarily transmitted by faeco oral route
E. People infected with HCV are prone to Hepato
cellular carcinoma
Ans c

• Hepatitis D virus (HDV) is a small, single-
stranded, negative sense RNA virus. It is
unique because it is a satellite virus for
Hepatitis B virus (HBV):
• HDV is considered to be a subviral satellite
because it can propagate only in the
presence of another virus, the hepatitis B
virus (HBV).
• Transmission of HDV can occur either via
simultaneous infection with HBV (coinfection)
or via infection of an individual previously
infected with HBV (superinfection
86. Each of the following statement about human immuno
deficiency virus is correct, except –
B. The CD4 protein on the T cell surface is the receptor for the
virus
C. There is appreciable antigen diversity in the envelope
glycoproteins of the virus
D. One of the viral genes codes for a protein that augments the
activity of the viral transcriptional promoter
E. A major problems with testing for antibody to the virus is its
cross reactivity with the human T cell lymphoma virus1
Ans d

• HIV primarily infects vital cells in the
human immune system such as helper T
cells (specifically CD4+ T cells),
macrophages and dendritic cells.

• HIV can infect a variety of immune cells such as CD4+
T cells, macrophages, and microglial cells.
• HIV-1 entry to macrophages and CD4+ T cells is
mediated through interaction of the virion envelope
glycoproteins (gp120) with the CD4 molecule on the
target cells and also with chemokine coreceptors.
• Macrophage (M-tropic) strains of HIV-1, or non-syncitia-inducing strains

(NSI) use the β-chemokine receptor CCR5 for entry and are thus able to
replicate in macrophages and CD4+ T cells.[37] This CCR5 coreceptor is used
by almost all primary HIV-1 isolates regardless of viral genetic subtype.
Indeed, macrophages play a key role in several critical aspects of HIV
infection. They appear to be the first cells infected by HIV and perhaps the
source of HIV production when CD4+ cells become depleted in the patient.
Macrophages and microglial cells are the cells infected by HIV in the central
nervous system. In tonsils and adenoids of HIV-infected patients, macrophages
fuse into multinucleated giant cells that produce huge amounts of virus

• There is genetic diversity in the
envelope glycoprotein of human
immunodeficiency virus type 1 (HIV-1)
isolates

• Of the nine genes that are encoded within the
RNA genome, three
of these genes, gag, pol,
and env, contain information needed to
make the structural proteins for new
virus particles
•

• For example, env codes for a protein called gp160 that is
broken down by a viral enzyme to form gp120 and gp41.
The six remaining genes, tat, rev, nef, vif,
vpr, and vpu (or vpx in the case of HIV-
2), are regulatory genes for proteins that
control the ability of HIV to infect cells,
produce new copies of virus (replicate), or cause disease.

• The protein encoded by nef, for instance,
appears necessary for the virus to replicate
efficiently, and the vpu-encoded protein
influences the release of new virus particles
from infected cells.[
• The ends of each strand of HIV RNA contain
an RNA sequence called the long terminal
repeat (LTR). Regions in the LTR act as
switches to control production of new viruses
and can be triggered by proteins from either
HIV or the host cell
• activation of transcription from the human
immunodeficiency virus type 1 (HIV-1)
promoter by the viral Tat protein

87. Neutrophils are attracted to an infected
area by:
B. IgM
C. CI
D. C5a
E. C8
Ans c

• The classical pathway is
triggered by activation
of the C1-complex
(which consists of one
molecule C1q and two
molecules C1r and C1s),
either by C1q's binding
to antibodies from
classes M and G,
complexed with antigens
(a single molecule of
IgM is enough to initiate
the pathway. IgG is less
efficient, requiring more
molecules to do so), or
by C1q binding directly
to the surface of the
pathogen

• The alternative pathway is
triggered by C3 hydrolysis
directly on the surface of a
pathogen. It does not rely on
a pathogen-binding protein
like the other pathways.[
• In the alternative pathway, the
protein C3 is produced in the
liver, and is then cleaved into
C3a and C3b by enzymes in
the blood. If there is no
pathogen in the blood, the C3a
and C3b protein fragments
will be deactivated
• C3b binds to the surface of pathogens leading to
greater internalization by phagocytic cells by
opsonization
• C5a is an important chemotactic protein, helping
recruit inflammatory cells.
• Both C3a and C5a have anaphylatoxin activity,
directly triggering degranulation of mast cells as
well as increasing vascular permeability and smooth
muscle contraction.
• C5b initiates the membrane attack pathway,
which results in the membrane attack complex
(MAC), consisting of C5b, C6, C7, C8, and
polymeric C9.[

• MAC is the cytolytic endproduct of the
complement cascade; it forms a
transmembrane channel, which causes
osmotic lysis of the target cell

88. Natural killer cells are:
B. B cells that can kill without complement
C. Cytotoxic T cells
D. Increased by immunisation
E. Able to kill virus infected cells without prior
sensitization
Ans d

• Natural killer cells (or NK cells) are a type of
cytotoxic lymphocyte that constitute a major
component of the innate immune system.
• NK cells play a major role in the rejection
of tumors and cells infected by viruses.
• The cells kill by releasing small cytoplasmic
granules of proteins called perforin and
granzyme that cause the target cell to die by
apoptosis.

• NK-cells are defined as large granular
lymphocytes that do not express T-cell
antigen receptors (TCR) or Pan T marker
CD3 or surface immunoglobulins (Ig) B
cell receptor but that usually express the
surface markers CD16 (FcγRIII) and
CD56 in humans,

not any more that
They are discovered to be
natural
• They were named "natural killers"
because of the initial notion that they do
not require activation in order to kill cells
that are missing "self" markers of major
histocompatibility complex (MHC) class I.
However, it
is now known that
the cells are activated.
• NK cells are activated in response to
interferons or macrophage-derived
cytokines. They serve to contain viral
infections while the adaptive immune
response is generating antigen-specific
cytotoxic T cells that can clear the infection.
Patients deficient in NK cells prove to be
highly susceptible to early phases of herpes
virus infection.

Given their strong cytolytic activity and the potential for auto-
reactivity, Natural Killer cell activity is tightly regulated.
Natural Killer cells must receive an activating signal, which
can come in a variety of forms, the most important of which are
listed below.
Cytokines'
• The cytokines play a crucial role in NK-cell activation. As these are stress-molecules,
released by cells upon viral infection, they serve to signal to the NK-cell the presence of
viral pathogens.
'Fc Receptor'
• NK-cells, along with macrophages and several other cell types, express the FcR molecule,
an activating biochemical receptor that binds the Fc portion of antibodies. This allows
Natural Killer cells to target cells against which a humoral response has been mobilized
and to lyse cells through Antibody-dependant cellular cytotoxicity (ADCC).
'Activating and inhibitory receptors'

• Aside from the Fc receptor, Natural Killer cells express a variety of receptors that serve to
either activate or suppress their cytolytic activity. These receptors bind to various ligands
on target cells, both endogenous and exogenous, and have an important role in regulating
the NK-cell response

89. Antigen presenting cells that activate
helper T cells must express which one of
the following on their surfaces:
B. IgE
C. Gamma interferon
D. Class I MHC antigens
E. Class II MHC antigens
Ans d

Antigen presentation stimulates T cells to become either
"cytotoxic" CD8+ cells or "helper" CD4+ cells.

Function of T helper cells: Antigen presenting cells (APCs) present
antigen on their Class II MHC molecules (MHC2).
Helper T cells recognize these, with the help of their expression of CD4
co-receptor (CD4+).

The activation of a resting helper T cell causes it to release cytokines and
other stimulatory signals (green arrows) that stimulate the activity of
macrophages, killer T cells and B cells, the latter producing
antibodies.

90. Complement lysis cell by:
B. Enzymatic digestion of the cell membrane
C. Activation by Adenyl ctyclase
D. Insetion of complement proteins into the
cell membrane
E. Inhibition of elongation factor 2
ANS C

• The membrane attack complex (MAC) is
typically formed on the surface of
intruding pathogenic bacterial cells as a
result of the activation of the complement
system, and it is one of the ultimate weapons
of the immune system

• It is composed of a complex of four
complement proteins (C5b, C6, C7, and C8)
which bind to the outer surface of the plasma
membrane, and many copies of a fifth protein
(C9) that hookup to one another, forming a ring in
the membrane. C6-C9 all contain a common
MACPF domain.
• This region is homologous to cholesterol
dependent cytolysins from Gram positive
bacteria.

The ring structure acts as a tunnel through the membrane,
allowing free diffusion of molecules in and out of the cell,
which disrupts the internal environment of the cell, killing it
quickly.

The MAC acts, analogically, like an oil rig by drilling into
the cell and having the contents come out.

91. A Medical student becomes extremely
anxious a night before biochemistry exam
and beings to hyperventilate
uncontrollably. Which initial effects does
hyperventilation have on students PCO2
and blood PH?
• No effect
• PCO2 and PH increases
• PCO2 decreases and PH increases
• PCO2 decreases and PH decreases
AnsDreamz
c Learning Page 296
92. Which of the following statement best
characterizes glucose?
B. It usually exists in furanose form
C. It is a Ketose
D. Carbon 2 is the anomeric carbon atom
E. It is a reducing sugar
Ans d

• Glucose is by far the most common
carbohydrate and classified as a
monosaccharide, an aldose, a hexose,
and is a reducing sugar

• In sugar chemistry, an anomer is a special
type of epimer.
• It is a stereoisomer (diastereomer, more
exactly) of a saccharide (in the cyclic form)
that differs only in its configuration at the
hemiacetal (or hemiketal) carbon, also
called the anomeric carbon. If the structure is
analogous to one with the hydroxyl group on
the anomeric carbon in the axial position of
glucose, then the sugar is an alpha anomer. If,
however, that hydroxyl is in the equatorial
position, then the sugar is a beta anomer.

• For example, α-D-glucopyranose and β-D-glucopyranose,
the two cyclic forms of glucose, are anomers

93. The glycolytic pathway requires which of the following
allosteric regulatory enzymes?
B. Glucokinase, Phosphofructokinase and pyruvate
kinase
C. Hexokinase, Aldolase and Pyruvate Kinase
D. Hexokinase, glyceraldehyde 3 – phosphate
dehydrogenase and enolase
E. Hexokinase Phosphofructokinase and pyruvate
kinase
Ans d

• Flux through a metabolic pathway can
be regulated in several ways:
– 1. Availability of substrate
– 2. Concentration of enzymes responsible
for ratelimiting steps
– 3. Allosteric regulation of enzymes
– 4. Covalent modification of enzymes (e.g.
phosphorylation)

• Of the 10 steps in the glycolytic
pathway, three involve large negative ∆
G and are essentially irreversible.
– These are steps 1 (phosphorylation of
glucose), 3 (phosphorylation of fructose6
phosphate) and 10 (transfer of phosphate
from phosphoenolpyruvate to ADP).

• The enzymes responsible for catalyzing
these three steps, hexokinase (or
glucokinase) for step 1,
phosphofructokinase for step 3, and
pyruvate kinase for step 10, are the
primary steps for allosteric enzyme
regulation

94. The synthesis of 1.25
dihydroxycholecalciferol takes place:
B. In the skin under the action of ultra violet
light from 7 – dehydrocholesterol
C. In the liver from Cholecalciferol
D. In the Kidney from 25-
hydroxycholecalciferol
E. In the Intestine from Cholecalciferol
Ans c

• 25-hydroxycholecalciferol is further
hydroxylated in the kidneys by the enzyme
1α-hydroxylase, into two dihydroxylated
metabolites, the main biologically active
hormone 1,25-dihydroxycholecalciferol
(1,25(OH)2D3 or calcitriol) and
24R,25(OH)2D3.
• This conversion occurs in a tightly regulated
fashion.
95. Quantitatively the most important enzyme
involved in generating Ammonia from
Aminoacids in human is :
B. Alpha – amino acid oxidase
C. C – Arginase
D. Glutamate dehydrogenase
E. Glutamine synthetase
Ans d

• Glutamate dehydrogenase is an enzyme,
present in mitochondria of eukaryotes, as are
some of the other enzymes required for
urea synthesis, that converts glutamate to
α-Ketoglutarate, and vice versa. The
produced ammonia is, however, usually bled
off to the urea cycle.

reaction catalyzed by glutamate
dehydrogenase is:

• Its cofactor for the glutamate to α-
Ketoglutarate reaction, which produces
ammonium as a byproduct, is NAD+(or
NADP+).

96. To what metabolic intermediate is ethanol
normally converted?
B. Pyruvate
C. Acetyl CoA
D. Glucose
E. Phosphoenol pyruvate
Ans b

• Ethanol to Acetaldehyde
– alcohol dehydrogenase
• Acetaldehyde to Acetic
Acid
• Acetic Acid to Acetyl-
CoA

97. Which of the following statement is
correct?
B. The Alpha helix can be composed of more
than one polypeptide chain
C. Beta – sheets exist only in the anti- parallel
form
D. Beta bends often contain proline
E. Domains are a type of secondary structure
Ans c

• Each of the beta-bends contains a
proline residue at one of the corners

The quaternary structure is that level of form in which units
of tertiary structure aggregate to form homo- or hetero-
multimers. This is found to be remarkably common,
especially in the case of enzymes
• Covalently-connected tertiary domains

– In this class of protein, domains are usually formed as
modules covalently "strung together" on a single
polypeptide chain. The individual chains of antibodies
are like this, strings of immuno-globulin domains.
However, light and heavy chains then combine to
produce hetero-multimers, which may even associate
into higher complexes, as with IgM

98. All of the following are features of
Homocystinuria, except :
B. Accumulation of homocystine occurs in the
urine
C. Elevation of Methyl Malonyl CoA occurs
D. It is due to the Deficiency of Cystathionine
synthase
E. Mental retardation, Osteoporosis,
myocardial Infarction and Characteristic
dislocation of the lens
Ans b
• Homocystinuria, also known as Cystathionine
beta synthase deficiency, is an inherited disorder
of the metabolism of the amino acid
methionine, often involving cystathionine beta
synthase.
• It is an inherited autosomal recessive trait, which
means a child needs to inherit the defective gene
from both parents to be affected.

• This defect leads to a multisystemic disorder
of the connective tissue, muscles, CNS, and
cardiovascular system.
– Homocystinuria represents a group of
hereditary metabolic disorders characterized by
an accumulation of homocysteine in the
serum and an increased excretion of
homocysteine in the urine

Clinical features of Homocystinuria
• A family history of homocystinuria
• Nearsightedness
• Flush across the cheeks
• Tall, thin build
• Long limbs
• High-arched feet (pes cavus)
• Knock-knees (genu valgum)
• Pectus excavatum
• Pectus carinatum
• Mental retardation
• Psychiatric disease
• Eye anomalies:
• 90% have ectopia lentis
• Myopia
• Glaucoma
• Optic atrophy
• Seizure
• extensive atheroma formation at young age which affects many arteries but not the
coronary arteries

99. A four year old boy of first degree consanguinous couple was
noted by the parents to have darkening of the urine to an
almost black colour when it was left standing. He had
normal sibling and there was no other medical problem.
Childhood growth and development were normal. Which of
the following is most likely to be elevated in this patient?
B. Methyl Malonate
C. Hemogentisate
D. Phenyl pyruvate
E. Alpha – Keto isovalerate
Ans b

100. An individual with Insulin Resistance:
B. Usually shows normal fasting glucose
levels
C. Usually shows elevated fasting insulin
levels
D. Is treated by injection of insulin
E. Is rarely obese
Ans b

• Elevated levels of fasting insulin
serve as reasonably reliable single-
sample measures of insulin resistance
in nondiabetic populations

101. Which of the following statement is not
true?
B. Glutathione is an intracellular reducing
agent
C. Involved in the transport of certain
Aminoacids into the cells
D. It is a dipeptide
E. It is necessary for the reaction catalysed
by glutathione peroxidase
Ans c

• Glutathione (GSH) is a tripeptide.
• It contains an unusual peptide linkage
between the amine group of cysteine and the
carboxyl group of the glutamate side chain.
Glutathione, an antioxidant, protects cells
from toxins such as free radicals

• Thiol groups are kept in a reduced state within ~5 mM in
animal cells. In effect, glutathione reduces any disulfide
bonds formed within cytoplasmic proteins to cysteines
by acting as an electron donor. Glutathione is found
almost exclusively in its reduced form, since the
enzyme that reverts it from its oxidized form
(GSSG), glutathione reductase, is constitutively active
and inducible upon oxidative stress. In fact, the ratio of
reduced glutathione to oxidized glutathione within cells
is often used scientifically as a measure of cellular
toxicity.

• Excess glutamate at synapses, which may
be released in conditions such as
traumatic brain injury, can prevent the
uptake of cysteine, a necessary building
block of glutathione. Without the
protection from oxidative injury afforded by
glutathione, cells may be damaged or killed

102. Which of the following statement
regarding the action of Aspirin is true?
B. It is a specific inhibitor of P2 Y2 receptor
for ADP
C. It interferes with fibrinogen binding
D. It inhibits platelet cyclo – oxygenase
system by irreversible acetylation
E. It prevents fibrinolysis
Ans c

• Aspirin's ability to suppress the production of
prostaglandins and thromboxanes is due to its irreversible
inactivation of the cyclooxygenase (COX) enzyme.
Cyclooxygenase is required for prostaglandin and
thromboxane synthesis. Aspirin acts as an acetylating agent
where an acetyl group is covalently attached to a serine
residue in the active site of the COX enzyme. This makes
aspirin different from other NSAIDs (such as diclofenac and
ibuprofen), which are reversible inhibitors.
• Low-dose, long-term aspirin use irreversibly blocks the
formation of thromboxane A2 in platelets, producing an
inhibitory effect on platelet aggregation

103. A ten year old girl is brought to the Dermatologist by her
parents. She has many freckles on her face, neck arms and
hands and parent report that she is sensitive to sunlight. Two
basal cell carcinomas are identified on her face. Which of the
following is most likely to be defective in this patient?
B. Repair of double strand breaks
C. Removal of mismatched bases from 3’ end of Okazaki
fragments
D. Removal of Pyrimidine dimer from DNA
E. Removal of Uracil from DNA
Ans c

104. Many anti – microbials inhibit protein translation.
Which of the following antimicrobial is correctly based
with its mechanism of action?
• Tetracycline inhibit peptidyl transferase
• Diphtheria toxin binds to 30 s Ribosomal subunit
• Puromycin inactivates ECF2
• Erythromycin binds to 50 S Ribomal subunit
• Ans d

• Tetracycline inhibits cell growth by
inhibiting translation.
– It binds to the 16S part of the 30S ribosomal
subunit and prevents the amino-acyl tRNA
from binding to the A site of the ribosome.
The binding is reversible in nature.

• The Peptidyl transferase is an
aminoacyltransferase and the primary enzymatic
function of the ribosome which forms peptide links
between adjacent amino acids using tRNAs during
the translation process of protein biosynthesis.
• Peptidyl transferase activity is carried out by the
ribosome, and in particular, an RNA (not a protein)
component of the ribosome. There are few protein
complexes that act as peptidyl tranferases.
Chloramphenicol binds to A2451 and
A2452 residues in the 23S rRNA of the ribosome
and inhibits peptide bond formation.

Diphtheria toxin
• It catalyzes the ADP-ribosylation eukaryotic

elongation factor-2 (eEF2), inactivating this
protein. It does so by ADP-ribosylating the
unusual aminoacid diphthamide. In this way,
it acts as a RNA translational inhibitor.
The exotoxin A of Pseudomonas aeruginosa
uses a similar mechanism of action.

• Erythromycin may possess bacteriocidal
activity, particularly at higher concentration
• By binding to the 50S subunit of the bacterial 70S rRNA
complex, protein synthesis and subsequently structure/function
processes critical for life or replication are inhibited
• Erythromycin interferes with aminoacyl
translocation, preventing the transfer of the
tRNA bound at the A site of the rRNA complex to
the P site of the rRNA complex.
• Without this translocation, the A site remains occupied and thus the
addition of an incoming tRNA and its attached amino acid to the
nascent polypeptide chain is inhibited. This interferes with the
production of functionally useful proteins and is therefore the basis
of antimicrobial action.

105. In which of the following tissues is
glucose transport into cells enhanced by
Insulin?
B. Brain
C. Lens
D. Red blood cells
E. Adipose tissue
Ans d

106. Which one of the following statements is not true?
B. In the liver bilirubin is made water soluble by
conjugation with two molecules of glucuronic acid and
is secreted into Bile
C. In obstructive jaundice urine urobilinogen and fecal
urobilinogen are absent
D. In Haemolytic jaundice ‘direct’ serum Bilirubin is
increased
E. Rota syndrome is a begin condition where liver
histology may be normal
Ans c

107. True statement about the for Na+ - K+ transport
pump:
B. 2 sodium ions are exchanged for 3 potassium ions
C. 3 sodium ions are exchanged for 2 potassium ions
D. 1 sodium ion is exchanged for 1 potassium ion
E. 2 sodium ions are exchanged for 2 potassium ions
Ans b

The Na+/K+-ATPase helps maintain resting potential, avail
transport and regulate cellular volume.[

The pump, with bound ATP, binds 3 intracellular Na+ ions.
• ATP is hydrolyzed, leading to phosphorylation of the pump
at a highly conserved aspartate residue and subsequent
release of ADP.[citation needed]
• A conformational change in the pump exposes the Na+ ions
to the outside. The phosphorylated form of the pump has a
low affinity for Na+ ions, so they are released.[citation
needed]
• The pump binds 2 extracellular K+ ions. This causes the
dephosphorylation of the pump, reverting it to its previous
conformational state, transporting the K+ ions into the
cell.[citation needed]
• The unphosphorylated form of the pump has a higher
affinity for Na+ ions than K+ ions, so the two bound K+
ions are released. ATP binds, and the process starts again

Pump, with bound ATP, binds 3 intracellular Na+ ions.
The pump binds 2 extracellular K+ ions.

108. Resting membrane potential of a large
nerve is :
B. -55 mv
C. -90 mv
D. +60 mv
E. +70 mv
Ans b

• The resting potential of a cell is the membrane potential
that would be maintained if there were no action potentials,
synaptic potentials, or other active changes in the
membrane potential.
• In most cells the resting potential has a
negative value of ~-70mV, which by convention
means that there is excess negative charge inside
compared to outside. The resting potential is mostly
determined by the concentrations of the ions in the fluids on
both sides of the cell membrane and the ion transport
proteins that are in the cell membrane. How the
concentrations of ions and the membrane transport proteins
influence the value of the resting potential is outlined
below.

• Most nerve cells have steady Resting
Membrane Potential (RMP) of from
- 50 to - 90 mV,

109. Monocytes do not participate in one of
the following functions:
B. Originate from the precursons of bone
marrow
C. Ingest dead granulocytes
D. Migrate from blood into tissues
E. Manufactures immunoglobulin
Ans c

• Monocyte is a leukocyte, part of the human
body's immune system.
• Monocytes have two main functions in the
immune system:
– (1) replenish resident macrophages and dendritic
cells under normal states, and
– (2) in response to inflammation signals,
monocytes can move quickly (aprox. 8-12 hours)
to sites of infection in the tissues and derive into
macrophages and dendritic cells to elicit an
immune response

• Monocytes are produced by the bone marrow
from haematopoietic stem cell precursors
called monoblasts.
• Monocytes circulate in the bloodstream for
about one to three days and then typically
move into tissues throughout the body. They
constitute between three to eight percent of the
leukocytes in the blood. In the tissues monocytes
mature into different types of macrophages at
different anatomical locations.

Monocytes are usually identified in stained smears by
their large bilobate nucleus.

110. Intrinsic factor of Castle is secreted by:
B. Parietal cell
C. Chief cell
D. Neuroglial cell
E. Nerve cell
Ans a

• intrinsic factor
– A relatively small mucoprotein secreted
by the parietal cells of gastric glands

111. Which law describes the relationship
between wall tension and vessel wall
radius?
B. Poiseuille’s law
C. Ohm’s law
D. Frank sterling law
E. Laplace law
Ans d

• Laplace's law
• The equilibrium relationship between
transmural pressure difference (dP), wall
tension (T), and radius of curvature (R) in
a concave surface;
– for a sphere: dP = 2T/R; for a cylinder: dP =
T/R.

Poiseuille's law
• The law that the volume flow of an

incompressible fluid through a circular
tube is equal to π/8 times the pressure
differences between the ends of the tube, times
the fourth power of the tube's radius divided by
the product of the tube's length and the
dynamic viscosity of the fluid.

112. True statement about Nitric oxide:
B. Also known as endothelium derived
relaxing factor (EDRF)
C. Deficiency is associated with hypotension
D. Produces smooth muscle relaxation
throughout the body
E. Play no role in formation of new blood
vessels
Ans a

• Endothelium-derived relaxing factor (EDRF) is
nitric oxide produced and released by the
endothelium that results in smooth muscle
relaxation. It is released in response to a variety of
chemical and physical stimuli. It causes the smooth
muscle in the vessel wall to relax by activating the
soluble guanylate cyclases (sGC), increasing the
cyclic guanosine monophosphate (cGMP)
concentration and activating the protein kinase G,
resulting in vasodilation. It is also the active
substance absorbed into the blood stream by people
using nitroglycerin tablets or spray under their
tongue, by patch, pill or intravenous infusion of
nitroglycerin.
113. Which component of the cardiac tissue
has the highest propagation velocity?
B. Purkinje fibers
C. A-V Node
D. Atrial Muscle
E. Ventricular Muscle
Ans a

• An action potential in one muscle cell is
propagated to adjacent muscle cells via direct
electrotonic propagation across the gap
junctions. The gap junctions cause every cell in
the heart to be electrically coupled to its
neighboring cells and that is what causes the
heart to behave like a single motor unit.
Theoretically, an ion inside an SA nodal cell
could travel through every cell in the heart
without ever having to enter the extracellular
space.

• The Purkinje cells are still muscle cells but contain
fewer contractile proteins than contractile cells. They
are specialized not for contraction but, rather, for fast
electrical propagation.
– The large diameter of the Purkinje cells gives them a
high conduction velocity. (the greater the diameter of a
nerve axon, the greater the propagation velocity of nerve
action potentials.)
– A Purkinje fiber has a particularly high density of gap
junctions between its cells, and they will conduct action
potentials at about 4 m/sec over the ventricle.
– Atrial and ventricular muscle cells on the other hand
conduct at only 1 m/sec.

114. Einthoven’s law states:
B. The sum of electrical potentials in leads I
and III equals the potential in lead II
C. The difference in electrical potential in two
standard leads in equal to the third
D. The product of electrical voltage difference
between two leads is equal to third
E. None of the above
Ans a

• Lead I was a recording of the cardiac
potentials between RA and LA.
• Lead II = recording between RA and LL.
• Lead III = recording between LA and LL.
Einthoven's law- Lead I + Lead III = Lead II

115. Goldblatt hypertension:
B. Hypertension that occurred in Goldblatt
C. Hypertension in response to renal vascular
obstruction
D. Hypertension in diabetes patients
E. Hypertension due to excess of aldosterone
Ans b

116. Total surface area of the alveoli contact
with capillaries:
B. 10 square meters
C. 30 square meters
D. 70 square meters
E. 120 square meters
Ans c

• The lungs contain about 300 million alveoli
representing a total surface area of approx.
70-90 square meters (m2).

117. Macula densa is located in :
B. Proximal convoluted tubule
C. Thick ascending limb of the loop of Henle
D. Descending limb of the loop of Henle
E. Collecting tubule
Ans b

• In the kidney, the macula densa is an area of
closely packed specialized cells lining the
wall of the distal convoluted tubule (DCT) at
the point of return of the nephron to the
vascular pole of its parent glomerulus
glomerular vascular pole
• The macula densa is a specialized
patch of epithelial cells located in the
distal portion of the thick ascending
limb of Henle's loop.

cells of the macula densa are sensitive to the ionic content and
water volume of the fluid in the DCT, producing molecular
signals that promote renin secretion by other cells of the
juxtaglomerular apparatus

• Renin production by the kidney
occurs at the juxtaglomerular
apparatus. The components of this
structure are the macula densa of
the distal convoluted tubule,
the afferent and efferent arterioles
and the mesangium

• The.[1] The release of renin is an essential
component of the renin-angiotensin-
aldosterone system (RAAS), which
regulates blood pressure and volume.

118. ADH causes :
B. Increased water excretion
C. Increased absorption of water along with
solute from DCT
D. Increased permeability of collecting ducts
of the Kidneys and water enters the
hypertonic interstitium
E. Increased permeability of initial portion of
DCT to water by insertion of Aquaporin – 4
Ans d

• Kidney
• AVP increases the permeability to water of the distal
convoluted tubules and collecting tubules in the nephrons of
kidneys and thus allows water reabsorption and excretion of
a smaller volume of concentrated urine - antidiuresis. This
occurs through insertion of additional water
channels (aquaporins) into the apical
membrane of the duct epithelial cells. V2
receptors, G protein-coupled receptors coupled to Gs, on the
basolateral membrane of the cells lining the distal convoluted
tubules and conducting tubules (in the nephron) have an active
site for AVP. The G protein, which is in contact with the V2
receptor inside the cell, move to adenylyl cyclase, triggering
adenylyl cyclase to convert ATP into cAMP, plus 2 inorganic
phosphates.

• The repressor protein that regulates the gene for protein
kinase A (PKA) has a binding site for cAMP, causing the
repressor protein to change its shape and leave the operator
region of the gene. This allows for transcription of the gene
for PKA. PKA then signals ATP to dephosphorylate,
providing energy for vesicles (which contain aquaporin
channel proteins in their their membranes) to fuse with the
apical membrane of the cell. The aquaporin allow water to
pass out of the nephron (at the distal convoluted tubules and
the conducting tubules) and into the cell, increasing the
amount of water re-absorbed from the filtrate.

• AVP also increases permeability of the
medullary portion of the collecting duct to
urea, allowing increased reabsorption of
urea into the medullary interstitium, down
the concentration gradient created from the
removal of water in the cortical collecting
duct

119. Time period of spermatogenesis from
germinal cell to sperm:
B. 24 days
C. 45 days
D. 74 days
E. 81 days
Ans c

• In mammals it occurs in the male testes and
epididymis in a stepwise fashion, and for
humans takes approximately 64 days

120. Barr body genetically represents:
B. Inactive X chromosome
C. Inactive Y chromosome
D. Active X chromosome
E. Active Y chromosome
Ans a

121. Colour pigments in cones are all, except
–
B. Red
C. Blue
D. Green
E. Yellow
Ans d

122. Parasympathetic stimuation causes
vasodilatation in penis by secretion of:
B. Acetylcholine
C. Nitric oxide
D. Epinephrine
E. Norepinephrine
Ans b

• NO is produced in the penis in response
to parasympathetic stimulation

123. Cricothyroid muscle is
B. An abductor of vocal cords
C. An adductor of vocal cords
D. A tensor of vocal cords
E. Is supplied by recurrent laryngeal nerve
Ans c

• The cricothyroid muscle
attaches to the anterolateral
aspect of the cricoid and the
inferior cornu and lower
lamina of the thyroid
cartilage, tilting the thyroid
forwards and tensing the
vocal cords. It is the only
laryngeal muscle supplied by
the external laryngeal nerve
(rather than the recurrent
laryngeal nerve).
• The Cricothyreoidei produce tension and
elongation of the vocal folds by drawing up
the arch of the cricoid cartilage and tilting
back the upper border of its lamina; the
distance between the vocal processes and the
angle of the thyroid is thus increased, and
the folds are consequently elongated.

124. Ansa cervicalis nerve has its root of
origin from:
• XI cranial nerve
• XII cranial nerve
• 1st and 2nd cervical spinal nerve
• 3rd and 4th cervical spinal nerve
Ans c

• The ansa cervicalis is a loop of nerves that are part of the cervical
plexus.

• Branches from the ansa cervicalis innervate all but one of
the infrahyoid muscles, including the sternohyoid muscle,
the sternothyroid muscle, and the omohyoid muscle.
• The thyrohyoid muscle is innervated by C1 only.

125. All the following muscles have
attachment to humerus, except
B. Pectoralis major
C. Pectoralis minor
D. Teres major
E. Teres Minor
Ans b

• The Pectoralis minor is a thin, triangular
muscle, situated at the upper part of the chest,
beneath the Pectoralis major.

Origin and insertion
• It arises from the upper
margins and outer surfaces
of the third, fourth, and fifth
ribs, near their cartilage and
from the aponeuroses
covering the Intercostalis.
• The fibers pass upward and
lateralward and converge to
form a flat tendon, which is
inserted into the medial
border and upper surface
of the coracoid process of
the scapula.

126. All these following muscles can rotate
the femur laterally, except:
B. Gracilis
C. Sartorius
D. Pyriformis
E. Obturator internus
Ans a

• These are often divided into four groups
according to their orientation around the hip
joint: the gluteal group, the lateral rotator
group, the adductor group, and the
iliopsoas group.

Gluteal group
• The gluteal muscles
include the gluteus
maximus, gluteus
medius, gluteus
minimus, and tensor
fasciae latae. They cover the lateral
surface of the ilium. The gluteus maximus,
which forms most of the muscle of the buttock,
originates primarily on the ilium and sacrum and
inserts on the gluteal tuberosity of the femur as
well as the iliotibial tract, a tract of strong
fibrous tissue that runs along the lateral thigh to
the tibia and fibula. The gluteus medius and
gluteus minimus originate anterior to the gluteus
maximus on the ilium and both insert on the
greater trochanter of the femur. The tensor
fasciae latae shares its insertion with the gluteus
maximus at the ilium and also shares the
insertion at the iliotibial tract.
Adductor group
• The adductor brevis,
adductor longus,
adductor magnus,
pectineus, and gracilis
make up the adductor
group. The adductors
all originate on the
pubis and insert on the
medial, posterior surface
of the femur, with the
exception of the gracilis
which inserts just below
the medial condyle of
the tibia.
Iliopsoas group
• The iliacus and psoas major
comprise the iliopsoas group.
The iliopsoas is a large muscle
that runs from the transverse
processes of the T-12 to L-5
vertebrae, joins with the
iliacus via its tendon, and
connects to the lesser
trochanter of the femur. The
iliacus originates on the iliac
fossa of the ilium. Together
these muscles are commonly
referred to as the "iliopsoas".

• Lateral rotator group
• This group consists of the externus and
internus obturators, the piriformis, the
superior and inferior gemelli, and the
quadratus femoris.
– These six originate at or below the acetabulum
of the ilium and insert on or near the greater
trochanter of the femur.

Sartorius Actions
• Assists in flexion,
abduction and
lateral rotation of
hip, and flexion and
medial rotation of
knee.
• Looking at the
bottom of one's foot,
as if one were
checking to see if
one had stepped in
gum, demonstrates
all 5 actions of
sartorius.
• The Gracilis (Latin:
slender) is the most
superficial muscle on the
medial side of the thigh.
It is thin and flattened,
broad above, narrow and
tapering below. It arises by
a thin aponeurosis from the
anterior margins of the
lower half of the
symphysis pubis and the
upper half of the pubic
arch
• Action. Adducts hip.
Flexes knee and med
rotates flexed knee

127. All the following are derived from neural
crest cells, except
B. Melanocytes
C. Autonomic neurons
D. Sensory neurons
E. Motor neurons
Ans

• Neural Crest - Head (see also Head Development
Notes)
Mesencephalon and caudal Proencephalon
• parasympathetic ganglia CN III
• connective tissue around eye and nerve
• head mesenchyme
• pia and arachnoid mater
• dura from mesoderm

Mesencephalon and Rhombencephalon
• pharayngeal arches
• look at practical notes on neck and head.
• cartilage rudiments (nose, face, middle ear)
• face
• dermis, smooth muscle and fat
• odontoblasts of developing teeth
Rhombencephalon
• C cells of thyroid
• cranial nerve ganglia
• neurons and glia
• parasympathetic of VII, IX, X
• sensory ganglia of V, VII, VIII, IX, X

Neural Crest- Spinal Cord
• peripheral nervous system
• dorsal root ganglia (sensory N)
• parasympathetic ganglia
• sympathetic ganglia
• motoneurons in both ganglia
• all associated glia
Derivatives of Neural Crest Cells -Summary
• Spinal ganglia (prevertebral/paravertebral)
• Ganglia of the autonomic nervous system (ANS)
• Ganglia of cranial nerves V, VII, IX, X
• Sheaths of peripheral nerves
• Meningeal coverings of brain and spinal cord
• Pigment cells (melanocytes)
• Adrenal medulla
• Odontoblasts of tooth
• Other components of head

• The neural crest, a transient component of the ectoderm,
is located in between the neural tube and the epidermis
(or the free margins of the neural folds) of an embryo
during neural tube formation. Neural crest cells quickly
migrate during or shortly after neurulation, an embryological
event marked by neural tube closure.
• has been referred to as the fourth germ layer, due to its
great importance. The neural crest can give rise to neurons
and glia of the autonomic nervous system (ANS); some
skeletal elements, tendons and smooth muscle;
chondrocytes, osteocytes, melanocytes, chromaffin cells,
and supporting cells and hormone producing cells in certain
organs

128. Myelination of axons in Spinal cord is
done by:
B. Schwann cells
C. Fibrous astrocytes
D. Oligo dendrocytes
E. Protoplasmic astrocytes
Ans a

• Schwann cells (also referred to as
neurolemmocytes) are a variety of glial cell
that mainly provide myelin insulation to axons
in the peripheral nervous system

129. Portal vein is formed by union of:
B. Splenic vein and gastro duodenal vein
C. Splenic vein and superior mesenteric vein
D. Splenic vein and inferior mesenteric vein
E. Superior mesenteric vein and inferior
mesenteric vein
Ans b

Portal vein can refer to:
• the hepatic portal vein,
a large vein that
carries blood from the
digestive tract to the
liver and is formed by
the splenic vein and
superior mesenteric
vein

130. All the following are totally covered by
peritoneum, except –
B. Rectum
C. Sigmoid colon
D. Transverse colon
E. Iieum
Ans a

Transverse colon
• The transverse colon is the part of the colon from
the hepatic flexure (the turn of the colon by the
liver) to the splenic flexure (the turn of the colon by
the spleen). The transverse colon hangs off the
stomach, attached to it by a wide band of tissue
called the greater omentum. On the posterior side,
the transverse colon is connected to the posterior
abdominal wall by a mesentery known as the
transverse mesocolon.
• The transverse colon is encased in peritoneum,

and is therefore mobile (unlike the parts of the
colon immediately before and after it).
• Structures that lie behind the peritoneum are termed "retroperitoneal". These
include:
Primarily retroperitoneal:
• urinary
– adrenal glands
– kidneys
– ureter
– bladder
• circulatory
– aorta
– inferior vena cava
• digestive
– esophagus (part)
– rectum
• Reproductive
– uterus
• Secondarily retroperitoneal:
– the head and neck of the pancreas (but not the
tail)
– the second and third portions of the duodenum
(but not the first or fourth)
– ascending and descending portions of the colon
(but not the transverse or sigmoid)

131. Herring bodies are seen in –
B. Pars anterior
C. Pars intermedius
D. Pars tuberalis
E. Pars posterior
Ans d

• Herring bodies are structures found in the
posterior pituitary.
– They represent the terminal end of the axons from the
hypothalamus, and hormones are temporarily stored
in these locations.
• ADH and oxytocin are both stored in Herring

bodies, but are not stored simultaneously in the
same Herring body

132. The blood supply of lung tissue proper is
by:
B. Pulmonary veins
C. Pulmonary arteries
D. Interocostal arteries
E. Bronchial arteries
Ans d

133. Fallot’s Tetralogy consists of all, except –
B. Ventricular septal defect
C. Right ventricular hypertrophy
D. Pulmonary stenosis
E. Left ventricular hypertrophy
Ans d

134. Sex determining region of “Y”
chromosome is located on:
B. ‘p’ arm of ‘Y’ chromosome
C. ‘q’ arm of ‘Y’ chromosome
D. Nuclear zone
E. Telemere of ‘Y’ chromosome
Ans a

• The SRY gene encodes the testis determining factor,
which is also referred to as the SRY protein.
• This intronless gene encodes a transcription factor
that is a member of the high mobility group (HMG)-
box family of DNA-binding proteins. This protein is
the testis-determining factor (TDF), which initiates
male sex determination.
• Mutations in this gene give rise to XY females with
gonadal dysgenesis (Swyer syndrome); translocation
of part of the Y chromosome containing this gene to
the X chromosome causes XX male syndrome
• sex-determining regions of the short arm of the
human Y chromosome

135. The following nuclei belong to the basal
ganglia, except
B. The substantia nigra
C. Amygdaloid nuclear complex
D. Caudate nucleus
E. Lentiform nucleus
Ans b

• The basal ganglia (or basal nuclei) are a
group of nuclei in the brain interconnected
with the cerebral cortex, thalamus and
brainstem.
• Mammalian basal ganglia are associated
with a variety of functions: motor control,
cognition, emotions, and learning.

• The five individual nuclei that make up the
primate basal ganglia, along with their major
subdivisions, are:
• rostral
– the striatum, which consists of
• putamen
• caudate nucleus
• nucleus accumbens
– external segment of the globus pallidus (GPe)
– internal segment of the globus pallidus (GPi)

Caudal
subthalamic nucleus (STN)
substantia nigra (SN)
– substantia nigra pars compacta (SNc)
– substantia nigra pars reticulata (SNr)
– substantia nigra pars lateralis (SNl)

• lentiform nucleus or lenticular nucleus
comprises the putamen and the globus
pallidus within the basal ganglia.

136. Broca’s area occupies the:
B. Superior frontal gyrus
C. Inferior frontal gyrus
D. Superior temporal gyrus
E. Inferior temporal gyrus
Ans b

• Broca's area is a section of the human brain
that is involved in language processing,
speech or sign production, and
comprehension

Broca's area is located in the opercular and triangular sections
of the inferior frontal gyrus of the frontal lobe of the cortex.
Broca's and Wernicke's areas are found unilaterally in the brain
(left hemisphere).

• Broca's area comprises Brodmann area
44[ and (according to some authorities)
Brodmann area 45
• Broca's Area is connected to Wernicke's
area by a neural pathway called the
arcuate fasciculus

137. Cleft-lip is due to failure of union of:
B. Medial nasal process with maxillary process
C. Medial nasal process with lateral nasal process
D. Medial nasal process with frontonasal process
E. Medial nasal process with mandibular process
Ans a

• Lip cleft can occur as one sided (unilateral)
or two sided (bilateral).
• It is due to the failure of fusion of the
maxillary and medial nasal processes
(formation of the primary palate).

138. Following are the parts of Broad ligament, except:
• Ligament of ovary
• Mesovarium
• Suspensory ligament of ovary
• Mesosalpinx
Ans a

• The broad ligament of the uterus is the wide
fold of peritoneum that connects the sides of
the uterus to the walls and floor of the pelvis.

• The broad ligament may be divided into
three subcomponents\
• Mesometrium - the mesentery of the uterus;
the largest portion of the broad ligament
• Mesosalpinx - the part that surrounds the
uterine tube
• Mesovarium - the part that surrounds the
ovary

The contents of the broad ligament include the following:
• Reproductive
– Fallopian tube
– ovary
• vessels
– ovarian artery (is in suspensory ligament)
– uterine artery
• ligaments
– ovarian ligament
– round ligament of uterus
– suspensory ligament of the ovary

139. The “Theory of contagion” was
enunciated by:
B. Paracelsus
C. Louis Pasteur
D. Fracastorius
E. Charaka
Ans c

• Girolamo Fracastoro (also known as
Hieronymus Fracastorius), was born in
1478 in Verona, at that time still part of the
Republic of Venice, to a noble family.
• Fracastorius's theory of contagion
are remarkably modern except for his
idea that "germs" were chemical
substances
• FRACASTORO'S THEORY OF
CONTAGION

140. Physical Quality of Life Index does not
consider:
B. Infant Mortality rate
C. Life expectancy at age one
D. Life expectancy at birth
E. Literary
Ans c

• The physical quality-of-life index (PQLI) is
an attempt to measure the quality of life or
well-being of a country. The value is a
single number derived from basic literacy
rate, infant mortality, and life expectancy at
age one.

141. Prevalence is compared with:
B. Photograph
C. Film
D. Continuous record
E. None of these
Ans b

• The relationship between incidence (rate), point
prevalence (ratio) and period prevalence (ratio) is
easily explicated via an analogy with photography.
Point prevalence is akin to a flashlit
photograph: what is happening at this instant
frozen in time.
• Period prevalence is analogous to a long
exposure (seconds, rather than an instant)
photograph: the number of events recorded in the
photo whilst the camera shutter was open.
• In a movie each frame records an instant (point
prevalence); by looking from frame to frame one
notices new events (incident events) and can relate
the number of such events to a period (number of
frames)
Dreamz Learning-> incidence rate. Page 446
142. Secondary prevention includes:
B. Health promotion
C. Specific protection
D. Early diagnosis and treatment
E. Disability limitation and rehabilitation
Ans c

143. Killing power of a disease is represented
by:
B. Proportional mortality rate
C. Specific death rate
D. Case fatality rate
E. Standardized death rate
Ans c

144. Live vaccines include all, except:
B. Sabin vaccine
C. Salk vaccine
D. Measles vaccine
E. BCG vaccine
Ans b

• Salk's vaccine was composed of
"killed" polio virus,

145. The diagnostic power of the test is
reflected by:
B. Sensitivity
C. Specificity
D. Predictive value
E. Validity
Ans c

• In addition to sensitivity and
specificity, the performance of a
screening test is measured by its
“predictive value” which reflects the
diagnostic power of the test.

• The value of a diagnostic test is reflected by its
sensitivity, specificity and both positive and
negative predictive accuracies.
• Sensitivity and specificity reflect the validity of
the test, and they do not depend on the
incidence of mortality in the population.
• The predictive accuracies, on the other hand,
reflect the performance of the test in the
selected population, and depend on the
incidence of mortality.
146. The following are common complications
of Measles,except:
B. Diarrhea
C. Pneumonia
D. Sub-acute Sclerosing Pan Encephalitis
E. Otitis Media
Ans c

• . The most common complications are: measles-associated
diarrhoea, pneumonia and other respiratory complications and
otitis media.
The more serious are the neurological complications which include
febrile convulsions, encephalitis and sub-acute sclerosing pan-
encephalitis (SSPE). Subacute sclerosing panencephalitis is a
rare complication which develops many years after the initial
measles infection.
It is characterised by progressive mental deterioration leading to
paralysis, probably due to persistence of the virus in the brain. The
diagnosis of SSPE may be made early by the demonstration of
high levels of measles complement fixing antibodies in CSF and
serum. The frequency of SSPE is about 7 cases for each one
million cases of natural measles (19). Encephalitis is another
serious complication. It occurs in about 1 in 1000 cases. The cause
is unknown. Measles vaccination definitely constitutes a protection
against the neurological and other complications by preventing
natural measles from occurring

147. The percent body weight loss is severe
dehydration will be:
B. 2%
C. 5%
D. 8%
E. 10%
Ans d

148. In a stroke control programme, the first
priority is given to:
B. Control of arterial hypertension
C. Detection of Transient Ischemic Attacks
D. Control of Diabetes
E. Elimination of smoking
Ans a

• Stroke control
programme
• The aim of a stroke control
programme is to apply at community
level effective measures for the
prevention of stroke.
• The first priority goes to
control of arterial
hypertension which is a
major cause of stroke.

• As transcient ischaemic attacks (TIA) may be one of the
earliest manifestations of stroke, their early detection and
treatment is important for the prevention of stroke (2).
Control of diabetes, elimination of smoking, and
prevention and management of other risk factors at the
population level are new approaches. Treatment for acute
stroke is largely the control of complications. Facilities for
the long-term follow-up of patients are essential. The
education and training of health personnel and of the
public form an integral part of the programme. For any
such programme, reliable knowledge of the extent of the
problem in the community concerned is essential (2).

• In summary, control of stroke that was once
considered an inevitable accompaniment to
aging is now being approached through
primary prevention. It has generated the
hope that stroke can be tackled by
community health action.

149. Chikungunya fever is transmitted by all
the vectors, except:
B. Anopheles
C. Culex
D. Aedes
E. Mansonia
Ans a

• Chikungunya Fever
• A dengue-like disease caused by a group A
virus, the chikungunya virus and transmitted
by Aedes, Culex and Mcmsonia mosquitoes. It
is manifested by high fever and severe articular
pains in the limbs and spinal column
• . The virus was first isolated from patients and
mosquitoes during an epidemic in Tanzania in
1952-53. Chikungunya is a local word meaning
“doubling up” owing to excruciating joint pains.
150. Incubation period in Yellow Fever is:
B. 2 days
C. 3-6 days
D. 12-14 days
E. 30 days
Ans b

Incubation period - Yellow Fever
• 3 to 6 days (6 days recognized under

International Health Regulations).

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