Rx McQ's

AIIMS MD/MS 2013 MAY QUESTION NO. 3 TO 17

noreply@blogger.com (RxPPT) — Fri, 11 Oct 2013 12:45:00 +0000

3. Ridley Jopling classification is based on
a) Clinical, bacteriological, immunological
b) Clinical, histopathological, epidemiological
c) Clinical, histopathological, bacteriological
d) Clinical, bacteriological, epidemiological

Ans: a
RJ classification for Leprosy is based on Clinical (skin and nerve involvement), bacteriological (bacteriological/morphological index in skin and nasal smears) and immunological criteria (Lepromin test).

4. Meningococcal meningitis is called hyper-endemic when incidence is- a) <2/100,000 b) 2-10/ 100,000 c) >10/100,000 d) >100/ 100,000

Ans: c
WHO definition-
In the African meningitis belt, Epidemic - >100 cases/100 000 population/year
Endemic countries High endemicity (hyperendemic)->10 cases/100 000 population/year Moderate endemicity-2–10 cases/100 000 population/year Low endemicity- <2 cases/100 000 population/year
An outbreak outside the meningitis belt may be defined as a substantial increase in invasive meningococcal disease in a defined population above that which is expected by place and time.

5. Meningococcal vaccine is given in- a) Male persons aged 65 year or above with Diabetes Mellitus b) Children aged 4-8 years c) Paramedical working in testing labs d) Adolescents

Ans: c
Highly or moderately endemic countries
WHO recommends that countries with high (>10 cases/100 000 population/year) or intermediate endemic rates (2–10 cases/100 000 population/year) of invasive meningococcal disease and countries with frequent epidemics should introduce appropriate large- scale meningococcal vaccination programmes.
Low endemic countries
In countries where the disease occurs less frequently (<2 cases per 100 000 population/year), meningococcal vaccination is recommended for defined risk groups-
• Children and young adults residing in closed communities, e.g. boarding schools or military camp • Laboratory workers at risk of exposure to meningococci • Travellers to high-endemic areas • Individuals suffering from immunodeficiency, including asplenia, terminal complement deficiencies, or advanced HIV infection.
In Canada and the United States
Vaccines are recommended for
• Routine administration to adolescents aged 11–18 years* • Selective immunization of individuals aged 2–55 years who belong to certain high-risk groups (e.g. persons with asplenia or terminal complement deficiencies, advanced HIV infection, or laboratory personnel working with N. meningitidis).
*-In the United States it is also recommended that all previously vaccinated adolescents receive a booster dose of quadrivalent conjugate vaccine at 16 years of age.
Travel to Saudi Arabia
Vaccination is mandatory for all pilgrims ≥ 2 years to Mecca (Haj and Umra). It has to be administered 10 days before the trip and remains legally valid for 3 years
Antibiotic Chemoprophylaxis
• Antibiotic chemoprophylaxis among close contacts of a patient with invasive meningococcal disease is recommended to prevent secondary cases. • Antibiotic regimens for prophylaxis include rifampin, ciprofloxacin, and ceftriaxone. Ceftriaxone is recommended for pregnant women. • Chemoprophylaxis (preventive administration of antibiotics) for meningococcal meningitis has no place in travel medicine.

6. If childhood blindness is assessed using blind school standards as compared to population survey standards, what will happen to prevalence of blindness?
a) Underestimated b) Overestimated c) Remain same d) None of them is used for evaluation

Ans: c
According to NAB (National Association for Blind), India Legal blindness is defined as visual acuity of not greater than 20/200 in the better eye with best correction or a visual field of less than 20 degrees.
What does 20/200 means?
A person with normal visual acuity can see an object clearly, at 200 feet; a legally blind person must be 20 feet or closer to see the same object. Note: 20/200 feet is same as 6/60 meters
According to NPCB, the criteria for blindness (Economic Blindness) is visual acuity of <6/60 in the better eye with best possible correction.
Thus, since both the criteria are same, the prevalence will remain same.

7. Under HBNC, Remuneration is not given to ASHA for? a) Recording of birth weight b) Registration of birth c) Giving first dose of OPV and DPT d) Institutional delivery

Ans: d
Under HBNC, the ASHA will be paid Rs. 250/- for the care of the mother and the new born. She will be conducting • Six visits in case of institutional delivery (Days 3,7,14,21,28 and 42) and • Seven visits in case of home delivery (Days 1,3,7,14,21,28 and 42)
The payment will be made subject to- • Ensuring that birth weight is recorded in the Maternal and Child Protection card • Ensuring that the newborn is immunized with: BCG, first doses of DPT and OPV and entered in MCP card • Ensuring birth registration
• Both mother and newborn are safe until the 42nd day of delivery
At central level, some incentives recommended are as below-
• JSY-Institutional Delivery (rural) LPS Rs.350 for ASHA & Rs.250 for ref transport; Urban Rs. 200 • Motivation for Tubectomy/Motivation for Vasectomy/NS-Rs.150/200 • Immunization Session – Rs. 150 • Organizing Village Health Nutrition Day Rs.150 • DOTS Rs.250 • Household toilet promotion Rs.75 • Detection, referral, confirmation and registration of Leprosy case/after complete treatment for PB Leprosy cases/after complete treatment for MB Leprosy cases- Rs. 100/200/400

8. An ophthalmologist working in district hospital can do following surgical procedure most commonly? a) Phaco-emulsification b) DCR c) Bilateral Lamellar Tarsus Rotation d) Pars plana vitrectomy

Ans: a
Under NPCB, training of ophthalmologists is done on multiple topics. Out of which the universal training which is done for ophthalmologists even at sub-district hospital and district hospital level is - • ECCE/IOL implantation • SICS (Small Incision Cataract Surgery) • Phaco Emulsification
Also, cataract is the most common ophthalmic surgery done in India at all levels.

9. A disease has 80% prevalence in a population of 100 persons. What will be the range of prevalence that will be obtained with 95% probability (confidence interval) if the test is repeated? a) 60-100% b) 65-95% c) 70- 80% d) 72-88%
Ans: d
The 95% confidence limits for a proportion are p ± 1.96 s.e.p, where s.e.p is the standard error of a proportion.
p = sample proportion =proportion of diseased persons=0.8
q=1-p=0.2
s.e.p =
Square root (pXq/ n)
=square root (0.8X0.2/100)
=square root (0.0016)
=0.04
Now the range with 95% confidence interval limits will be
=0.8+/- 2(0.04)
=0.8 +/- 0.08
=0.72-0.88
=72-88%

10. In a population, 50 % of the population is diseased. If the investigator wants to say with 95% confidence that 45-55% of the population is diseased, then what should be the minimum sample?
a) 100 b) 200 c) 300 d) 400
Ans: d
In this example also, we need to use Standard Error of proportions
The 95% confidence limits for a proportion are p ± 1.96 s.e.p, where s.e.p is the standard error of a proportion.
p = sample proportion =proportion of diseased persons=0.5
q=1-p=0.5
s.e.p = Square root (pXq/ n)
Now here, the range of proportions with 95% confidence is mentioned as-
45-55%
hence,
2 s.e.p = 0.55-0.50=0.05
s.e.p =0.025
Further,
0.025=square root (pXq/n)
0.025= square root (0.5X0.5/n)
0.025=square root (0.25/n)
0.025= 0.5/square root n
Therefore,
Square root of n= 0.5/0.025
Square root of n=20
N=400
Thus, the sample size required will be 400

11. HPI includes all except
a) Probability at birth of not surviving till age 40 b) Child literacy rate c) % of population not using an improved water source d) % of children underweight for age

Ans: b Human poverty index-

HPI-1 (for developing countries) a. Long and healthy life- Vulnerability to death at early age- probability at birth of not surviving to age 40 years b. Knowledge- Illiteracy- adult literacy rate c. Standard of living- % of population not using an improved water source % of children underweight for age
HPI-2 (developed Countries)
a. Probability at birth of not surviving to age 60 b. % of adults lacking functional literacy skills c. % of population below income-poverty line d. Rate of long-term unemployment.

12. Diseases under IDSP a/e
a. Snake bite   b. Upper RTI    c. Leptospirosis d. Tuberculosis

Ans: b
Communicable Diseases under IDSP
For the purpose of surveillance under IDSP, the following diseases are to be reported under the P form. The list is as given below:
1. Acute Diarrheal Disease (including acute gastroenteritis) 2. Bacillary Dysentery 3. Viral Hepatitis 4. Enteric Fever 5. Malaria 6. Dengue/Dengue Hemorrhagic Fever (DHF)/ Dengue shock syndrome (DSS) 7. Chikungunya 8. Acute Encephalitis Syndrome (AES) 9. Meningitis 10. Measles 11. Diphtheria 12. Pertussis 13. Chicken Pox 14. Fever of unknown origin (PUO) 15. Acute Respiratory Infection (ARI)/Influenza Like illness (ILI) 16. Pneumonia 17. Leptospirosis 18. Acute Flaccid Paralysis < 15 years of age 19. Dog Bite 20. Snake Bite 21.Any other state specific disease (check with your district surveillance additional list of diseases) 22. Unusual syndrome (not being captured by any of the above)

13. Number of MDG goals directly related to health are-
a. 3   b. 4   c. 5   d. 6

Ans: a The Millennium Development Goals (MDGs) are eight goals to be achieved by 2015 that respond to the world's main development challenges. It was adopted in 2000.
In total there are 8 goals, 21 quantifiable targets and 60 indicators.
Out of these, 3 goals, 8 targets and 18 indicators are directly related to health.
Goal 1: Eradicate extreme poverty and hunger • Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day • Halve, between 1990 and 2015, the proportion of people who suffer from hunger Goal 2: Achieve universal primary education • Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling Goal 3: Promote gender equality and empower women • Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015 Goal 4: Reduce child mortality • Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate Goal 5: Improve maternal health • Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio • Achieve, by 2015, universal access to reproductive health Goal 6: Combat HIV/AIDS, malaria and other diseases • Have halted by 2015 and begun to reverse the spread of HIV/AIDS • Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it • Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases (tuberculosis) Goal 7: Ensure environmental sustainability • Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation Goal 8: Develop a Global Partnership for Development • In cooperation with pharmaceutical companies, provide access to affordable essential drugs in developing countries

14. About deworming under national child health program true are all except
a. It is done for all pre school and school children yearly b. Albendazole 400mg for>2 years c. Mebendazole 100mg for>1year d. It is linked with Vitamin A supplementation program

Ans: c
The Government of India has come with following guidelines for deworming of children Category Prevalence* Action for deworming High More than 70% Preschool and school-age children 2-3 times each year
Moderate 50-70% Preschool and school-age children at least once each year
Low Less than 50% Only symptomatic individuals (i.e. those who pass worms in their stools)
*- Refers to percentage of children with any one of the three STH infections (Ascariasis, Trichuriasis or hookworm infection)
Drugs and their dosages for routine deworming in children- Drug Doses by age Below 1 year 1 -2 years 2 years upwards
Albendazole (400 mg tablets)
Not to be given (Safety not established)
Half tablet One tablet
Mebendazole (500 mg tablets)
Not to be given (Safety not established)
One tablet One tablet
Deworming should be linked with Vitamin A prophylaxis program for children between the ages of 13-59 months
15. Number of primary vision centers according to Vision 2020
a. 100,000    b. 20,000    c. 40,000   d. 30,000
Ans: b

16. 3 year bachelor para-medical course for rural health service was given by
a. Sundar committee    b. Srivastava committe c. High level expert group of universal health program for India     d. Central bureau of health intelligence

Ans: c It was proposed by Ministry of Health and family welfare and received backing of Planning Commission of India’s HLEG on UHC
17. If the confidence interval is increased, what will happen?
a) Previously significant values would become insignificant b) Previously insignificant values will become significant c) No change d) Cannot be commented on the basis of information provided
Centres of excellence - 20

Training centre- 200 Tertiary eye care including retinal surgery, corneal transplantation, glaucoma surgery, training and CME

Service centres 2000 2 ophthalmic surgeons & 8 ophthalmic paramedics-Cataract surgery, other common eye surgeries, facilities for refraction, referral services

Vision centres 20,000 1 per 50,000 populations,1 Ophthalmic assistant Primary eye care, refraction and prescription of glasses, school eye screening programme, screening and referral SERVICES
Ans: b Confidence interval gives the range of the values. When we are using 95% confidence intervals, it means that we are 95% confident that the values in the range are significant. Beyond the range are insignificant. Thus, when we increase the confidence interval range, the insignificant also becomes significant.
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AIIMS MD/MS MAY 2013 QUESTION NO. 2

noreply@blogger.com (RxPPT) — Fri, 11 Oct 2013 12:36:00 +0000

Amount of vitamin A given to mother postpartum (in IU)
a) 50, 000
b) 1Lakh
c) 1.5 lakh
d) 2 Lakh

Ans: d
There was a previous recommendation by WHO on giving 2 lacs IU of Vitamin A to pregnant women immediately after delivery, which was withdrawn in 2011
Check this link for more details.
http://whqlibdoc.who.int/publications/2011/9789241501774_eng.pdf

AIIMS MD/MS MAY 2013 QUESTIONS 1.

noreply@blogger.com (RxPPT) — Fri, 11 Oct 2013 12:33:00 +0000

1. Type of growth chart used by Anganwadi workers (ICDS) for growth monitoring -
a) NCHS
b) CDC
c) IAP
d) MGRS

Ans: d
Right answer is WHO child growth standards, which is also called as MGRS standards (Multicenter growth reference study)

525. Which is the Nucleus of Masseteric Reflex

noreply@blogger.com (RxPPT) — Fri, 10 Aug 2012 07:35:00 +0000

a. Chief Sensory Nucleus

b. Nucleus of Spinal Tract of Trigeminal Nerve

c. Nucleus of Mesencephalic Tract of Spinal Nerve

d. Dorsal Vagal Nucleus

Answer

c. Nucleus of Mesencephalic Tract of Spinal Nerve

Reference

Gray’s Anatomy 38^th Edition Page 1237

QTDF
Gray

Quality

Thinker

Status

New

Discussion

Ä The trigeminal, the largest cranial nerve, is the sensory supply to the face, the greater part of the scalp, the teeth, the oral and nasal cavities, the dura mater and the cerebral blood vessels. It gives the motor supply to the masticatory muscles, and the anterior belly of digastric and mylohyoid, and contains proprioceptive nerve fibres from the masticatory and probably the extraocular and facial muscles

Expanation

a. Chief Sensory Nucleus is concerned with Tactile sensation.

b. Nucleus of Spinal Tract of Trigeminal Nerve is concerned with Pain and Temperature Sensation.

c. Nucleus of Mesencephalic Tract of Spinal Nerve is concerned with proprioception

d. Dorsal Vagal Nucleus is a General Visceral Efferent Nucleus which innervates glands of the head, the sphincter pupillae and ciliary muscles, and the thoracic and abdominal viscera.

Comments

Ä Masseter is supplied by a branch of the anterior trunk of the mandibular nerve.

Tips

Other ascending fibres enter the mesencephalic nucleus, a column of unipolar cells, whose peripheral branches may convey proprioceptive impulses from the masticatory muscles; it is also stated that similar impulses reach it from the teeth and from the facial and ocular muscles. Its neurons are unique in being the only primary sensory neurons with somata in the CNS. It is the relay for the only supraspinal monosynaptic reflex, namely the 'jaw-jerk'. If, however, the primary proprioceptive neurons of extraocular muscles are in fact situated in their motor nerves or in the trigeminal ganglion, some mesencephalic trigeminal neurons may be 'secondary' in status. Small multipolar cells, possibly interneurons, occur near the unipolar neurons.

524. All of the following are Somatic Efferent except

noreply@blogger.com (RxPPT) — Fri, 10 Aug 2012 07:14:00 +0000

a. Facial nerve

b. III Nerve

c. IV Nerve

d. VI Nerve

Answer

a) Facial nerve

Reference:

Gray’s Anatomy 38^th Edition Pages 238, 241

QTDF

Gray / Neuroanatomy Books

Quality

Thinker

Status

New

Discussion

General somatic efferent neurons exit ventrally in a similar manner to those of the spinal cord, comprising the oculomotor, trochlear, abducens and hypoglossal nerves. Thus nerves III, IV, VI and XII parallel the organization of the somatic motor neurons in the spinal cord.

Explanation

Self Explanatory

Comments

The second motor component, special branchial efferent, comprises the accessory nerve and the motor parts of the trigeminal, facial, glossopharyngeal and vagus nerves, whose nerve exit points lie more dorsally than the somatic motor system.
The cranial nerves also contain a third class of efferent neurons, the general visceral efferent neurons (parasympathetic preganglionic) travelling in nerves III, VII, IX and X, which leave the hindbrain via the same exit points as the special branchial efferent fibres.
The most rostral sensory ganglion, the trigeminal (V) comprises both neural crest and placode-derived neurons that mediate general somatic afferent functions. In the case of more caudal cranial nerves (VII, IX and X) the same applies, but the two cell populations form separate ganglia in the case of each nerve. Analogous with the trigeminal, the proximal series of ganglia is neural crest derived (forming the proximal ganglion of VII, the superior ganglion of IX and the jugular ganglion of X) while the distal series derives from placodal cells (forming the geniculate ganglion of VII, the petrosal ganglion of IX and the nodose ganglion of X). These ganglia contain neurons that mediate special, general visceral and somatic afferent functions. The VIIth nerve has a vestibular ganglion containing both crest and placodal cells and an acoustic ganglion from placodal neurons only; it conveys special somatic afferents.
Both neurons and supporting cells of the cranial autonomic ganglia in the head and the trunk originate from neural crest cells

Tips

Types of Functional Components in a Nerve

			Fibres and Sensation Carried	Nucleus
Sensory or Afferent	Visceral	General	General Visceral Afferent · Pain arising from Viscera	· Dorsal Nucleus of Vagus
	Visceral	Special	Special Visceral Afferent · Taste	· Nucleus Tractus Solitarius · Nucleus of Dorsal Visceral Gray
	Somatic	General	General Somatic Afferent · Exteroceptive impulses – cutaneous sensations of pan, touch and temperature - · Proprioceptive impulses arising in muscles, tendon and joints conveying information regarding movement and position of joint	· Chief Sensory Nucleus (Tactile) · Nucleus of Spinal Tract of Trigeminal Nerve (Pain Temp) · Nucleus of Mesencephalic Tract of Spinal Nerve (Proprioception) ·
	Somatic	Special	Special Somatic Afferent · Vision · Hearing · Equilibrium	· Nucleus of the Vestibulocochlear nerver
Motor of Efferent	Visceral	General	General Visceral Efferent · General visceral efferent neurons · Parasympathetic preganglionic (III, VII, IX and X) · innervate glands of the head, · the sphincter pupillae and ciliary muscles, · and the thoracic and abdominal viscera. · Smooth muscle · Cardiac Muscle · Glands	· Dorsal Vagal Nucleus · Superior Salivatory Nucleus · Inf Salivatory Nucleus · Lacrimatory Nucleus · Edinger Westpal Nucleus
	Visceral	Special	Special Visceral Efferent · (accessory nerve and the motor parts of the V, VII, IX, X nerves) · Also called as Branchial Efferent. · Striated muscles developing within the pharyngeal (branchial) arches · Mucles of Mastication, face, larynx	· Nucleus Ambigus
	Somatic	General	General Somatic Efferent · Supply striated muscle now known to be derived from the cranial (occipital) somites and prechordal mesenchyme. · Muscles of Body wall and Limbs · Eye and Tongue ·	· Oculomotor Nucleus (III) · Trochlear Nucleus (IV) · Abducent Nucleus (VI) · Hypoglossal Nucleus (XII)

523. ‘P’ wave in ECG recording is caused due to:

noreply@blogger.com (RxPPT) — Thu, 09 Aug 2012 12:30:00 +0000

1. Atrial depolarization.

2. Atrial repolarization.

3. Ventricular depolarization.

4. Ventricular repolarization.

ANS: 1 (ganong's 551.. (22))

522. For a normal healthy person, the daily requirement of vitamin C is:

noreply@blogger.com (RxPPT) — Mon, 30 Jul 2012 10:09:00 +0000

A. 10 to 50 mg B. 50 to 100 mg

C. 100 to 200 mg D. 200 to 300 mg

Ans. B (Harrison 16th ed., p 406): The recommended dietary allowance of vitamin C is 60 mg for adult male and female. In infants the need is 30-35 mg/day. In pregnant women requirement is 70 mg/day and lactating women need 90-95 mg/day.

Which of the following are risk factors for deep venous thrombosis? 1. Duration of surgery more than 30 minutes 2. Prior history of venous thrombosis 3. Age less than forty years 4. Obesity Select the correct answer using the codes given below: Codes:

noreply@blogger.com (RxPPT) — Mon, 30 Jul 2012 08:00:00 +0000

A. 1, 2 and 3 B. 1, 2 and 4 C. 2, 3 and 4 D. 1, 3 and 4

Ans. B (Kumar and Clark 4th ed., p 409, 742; Harrison 16th ed., p 1491): The various risk factors for DVT are old age,obesity, immobility, pregnancy and puerperium, trauma or surgery (especially of pelvis, hip or legs), malignancy, prior history of venous thrombosis, OCP, malignancy, infection etc.

520. The lamina propria is:

noreply@blogger.com (RxPPT) — Sat, 28 Jul 2012 17:51:00 +0000

A. epithelial tissue
B. connective tissue
C. adipose tissue
D. muscle tissue

The correct answer is B. The lamina propria is a loose connective tissue located within the mucosal
layer, just underneath the epithelium. In the oral cavity, it will be found below the outer layer of
stratified squamous epithelium. The lamina propria in the oral cavity often forms wedge-like
extensions into concavities in the epithelium, known as connective tissue papillae. The corresponding
epithelial extensions into the connective tissue are known as rete pegs.

519. A 5-year-old child develops a febrile disease with cough, a blotchy rash, and cervical and axillary lymphadenopathy. Also noted is an erythematous, maculopapular rash behind the ears and along the hairline, involving the neck and, to a lesser extent, the trunk. Examination of this patient's oropharynx would likely reveal which of the following lesions?

noreply@blogger.com (RxPPT) — Thu, 26 Jul 2012 17:47:00 +0000

A. Adherent thin, whitish patch on gingiva
B. Cold sores on the lips
C. Curdy white material overlying an erythematous base on the oral mucosa
D. Large shallow ulcers on the oral mucosa
E. Multiple small white spots on the buccal mucosa

The correct answer is E. The disease described is measles (rubeola), which has the typical
presentation described in the question stem. Measles is caused by a Morbillivirus, an RNA virus
belonging to the Paramyxovirus family. Koplik's spots, which are pathognomonic for measles, are
small, bluish-white spots on the buccal mucosa in the early stages of measles. These lesions appear
just before the onset of the characteristic rash which is a brick red irregular maculopapular rash that
onsets 3-4 days after the onset of the prodrome (which can also involve the extremities) and fade as
the rash develops. This is usually a prodrome of fever, coryza, cough, conjunctivitis, malaise, irritibility
and photophobia as well as koplik's spots. Leukoplakia is a premalignant condition characterized by
adherent whitish patches on the gingiva (choice A) and other sites in the oral cavity. Histologically,
they are similar to hyperkeratoses. Cold sores of the lips (choice B) are due to infection with herpes
viruses. Candida infection (thrush) produces curdy white material loosely attached to an erythematous
base (choice C). When removed there is typically a painful lesion that may bleed. Aphthous ulcers
are large shallow ulcers of the oral mucosa (choice D), commonly known as canker sores. No
systemic involvement is seen

519. Delta waves of electroencephalogram have frequency of:

noreply@blogger.com (RxPPT) — Thu, 26 Jul 2012 17:43:00 +0000

1. More than 14 cycles per second.
2. Between 8 and 13 cycles per second.
3. Less than 3.5 cycles per second.
4. Between 4 and 7 cycles per second.

Ans 3 : Ganong's 195

518. Which of the following cell types show abnormal function when there is a history in a young adult of multiple arm and leg fractures following minor falls, with a slight weakness of facial muscles on the left, mild anemia, and with generalized bony widening with partial obliteration of marrow spaces?

noreply@blogger.com (RxPPT) — Wed, 25 Jul 2012 17:43:00 +0000

A. Granulocytic stem cells
B. Megakaryocytes
C. Plasma cells
D. Osteoblasts
E. Osteoclasts

The correct answer is E. The disease described is osteopetrosis (Albers-Schonberg disease), which
is a group of hereditary diseases in which impaired osteoclast function leads to reduced bone
resorption. The abnormal osteoclasts frequently are enlarged, with bizarre shapes. The bones
become thick and brittle; other features include anemia secondary to marrow loss and cranial nerve
deficits secondary to narrowing of bony ostea. An autosomal recessive, severe form of the disease
produces death in childhood. A relatively benign, autosomal dominant form presents in adulthood.

Abnormal proliferation of granulocytic stem cells (choice A) can produce myelocytic leukemias.

Megakaryocyte abnormalities (choice B) can produce platelet disorders, but not deficient bone
resorption.

In multiple myeloma, neoplastic plasma cells (choice C) can cause lytic bone lesions characterized
by excessive resorption of bone.

Abnormally low osteoclast, rather than osteoblast (choice D), function is the problem in osteopetrosis.

517. A 5-year-old child has blue-tinged sclera, hearing loss, and small, slightly blue, misshapen teeth. Radiologic studies confirm the presence of numerous fractures of various ages. No significant degree of bruising is seen over sites of recent fracture. The disease this child most likely has is related to abnormal metabolism involving which of the following substances?

noreply@blogger.com (RxPPT) — Tue, 24 Jul 2012 17:39:00 +0000

A. Collagen
B. Glycogen
C. Mucopolysaccharides
D. Purines
E. Tyrosine

The correct answer is A. The suspected disease is osteogenesis imperfecta, which is a rare genetic
disorder that occurs in both recessive and dominant forms. The clinical presentation, depending on
the specific form, varies from death in utero, to that described in the question stem, to very mild
disease with only a modest increase in bone fragility. Spontaneous fractures occur in utero or during
childhood. The different types all have defects in the synthesis of type I collagen, often with
insufficient or abnormal pro-1(1) or pro-2(1) chains. These deficits produce an unstable collagen triple
helix that is not as strong as normal collagen. Less severe mutations on type I collagen genes are
common, resulting in collagen disarray and predisposing to hypogonadal or idiopathic osteoporosis.

Defective glycogen (choice B) metabolism is associated with the various glycogen storage diseases,
such as von Gierke disease and Pompe disease. These diseases tend to present with profound
hypoglycemia, hepatomegaly, or muscle weakness.

Defective mucopolysaccharide (choice C) metabolism is associated with the mucopolysaccharidoses,
such as Hurler and Hunter syndromes. These diseases tend to present with abnormal facies
("gargoylism"), deformed ("gibbus") back, claw hand, and stiff joints.

Abnormalities of purine metabolism (choice D) are present in gout, which presents with joint
inflammation and often involves the great toe. The net result is due to chronic hyperuricemia.

Abnormalities of tyrosine metabolism (choice E) are associated with phenylketonuria (pale hair and
skin, mental retardation, musty smelling urine), albinism (pale hair, skin, increased skin cancer),
cretinism (decreased T3 and T4), tyrosinosis (liver and kidney disease), and alkaptonuria (chronic
arthritis and urine that turns black upon standing).

516. An animal is made diabetic by injection of a drug that destroys pancreatic ß cells. Removal of which of the following organs would most likely produce a decrease in blood glucose concentration in this animal?

noreply@blogger.com (RxPPT) — Mon, 23 Jul 2012 17:39:00 +0000

A. Anterior pituitary
B. Colon
C. Gonads
D. Kidney
E. Pancreas

The correct answer is A. The anterior pituitary produces the following hormones: thyroid-stimulating
hormone (TSH), adrenocorticotropic hormone (ACTH), follicle stimulating hormone (FSH), leutinizing
hormone (LH), prolactin, and growth hormone (GH). Two of these secretions (GH, ACTH) affect the
sensitivity of peripheral tissues to the action of insulin. Growth hormone has a direct effect on liver and
muscle to decrease insulin sensitivity. This may be partly through a growth hormone-induced decline
in insulin receptors or to unknown postreceptor defects. In excess, growth hormone is "diabetogenic,"
and approximately 25% of patients with acromegaly have diabetes. ACTH indirectly has antiinsulin
effects by virtue of the cortisol secretion it evokes. Like growth hormone, cortisol also decreases
insulin sensitivity in peripheral tissues. A third anterior pituitary hormone, TSH, also tends to increase
blood glucose levels. In this case, the effect is probably mediated mostly through increased glucose
absorption by the gut. Patients with hyperthyroidism can sometimes exhibit a postprandial glucosuria
because of excessive intestinal glucose absorption. In diabetic animals, the removal of the anterior
pituitary may lower blood glucose by increasing tissue sensitivity to whatever insulin remains.

Removal of the colon (choice B) should have little effect on blood glucose because dietary glucose is
absorbed in the small intestine.

Sex steroids secreted by the gonads (choice C) have little effect on blood glucose concentration.

The kidney (choice D) plays an important role in reabsorbing filtered glucose. In diabetes, the tubular
reabsorption maximum is exceeded and glucose spills over into the urine. The loss of glucose in the
urine helps to reduce the severity of the plasma hyperglycemia. Removal of the kidneys would, if
anything, make the hyperglycemia worse. Pancreatectomy (choice E) would make the hyperglycemia
worse by removing the source of any remaining insulin.

515. An abrasion results in the total loss of epidermis over a large area of an arm, but one month later, the abrasion has healed, with regrowth of the epidermis. Which of the following mechanisms accounts for the restoration of the epidermis over the abraded area?

noreply@blogger.com (RxPPT) — Mon, 23 Jul 2012 17:29:00 +0000

A. Growth of epidermis from hair follicles and sweat glands in the dermis
B. Migration of endothelial cells from newly grown capillaries
C. Transformation of dermal fibroblasts into epidermal cells
D. Transformation of macrophages into epidermal cells
E. Transformation of melanocytes into epidermal cells

The correct answer is A. The dermis contains skin appendages (e.g., hair follicles), which contain
epithelial stem cells. In the process of healing a large area where the epidermis has been lost but the
dermis is intact, re-epithelialization occurs by growth of epidermal cells from the underlying skin
appendages, as well as from the intact epidermis along the wound edges. Physiologically, the dermis
lies beneath the epidermis. It has two major components, a superficial papillary layer and a deeper
reticular layer. The papillary layer contains the capillaries and the sensory neurons, which supply the
surface of the skin. The reticular layer consists of an interwoven meshwork of dense irregular
connective tissue.
None of the other cell types are known to directly contribute to the regeneration of epidermis over
abraded skin.

514.Papillary carcinomas spread by the route of

noreply@blogger.com (RxPPT) — Wed, 11 Apr 2012 18:30:00 +0000

a.Lymphatics
b.Hematogenous
c.Direct
d.All

Ans-a.Lymphatics

Follicular carcinoma spreads via hematogenous route.Medullary and papillary carcinoma spreads via lymphatics and anaplastic has a direct spread

513.All structures are preseved in radical neck surgery except

noreply@blogger.com (RxPPT) — Wed, 11 Apr 2012 18:25:00 +0000

a.Carotid arteries
b.Cranial nerves 7,9,10
c.Phrenic nerve
d.Accessory nerve

Ans-d.Accessory nerve

512.All are the causes of hypokalemia except

noreply@blogger.com (RxPPT) — Wed, 11 Apr 2012 18:21:00 +0000

a.Following trauma
b.starvation
c.loss of GIT secretions
d.All of the above

Ans-d.All of the above

511. When the dentist enters the operatory, the patient, who is new to the office, stands close to the wall, has his arms folded, and is looking at the floor. The dentist should initiate communication by saying which of the following?

noreply@blogger.com (RxPPT) — Sat, 07 Apr 2012 09:50:00 +0000

A. Let's get going, I've got a lot to do.
B. What are you angry about?
C. Didn't my assistant get you seated?
D. You seem uncomfortable; did you have a bad dental experience?
E. Hi, I'm Doctor Wilson, what brings you here today?

ANSWER >>> E

510.If a patient suddenly becomes unconscious during treatment, the practitioner should immediately assess the patient's

noreply@blogger.com (RxPPT) — Sat, 07 Apr 2012 09:47:00 +0000

A. airway and pulse.
B. airway and blood pressure.
C. pulse and blood pressure.
D. color and pupils.

Answer >>> A.

509. A 2-day-old developing plaque consists primarily of

noreply@blogger.com (RxPPT) — Sat, 07 Apr 2012 09:45:00 +0000

A. Treponema species.
B. Bacteroides species.
C. filamentous organisms.
D. gram-positive cocci and rods.
E. a structureless, non-mineralized pellicle.

Answer >> D gram positive cocci and rods

508. A major sensory innervation of the temporomandibular joint is derived from the

noreply@blogger.com (RxPPT) — Sat, 07 Apr 2012 09:43:00 +0000

1. great auricular nerve.
2. auriculotemporal nerve.
3. inferior alveolar nerve.
4. temporal branches of the facial nerve.

The correct answer is choice 2. The temporomandibular joint is innervated by nerves from the auriculotemporal and masseteric branches of the mandibular nerve or V3. Choice 1, the greater auricular nerve, exits the spinal cord from levels C2 and C3 and innervates cutaneous areas of the neck, lower face and posterior head. Choice 3, the inferior alveolar, is a branch of the mandibular nerve or V3 which innervates the mandibular teeth, alveolar bone and gingiva. Choice 4, the temporal branches of the facial nerve, innervate the facial muscles above the palpebral fissure of the eye. So the correct answer is choice 2.

507. A fracture of the hamulus affects the action of which of the following muscles?

noreply@blogger.com (RxPPT) — Sat, 07 Apr 2012 09:39:00 +0000

A. Superior constrictor of the pharynx
B. Levator veli palatini
C. Tensor veli palatini
D. Salpingopharyngeus
E. Buccinator

The correct answer is choice C. The tendon of tensor veli palatini hooks around the pterygoid hamulus to insert into the palatal aponeurosis. Choice A is incorrect. The superior constrictor inserts into the pharyngeal tubercle of the occipital bone and the midline pharyngeal raphe. Choice B is incorrect. The levator veli palatini (levator palati) arises from the cartilaginous rim of the auditory tube and inserts directly into the palatal aponeurosis. It does not have contact with the hamulus. Choice D is incorrect. Salpingopharyngeus passes from the toms tubarius to the wall of the pharynx. Choice E is incorrect. Buccinator originates from the pterygomandibular raphe and inserts by blending with other muscles of facial expression around the corner of the mouth in an arrangement known as the modiolus.

506. A disturbance in cartilage formation in a fetus results in deformities of theA disturbance in cartilage formation in a fetus results in deformities of the

noreply@blogger.com (RxPPT) — Sat, 07 Apr 2012 09:37:00 +0000

1. sphenoid and zygomatic bones.

2. axial skeleton and the base of the skull.

3. axial skeleton and the flat bones of the skull.

4. petrous portion of the temporal bones and the parietal bones.

The correct answer is choice 2. Some bones in the human skeleton are formed by ossification of a cartilaginous model while others are not. When the bone is formed in a connective tissue other than cartilage, it is termed intramembranous ossification rather than cartilage ossification. Disturbance in cartilage formation will affect those bones produced on a cartilage model, but not those produced intramembranously. Let's check the choices. In general, the axial skeleton and skull base are ossified from cartilage models, so choice 2 is correct. Choice 3 is incorrect as most flat bones of the skull are intramembranous, not cartilaginous. Choice 4 is incorrect. The petrous portion of the temporal bone is from a cartilage model, while the squamous part is membranous. The parietal hones ossify intramembranously. Choice 1 is also incorrect. The sphenoid is mostly cartilaginous in ossification, but part of the greater wing is membranous. However, the zygomatic bone is intramembranous. So again the correct answer to question is choice 2.

505.A child presents with massive hepatomegaly, hypoglycemia and there is no improvement with glucagon. The probable diagnosis is:

noreply@blogger.com (RxPPT) — Sun, 19 Feb 2012 14:20:00 +0000

1.Von Geirke's disease.

2.Mcardle

3.Cori.

4.Forbe.

Ans-1.Von Geirke's disease

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