Rapid Review Usmle Step 1 ND CK

Important high yield
Very very very #imppoints

1. Potassium is mainly regulated by - Aldosterone.
2. Tip of scapula at level – T7.
3. Oblique fissure of the lung at level - T3 to T6 Costochondral.
4. Decussating of medial lemniscuses - Internal Arcuate Fibers.
5. Superficial temporal artery relation with which nerve - Auriculotemporal nerve.
6. Correct about Thyroid gland - lymph drainage to deep cervical lymph nodes.
7. Anemic hypoxia occur in – Methemoglobulenemia.
8. In cerebral circulation brain arteries - Do not anastomose once entered in the brain
(controvertial).
9. Phase 1 of transformation of drug metabolism – Oxidation.
10. Standard deviation shows - Variability of individual observation.
11. Counseling in patients is - To help themselves.
12. A young girl who is going to die and asks you “Am I going to die?” Doctor response
should be – “What your parents have told you?”
13. In whole wheat – Thiamine.
14. Cholesterol enriched diet – Egg.
15. Origin of peroxisomes – SER.
16. Organelle where protein combines with carbohydrates, packed and released - Golgi
complex.
17. Correct about DNA – Euchromatin is transcriptionally active.
18. ADPKD associated with – Renal failure (Vs) Cerebral haemorrhage (controversial) here
most probable Renal failure.
19. Cause of delay in healing – Infections.
20. PaO2 decreased, PCO2 increased, hydrogen ion increased; manifestation (looked like
kind of COPD) – Hypoventilation.
21. PCO2 31, HCO3 19, pH increased (Metabolic alkalosis scenario) - Hyperventilation
22. Person with tachycardia, and heat intolerance with low level of TSH, on giving TRH; level
of TSH and thyroid hormones increases. Diagnosis – Hyperthyroidism with thyroid problem.
23. Origin of oxytocin and ADH – Hypothalamus.
24. Difference between systemic and pulmonary circulation - Low resistance in pulmonary
circulation.
25. Mean systemic filling pressure is regulated by - Venous return.
26. Systolic pressure is directly related to which one of the following – Renin.
27. ADH responds to – Osmolarity.
28. Osmoreceptors – ADH.
29. Right border of heart on X-ray also visible a part of – SVC.
30. In MI sensitive cardio marker – Troponin T.
31. Diabetic nephropathy investigation - Urine albumin.
32. Young boy with generalized edema and proteinuria - Lesion of basement membrane.
33. Lesion of parasympathetic system affects mostly - GI muscles.
34. Stress hormone of our body - ACTH.
35. S2 sound heard on - Closure of aortic and pulmonary valve.
36. A patient with history hemorrhage (trauma) receives a bag stored for 2 weeks mainly
contains – RBCs.
37. Due to inspiration – Decreased negative intrapleural pressure.
38. Important buffer of blood - HCO3-.
39. Max increase in ECF due to infusion of - Hypertonic Nacl.
40. Auscultation of tricuspid valve best heard at – Right lower end of the body of sternum.
V VV Important>>>>>>>>>>
THE BEST #NEUROANATOMY Points
Nervous System: Central nervous system = Brain + spinal cord.
■ Peripheral nervous system = Somatic.
■ Autonomic system = Visceral.
■ Myenteric nervous system = GI, intrinsic.
Cerebral cortex’s Gray matter consist externally of = (6 layers)
Fucntions of Cerebral Cortex : Motor speech (Broca’s) area = (44, 45), Primary auditory cortex = (41,
42), Associative auditory cortex (Wernicke’s area) = (22) , Principal visual cortex = (17) , Principal
sensory areas = (3, 1, 2) , Principal motor area = (4) , Premotor area = (6) (part of extrapyramidal
circuit) , Frontal eye movement and pupillary change area = (8) .
Diencephalon contributes to = Rathke’s pouch (forming part of posterior pituitary).
Ventral posterior medial (VPM) Nuclei of Thalamus controls =Facial sensation including Pain.
All cranial nerves (except Cranial Nerve I and II) originate from the = brain stem.
All cranial nerve motor nuclei have unilateral corticonuclear connections except=
■ CN VII: Upper third
muscles of facial
expression have
bilateral innervation.
■ CN XII: Genioglossus
muscles have = bilateral
motor innervation.
All cranial nerve sensory nuclei have unilateral representation except = hearing.
Hearing is bilateral; Person cant go deaf in one ear from a stroke to the unilateral temporal area.
Taste Sensation : Taste to the anterior 2/3 of the tongue is CN VII via the = chorda tympani and the
posterior 1/3 by = CN IX. CN X caries taste fibers from the = palate.
PARASYMPATHETIC GANGLIA:
1: Pterygopalatine Ganglion supplies = Lacrimal Glands and Glands in Palate & Nose
2: Otic Ganglion supplies = Parotid Gland
3: Submandibular Ganglion supplies = SubMandibular, Sublingual small Salivary Glands.
4: Ciliary Ganglion supplies = Ciliary Muscles, Spincter pupillae, Dilator, Pupillae and Tarsal
muscles.
Trochlear nerve: The smallest cranial nerve and the only cranial nerve that exits from the = posterior
surface of the brain stem.
Blurred vision = with a lesion to any of = CN III, IV, VI.
Ptosis (drooping eyelid) and dilated pupil with = CN III injury (levator
palpebrae superioris and sphincter pupillae muscle).
Lesion CN VI = eye persistently directed toward nose (because of lateral rectus).
Horner’s syndrome:
Lesion of oculosympathic pathway (sympathetics don’t come from CNs but run with them; come
from superior cervical ganglion, ciliospinal center of Budge); miosis, ptosis, hemianhidrosis, apparent
enophthalmos.
Argyll Robertson pupil:
Think prostitute’s pupil—accommodates but does not react; also associated with syphilis. No miosis
(papillary constriction) with either direct or consensual light; does constrict with near stimulus
(accommodation-
convergence). Occurs in = syphilis and diabetes.
V1 and V2 of Trigeminal Nerve are purely = sensory and V3 Trigeminal Nerve is both = sensory and
motor.
The Buccal nerve of V3 provides sensation to = the cheek; whereas the buccal branch of CN VII is
motor to the = buccinator muscle.
CN V—Trigeminal Nerve: Largest cranial nerve. No parasympathetic fibers are contained with the
trigeminal nerve at its origin.
Lingual nerve: A) General sensation: Anterior 2/3rd of tongue, floor of mouth, and mandibular lingual
gingival.
B) Carries (from chorda tympani [VII]): Taste sensation: Anterior 2/3rd tongue.
C) Preganglionic parasympathetic: To submandibular ganglion.
Auriculotemporal nerve: A) Sensory: Front of ear & TMJ.
B) Postganglionic parasympathetic: To parotid gland.
Inferior alveolar nerve: A) Gives off nerve to mylohyoid and inferior dental plexus; terminates
as mental nerve.
B) Motor to = mylohyoid.
C) Sensory to = teeth, skin of chin, lower lip.
Mental nerve: Termination of inferior alveolar nerve.
Sensory to = skin of chin, skin, and mucous membrane of lower lip.
Ophthalmic Nerve (V1) Sensory supply to = the Upper eyelid, cornea, conjunctiva, frontal sinus,
upper nasal mucosa and forehead.
Maxillary Nrve (V2) Sensory supply to = Lower eyelid, upper cheek, lip, gums, palate, nose, tonsils,
hard palate and upper teeth.
Mandibular Nerve (V3) sensory supply to = Tongue (general), temporoauricular skin, lower face,
lower teeth.
Motor Supply to = Muscles of mastication, tensor tympani, mylohyoid, anterior belly of digastric,
tensor veli palatini
IMPORTANT BRANCHES OF TRIGEMINAL NERVE V3:
A) Lingual nerve:
General sensation: Anterior 2/3rd of tongue, floor of mouth, and mandibular lingual gingival. Carries
(from chorda tympani [VII]):
Taste sensation: Anterior 2/3rd tongue.
Preganglionic parasympathetics: To submandibular ganglion.
B) Auriculotemporal nerve:
Sensory: Front of ear, TMJ.
Postganglionic parasympathetic: To parotid gland.
C) Inferior alveolar nerve:
Gives off nerve to mylohyoid and inferior dental plexus; terminates
as mental nerve.
Motor to: mylohyoid.
Sensory to : teeth, skin of chin, lower lip.
D) Mental nerve:
Termination of = inferior alveolar nerve.
Sensory to : skin of chin, skin, and mucous membrane of lower lip.
E) Motor branches: Motor to muscles of = mastication, anterior digastric, and so on.
INFERIOR ALVEOLAR NERVE BLOCK:
Anesthetize the mandibular teeth.
Block this branch of V3 as it enters the mandibular foramen.
Needle Course:
Pierces:
■ Buccinator (between palatoglossal and palatopharyngeal folds).
■ Lies lateral to = medial pterygoid at the mandibular foramen.
■ If the needle penetrates too far posteriorly can hit parotid gland and CN VII, it will lead to =
Ipsilateral facial paralysis.
Lingual Nerve:
The lingual nerve is found in the = pterygomandibular space with the inferior alveolar nerve, artery,
and vein.
The lingual artery does not run with = the lingual nerve. The lingual artery is = medial to the
hyoglossus muscle, whereas the lingual vein and nerve are lateral to = the hyoglossus (as is the
submandibular duct and hypoglossal nerve [XII]).
The submandibular duct is crossed twice by the = lingual nerve.
If the lingual nerve is cut after the chorda tympani joins, you lose both = taste and tactile sensation.
The lingual nerve: can be damaged with third molar extraction because it lies close to the
mandibular ramus in the vicinity of the third molar.
TRIGEMINAL NUCLEI:
■ There are four paired nuclei (both motor and sensory).
Trigeminal Nerve:
All sensory information from the face is relayed through = VPM nucleus of
thalamus; sensory information from the rest of the body is through the = VPL.
From the thalamic nuclei (VPM or VPL), information relays to the = somatosensory
cortex (areas 3, 1, 2); the facial segment of the sensory homunculus
comprises a large area of the = lateral parietal lobe.
Parts of CNs VII and IX travel with = trigeminospinal tract.
All CN V afferent cell bodies are located within = trigeminal ganglion except
proprioceptive inputs.
Mesencephalic nucleus of CN V is the only case where primary sensory cell bodies are located
within the = CNS, rather than in ganglia.
Touch & Pressure is carried by = A-beta fibers.
Pain & Temperature is carried by = A-delta and C-Fibers.
Proprioception is carried by = A-alpha Fibers.
Sensation in teeth can be misinterpreted in = ear (because of the cross innervation).
Herpes zoster often affects = V1 division.
Trigeminal neuralgia (tic douloureux) : can affect V2 and V3.
SENSATION OF EXTERNAL EAR:
A) Auriculotemporal nerve (V3) supplies = Anterior half of external ear canal and facial surface of
upper part of auricle.
B) Auricular branch of vagus (CN X) supplies = Posterior half of external ear canal (so stimulation
can cause reflex symptoms: eg, fainting, coughing, gagging).
C) Greater auricular nerve (C2, C3) supplies = Inferior auricle (anterior and posterior)
D) Lesser occipital nerve (C2, C3) supplies = Cranial surface of upper auricle.
Corneal reflex: If stimulating right eye:
■ Lesion R V1 = neither
eye blinks.
■ Lesion L V1 = bilateral
blink.
■ Lesion R VII = only left
eye blinks (indirect).
■ Lesion L VII = only right
eye blinks (direct).
Levator palpebrae superioris (CN III) keeps the eyelid open; lesion results in = ptosis.
Orbicularis oculi (CN VII) closes eyelid; lesion results in inability to close, no corneal reflex.
TRIGEMINAL LESIONS:
Sensory: Division V1, 2, 3 = Deficits along distribution (pain, temperature, touch, pressure,
proprioception)
Motor: Division V3 only =
Temporalis and masseter muscles
■ Ipsilateral weakness of jaw closure
■ Ipsilateral open bite
Pterygoid muscle
■ Weakness of jaw opening
■ Deviation to ipsilateral side on opening
Diminished/loss of reflexes.
Facial Nerve passes through = Facial Canal.
CN VII NUCLEI:
A) Main motor nucleus
B) Superior salivatory Nucleus
C) Nucleus of the solitary tract (gustatory nucleus)
IMPORTANT MUSCLES OF FACIAL EXPRESSION (ALL CONTROLLED BY CN VII):
A) Orbicularis Oris : Whistle, Pulls lips against teeth, protrudes lips.
B) Depressor anguli Oris: Frown, Pulls down angle of mouth.
C) Zygomaticus Major: Smile, Pulls angle of mouth up and back.
D) Risorius: Smile, Pulls angle of mouth laterally.
E) Orbicularis oculi: Closes eye.
OTHER MUSCLES CONTROLLED BY CN VII:
A)Buccinator: Holds food on occlusal table (accessory muscle of mastication); tenses cheek
(blowing, whistling)
B) Stapedius: Decreases vibration of the stapes (decreases perception of sound)
CN VII LESIONS:
A) Lower motor neuron lesion: Ipsilateral paralysis/weakness of upper and lower face; loss of
corneal reflex (efferent limb).
B) Upper motor neuron lesion: Contralateral lower face weakness only.
Bell’s palsy: Acute 7th nerve palsy.
Stroke: is an example of = an upper motor neuron lesion.
Bell’s palsy: is an example of a = lower motor neuron lesion.
Facial and maxillary arteries supply blood to the = buccinator.
GREATER PETROSAL NERVE
A) carries Taste from = palate via palatine nerves.
B) Greater petrosal nerve is the parasympathetic root of the = pterygopalatine ganglion.
Central hearing connections are bilateral, so a central lesion will not cause deafness in = either ear.
Caloric test is testing the vestibuloocular reflex. COWS Cold Opposite Warm Same.
The gag reflex: is mediated by CN IX (afferent-unilateral) and CN X (efferent-bilateral).
CN IX—Glossopharyngeal:
A) Carries taste from = posterior third of the tongue.
B) Parasympathetic/secretomotor: Parotid via = otic ganglion.
C) Gag reflex (afferent limb) (fauces).
D) Chemo-, baroreception (afferent limb)—carotid body, carotid sinus.
Chemoreception: Carotid body; oxygen tension measurement.
Baroreception: Carotid sinus; blood pressure changes. Mediated CN IX (afferent) and CN X
(efferent).
Vagus nerves: lose their identity in the esophageal plexus. The anterior gastric nerve can be cut
(vagotomy) to reduce gastric secretion.
The cardiac branches of the vagus: (form the cardiac plexus) are preganglionic parasympathetic
nerves that synapse with postganglionic parasympathetic nerves in the = heart.
The abdominal viscera below the left colic flexure (and genitalia and pelvic viscera) are supplied by =
pelvic
splanchnic nerves (parasympathetic preganglionics).
With CN XII paralysis, the tongue tends to fall back and obstruct the airway (genioglossus).
CN XI LESIONS:
A) Paralysis of SCM: difficulty turning head to = contralateral side.
B) Paralysis of trapezius: Shoulder droop.
In addition to deviation to the affected side (with damage to CN XII/hypoglossal Nerve and resultant
denervation atrophy), dysarthria (inability to articulate) can be experienced by the patient.
Hypoglossal Nerve: Passes between External Carotid Artery and Internal Jugular Vein.
CN XII LESIONS:
A) Lower motor neuron: Tongue deviates toward side of =lesion.
B) Upper motor neuron: Tongue deviates away from side of = lesion.
Spinal Cord:
A) 40–45 cm long.
B) Extends to L1–L2 (L3 in a child).
CSF: is located in the = subarachnoid space. This space is entered during a = lumbar “tap” or
puncture.
In the spinal cord, white matter is peripheral and gray matter is central, the reverse of the = cerebral
cortex.
The spinal cord is protected by the = bony and ligamentous walls of the = vertebral canal and CSF.
The cell bodies for afferent/sensory nerves are located in the = dorsal root ganglion.
Tracts:
A) Ascending/sensory:
a) Anterior spinothalamic = Touch, pressure.
b) Lateral spinothalamic = Pain, temperature
c) Posterior columns (gracilis and cuneatus) = Proprioception, position sense.
d) Spinocerebellar = Motor coordination, proprioception.
B) Descending/motor:
a) Corticospinal = Motor
b) Tectospinal = Movement of head
c) Rubrospinal = Muscle tone, posture, head, neck, upper extremities
d) Vestibulospinal = Equilibrium (interface with CN VIII)
e) Reticulospinal = Muscle tone, sweat gland function
NERVE FIBER TYPES:
A) A Fiber:
a) A-α: Proprioception & Motor
b) A-β: Sensory, Touch and Pressure
c) A-γ: Muscle spindle
d) A-δ: Sharp pain, Temperature and Touch
B) B Fiber: Preganglionic autonomic.
C) C Fiber: Dull pain, Temperature, Postganglionic and autonomic.
Splanchnic nerves: are sympathetic nerves to the = viscera. They pass through the sympathetic
chain ganglia without synapse (exceptions to short preganglionic and long postganglionic) and
synapse in the effector.
Sympathetic Nervous System :
■ Thoracolumbar
■ “Fight or flight”
Parasympathetic Nervous System :
■ Craniosacral.
■ “Rest and digest.”
Postganglionic autonomic fibers: are unmyelinated = C-fibers.
Gray rami: connect sympathetic trunk to every = spinal nerve.
White rami: are limited to = spinal cord segments between T1 and L2.
Cell bodies of the visceral efferent preganglionic fibers (visceral branches of sympathetic trunk) are
located in the = interomediolateral horn of the spinal cord.
Cell bodies of visceral afferent fibers are located in the = dorsal root ganglia.
Common #palpablesites
Upper limb
Front of right upper extremity
*.Axillary pulse: located inferiorly of the lateral wall of theaxilla
*.Brachial pulse: located on the inside of the upper arm near the elbow, frequently used in place ofcarotid
pulse in infants (brachial artery)
*.Radial pulse: located on the lateral of the wrist (radial artery). It can also be found in theanatomical snuff
box.
*.Ulnar pulse: located on the medial of the wrist (ulnar artery).
Lower limb
*.Femoral pulse: located in the inner thigh, at the mid-inguinal point, halfway between the pubic symphysis
and anterior superior iliac spine (femoral artery).
*.Popliteal pulse: Above the knee inthe popliteal fossa, found by holding the bent knee. The patientbends the
knee at approximately 124°, and the physician holds it inboth hands to find the popliteal artery in the pit
behind the knee (Popliteal artery).
*.Dorsalis pedis pulse: located on top of the foot, immediately lateral to the extensor of hallucis longus
(dorsalis pedis artery).
*.Tibialis posterior pulse: located on the medial side of the ankle, 2 cm inferior and 2 cm posterior to the
medial malleolus (posterior tibial artery). It is easily palpable over Pimenta's Point.
Head and neckArteries of the neck.
*.Carotid pulse: located in the neck (carotid artery). The carotid arteryshould be palpated gently and while the
patient is sitting or lyingdown. Stimulating its baroreceptors with low palpitationcan provoke
severebradycardiaor even stop the heart in some sensitive persons. Also, a person's two carotid arteries should
not be palpated at the same time. Doing so may limit theflow of blood to the head, possibly leading to fainting
or brainischemia. It can be felt between the anterior border of thesternocleidomastoid muscle, above the hyoid
bone and lateral to the thyroid cartilage.
*.Facial pulse: located on the mandible (lower jawbone) on a line with the corners of the mouth(facial artery).
*.Temporal pulse: located on thetempledirectly in front of the ear (superficial temporal artery).
Torso
*.Apical pulse: located in the 5th left intercostal space, 1.25 cm lateral to themid-clavicular line. In contrast
with other pulse sites, the apical pulse site is unilateral, and measured not under an artery, but below
theheartitself (more specifically, the apex of theheart).
#Important
****Clear Handy Points******
• Trisomy 21 = Down syndrome. (Age for Drinking is 21)
• Trisomy 13 = Patau syndrome.(Age for Puberty in females is 13)
• Trisomy 18 = Edward syndrome.(Age for voting in Election is 18)
• Increased alpha feto protein plus increased albumin = Anencephaly.
• Vitamin A prevents squamous cell carcinoma.
• Right border of heart is made by right atrium.
• Trephine biopsy Indicates = aplastic anemia > ALL.
• In anesthesia halothane is always given with Nitric oxide.
• Most diagnostic test for TB = PCR > AFB > Caseous.
• Down syndrome occurs 1/100.
• Common genital vesicle is herpes simplex virus.
• Inferior orbital fissure contents are maxillary nerve and its zygomatic branch, inferior ophthalmic
vein and sympathetic nerves and this fissure communicates with pterygo palatine fossa.
• Superior orbital fissure communicates with middle cranial fossa and it transmits lacrimal nerve,
frontal nerve, trochlear nerve, oculomotor nerve, abducent nerve, nasociliary nerve and superior
ophthalmic vein.
• Thyroid is the only endocrine gland that stores its secretions outside the cell.
• Sensations from the tip of nose are carried by ophthalmic division of trigeminal nerve.
• Tensor tympani is supplied by mandibular division of trigeminal nerve.
• Stapedius is supplied by facial nerve.
• Nucleus raphe synthesize serotonin.
• Locus Ceruleus = Nor epinephrine.
• At term CRL = 36 cm and CHL = 50 cm.
• CRL used b/w 7 - 14 weeks.
• BPD is used 16 - 30 weeks.
• Sperm life in genital tract is 24 to 48 hours.
• 2nd most common cause of osteoporosis in old age is Cushing syndrome.
• Prenatal chromosome is detected at 14 -18 weeks.
• Bronchial asthma plus hypertensive patient > Best drug Verapamil.
• Aphasia and facial nerve palsy > damage to middle meningeal artery.
• Diabetic plus hypertensive patient > Best drug Captopril.
• Inferior wall MI > Right marginal artery block.
• Epidermis of partoid gland is derived from ectoderm.
• To kill spores of surgical instrument > moist heat at 160 C for 1 hr.
• Food poisoning caused by Staph. Aureus is through entertoxin.
• Least positive value for Widal is 1:120.
• Trigeminal ganglion is completely covered by dura.
• Tactile sensation is carried by dorsal white column to medial leminiscus.
• Anti HBcAg = positive window period.
• MAP = diastolic +1/3 pulse pressure.
• Insulin secretion is inhibited by beta blocker.
• Highest triglyceride = VLDL.
• Highest cholesterol = LDL.
• Highest lipoprotein = HDL.
• Which is not a phospholipid = Plasmalogen.
• Best way to check bone density is the scan of spine.
• End break down of glucose is pyruvate.
• In pre eclamptic patient hydralazine is the drug of choice before surgery.
• In down syndrome: Triple test (alpha feto protein is decreased, b-HCG is increased and estriol is
decreased) and if we add up inhibin which is increased then it will be called as Quadruple test.
• Identification of turner syndrome is by barr bodies.
• PLAP (Placental Alkaline Phosphatase) is a tumor marker in seminoma and ovarian carcinoma.
• Tubo ovarian abscess by IUCD - most causative agent is Actinomycosis.
• Major intracellular buffer is Hb.
• DVT more common in popliteal vein but pulmonary embolism is through femoral veins.
• Investigation of DIC D-dimers, FDPs, Platelet count and PT (except clotting time).
• Referred pain: Cervix S2-S3 <> Ovary -T10-T11 <> Testis -T10 <> Umbilicus -T10 <> Kidney T12-
L2.
• Trimethoprim (co-trimoxazole ) side effect > megaloblastic anemia plus leukopenia.
• Sacrospinous ligament does NOT contribute in wall of perineum.
• Lesser omentum connects with duodenum.
• Sphincteric urethra is known as external urethral sphincter and is supplied by pudendal nerves
where as internal os is supplied by inferior hypo gastric plexus.
• Nerve supply of rectum is hypogastric plexus.
• Uterine tube is 10 cm long.
• Urachal cyst is the remanant of allantois.
• Thyroid gland is derived from endoderm.
• Thymus and inferior parathyroid develops from 3rd branchial pouch.
• Superior para thyroid is developed from 4th brachial pouch.
• Diaphragmatic hernia occurs due to absence of pleuro peritoneal membrane.
• Superior thyroid artery is related to external laryngeal nerve which supplies posterior cricothyroid
muscle of larynx and damage to it will cause hoarseness.
• Inferior thyroid artery is also related to recurrent laryngeal nerve which runs b/w trachea and
esophagus and its most common injury is in thyroidectomy.
• In papillary carcinoma of thyroid > it occurs in young age and involves cervical lymph nodes.
• Tracheostomy is done at 2nd tracheal ring by pulling the isthmus inferiorly.
• Nonfunctional nodule or cold nodule has high chances of malignant transformation.
• Erythropoiesis in middle trimester is in the liver.
• Right coronary artery supplies SA node.
• Levator ani muscle is supplied by L2, L3 & L4.
• Defect in Bulbus Cordis results in VSD, hypertrophy of Right ventricle, congenital cyanosis,
transposition of great vessels (but not ASD).
Endocardial cushion is important for the formation of four chambers of heart.
• Thirst is least stimulated by blood pressure.
• Important hormone involved in gluconeogenesis is Cortisol.
• Apoptosis is inhibited by bcl-2 inhibition.
• Low serum complement in SLE.
C3b & IgG are Opsonins & C5a is chemotactic protein.
• Urea is an important indicator for muscle protein loss.
ESR is decreased when albumin is increased.
• Drug which does not cause gynecomastia is Androgen & drugs which cause gynecomastia are
Digoxin, Girsoefulvin, Cimetidine, Androgens, Spironolactone and Ketoconazole.
Tx of hirstuism is Cyproterone Acetate.
• Pyruvic acid is intermediate from glucose to acetyl coA.
Epinephrine .nor epinephrine & dopamine are derived from tyrosine.
End product of Purine is Uric acid.
RBCs have glycolytic enzyme activity.
End product of glucose gives 2 Pyruvate.
Alanine should be taken in diet.
• Cisplatin is more notorious to cause renal toxicity.
• Dysplasia is seen in epithelia.
• MRNA has a codon.
• HSV is associated with vulvar papules.
• Wart on the lateral wall of introitus it is caused by HPV.
Plaque like lesion on posterior superior wall of vagina is squamous cell carcinoma.
• German Measles causes Congenital Cataract.
Anterior abdominal wall swelling with umbilical cord attached to it in a new born baby is known as
Omphalocele.
• Beta-lactam acts on the Cell Wall.
• Streptomycin causes ototoxity.
Isoniazid > Hepatotoxicity.
Pyrazinamide > Gout.
Rifampicin > red color of body secretions.
• Opportunistic organism > E. Coli.
Pseudomembranous colitis is caused by C. difficile.
Most common organism involved in gynecological & abdominal procedures is E.coli.
• Vulvular itching = Chlamydia; fish like smell; Bacterial Vaginosis.
• Vitamin K dependent: Factors 2, 7,9,10, Protein C, Protein S, Fibrinogen and Prothrombin.
Intrinsic and Extrinsic pathways of coagulation converge at factor 10.
• Threonine does not contain Sulfa group.
• Autosomal dominant is hereditary Spherocytosis & Poly cystic kidney disease.
• Lens opacity causing drugs >Chlorpromazine, Amidarone, Tamoxifen, Gold & Iron toxicity.
Drugs causing corneal opacity > Amiodarone, Chloroquine, Mepacrine & Copper.
• Ribosome have purple color on Eosin & Methylene blue staining
High energy content > Starch.
High energy compound > ATP
Antidote of warfarin is vitamin K but if action is more quickly required then FFP.
• Olfactory cells are the only neurons in the body that regenerates.
• Projectile vomiting greenish in color means bilious vomiting so it is due to duodenal atresia but if
projectile vomiting non bilious then it is hypertrophic pyloric stenosis.
• Pulmonary trunk relation with the bronchus at the hilum of the lung-mnemonic is RALSR- Right
Anterior & Left Superior.
• Rhino sinusitis is caused by Strep Pneumonia, H. Influenza, M Catarrahalis.
• Homan’s sign is present in DVT in which if you dorsiflex the foot there will be pain in calf muscles.
• Classic triad of Pulmonary Embolism: -
-Neurological manifestations.
-Petechial rash.
-Hypoxemia.
• Nitrogen bubbled precipitator in ascending divers and can be treated with hyperbaric oxygen.
• CT pulmonary angiography is the best test to detect Pulmonary Embolism.
• The most common infectious agent transmitted by blood transfusion is cytomegalovirus (CMV),
which is present in donor lymphocytes.
• Before blood is transfused into newborns or patients with T-cell deficiencies, it must be irradiated to
kill donor lymphocytes. This prevents the patient from developing a graft-versus-host reaction or a
CMV infection.
• Yersinia enterocolitica, a pathogen that thrives on iron, is the most common contaminant of stored
blood.
• Iron is stored in bone macrophages.
• Structures passing thru superior orbital fissure....
NOT-FAL
NASOCILLIARY<>OPTHALIMIC VEIN<>TROCHLEAR<>FRONTAL
ABDUCENT<>LACRIMAL
• Cranial Nerve Foramina
CN I passes through > cribriform plate
CN II > optic canal
CN III, IV, VI (ophthalmic division), VI > superior orbital fissure
(Maxillary div > foramen rotundum, mandibular div > foramen ovale)
CN VII, VIII > internal acoustic meatus
CN IX, X, XI(cranial root) > Jugular foramen (accessory nerve spinal root >foramen magnum)
CN XII > hypoglossal canal.
●#ANATOMICALLEVELS●
TOP 🐙 🐙 ANATOMICAL LEVELS TO RELATED STRUCTURES
🐙 🐙 🐙 BOTTOM
🐙
C1-C2 VERTEBRA: vocal cords

🐠
C2-oropharynx and soft palate with mouth open

🐠
C3-hyoid bone
🐠
level of larynx in infants-C2-C3

🐠
level of larynx in adults-C3-C6

🐠
C3-C4:bifurcation of common carotid artery

🐠
C4 &C5-thyroid cartilage
🐠
C6-cricoid cartilage
🐠
C6-begining of trachea
🐠
C6-begining of oesophagus
🐠
C7-vertebra prominence
🐠
thyroid lobe superior extent-oblique line of thyroid cartilage

🐠
isthmus of thyroid gland-2nd through 4th tracheal rings

🐠
thyroid lobe inferior extent-sixth tracheal ring

🐠
spine at root of scapula-opposite third thorasic spine

🐠
thoracic inlet-T1
🐠
superior angle of scapula-overlies part of 2nd rib-1st intercoastal space superior to angle/T2
🐠
jugular notch-T2&T3 vertebral junction

🐠
carnia-T3-4 or T4
🐠
manubrium Sterni-T3&T4
🐠
sternal angle-T4&T5
🐠
body of sternum-T5to T9 vertebra

🐠
greater splanchnic nerve-T5-T9 sym ganglia

🐠
apex of heart/mitral value-5th intercoastal space

🐠
base of heart/supine position-T5 to T8 vertebra

🐠
🐠base of heart/erect position-T6 to T9
🐠oblique fissure of lung-T6
🐠inferior angle of scapula-T7
🐠vena caval foramen-T8
🐠xiphoid process-T9
🐠xiphisternal joint-T9 vertebra typicaly
🐠esophageal hiatus-T10
🐠termination of oesophagus-T11
🐠lesser splanchnic nerve-T10-T11 sym ganglia
🐠least splanchnic nerve- T12 sym ganglian
🐠aortic hiatus-T12
🐠coeliac trunk branch of abdominal aorta-T12
🐠median arcuate logament of respiratory diaphragm- T12 &L1 junction
🐠pulmonary valve-left 2nd intercoastal space medial
🐠aortic valve-right 2nd intercoastal space
🐠tricuspid valve-right lower sternum
🐠nipple in male-4th intercoastal space in midclavicular line
🐠transpyloric plane-L1
🐠celiac trunk-L1 superior border
🐠superior mesentric artery-L1 inferior border
🐠pylorus of stomach-L1
🐠1st part of duodenum-L1
🐠left renal vein-L2
🐠2nd part of duodenum-L1,L2,L3right side
🐠3rd part of duodenum-L3
🐠left crus of diagphram-L2
🐠right crus of diagphram-L3 vertebra
🐠inferior mesentric artery-L3
🐠subcoastal plane-L3
🐠spinal cord termination
L1 in adults
L3 in New borns
🐠spleen-obliquely along axis of 10th rib
🐠right kidney-
Superior pole-T12
Inferior pole-L3
Hilum-L1
🐠left kidney-
Superior pole-T12
inferior pole-L3
Hilum-L1
🐠pancrease head-L2&L3
🐠umbilicus(in supine/recumbent position)-disc between L3-L4
🐠bifurcation of abdominal aorta-L4
🐠supracristal plane/higheat point on illiac crest-L4
🐠transtubercular plane-L5
🐠 origin of inferior vena cava-L5by by
🐠 anterior superior illiac spine-S1/sacral promontary
🐠 posterior auperior illiac spine-S2
🐠 pubic symphysis-tip of coccyx
IMPORTANT POINTS FROM #ENDOCRINOLOGY

• Half life of transthyritin I s2 days
• Half life of TBG is 5 days
• Half life of albumin Is 13 days
• Levels of TBG are increased in estrogen treated patients. Methadone, heroin, major tranquiliers,
clofiberate
• Levels of TBGs are decreased by glucocorticoids, adndorgens, danazole, and L asparginase(a
chemotherapeutic drug){patient remains euthyroid coz level of T3 and T3 decrease due to feedback}
• salicylates, phenytoin, mitonate(a cancer chemotherapeutic drug) and 5 florouracil inhibit binding of
T3 and T4 with the TBG and produce effects similar to decreased TBGs{ patient remains euthyroid
coz level of T3 and T3 decrease due to feedback}
• Thyroid hormone binds with its receptors in nucleus via ZINC FINGERS
• Thyroid hormone increase the metabolism in all metabolically active tissues except
UBLAST(uterus, brain(in adults), lymph nodes, anterior pituitary, spleen, testes)
• Thyroid hormone donot increase the metabolism in uterus but is required for the normal menstrual
cycle and fertility
• Yellow tinge in hypothyroidism is produced due the acconulation of carotene inblood stream.
Thyroid hormne is required for conversion of carotene to Vit A in liver. Carotenimia os distinguished
from the jaundice because it donot involves sclera
• Vitamin deficiency syndromes may be precipitated in hyperthoiridism coz when metabolic rate is
increased the demand of almost all vitamins is increased
• Myxedema in hypothoiridism occurs due to retention of water by osmotic effect of protein
complexes with the hyaluronic acid and chodroitin sulphate etc in the skin. With the administration of
thyroid hormone the proteins are metablised and dieresis occurs until edema is relieved
• Thyroid hormone increase the glucose absorption from the GIT and increased the plasma glucose
level rapidly after carbohydrate rich meal however it falls rapidly after sometime
• Thyroid hormone increases the LDL receptors in liver lowering the plasma cholesterol levl
• Myxedema is one disease that can be diagnosed on telephone….
• Hyperthoiridosm causes increased pulse pressure
• Resistin and TNF alpha increase the insulin resistant
• Leptin and adiponectin decrease it s resistance
• Insulin/glucagon level ratio in different conditions
a. Large carbohydrate meal 70
b. Iv glucose 25
c. Small meal 7
d. Overnight fast 2.3
e. Low carbohydrate diet1.8
f. Strvation 0.4
(thing to remember is IV glucose has less effect on insulin release than oral glucose)
• Immediately after hypophysectomy the zona fasciculate and reticularis start to degenerate. Zona
glomerulosa remains normal due to effect of angiotensin II. Ability of excretion of aldosteron
secretion and Na preservation may hamper in long standing hypopituitrism due the absence of a
pituitary factor that that maintains the responsiveness of zona glomerulosa.
• Injections of ACTH or stimuli that cause endogenous secretion cause hypertrophy of zona
fasciculate and reticularis but actually causes atrophy of zona glomerulosa
• Effect of dopamine in circulation blood Is unknown but it produces vasodilation in kidney and of
mesenteric vessels. Elsewhere it produces vasoconstricton. It has a positive ionotropic acton by
action on beta 1 receptors.the net effect of ibjection of moderated dose of dopamine is increase in
systolic BP and no change in diastolic BP. By these properties it is used in ccardiogenic and
traumatic shocks.
• Adrenals release norepinephrine selectively in emotional stress in which the individual is familiar
with. Epinephrine secretion increase in stress with which individual do not know what to expect.
• Glucocorticoids increase the no of neutrophils, platelets ns RBC in circulation. They decrease the
no of eiosinophils, basophils and lymphocytes. They also decrease the size of lymph nodes and
thymus.
• 25OH cholecalciferol is converted to 1,25diOHcholcalciferol in proximal convoluted tubules of
kidney.
• Sarcoidosis is associated with increase 1,25diOHchlcalciferol produced by pulmonary
macrophages upon stimulation by gamma interferon.
• PIEBALDISM: the patches of skin lacking melanin as a result of congenital defect of migration of
pigment cell precursors from the nural crest during embryonic development. Vitelago is similar
patchy loss of melanin but onset is after birth and is progressive
• GH secretion Is inhibited by REM sleep, glucose, cortisol, FFA, medroxyprogesteron, and GH.
• GH secretion is increased by exercise, amino acid, glucagon, pyrogens, going to sleep, estrogen
and androgens.
• Blood testes barrier is formed by sertoli cells. Germ cells pass thru this barrier by breaking the tight
junctions above them followed by reformation of junctions.
• Menstrual blood is predominantly arterial. 25% is venous in origin.
• Human milk contains **ALIAN** more than cow milk. Ascorbic acid, Lactose, Iron, vit A, Nicotinic
acid
COMMONLY TESTED FACTS

I) ONLY TWO Cranial Nerves Decussate:
Optic & Trochlear.
2 & 4 Decussate.
2 & 4 Decussate.
2 & 4 Decussate.
II) Almost all the questions of leukemias can be correctly answered just by knowing the age range of
these cancers:
0-14: ALL
14-39: AML
40-59: CML
60+: CLL
III) Rhabdomyolysis causes HYPERkalemia.
HYPOkalemia causes Rhabdomyolysis
IV) ALL causes of hypopituitarism result in deficiency of MORE than ONE hormone EXCEPT
Kallmann Syndrome
V) Clostridium:
Tetani - causes SPASTIC paralysis.
Botulinum - causes FLACCID paralysis.
Perfringes - causes NO paralysis
VI) IN Nephron:
Maximum reabsorption of H2O take place in Proximal Convoluted Tubules, REGARDLESS to ADH
status (present or absent).
VII) Offspring of Older Women: Inc incidence of Trisomy 21 (DOWN Syndrome).
Offspring of Older Men: Inc incidence of Achondroplasia & Marfan Syndrome.
VIII) Know the difference:
Cisplatin is NEPHrotoxic.
Cyclophosphamide is CYStotoxic (Hemorrahagic CYSitis)
IX) Try to Understand that:
History of Smoking = Bronchogenic Cancer.
Exposure to Asbestos = Mesothelioma.
Smoking Hx + Asbestos exposure = Bronchogenic Cancer.
X) Until proven Otherwise:
Post-coital vaginal bleeding is Cervical cancer.
Post-menopausal vaginal bleeding is Endometrial cancer.
Most important component of shock
Q: Most important component of shock is??
a) Hypotension
b) Tachycardia
c) Tissue hypoxia
d) Temperature
Answer: C
Explanation: By definition shock is inadequate tissue perfusion, which is just ANOTHER way of
saying "Tissue Hypoxia".
Q: Young female with low MCV and MCH but normal Fe and TIBC, most likely test to make
Diagnosis?
A. bone marrow aspiration
B. Hb A2
C. Retic count
Answer: B
Explanation: Microcytic Anemia With NORMAL Iron studies (Serum Iron, TIBC, Ferritin etc) =
Thalassemia.
Hb electropheresis is the Next best Investigation.
Question: One of the following is not an oncogenic virus?
a.EBV
b. Hep B
c.Hep D
d.herpes virus
e. HPV
Answer: C
Remember:
If Hep D and Herpes are in options SELECT Hep D.
If Hep D and HSV in options SELECT HSV.
Herpes --> family of 8 viruses (Including HHV8 and EBV - BOTH are carcinogenic)
1) Microcytic Anemia with Low Ferritin & High TIBC = Iron deficiency Anemia.
2) Microcytic Anemia with High Ferritin & Low TIBC = Anemia of Chronic Disease.
3) Microcytic Anemia with High Serum Iron = Sideroblastic Anemia.
4) Microcytic Anemia with NORMAL Iron studies = Thalassemia.
________
TIBC = Total Iron Binding Capacity
Ferritin = Stored Iron
A young female with pregnancy developed nausea vomiting and jaundice suddenly she died which is
most unlikely in this patient?
A. HAV
B. Hep B
C. Hep C
D. Hep D
E. . Hep E
Answer: C (Hepatitis C)
Explanation: ALL Hepatitis viruses can cause Acute fulminant hepatitis EXCEPT Hepatitis C. The
given presentations are HIGHLY suggestive of Fulminant hepatitis and the Least likely or most
Unlikely cause will be Hepatitis C.
Coagulative Necrosis is seen in...
A.TB
B. Pyogenic infections
C.all infractions
D.gangrene
E.brain
Answer: A
Explanation: Yes! I know I know, T.B & Caseous Necrosis thing. Actually Caseous is variant of
Coagulative Necrosis that's why here the correct answer is T.B (a)
Why NOT Gangrene?
We have TWO types of Gangrenes (a) Gas (b) Wet
Gas Gangrene is related to Coagulative while Wet Gangrene is related with Liquifective Necrosis.
Here in question we have generalized term "Gangrene" which can be BOTH - either Gas or Wet.
1)
Oral Cavity:
Premalignant CONDITIONS = Submucous Fibrosis & Lichen planus.
Premalignant LESIONS = Erythroplakia & Leukoplakia.
2)
Isolated 6th cranial nerve palsy causes HORIZONTAL diplopia.
Isolated 4th cranial nerve palsy causes VERTICAL diplopia.
3)
Fluent aphasia: Cerebral lesion is POSTERIOR to the central sulcus.
Nonfluent aphasia: Cerebral lesion is ANTERIOR to the central sulcus.
Tamoxifen is an estrogen receptor AGONIST in the uterus.
Raloxifene is an estrogen receptor ANTAGONIST in the uterus.
Tamoxifen for PREmenopausal women with high risk for breast cancer.
Raloxifene for POSTmenopausal women with high risk for breast cancer.
ALL steroid hormones are protein bound EXCEPT DHEA.
ALL protein hormones are not bound to plasma proteins EXCEPT IGF-1.
ALL hormones are secreted in pulsatile fashion EXCEPT Thyroxin.
Regarding TB:
#Ghon Complex - ONLY in #PRIMARY T.B.
#Cavitation - ONLY in #SECONDARY T.B.
Calcification, Positive PPD, Caseating granuloma - in BOTH.
The MOST COMMON thyroid Carcinoma is Papillary (P-opular).
It also has P-sammoma bodies on histology.
It causes P-alpable lymph nodes (lymphatic spread)
n. MeninGitidis ferments Maltose & Glucose.
n. Gonorrhoeae ferments ONLY Glucose.
LYMPHATIC DRAINAGE OF MAJOR ORGANS
GIT: all lymph of GIT is drained into CYSTERNA CHYLI, THORACIC DUCT & then finally drains into
LEFT SUBCLAVIAN VEIN
CERVICAL ESOPHAGUS drains into Deep cervical nodes
THORACIC ESOPHAGUS drains into posterior mediastinal nodes
ABDOMINAL ESOPHAGUS drains into Preaortic & celiac nodes
STOMACH is drained to Aortic nodes
SMALL INTESTINE drains into Superior Mesentric nodes
LARGE INTESTINE drains into Central nodes through Epicolic, Paracolic & Intermediate nodes
RECTUM: Upper half drains into Inferior mesentric nodes
Lower half drains into internal iliaac nodes
ANAL CANAL: Upper half into internal iliac nodes
Lower half into Superficial inguinal nodes
MALE GENITAL TRACT
SCROTUM drains into Superficial inguinal nodes
TESTIS drains into Paraaortic nodes
PROSTATE drains into Internal & external Iliac nodes
PENIS.. Skin.. Superficial Inguinal nodes
Deep structure.. Internal Iliac nodes
FEMALE GENITAL TRACT
OVARY, FALLOPIAN TUBES, UPPER UTERINE CORPUS drains into Aortic & paraaortic nodes.
UPPER VAGINA, CERVIX drains into External & Internal Iliac nodes.
LOWER VAGINA & VULVA drains into Inguinal nodes.
V VV Important>>>>>>>>>>
THE BEST #NEUROANATOMY Points
muscles of facial
expression have
motor innervation.
muscles.
enophthalmos.
(accommodation-
motor.
The buccal nerve of V3 provides sensation to = the cheek; whereas the buccal branch of CN VII is
gingival.
C)Preganglionic parasympathetics: To submandibular ganglion.
Auriculotemporal nerve: A)Sensory: Front of ear & TMJ.
B)Postganglionic parasympathetic: To parotid gland.
as mental nerve.
lower teeth.
A) Lingual nerve:
as mental nerve.
D) Mental nerve:
Needle Course:
Pierces:
Lingual Nerve:
and vein.
TRIGEMINAL NUCLEI:
Trigeminal Nerve:
eye blinks.
blink.
TRIGEMINAL LESIONS:
proprioception)
Pterygoid muscle
CN VII NUCLEI:
CN VII LESIONS:
(efferent).
pelvic
CN XI LESIONS:
CN XII LESIONS:
Spinal Cord:
A) 40–45 cm long.
puncture.
cortex.
Tracts:
NERVE FIBER TYPES:
A) A Fiber:
■ Thoracolumbar
■ Craniosacral.
Cell bodies of visceral afferent fibers are located in the = dorsal root ganglia.
#IMPORTANT CONFUSING BCQS OF #PHYSIOLOGY FROM BCQ BOOKS

SOLVED(cvs MCQs)
1.2yr old boy brought to emergency with frequent lose stools, abdominal pain, fever and vomiting.
Eyes are sunken, tongue is dry and coated. Which of the following explains the condition
a. Cellular swelling
b. Decreased ATP production by the cells
c. Decreased ECF volume
d. Decreased Ca ion concentration in ECF
e. Dehydration
Ans E
2. ECG of the patient with electrolyte disturbance shows prolonged PR interval, inverted T wave, and
prominent U wave. He has
a. High K concentration
b. Hypercalcemia
c. Hypokalemia
d. Low plasma calcium
e. Low plasma Na
Ans C
3. arterial baroreceptors in the carotid sinus and arch of aorta
a. Are located in tunica media
b. Help maintain arterial BP
c. Respond to change in partial pressure of oxygen
d. Send impulses to brainstem only thru vagus
e. Undergo adaptation within seconds
Ans B
4. as a result of simultaneous injection of small volume of water into the carotid art and hemorrhage
upto 12% of total blood col
a. Aldosteron secretion is inhibited
b. GFR is increased
c. Urinary Na excretion is increased
d. Urine osmolarity decrease and flow rate increase
e. Urine osmolarity increase and flow rate decrease
Ans E
5. PR interval in ECG
a. Becomes abnormal in heart block
b. Includes the PR segment
c. Includes the wave of atrial depolarization
d. Represents atrial depolarization and conduction thru AV node
e. Represents the interval b/w the atrial contraction and the ventricular contraction
Ans A
6. SA node
a. Has membrane potential of -65 to – 80
b. Controlled by autonomic nerves
c. Less permeable to Na
d. Is located in right atrium on the septum
e. Spontaneously generates impulses
Ans E
7. cardiac index
a. Increases with the heart disease
b. Is cardiac output per square meter of the body surface area
c. Is percentage of end diastolic vol ejected during sustole
d. Is the total amount of blood ejected by both ventricles
e. Normal value in young male is 5.5
its BBBB
8. QRS complex has properties except
a. Comes after P wave
b. Consists of positive and negative waves
c. Has varialble amplitude in different leads
d. Is due to atrial depolarization
e. Occurs just before the vent systole
Ans D
9. the common denominator in various forms of shock is
a. Arteriolar relaxation with subsequent loss of peripheral resistance
b. Blood loss
c. Circulating blood volume less than the size of intravascular vol
d. High hematocrit values
e. Reduction of plasma vol
Ans C
10 cardiac muscles are functional syncytium because they have
a. Actin and myosin filament
b. Gap junctions b/w adjacent cells
c. Larger T tubules
d. Slow Ca Na channels
e. Transverse striation
Ans B
11. the most common early manifestation of transfusion reaction is
a. Allergic
b. Febrile
c. Hemolytic
d. Urticaria
e. Vasovagal
Ans B
12. in normal healthy person the 2nd heart sound
a. Generates viberation in ventricular wall during systole
b. Has a duration of 0.14 sec
c. Caused by vent filling
d. Normally has low frequency
e. Occurs during isovolumetric relaxation phase of cardiac cycle
Ans E
13. atrial flutter
a. Causes a very rapid rate of contraction of atria
b. Follows by 4-5 beats of atria for every beat of ventricle
c. Is a condition caused by circus movement in th atria
d. Lead very high vol of blood pumped by atria
e. Shows P wave which is very weak
Ans C
14. following help in non progressive compensatory shock except
a. Angitensin
b. Barroreceptor reflex
c. CNS ischemic response
d. Inc sympathetic reflexes
e. Stress compression of capillaries
Ans E
15. a patient complaints of generalize weakness and palpitations. Pulse is irregularly irregular. ECG
shows absent P waves, QRS complexes are normal but with irregular intervals. Diagnosis is
a. AV block
b. Atrial fibrillation
c. Atrial flutter
d. SA block
e. Vent fibrillation
Ans B
16. unconscious patient with cold calmy skin and rapid pulse. He is pale. Mean art BP is 50 mmHg.
At this stage the mechanism providing max compensation is
a. Baroreceptor mech
b. Bainbridge reflex
c. CNS ischemic response
d. Chemoreceptor reflex
e. Volume reflex
Ans C
17. the systolic BP is highest at
a. Aorta
b. Central vein
c. Pulmonary artery
d. Renal artery
e. Right atrium
Ans D
18. chronic pressure over load on left ventricle due to aortic stenosis result in
a. Altered left ventricular distensibility
b. Decreased contractility
c. Ejection fraction 60%
d. End diastolic vol 230 ml
e. Left ventricular dilation
Ans B ??
19. 18 yr old female with history of rheumatic ever comes with dyspnea. Examination shows mitral
regurgitation. Most probably the murumer will be
a. Ejection systolic in aortic area
b. Ejection systolic in pulmonary area
c. Machinery at left sterna edge
d. Pansystolic at apex beat area
e. Systolic at tricuspid area
Ans. D
20. a pregnant lady developes severe breathlessness. O/E his pulse was irregularly irregular, she
had a mid diastolic murmer. Most appropriate investigation will be
a. Constant R-R interval;
b. Globular heart shadow on Xray
c. P mitrale on ECG
d. RVH on ECG
e. Raised pressure gradient across mitral valve
Ans .E
21. 50 yr old man presented with the one hour of chest pain, sweating and breathlessness. Most
appropriate investigation will be
a. CKMB
b. CPK
c. LDH
d. SGOT
e. Trop T
Ans is AAAA CPSP key
22. the AV nodal delay is
a. Affected by stimulation of autonomic nerves to th heart
b. Because of the slow conduction
c. Due to activation of slow Ca Na channels
d. Due to less no of intercalated discs in AV node
e. Imp because it allows the atria to complete their contraction before the ventricles begin to contract
Ans E
23. the mean arterial BP
a. Decreases in old age
b. Equals the diastolic BP plus one third of pulse pressure
c. Is normally about 80 mmHg
d. Is difference b/s systolic and diastolic BP
e. Is the value half way b/w systolic and diastolic BP
Ans B
24. the most characteristic ECG finding showing MI is
a. Deep and wide Q wave
b. Elevation of ST segment in the leads overlying the area of infarct
c. Peaked T waves
d. Prolonged PR interval
e. Prominent P wave
Ans B
25. the carotid baroreceptors
a. Are located in carotid bodies
b. Discharge at increase rate when arterial BP rises
c. Receives sensory innervations from vagus
d. Show decrease rate of discharge with carotid massage
e. Undergo adaptation within minutes
Ans B
26. cardiac reserve
a. Decrease in athletes
b. Inc in vitamin deficiency
c. Inc in ischemic heart disease
d. Is the cardiac output per square meter of the body
e. Is the max percentage by which the cardiac out put can be increased above normal
Ans E
27. cardiac out put is not decreased in
a. Acute venous dilation
b. Beriberi
c. Cardiac temponade
d. MI
e. Venous obstruction
Ans B
28. 45 yr man presented with sudden onset of retrosternal chest pain with sweating and
breathlessness. O/E BP was 90/60, and pulse was 110/min, low volume. Most likely diagnosis is
a. Dissecting aneurysm
b. MI
c. Pneumonia
d. Pulmonary embolism
e. Tension pneumothorax
Ans B
29. 25 yr old lady presented with dizziness and blue discoloration of extremities for two days of
duration. o/e cyanosis of lips and extremities is present. Systemic examination is normal. Mowt
appropriate investigation is
a. Arterial blood gases
b. ECG
c. Echocardiography
d. Spectroscopic examination of Hb
e. Xray chest
Ans D
30. the first heart sound is produced due to vibration of
a. Closure of AV valve at the beginning of ventricular systole
b. Caorctation of atria
c. Contraction of ventricles
d. Flow turbulence in aorta and pulmonary art
e. Opening of semiluner valves
Ans A
31. 40 yr male patient presented with chest pain for 30 minutes, ECG shows ST segment elevation
in lead II, III, aVF. He is suffering from
a. Anterior wall MI
b. Anterolateral wall MI
c. Anteroseptal MI
d. Inferior wall MI
e. Posterior wall MI
Ans D
32. in cardiac valve lesions angina pain is most common in
a. Aortic regurgitation
b. Aortic stenosis
c. Mitral regurgitation
d. Mitral stenosis
e. Tricuspid regurgitation
Ans . B
33. in cardiac cycle the first heart sound occurs in
a. Atrial systole
b. Ejection phase
c. Isovolumetric contraction
d. Isovolumetric relaxation
e. Rapid inflow
Ans C
34. most imp cause of decreased voltage of QRS complex is
a. Atrial fibrillation
b. Atrial flutter
c. Bundle branch block
d. Mitral stenosis
e. Old MI
Ans E??
35. for long term control of BP the role of one of the following is vital
a. Brain
b. Heart
c. Kidney
d. Liver
e. Lungs
Ans C
36. if a patient is having low cardiac output, he is most probably having
a. AV fistula
b. Anemia
c. Beriberi
d. Hyperthyroidism
e. Obstruction of IVC
Ans E
37. during the measurement of cardiac out put the dye used during the indicator dilution method is
a. Cardiogreen
b. Congored
c. Evans blue
d. Gentian violet
e. Potassium dichromate
Ans. A
38. first heart sound
a. Has a duration of 0.11 second
b. Has a high pitch
c. Hs a very high frequency
d. Is due to closure of aortic valve
e. Occurs in isovolumetric contraction phase of cardiac cycle
Ans , B/ E seams more ppropriate
39. heart becomes extremely flaccid and dilated with slow heart rate due to increase in
a. Calcium ion in ECF
b. Lithium inn ECF
c. Megnesium in ECF
d. Potassium in ECF
e. Sodium in ECF
Ans D
40. cardiac muscles cannot be tetanized because
a. Action potential with plateau
b. Gap junctions
c. Long duration of contraction
d. Long refractory period
e. Property of automaticity
Ans D
41. a person is having atrial rate 200-350 per min, 3:1 AV block, and saw toothed shaped P wave in
ECG. He us having
a. AV nodal paradoxysmal tachychardia
b. Atrial fibrillation
c. Atrial flutter
d. Complete AV block
e. Ventricular fibrillation
Ans. C
42. a patient shows progressive prolongation of PR interval in successive heart beats followed by a
drop of beat… he is most likely having
a. Atrial flutter
b. Complte AV block
c. First degree AV block
d. Mobitz I block
e. Mobitz II block
Ans. D..
43. stimulation of sympathetic nerves to the heart produces
a. Decrease in conduction velocity thru ventricles
b. Decreased coronary blood flow
c. dEcreased stroke volume
d. hyperpolarization of SA nodal fibers
e. shortening of AV nodal delay
ans. E
44. during exercise the coronary blood flow increases because of
a. increased arterial BP
b. incresesd heart rate
c. parasympathetic inhibition
d. release of vasodilator metabolites in the myocardium
e. sympathetic stimulation
ans, D
45. in patients with cardiac failure Edema results from increased formation of interstitial fluid. It is
due to
a. decreased arterial BP
b. decreased plasma colloid osmotic pressure
c. increased capillary permeability
d. inc caollary pressure secondry to increase venous pressure
e. salt and water retention by kidney
ans D
46. regarding coronary circulation all of the following are true except
a. arteries can develop collaterals
b. exercise causes vasodilation
c. most of the blood flows during diastole
d. under resting condition the blood flow is 750 ml/min
e. vasodilation occurs in tachycardia
ans D
47. atrial fibrillation is charecterised by
a. saw tooth appearance on ECG
b. increased cardiac output
c. multiple P waves preceding QRS complexes
d. pulsus deficit
e. QRS complexes occurring regularly on ECG
Ans. DD
48. stroke volume is increased in al except
a. Administration of digoxin
b. Infusion of dopamine
c. Intake of caffeine
d. Parasympathetic stimulation
e. Stretched cardiac muscles
Ans D
49. during rest in a well trained athlete there is increase in
a. Arterial BP
b. Cardiac output
c. Heart rate
d. Stroke volume
e. Sympathetic activity
Ans D
50. aortic regurgitation is charecterised by
a. Bounding pulse
b. Capillary pulsation in nail beds
c. Early diastolic murmur
d. Femoral bruit
e. Heaving apex beat
Ans. Saray he theek hain key says C
#basicOsteology
Tag your #friends
With #key
#Important
The first costochondral joint is a type of:
Fibrous joint
Synovial joint
Syndesmosis
Syncendrosis
D is correct
Endochondral ossification is seen in:
Long bones
Flat bones of the skull
Mandible
Nasal bones
A is correct
Which of the following bones do not contribute to the nasal septum?
Sphenoid
Lacrimal
Palatine
Ethmoid
B is correct
Fibrocartilage is present in all, EXCEPT:
Pinna
Symphysis pubis
Intervertebral disc
Menisci of knee joint
A is correct
Which of the following is the first fetal bone to ossify under normal circumstances?
Lower end of femur
Clavicle
Upper end of humerus
Upper end of tibia
B is correct
Superior radioulnar joint is:
Hinge joint
Pivot joint
Saddle joint
Ball and socket joint
B is correct
All of the following are examples of traction epiphysis, EXCEPT:
Mastoid process
Condyles of tibia
Trochanter of femur
Tubercles of humerus
B is correct
A child who has had abnormal development of the membranous bones has a broad skull with
associated facial and dental anomalies. Which other bones are most likely to also be affected?
Clavicles
Femurs
Metatarsals
Phalanges
A is correct
Incudomalleolar joint is a;
Saddle joint
Pivot joint
Gliding joint
Hinge joint
A is correct
Superior radioulnar joint is:
Hinge joint
Pivot joint
Saddle joint
B is correct
Metacarpophalangeal joint is coming under the following classification of joints:
Plant joint
Condyloid joint
Saddle shaped joint
B is correct
A 7 year old boy is taken to a physician because he has developed pain in his right hip. On physical
examination, the physician feels a large mass near the iliac crest. Plain x-ray films demonstrate a
large lytic lesion of the ilium. MRI studies show that the tumor appears to arise in the bone, but
extends into the adjacent soft tissues. A large incisional biopsy demonstrates a tumor composed of
sheets of small, round, blue cells. Which of the following is the most common bone to be affected by
this tumor?
Femur
Humerus
Mandible
Maxilla
A is correct
Which of the following cervical joint helps a person to look towards the right or left?
Atlanto-occipital joint
Atlanto-axial joint
C2-C3 joint
C3-C4 joint
B is correct
Which of the following type of epiphysis is seen in the trochanter of femur?
Pressure epiphysis
Traction epiphysis
Atavistic epiphysis
Both A and B
B is correct
The first costochondral joint is a type of:
Fibrous joint
Synovial joint
Syndesmosis
Syncendrosis
D is correct
All of the following are examples of traction epiphysis, EXCEPT:
Mastoid process
Condyles of tibia
Trochanter of femur
B is correct
Temporomandibular joint is a :
Plant joint
Synovial joint
Saddle shaped joint
B is correct
Which of the following is an intra-articular tendon?
Sartorius
Semitendinosus
Anconeus
Popliteus
D is correct
The type of joint between the sacrum and the coccyx is a:
Symphysis
Synostosis
Synchondrosis
Syndesmosis
A is correct
Kerckring's center for ossification is one of the variant of skull anatomy which is associated with:
Temporal bone
Occipital bone
Frontal bone
Turner
B is correct
Number of ossification centres in femur is:
2
4
5
7
C is correct
All of the following are types of epiphysis, EXCEPT:
Traction
Atavistic
Friction
Pressure
C is correct
The spine of the scapula can be palpated at which of the following level of vertebrae?
T1
T3
T5
T7
B is correct
Which of the following is an example of a bone that is independent phylogenetically but is now fused
with another bone?
Trocanter of femur
Tubercle of humerus
Coracoid process of scapula
Anterior tubercle of talus
C is correct
The lumbar region of the vertebral column permits all of the following movements, EXCEPT:
Flexion
Rotation
Extension
Lateral flexion
B is correct
All are types of elastic cartilages, EXCEPT:
Pinna
Epiglottis
Tip of arytenoid
Thyroid cartilage
D is correct
All of the following physiological processes occur during the growth at the epiphyseal plate except:
Proliferation and hypertrophy
Calcification and ossification
Vasculogenesis and erosion
Replacement of red bone marrow with yellow marrow
D is correct
Nucleus pulposis is derived from:
Neural crest
Notochord
Sclerotome
None of the above
B is correct
Which of the following is not a recognised form of epiphysis?
Traction
Atavistic
Friction
Pressure
C is correct
All of the following statements are true for metaphysis of bone, EXCEPT:
It has greatest growth activity
It is the strongest part of bone
It is the most vascular part of bone
It is the region favouring hematogenous spread of infection
B is correct
The site where elastic cartilage is found is which of the following?
Auditory tube
Nasal septum
Articular cartilage
Pubic symphysis
A is correct
Which of the following type of joint is proximal radioulnar joint?
Hinge joint
Pivot joint
Saddle joint
C is correct
All of the following characteristics differentiate a typical cervical vertebrae from a thoracic vertebrae
except
Mas a triangular vertebral canal
Has foramen transversarium
Superior articular facet is directed backwards & upwards.
Has a large vertebral body
D is correct
Which is not a fibrous joint:
Gomphoses
Cranial sutures
First costochondral joint
Inferior tibiofibular joint
C is correct
A 5 year old boy falls off his bike and fractures his humerus. He is taken to the emergency room ,
and the bone is set by one of the emergency room physicians. Which of the following is responsible
for producing the majority of the new bone that will reunite the two fragments?
Cancellous bone
Cartilage
Compact bone
Periosteum
D is correct
Articular cartilage at the end of bones is composed of which of the following?
Fibrocartilage
Hyaline cartilage
Elastic cartilage
Chondronectin
B is correct
Most fascia of the body that attach to bones attach by which of the following mechanisms?
Blending with the covering periosteum
Inserting deeply into the cancellous bone
Inserting deeply into the cartilage
Inserting deeply into the diaphysis
A is correct
The nucleus pulposus is composed of which of the following?
Cancellous bone
White fibrocartilage
Elastic fibrocartilage
Hyaline cartilage
B is correct
Atavistic epiphysis is seen in:
Trochanters of femur
Lower end of radius
Coracoid process of scapula
D is correct
A sesamoid bone is present in the tendon of which of the following muscles?
Flexor hallucis longus.
Extensor hallucis brevis.
Adductor hallucis
Flexor hallucis brevis
D is correct
All are types of elastic cartilages, EXCEPT:
Pinna
Epiglottis
Tip of arytenoid
Thyroid cartilage
D is correct
#biostatics
#questions
With
#key
Tag your #friends
Which among the following is a mode of primary prevention?
Pap smear collection
Marriage counselling
Breast examination
Rehabilitation
B is the answer
Which of the following is true regarding sampling?
a. In simple random sampling the population is divided into strata
B. Snowball sampling is used for hidden population
c. Snowball sampling is used for hidden population More sample in systemic random sampling
D. Cluster sampling is less cost effective
B is the answer
Confirmed case of fluorosis is defined by presence of fluoride in urine more than:
1 mg/L
3 mg/L
5 mg/L
7 mg/L
A is the answer
Montenegro test is used for diagnosis of:
Kala azar
Leprosy
Malaria
Leptospirosis
A is correct
All of the following statements regarding case control study are true, except
Used to find the relative risk
Odds ratio can be calculated
Relatively cheap
Used for rare diseases
A is correct
You are the medical officer in charge of the immunisation programme at a sub-centre and you are
informed by the local worker that one of the children who was immunised has has been dizzy. On
further investigation it was confirmed that the symptoms were due to anxiety of pain of the injection
and not as a result of the vaccine. You would consider the incidence as:
Vaccine reaction
Injection reaction
Programme error
Coincidental
B is correct
Which of the following is not a proxy measure of the incubation period of a disease?
Communicable Period
Latent Period
Serial Interval
Generation Time
A is correct
Rotavirus vaccine doses should not be initiated beyond which age to prevent complications:
6 weeks
10 weeks
12 weeks
32 weeks
C is correct
Which of the following is an example of an enzootic?
Leprosy
Typhoid
Cholera
Anthrax
D is correct
Which of the following is NOT one of the degrees of health as per spectral concept of health?
Good Health
Better Health
Positive Health
Freedom from Sickness
A is correct
A 20 year old is found to have blood pressures of 134/86 and 136/89 on two separate occasions. He
will be classified as:
Normotensive
High normal BP
Stage 1 hypertension
Stage 2 hypertension
B is correct
True about case control study A/E
Less expensive
Those with disease and not diseased compared
Attributable risk is estimated
None of these
C is correct
Which of the following statements is true about BCG vaccination?
Distilled water is used as diluent for BCG
The site of injection should be cleaned with spirit
Mantoux test becomes positive after 48 hours of vaccination
WHO recommends Danish 1331 strain for vaccine production
D is correct
What is the amount of fluid to be given to a 2 year child weighing 12 Kg with severe dehydration in
the first half an hour of IV rehydration?
120 ml
240 ml
360 ml
840 ml
C is correct
Which of the following disease is NOT included under diseases considered as eradicable by the
International Task Force for Disease Eradication?
Polio
Measles
Rubella
Malaria
D is correct
Incidence rate can be calculated from:
Cohort study
Case control study
Cross sectional study
Descriptive study
A is correct
By which of the following method the incidence of a disease can be calculated?
Prospective study
Retrospective study
Case control study
Cross sectional study
A is correct
Ability of an organism to induce clinically apparent illness is known as:
Infectivity
Pathogenicity
Virulence
Viability
B is correct
Movement across socioeconomic levels is termed as:
Social Equality
Social Upliftment
Social Mobility
Social Insurance
C is correct
Which of the following vaccine is associated with Toxic Shock Syndrome?
Infected BCG vaccine
Infected DPT vaccine
Infected Polio vaccine
Infected Measles vaccine
D is correct
Breast milk fully meets the nutritional requirements of the infant in the first few months of life. All of
the following are true about breast milk, EXCEPT:
Maximum output is seen at 12 months
Coefficient of iron absorption is 70%
Calcium utilization from breast milk is more than cow's milk
Breast milk protein is reference protein
A is correct
IQ of 98 is classed at which level of intelligence?
Idiot
Normal
Superior
Near genius
B is correct
Endemic Disease' means that a disease:
Occurs clearly in excess of normal expectancy
Is constantly present in a given population group
Exhibits seasonal pattern
Is prevalent among animals
B is correct
You are planning a screening program for a particular disease in your community. Which of the
following is the MOST cost effective method of screening?
Multiphasic screening
Mass screening
High risk screening
Any of the above
C is correct
Thrombocytopenia is an adverse reaction of which vaccine:
BCG
DPT
MMR
Hep B
C is correct
Which of the following is the best method of doing randomization?
Computer drawn randomization
Odd/even day hospital admission
Lottery
Random number table
D is correct
Specificity of a test refers to its ability to detect the following:
True positives
True negatives
False positives
False negatives
B is correct
In a village with population of 5000, 50 people have a disease and 10 of them died. What is case
fatality rate?
1%
2%
0.5%
20 %
D is correct
Calculate IMR if in a population of 100000 there are 3000 live births in a year and 150 infant deaths
in the same year:
75
18
5
50
D is correct
In the natural history of disease, all are true about the period of pathogenesis, EXCEPT:
Occurs after agent enters host body
Tertiary prevention is possible at this stage
Screening does not affect the course of the phase
Sub-clinical phase can be present
C is correct
Direct standardization is used to compare the mortality rates between two countries. This is done
because of the difference in which of the following parameters?
Causes of death
Numerators
Age distributions
Denominators
C is correct
Which of the following is not an essential component of primary health care?
Provision of Essential Drugs
Cost effectiveness
Immunization against major infectious diseases
Health education
B is correct
Early reaction of lepromin test is read at:
24 hours
36 hours
48 hours
72 hours
C is correct
While applying chi-square test to a contingency table of 6 rows and 6 columns, the degree of
freedom would be?
30
35
15
25
D is correct
Which of the following drugs has the highest bactericidal activity against Mycobacterium leprae?
Rifampicin
Clofazimine
Dapsone
Minocycline
A is correct
Allocation concealment is not possible in a research study conducted on the effects of Risperodone.
Selection bias in a study can be eliminated by which of the following procedures?
Randomization
Single blinding
Double blinding
Matching
A is correct
Which of the following study type is the best to study natural history of a disease?
Cohort Study
Case Control Study
Randomized Control Trials
Interventional Studies
A is correct
Tourniquet test is used in the diagnosis of:
Dengue
Scurvy
Malaria
Hypertension
A is correct
In a community, an increase in new cases denotes:
Increase in incidence rate
Increase in prevalence rate
Decrease in incidence rate
Decrease in prevalence rate
A is correct
Which of the following is the MOST useful index for the measure of the burden of disease in a
defined population?
Park’s index
Disability adjusted life years
Morbidity proportion
Case fatality rate
B is correct
The denominator for calculating the incidence rate of specific disease is which of the following?
Mid year population
Population at risk
Population observed
Total population
B is correct
The diagnostic power of a test to correctly exclude the disease is reflected by:
Sensitivity
Specificity
Positive predictivity
Negative predictivity
D is correct
All of the following indicators represent Human Development Index, except:
Life Expectancy at Birth
Life Expectancy at 1 year of age
Education
GDP
B is correct
All are indicators of goal 6 of Millennium Development Goal, EXCEPT:
HIV prevalence among women aged 15-49 years
Number of children orphaned by HIV/AIDS
Prevalence and death rates of tuberculosis
Prevalence and death rates of malaria
A is correct
Vitamin A prophylaxis is an example of:
Health promotion
Specific protection
Disability limitation
Primordial prevention
B is correct
A women is exposed to multiple sex partners has 5 times increased risk for Carcinoma Cervix. The
attributable risk is:
20%
50%
80%
100%
C is correct
You are asked to help consult on a study which was recently completed in coastal African country. In
this study, a total of 274 soldiers stationed in three different camps were examined and tested for the
presence of bacterial sexually transmitted diseases (STD) and human immunodeficiency virus (HIV)
positivity. In addition to the information from the clinical exam and laboratory specimens, interviews
were conducted to gather information on age, years of military service, ethnicity, and region of origin.
The data are now to be analyzed to learn which factors were associated with the presence of STDs,
including HIV. What is the most accurate description of this study design?
A case-control study
A cohort study
A clinical trial
A cross-sectional study
D is correct
Which of the following studies is BEST in establishing causal association in aetiology of a disease?
Case control study
Cohort study
Randomized control trial
Ecological study
C is correct
Which is not a method of primordial prevention of diseases?
Regular exercise
Abstinence from alcohol intake
Dietary change
Identification of cases of Tuberculosis
D is correct
Which of the following is associated with emotional valence and is most likely to be influenced by
motivation?
Attitude
Belief
Practice
Knowledge
C is correct
Rgarding experimental studies, in a randomized controlled trial (RCT) all are true, EXCEPT:
Baseline characteristics are comparable
Bias can be eliminated by double blinding
Sample size depends on the type of study
Dropouts are excluded from the study
D is correct
Which among the following statement is TRUE about 'serial interval'?
Time interval between invasion of infection and appearance of first sign or symptom
Time between onset of primary case and secondary case
Interval of time between receipt of infection by a host and maximum infectivity
Time in which infectious agent is transferred from one host to another
B is correct
Cause to effect progression is seen in all of the following research studies, EXCEPT:
Case control study
Ecological study
Cohort study
Randomized control trial
A is correct
A study was initiated in 1999 with a population of 5000 adults. They were enquired about their
drinking habits to study the relationship of alcohol consumption to the subsequent occurrence of
cancer. The study was planned for 20 years till 2015 to 2019. This is an example of what type of
epidemiological study?
Cross-Sectional Study
Case Control Study
Current Cohort Study
Retrospective Cohort Study
C is correct
The method of identifying missing cases and supplementing notified cases in the population is
known as:
Active surveillance
Passive surveillance
Sentinel surveillance
Monitoring
C is correct
Inner subjective thought of a person towards an individual or situation is best termed as:
Attitude
Value
Belief
Opinion
A is correct
You are the medical officer of a PHC in a taluka and you confirm the diagnosis of polio in one of your
patients. This can be considered as:
Endemic
Epidemic
Sporadic case
Pandemic
B is correct
Human development index includes All except
Crude death rate
Education
Life expectancy at birth
GDP
A is correct
Targeted intervention programmes for HIV are done among the following group of people, EXCEPT:
Commercial sex worker
Migrant laborers
Street children
Industrial worker
D is correct
A person wants to study deafness and mobile phone usage. He collected data on mobile phone
usage from government source and deafness from district and private clinics. This type of study is
known as:
Experimental study
Ecological study
Etiological study
Cross-sectional study
B is correct
Smoking is the cause of 85% of lung cancers that occurred within a group of smokers. This is an
example of which of the following statistics?
Population attributable risk.
Odds ratio
Attributable risk
Relative risk
C is correct
With regard to hypertension, which is not a mode of primary prevention?
Weight reduction
Exercise
Reduced salt intake
Early diagnosis of hypertension
D is correct
Which of the following is NOT a socio economic indicator of health care?
Dependency Ratio
Family Size
Life Expectancy at Birth
Level of Unemployment
C is correct
Iceberg phenomenon differentiates:
Apparent and inapparent
Symptomatic and asymptomatic
Cases and carriers
Diagnosed and undiagnosed
A is correct
Association can be measured by all of the following, EXCEPT:
Correlation coefficient
Cronbach's alpha
P value
Odds ratio
B is correct
Which of the following statement is not correct regarding case control study?
Proceeds from effect to cause
Exposure already occurred
Odd’s ratio can be determined
Incidence rate can be calculated
D is correct
Which one of the following is a good index of the severity of an acute disease?
Cause specific death rate.
Case fatality rate.
Standardized mortality ratio.
Five year survival.
B is correct
A new test for diabetes was carried out of the 80 people who were tested positive (+ve), it was found
that actually 40 had diabetes and out of 9920 people who were tested negative (-ve) only 9840 did
not have the disease actually. The sensitivity of this new test is:
33%
50%
65%
99%
A is correct
The comparison of mortality rates between two countries requires the application of direct
standardization. Which if the following parameters makes it necessary to have standardization?
Numerators
Denominators
Causes of death
Age distributions
D is correct
Patientswith STD are asked to name other persons of either sex who move in the same socio sexual
environment. These patients are then screened for the disease. This process is known as:
Cluster testing
Mass screening
High risk screening
None of the above
A is correct
Which of the following will cause an increase in the prevalence of disease?
Immigration of healthy persons
Increased cure rate of disease
Longer duration of disease
Increased death rate in disease
C is correct
You are conducting a study on a new type of infectious disease and find that the case fatality rate is
high. It means that:
The disease is highly infective
The disease has a short incubation period
The disease is caused by a virulent organism
All the above
C is correct
The population of a community on the 1st of June was recorded as 1,65,000. Total no. of new cases
of Tuberculosis, recorded from 1st January to 31st June were 22. Total Registered cases of
tuberculosis in the community were recorded as 220. What is the incidence of TB in this community
per 10 lakh population?
133
220
13.3
22
A is correct
The method in which the sample is taken from each predefined strata of society is called?
Simple random sampling
Systemic sampling
Stratified sampling
Multistaged sampling
C is correct
What is the major advantage of randomised sample in a clinical trial?
Facilitate double blinding
Help ensure that the study subjects are representative of general population
Ensure that the groups are comparable on baseline characteristics
Reduce selection bias in allocation of treatment
D is correct
Standard deviation is the measure of:
Chance
Central tendency
Deviation from the mean value
Range
C is correct
Degree of freedom of a chi square test in contingency table of 2 by 2 is?
1.0
Zero
2
4
A is correct
One of the epidemiological indices used to measure the tuberculosis problem in a community is the
prevalence of infection. Which among the following is widely used to estimate the prevalence of
tuberculosis infection in a population?
Sputum smear examination
Tuberculin test
Chest X-ray
Symptoms suggestive of tuberculosis
B is correct
All of the following holds true about cluster sampling, except:
Is a Rapid and simple method
Samples are similar to those in Simple Random Sampling
It is a type of probability sample
The sample size may vary according to study design
B is correct
Which of the following research methods include only people who are initially free of the disease of
interest?
Case series report
Cross-sectional
Case-control study
Cohort study
D is correct
In a population of 10,000, beta carotene was given to 6000 people. The remainder did not receive
any carotene. 3 out of the first group later suffered from lung cancer while 2 out of the secornd group
(non-recepients) also got lung cancer. What is your reasonable conclusion?
Beta carotene and lung cancer have no relation to each other
The p value is not significant
The study is not designed properly
Beta carotene is associated with lung cancer
A is correct
The ability of a test to correctly diagnose the percentage of sick people who are having the condition
is known as?
Sensitivity
Specificity
Positive predictive value
Negative predictive value
C is correct
#Important
#HEART_SOUNDS
☆☆☆☆
S1===Closure of MV TV
●Short frequency
●Long duration ===0.14 seconds
●Soft UB sound.
●Heard at APEX for MV and Left 5th ICS===TV.
Splitting===early MV closure === pathological mostly due to MS(best heard at apex left Lateral position )
☆☆☆
S2
●Closure of AV PV
●Long High frequency
●Short duration ===0.11---0.14 seconds
●High intensity === DUB sound
Due to Tautness of valves comparatively greater to MV TV.
●Splitting ===Early AV closure than PV ((which is delayed closed due to inspiration ))
Almost always Physiological
Pathological in AS.
☆☆☆☆☆
S3
●Rapid passive ventricle filling
●Due to loosening of MV TV in heart failure
●Pregnancy and children and young adolescents it's NORMAL
●In Adults it's due to HF & DCM so pathological.
●Best heard at apex.
☆☆☆☆
S4
●Due to atrial contraction against a stiffed Ventricle like HCM and HOCM.
●Vibrates atrium and not ventricle
●Always pathological sound.
●produced as a result of ACTIVE VENTRICLE FILLING against Pressure of HCM.
☆☆☆☆☆
S3 GALLOP
●when in heart failure SVT occurs.
Thus producing gallop sound.
☆☆☆☆
S4 Gallop
●HCM+++SVT.
●Gallop sound.
>>>>Very short words to differentiate between
THESE POINTS are #MOSTIMPORTANT regarding CONCEPT and MCQs SOLVING

DERIVED from GOLJAN patho, SNELL Neuroanatomy ,KATZUNG PHARMACOLOGY,
DAVIDSON,KAPLAN ANATOMY etc.......
READ Them as much as possible
MOST IMPORTANT POINTS
BAR BODY
Inactivated X chromosome
Transcriptionally inactive
Found in all females bcz of XX of which one inactivated(LYON HYPOTHESIS also called
LYONIZATION).
Its number in any karyotype depends on number of X chromosome
Its number is calculated by subtracting one from number of X chromosome
Like bar body =No of X-1.
E.g KARYOTYPE XXX==2 bar bodies etc
XX===one bar body in normal female.
BAR BODY is DIAGNOSTIC ONLY FOR TURNER whether Scarce or Scanty bar body.
Nowadays best TEST is KARYOTYPING for all CHROMOSOMAL Disorders.
■MC SITE OF CARCINOID TUMOUR==BENIGN LESION
OCCURS MOSLTU IN VERMIFORM APPENDIX.
DOESN'T METASTASIZE TO LIVER.
DOESN'T CAUSE CARCINOID SYNDROME
■■MC SITE OF CARCINOID MALIGNANCY ===SMALL INTES/ILEUM
MCC OF CARCINOID SYNDROME ===CARCINOID MALIGNANCY
Bcz of its neoplastic mets to liver that metastasis to hepatic vein and thus go to systemic circulation
Effects are
●●RECURRENT DIARRHEA
●●FACIAL FLUSHING CUTANEOUS DILATION.
●●BRONCHOCONSTRICTION
CARCINOID TUMOR localised to SMALL INTESTINE NEVER CAUSE
CARCINOID SYNDROME
BCZ of SEROTONIN DEGRADATION IN LIVER BY first pass effect.
It's mets to liver that cause carcinoid syndrome
Carcinoid tumors can also occur in lungs.
Reference for above discussion is GOLJAN PLUS FA.
■PERONIUS TERTIUS==DORSIFLEXION
PLUS EVERSION
SUPPLIED BY DEEP PERONIUS NERVE.
■PERONIUS LONGUS AND BREVITY
Cause== PLANTAR FLEXION
EVERSION.
HOLDS LATERAL PART OF LONGITUDINAL ARCHES.
■TIBIALIS ANTERIOR
SUPPLIED BY DEEP PERONIAL NERVE
EXTENSION OF FOOT
INVERSION
HOLDS MEDIAL PART OF LONGITUDINAL ARCH.
■TIBIALIS POSTERIOR
SUPPLIED BY TIBIAL NERVE
PLANTAR FLEXION OF FOOT
INVERSION
SUPPORTS MEDIAL LONGITUDINAL ARCH.
■POST CHOLECYSTECTOMY DRAIN
RIGHT SUBPHRENIC OR
RIGHT PARACOLIC GUTTER
■PANCREATITIS FLUID
LESSER SAC
OR
RIGHT PARACOLIC GUTTER
■DUODENAL PERFORATION ANTERIORLY
FLUID ACCUMODATION
IN
RIGHT PARACOLIC GUTTER.
PLAIN ABDOMINAL XRAY
AIR UNDER RIGHT DOME OF DIAPHRAGM
■IF SCIATIC NERVE DAMAGED
FOOT LATERAL PART SUPPLIED BY
SAPHENOUS NERVE (BRANCH OF FEMORAL NERVE).
■GREAT SAPHENOUS VEIN ACCOMPANIES
SAPHENOUS NERVE
■SMALL SAPHENOUS VEIN
accompanies
SURAH NERVE.
■HALF LIVES
ALBUMIN===2 WEEKS.
So it's not best in CIRRHOSIS for monitoring of ACUTE LIVER FAILURE
■VITAMIN K DEPENDENT FACTORS
HALF LIFE===5--72 HOURS
SO THEY ARE BEST FOR MONITORING OF
ACUTE LIVER FAILURE BY
DOING PROTHROMBIN TIME.
daily 2 times advise.
Factor 5 is another alternative.
■■HYDATID CYST
BEST IX== IMMUNOLOGY
■■AMEBIC LIVER ABSCESS
IX===IMMUNOLOGY OR SEROLOGY
■■PYOGENIC LIVER ABCESS
IX=== CT BRST OR USG.
MCC===E.COLI
PATHWAY===BILIARY TRACT FROM GUT.
■■PBS===AMA
■■GALL STONE ===USG BEST OF BEST.
NOT CT
■■GALL STONES COMPLICATIONS
LIKE
EMPHYMA
OR
CBD.
IX OF CHOICE===CT .....
■■LIVER TESTS OF IMAGING
MRCP ===IX ONLY
ERCP===used for IX PLUS TREATMENT
LIKE CBD.
■DIAPHRAGM
DOESN'T develop from PLEURA PERICARDIAL MEMBRANE
■TRIGEMINAL GANGLION
consist of
SENSORY PART which IS LARGEST
And lies in TRIGEMINAL CAVE (cover by DURA MATTER).
■APHASIA PLUS FACIAL PALSY=== MCA OCCLUSION
■RIGHT FACIAL PALSY PLUS LEFT HEMIPLEGIA
LESION=== PONS
■PT WITH SENSORY LOSS
PAIN THRESHOLD LOW TO ANY STIMULUS OF TOUCH
THALAMUS INVOLVED
■PURE MOTOR STROKE
ALSO CALLED DENSE STROKE
RIGHT COMPLETE HEMIPLEGIA
ANTERIOR 1/3RD OF POSTERIOR LIMB OF CAPSULE INVOLVED ARTERY IS
ANTERIOR CHOROIDAL ARTERY
BRANCH OF MCA
■■
PAIN FROM
PLEURA AND DIAPHRAGM
GALL BLADDER TO SHOULDER
REFER via C345== PHRENIC NERVE
■■PAIN MI == JAW AND LEFT ARM
refer via SYMPATHETIC NS==T1---5.
■■PAIN STOMACH ULCER TO EPIGASTRIUM
refer via GREATER SPLANCHNIC NERVE.
■■OBSTRUCTIVE LUNG DISEASE
DECREASED
FEV1/FVC
DECREASED FRV.
■■RESTRICTIVE LUNG DISEASE
DECEASED FEV1
DECREASED LUNG COMPLIANCE.
■■YELLOW ELASTIC LIGAMENTS
LIGAMENTUM FLAVUM
LIGAMENTUM NUCHAE
■■BLOOD VESSELS
have COLLAGEN TYPE 3.
BASEMENT MEMBRANE==TYPE 4 COLLAGEN
■■CELL MEMBRANE THICKNESS===8.5---10nm.
■■TISSUE FIXATIO==10%FORMALIN
used.
■■GBM==BUTTERFLY GLIOMA
■PILOCYTIC ASTROCYTOMA == MOST COMMON IN CHILDREN ==ROSEHALL FIBRES.
REF GOLJAN.
●●OLIGODENDRGLIOMA==SLOWEST GROWING TUMOR
FRIED EGG APPEARANCE
●●EPINDYMOMA
ROSSETS AND PSEUDORESSETS
●●MEDULLOBLASTOMA
BLUE CELL TUMOR
IN POSTERIOR CRANIAL FOSSA
MOST COMMON IN CHILDREN FIRST AID
●●MENINGIOMA
PSAMOMMA BODIES.
●●CRANIOPHARYNGIOMA
RATHKENNY POUCH REMNANT
IT CAUSES
WEIGHT LOSS
DISTURB SLEEP
BITEMPORAL HETERONYMOUS HEMIANOPSIA
SYNDROME CALLED ADIPOSOANDROGENIATLA SYNDROME.
■■FEMORAL ARTERY
LIES AT MIDPOINT OF INGUINAL LIGAMENT
■■FEMORAL VEIN LIES AT MID INGUINAL POINT
IT'S MEDIAL TO ARTERY
■■FEMORAL SHEATH CONTAINS
FV ,FA, EMPTY SPACE ,,LYMPH NODE OF CLOQUET.
■■VIRCHOW NODE
LEFT SUPRACLAVICULAR LYMPH NODE
POSITIVE IN PANCREATIC AND GASTRIC CARCINOMA
■■ACUTE HEMMORHAGIC PANCREATITIS.
CULLEN SIGN
GREY TURNER SIGN
■■ADULTS.
SPINAL CORD
CONES MEDULARIS
ENDS AT LOWER BORDER OF L1
Or upper border of L2.
IN CHILDREN ENDS AT L3.
CAUDATE EQUINA
OR
SUBARACHNOID SPACE
OR DURAL SPACE.
ENDS AT===S2.
■■POSITIVE ROMBERG TEST
SENSORY ATAXIA WHILE EYES CLOSED.
SHOWS PROBLEM IN DORSAL COLUMN MEDIAL LEMINISCUS SYSTEM.
■■CEREBELLUM
ATAXIA IS PRESENT IN EYES BOTH CLOSED AND OPEN.
BROAD BASE ATAXUA===MIDDLE LOBE INVOLVED === VERMIS OF CEREBELLUM.
■■MC NERVE INJURED IN THYROIDECTOMY
ELN=== in ligation of superior thyroid artery
●●HOARSNESS===RLN.
injured while ligation of inferior thyroid artery.
■■MC Carcinoma of THYROID
●●PAPILLARY CA.
●●Children exposed to radiation.
●●excellent prognosis
■■PROTRUSION OF LOWER JAW.
BY LATERAL PTRYGOID MUSCLE
SUPPLIED BY V3.
■■PROTRUSION OF TONGUE
BY GENIOGLOSSUS
SUPPLIED BY HYPOGLOSSAL NERVE.
■■BRONCHOPULMONARY SEGMENT
APEX DIRECTED TO LUNG ROOT.
SUPPLIED BY
TERTIARY BRONCHIOLES.
■■TRIAGONE OF BLADDER
DRAINED BY INTERNAL AND EXTERNAL ILAC LYMPH NODES.
■■MOST DEPENDENT PART OF LUNG
IS COSTODIAPHRAMATIC RECESS
■■MOST DEPENDENT PART OF PERITONIUM
IS POUCH OF DOUGLAS
HERE BLOOD FROM RUPTURED ECTOPIC PREGNANCY ACCUMULATE
EASILY ACCESSED SURGICALLY VIA POSTERIOR FOR NEXT OF VAGINA.
■■ERECTION BY PANS
EMESSION BY SANS
EJACULATION BY PUDENDAL NERVE.
■■INTERNAL HEMMORRHOIDS
SUPERIOR RECTAL VEIN TRIBUTARIES IN UPPER ANAL CANAL.
■■UPPER ANAL CANAL HAS
ANAL COLUMNS.
■■ARTERIAL THROMBI
●●LINES OF ZAHN== prominent
●Alternate dark gray layers of platelets intrspersed with lighter layers of fibrin.
■■VENOUS THROMBI
●●Mostly caused by venous stasis like hospital pts.
●● No prominent or absent lines of ZAHN.
■■POSTMORTEM CLOTS
●●Not true thrombi bcz of no attachment to vessel wall.
●●Two layered appearance
●Lower Red cell rich layer called CURRANT JELLY APPEARANCE
●CHICKEN FAT APPEARANCE =Upper poor cell layer
Regarding pigments in the body
■EXOGENOUS PIGMENTS
●●Carbon dust==Anthracosis
Silica Dust==Silicosis
Iron dust
●●Plumbism==Lead poisoning
●●Argyria==Silver poisoning and its deposition in skin & Conjunctiva.
■■ENDOGENOUS PIGMENTS
●1●BILIRUBIN
●2●MELANIN
●3●HEMOSIDERIN ==Aggregates of Ferritin.
Hemosiderin ==Insoluble form.
●Hemosiderosis== accumulation in macrophages with no parenchymal cells damage.
● HEMOCHROMATOSIS ==Accumulation in parenchymal cells with tissue damage and scarring.
☆☆HFE gene mutation is the cause
☆☆BRONZE DIABETES is caused by hemochromatosis which is TRIAD of
>>Micronodular Cirrhosis
>>DM
>>Skin Pigmentation.
●4●LIPOFUSCIN
● Also called PIGMENT of WEAR & TEAR
found due to aging process in hepatocytes and cardiomyocytes.
●BROWN ATROPHY== LIPOFUSCIN accumulation plus organ atrophy
■FAT EMBOLISM
●Cause is traumatic fracture of long bones mostly
Like RTA/MVA
●Emboli reach to lungs via veins
●Death can occur 24--72 hours.
●Rx is supportive
■AMNIOTIC EMBOLISM
●Occur after normal delivery mostly
●Death occurs even withen One hour.
●Cause mostly found on postmortem
Biopsy tissue contains amniotic tissue or different fetal tissue like lanugo hairs or other tissues etc.
●Very fatal
●Rx supportive.
■PRIMORDIAL FOLLICLE==surrounded by
●Flat epithelial cells
■PRIMARY FOLLICLES==Surrounded by
●SIMPLE cuboidal cells single layer.
■Vimentin ==Type 2 intermediate filament
●Mostly found in connective tissues
●Marker of Osteosarcoma =tumours of connective tissues.
●Bcz sarcomas are CONNECTIVE TISSUES MALIGNANCY
●Demarcates invasion of tissues
■Keratin==Type 1 intermediate Filaments
●Mostly found in epithelial cells of skin and GIT etc.
●Markers of CARCINOMAS
●Bcz Carcinomas are epithelial cells malignancies
1■Para - mesonephric duct ==also called Mullerian duct
Gives rise to
Uterus
Fallopian or uterine tubes
Upper part of vagina
Appendix testes
Etc.
2■Mesonephric ducts=also called Wolfian duct
Gives rise to
All male genital ductal system
●Epididymous
●Vas deferens
●Retes testes
●seminal vesicles.
Etc.
3■PNH best investigation ==Flow cytometry.
4■Right handed people will have
●●Right representational cortex and
● Left categorical cortex And
Vice versa
5■CIRRHOSIS
HEP C==MCC of cirrhosis in adults in Asia especially
Alpha antitrypsin deficiency ==MCC of cirrhosis in children
6■HCC
●HEP B ==MCC of HCC in adults in Asia HEP
●Hep C ==2nd MCC
■■purpose of fixation of tissue==
☆☆☆ Preserve tissue structure.
☆It's action===stabilisation of proteins by cross links formation b/w proteins molecules.
☆10% Formalin is used.
Pure formalin === 37% solution of formaldehyde gas in water.
■■For embedding process=== paraffin wax is used.
■■BASOPHILIC DYES stains acid.
Like DNA RNA===Stained with basic dye
So they are basophilic===Blue/purple color.
Basophilic dye===
●●●Hemotoxylin,Toluidine blue,methylene blue.
■■ACIDIC DYE stains basic organelles
Including cytoplasm.
Eg.Eosin stains cytoplasm pink.
■■Leydig cells of testes====Forms testosterone.
Present in Testes connective tissue interstitium.
■■ Sertoli cells present in Seminiferous epithelium.
FUNCTIONS.
☆Support
☆protection and nutrition to spermatozoa
☆Secretion
☆Phagocytosis of excess spermatid cytoplasm.
☆AMF (Anti-Mularian Factor)production.
☆☆☆Blood testes barrier formation.
■■Opthalmic division of CN --5
☆☆supplies Tip of Nose
☆☆blocked in surgery on external nose.
■■Capsule of liver called===Glisson capsule
■■Liver pours bile into Space of DISSI
■■Liver doesn't produce gamma globulin
Produces alpha and beta glubin proteins
Liver also doesn't produce interleukin
Liver portal triad===
☆Hepatic artery
☆Bile duct
☆Portal vein
■■GIT
Ileum contains M cells on pyer patches
That endocytose antigens
And present them to nearby lymphocytes
●●●ABO Blood grouping is due the process of these cells.
■■CLARA CELLS.
Found in lungs
Especially abundant in TERMINAL BRONCHIOLES
Function===RESERVE cells
Produce surfactant also
Regarding ATROPINE & ACETYLCHOLINE.
ATROPHINE :
It's TOXICITY causes
■■DRY as BONE.
Bcz
■It inhibits all secretions
Like sweating salivation lacrimation etc.
It acts at thermoregulatory sweat glands by blocking M receptors.
☆■☆It's this sweating inhibition effect is due to this mechanism and not due to CUTANEOUS
VESSELS CONTRACTION bcz it causes
■■RED AS BEET effect:Due to
CUTANEOUS VESSELS DILATION Causing redness in
Arms neck thorax etc vessels
An effect called as RED AS BEET.
■MAD AS HATTER.
●●ATROPINE in cns causes confusion, convulsions, seizures and HALLUCINATIONS this effect is
called as mad as hatter.
■■An important point At post ganglionic Sympathetic fibres go to smooth muscles SKELETAL blood
VESSELS that are mediated by Acetylcholine
Acetylcholine here mediate NO production which acts as vasodilator..
■■ORGANOPHOSPHORUS POISONING
●●Effect will be like INCREASED ACETYLCHOLINE due to acetylcholinesterase inhibition and so
indirect increase in acetylcholine.
Thus they produce effects opposite to atropine.
Like they do PARASYMPATHETIC EFFECTS.
A mnemonic
■■DUMBELSS
Diarrhea, Urination,Miosis,Bronchoconstriction ,lacrimation, salivation etc
REGARDING EYE.
■■STRAIGHT LOOKING.
●Upward movement==Superior Rectus+ IO
●Downward movement==Inferior Rectus+SO
■■ABDUCTED
●●ONE EYE
☆☆Upper gaze == Only SR==Supplied by CN--3
☆☆Down Gaze== Only IR==Supplied by==CN--3.
■■ADDUCTED
●●One Eye
☆☆Upper Gaze==IO only==supplied by CN--3.
☆☆Down Gaze==SO only==supplied by CN--4(SO4).
■■ACCOMMODATION
●●Medial Recti of both eyes(CN-3).
●●Ciliary muscle(CN-3).
==contraction causes relaxation of suspensory ligament of lense thus makes lens more round and
increase magnification power of lens for near vision (accommodation )
●●Sphincter pupilae contraction (CN--3).
●It makes beam of light narrow for more sharp vision or focusing.
REFRACTORY ERRORS::::
●●EMMETROPHIA ==Normal vision.
●●MYOPIA ==Short - sightedness
Causes.
●●MAIN PATHOLOGY==Light focuses in front of Retina while looking to nearby objects like reading.
●●CAUSES:
●Increase power of lens
●Long axial length of eye ball
etc.
●●Rx==Concave lenses==they increase focal length and decrease accommodation power.
●●HYPERMETROPIA ==Farsightedness
●●Main pathology==Light focuses behind retina in far vision.
☆☆Pt able to see near objects but can't see far objects bcz of decrease power of accumodation.
●●Causes
☆☆Old age
☆☆Decreased power of lens
☆☆Short axial length of eye ball.
●●Rx==Convex lenses to increase power of accommodation
■■ASTIGMATISM
●●This is due to uneven surface of CORNEA
●●Or it is due to difference in eye curvature at different angles.
●●Rx==Cylindrical Lenses.
☆☆ACCOMMODATION POWER::
●●Of eye is due to
●●Convex surface of CORNEA ==+48 dioptres ●●Concave surface== --5 Dioptres.
●●So total ===48--5==43 dioptres only via CORNEA.
■■MAIN SITE IN EYE FOR FOCUSING sharp images==FOVEA==Where only CONE CELLS are
present and no rod cells present
■■PHOTOISOMERIZATION
☆☆Process of Conversion of 1-Cis-Retinal form of vitamin A to All trans--retinoic acid is called
Photoisomerization.
☆☆This occurs in Retinal pigment epithelial layer of Retina(Which is First layer of retina from inside
to outside).
■■RODS
●●More sensitive to light than CONES
●●NIGHT VISION main cells are Rods due to greater light sensitivity.
■■CONES:
●●Less light sensitive
●●Daylight cells bcz can't work in night due to less or no light in night.
●●COLOR VISION is due to cones.
●●Sharp vision or focussing==cons
■■purpose of fixation of tissue==
☆☆☆ Preserve tissue structure.
☆It's action===stabilisation of proteins by cross links formation b/w proteins molecules.
☆10% Formalin is used.
Pure formalin === 37% solution of formaldehyde gas in water.
■■For embedding process=== paraffin wax is used.
■■BASOPHILIC DYES stains acid.
Like DNA RNA===Stained with basic dye
So they are basophilic===Blue/purple color.
Basophilic dye===
●●●Hemotoxylin,Toluidine blue,methylene blue.
■■ACIDIC DYE stains basic organelles
Including cytoplasm.
Eg.Eosin stains cytoplasm pink.
■■Leydig cells of testes====Forms testosterone.
Present in Testes connective tissue interstitium.
■■ Sertoli cells present in Seminiferous epithelium.
FUNCTIONS.
☆Support
☆protection and nutrition to spermatozoa
☆Secretion
☆Phagocytosis of excess spermatid cytoplasm.
☆AMF (Anti-Mularian Factor)production.
☆☆☆Blood testes barrier formation.
■■Opthalmic division of CN --5
☆☆supplies Tip of Nose
☆☆blocked in surgery on external nose.
■■Capsule of liver called===Glisson capsule
■■Liver pours bile into Space of DISSI
■■Liver doesn't produce gamma globulin
Produces alpha and beta glubin proteins
Liver also doesn't produce interleukin
Liver portal triad===
☆Hepatic artery
☆Bile duct
☆Portal vein
■■GIT
Ileum contains M cells on pyer patches
That endocytose antigens
And present them to nearby lymphocytes
●●●ABO Blood grouping is due the process of these cells.
■■CLARA CELLS.
Found in lungs
Especially abundant in TERMINAL BRONCHIOLES
Function===RESERVE cells
Produce surfactant also
Regarding ATROPINE & ACETYLCHOLINE.
Regarding KIDNEYS
☆■☆REF GOLJAN☆■☆
■■CRESCENTS== Formed from Parietal epithelial cells lining bowman capsule.
Found in GPS.
■■RENIN== Produced by JG cells.
Help in Long term bp regulation.
■■ERYTHROPOITIN ==Formed mainly by PERITUBULAR capillaries.
Also by mesangial cells.
■■Mesangial Deposition== occurs in IgA nephropathy.
■■Linear IF pattern ==GPS.
■■Granular IF pattern == SLE.
■■Subendotheilial IC deposits==HBV ,SLE.
■■Subepitheial deposits==PSGN.
■■Intra membranous IC deposition==GPS.
■■DIFFUSE PROLIFERATIVE DEPOSITS ==SLE.
●●Wire looping of cappilaries==SLE.
●●Subendotheilial deposits==SLE.
■■Rapidly progressive GN==GPS,MICROSCOPIC POLYANGITIS (P-ANCA),
●●CRESCENTS ==GPS.
■■MINIMAL CHANGE DISEASE ==
●●FUSION OF PODOCYTES.
●● Most common cause of NEPHROTIC SYNDROME in CHILDREN
●●SELECTIVE PROTEINURI== Only albumin.
●●Good prognosis
●●No CRF chances.
■■FSGN==MCC of NEPHROTIC SYNDROME in ADULTS.
●●HCV MCC
others IVDA.
●●Bad prognosis
●●Leads to CRF frequently.
But MEMBRANOUS GN== also MCC in adults Ref first aid.
■■MICROALBUMINURIA ==FIRST SIGN of DM nephropathy.
●●Best test== Albumin detection dipsticks.
■■GBM thickening
●●Membranous GN==IC deposition in GBM.
●●DM==increased Type 4 collagen.
production.
■■DIFFUSE MEMBRANOPROLIFERATIVE GN.
■TYPE 1
●●HCV>>>HBV.
●●SUBENDOTHEILIAL IC deposits.
■TYPE 2
●●C NEPHROTIC FACTOR.
●●DENSE DEPOSIT DISEASE
●●TRAM TRACK APPEARANCE on EM.
●●DIFFUSE INTRA MEMBRANOUS IC DEPOSITS.
■■MEDULLARY SPONGE KIDNEY
●●SWISS CHEEZE APPEARANCE
#CARDIOVASCULARDRUGSBYMUHAMMADIRFAN.
■THIAZIDE DIURETICS
act
On DCT Na/Cl transporter
■Increase Ca reabsorption
■So drug of CHOICE IN idiopathic hypercalciuria.
Good in Calcium oxalate stone Treatment
Causes hypercalcemia as well
So contraindicated in PHPT or malignancy hypercalcemia
■A/E
Hypokalemia
Hyperglycemia
Hyperurecemia
Hyperlipedemia
LOOP DIURETICS
■ACTS on TAL
Na/K/2Cl transporter
USES
HTN
HF
EDEMA
HYPERCALCEMIA
A/E.
Hypokalemia
Hypovolumia
OTOTOXITY.
■CLONIDINE
ALPHA 2 AGONIST
A/E
Rebound HTN
Rx==Clonidine
Or PHENTOLAMINE
■METHYLDOPA
■VERY SAFE IN PREGNANCY FOR HTN.
A/E COOMBS POSITIVE HEMOLYTIC ANEMIA.
■HYDRALAZINE==Used for HTN in Emergencies with Isoserbide dinitrates.
■MINOXIDIL== used forMALE PATTERN BALDNESS .
Both ATRERIOLAR VASODILATORS.
■NITRUPRUSSIDE
HTN EMERGENCIES
USED IV
A/E CYANIDE POISONING
Rx== Methylene blue.
Others are also.
■DIAZOXIDE
Used in
HTN EMERGENCIES
Rx of HYPOGLYCEMIA due to INSULINOMA.
A/E.
HYPOTENSION
HYPERGLYCEMIA.
■ACEI
Used in many
Like HF
HTN
DIABETIC NEPHROPATHY DOC.
Reduces ATII in blood.
A/E
HYPERKALEMIA
TERATOGENIC EFFECTS.
COUGH better avoided in bronchospasm pts asthma copd etc.
CALCIUM CHANNEL BLOCKERS.
VERAPAMIL
DOC===SVT.
ADENOSINE
DOC for AV NODAL ARRHYTHMIA.
DOC==VASOSPASTIC ANGINA.
A/E
Increased PR interval
Bradycardia
CHB.
Constipation
Contraindicated
In HB pts.
ANGINA
Treatment
Is NITRATES
To decrease frequency of angina
BETA BLOCKERS AND CCB
are used.
BETA BLOCKERS are CONTRAINDICATED in VASOSPASTIC ANGINA pts.
■■DIGOXIN
POSITIVE IONOTROPHISM EFFECTS.
ECG effects.
●●INCREASE AV REFRACTORY PERIOD.
●●DECREASED QT INTERVAL
●●T WAVE FLATTENING OR T WAVE INVERSION.
TOXICITY.
causes
●PREMATURE VENTRICULAR BEATS.
esp
1:1 ration of Normal heart beat with PVB.
Called BIGEMINY.
Rx of TOXICITY
DOC== DIGOXIN ANTIBODIES /DIGIBAND
Some Random points.
■■In type 1 HSR
●●IgE binds to mast cells and basophils.
●●IgE doesn't bind to Eosinophil which is a very wrong misconception I often note it.
●●Blood cells that raise==Eosinophils.
●●IL-5== Interleukin for Eosinophil activation and differentiation.
■■Gluconeogenesis
●●Main purpose is energy fuel availability for RBCs and BRAIN which is glucose.
●●RBCs totally depends on GLUCOSE for its energy bcz it lacks MITOCHONDRIA due to which it
can't use FA for its energy production unlike other tissues.
●●Brain can use FA and ketone bodies in case of starvation.
●●Fasting Hypoglycemia
●Most common cause==Alcoholism bcz of excess production of acetyl CoA which is converted to
ketone bodies due to lack of NADPH for the process of gluconeogenesis.
●Other causes are carnithine acyltransferase deficiency etc.
■■CHERRY RED SPOT MACULA
●●Occurs in
●Tay Sachs disease
●Nieman Pick Disease
●CRAO.
Etc.
■■Blue Sclera
● Osteogenesis Imperfecta.
Many others.
■■LONG chain fatty acids metabolism occurs in PEROXISOME while short chain Fatty acids (<<10
Carbon FA ) metabolism occurs In mitochondria.
■■REGARDING AIDS
■AIDS Defining infection== PNEUMOCYSTIS Carinii (old Jeroveci).
●● occurs when CD4 count less than 200 cells/dl.
●●Rx==TMP--SMZ.
■■Best HIV sensitive test==ELISA
●● But false positive in babies born to HIV Positive mother.
●● So in those babies best test==HIV RNA PCR.
●● In ADULTS first 1 to 2 months Elisa is false negative due to no anti HIV antibodies.
■HIV confirmatory test== Westren Blot.
●● But have some false negative results due to HIV some strains and HIV--3 undetectable.
●● So in these cases best==HIV RNA PCR.
●● For viral load and therapeutic response HIV RNA PCR is used.
Regarding PNEUMONIA
1<■>COMMUNITY AQUIRED PNEUMONIA
●●MCC== STREPTOCOCCAL PNEUMONIA.
●●Second MCC== H.INFLUENZA.
●●Most commonly in elderly children bcz of immunodeficiency.
■Causes ==LOBAR PNEUMONIA.
■Rx== PENICILLIN G
Amoxicillin +clavulunate.
■Penicillin Allergic== Macrolides.
■Penicillin Resistant ==VANCOMYCIN.
2<■■>HOSPITAL ACQUIRED (NOSOCOMIAL ) PNEUMONIA
■MCC== Pseudomonas
(Also causes pneumonia in CYSTIC FIBROSIS pts).
■Rx==CIPROFLOXACIN as a single agent.
Or
●●Ceftizidime plus amikacin
Or
●●Ciptriaxone plus Amikacin.
3<■■>ATYPICAL PNEUMONIA
■MCC==MYCOPLASMA PNEUMONIA
■It causes BRONCHOGENIC (Diffuse interstitial pneumonia ).
●PNEUMONIA that's worse on CXR but clinically mild.
■Rx
●●MACROLIDES==Erythromycin, Azithromycin, Clarithromycin.
●●PENICILLIN doesn't work in them why.
☆☆BCZ Penicillin and cephalosporins act by inhibition of CELL WALK SYNTHESIS while they have
NO CELL WALL
REGARDING TGs AND CARDIOVASCULAR
ADDED NEW POINTS AS WELL.
■■TG CONTENT
CHYLOMYCRONS(APOB48).
>>>>VLDL>>>>CHYLOMICRON REMNANTS
REMNANTS == AFTER CHYLOMYCRONS EMPTY INTO LIVER.
VLDL==APO-B100 CARRY ENDOGENOUS TGS SYNTHESISED IN LIVER.
HDL==GOOD CHOLESTEROL
BCZ these carry cholesterol from peripheral tissues like muscles adipose and blood vessels to liver
for degradation.
●●It should be greater than 40mg/dl.
●●Less than this carries high CAD risk.
●●It imports APO E & C to CHYLOMYCRONS in the blood.
●●●●AGENTS that increase HDL LEVEL
are
●●Familial Hx of longvity.
●●Exercise
●●NIACIN.
BAD CHOLESTEROL ==LDL.
●●●Bcz it carries cholesterol to peripheral tissues.
It should be less than 160--150mg /dl.
It is oxidised by free radicals in intema of vessels and thus form ATHEROMATOUS PLAQUES ==
PATHOGNOMONIC LESIONS of ATHEROSCLEROSIS.
Risks of Increased atherosclerosis
●●SMOKING ==FR formation.
●●HOMOCYSTINEMIA +MMA ==FOLATE DEFICIENCY AND B12 DEFICIENCY.
●FOLATE has a high role in CAD PREVENTION.
●●VTAMIN C & E reduces free radicals.
REGARDING CARDIAC ENZYMES
■■MOST SENSITIVE ==MYOGLOBIN
BUT less specific due to Non-Cardiao specificity
Raise in trauma skeletal muscle damage etc.
■■EARLIEST TO APPEAR==MYOGLOBIN.
■■MOST CARDIOSENSITIVE== TROP T.
CPSP KEY (if not mention withen one hour).
■■MOST CARDIOSPECIFIC ==TROP I.
■■CARDIOSPECIFIC raising withen one hour===CKMB.
Refer TOPAL CARDIOLOGY BOOK.
■■EMERGENCY CONDITIONS== BEST IS ECG.
TOPOGRAPHIC ST ELEVATION.
Elevation in specific leads.
Not all.
■ST ELEVATION == CONVEX ELEVATION e T WAVE INVERSION mostly In MI.
●●PERICARDITIS == ALL CHEST LEADS ST ELEVATION ==CONCAVE e PR DEPRESSION.
MI SPECIFICIC FEATURES
●●MENSTRUATING women less prone bcz of high estrogen protective effect on MI Occurence.
Below 50 years incidence is high in MEN than women.
After 50 years BOTH have equal chance.
●●HX==Important in parents only if MI has occured b4 50 years
Hx of family not important if above 55 round.
Ref MTB -- 2.
●●PERSISTENT RETROSTERNAL CHEST PAIN
●●SWEATING DUE TO SANS ACTIVATION.
●●VOMITING DUE TO Inferior wall mi that cause VASOVAGAL REFLEX.
●●DIFFUSE DULL SQUEEZING ACHING PAIN Not SHARP PAIN.
VT=post MI Most common cause of death in 24 hours
VENTRICULAR WALL RUPTURE==Most common cause of death from 3 day to 14 days mostly
round 10 days
VENTRICULAR ANEURYSM==Most commonly after 1 to 2 months after MI
PAIN of MI(HEART MYOCARDIUM) refers to Left arm and shoulder and jaw is through Sympathetic
fibres T1 to T5
●●PRECORDIAL PAIN=== PERICARDITIS
●●LOCALISED RIB CAGE TENDERNESS== CHOSTOCHONDRITIS.
●●MI PT==DYSPNEAC == CAN BE DUE TO ASSOCIATED PULMONARY EDEMA==LHF.
■■■■■ACUTE PERICARDITIS==
●●PAIN is SHARP aggravates with POSTURE of lying on back or SUPINALLY.
●●Pain relieves ==ANTERIOR RECUMBENT or inclining
Like recall it for ACUTE PANCREATITIS.
●●PRECORDIAL
●●DIFFUSE ST ELEVATION e PR DEPRESSION.
●●PERICARDIAL EFFUSION==MOSTLY IN SLE.
●●CONSTRICTIVE PERICARDITIS== MCC==TB
●●PERICARDIAL RUB KNUCKLE due to Calcification in pericardium post TB.
■■■■MYOCARDITIS
●●MOSTLY 1--2 WEEKS Hx of VIRAL INFECTION.
●●MCC== COXSACKIE B VIRUS.
others adenovirus etc
Bacteria== those causing ACUTE PERICARDITIS.
REGARDING DIGOXIN TOXICITY
#DIGOXINBYMUHAMMADIRFAN.
It's toxicity is increased by
■HYPOKALEMIA
■HYPERCALCEMIA
■HYPOMAGNESEMIA
Or see like if causes mentioned
Diuretics like loop thiazide etc.
REGARDING HIND GUT .
■■ANORECTAL RING
■It separates anal canal BELOW from RECTUM ABOVE.
■■ANAL CANAL
■Starts at end of rectum.
■UPPER 2/3RD.
●●Derived from endoderm==epithelium simple columnar epithelium.
●●Supplied by superior rectal artery.
●●Drained by Superior Rectal vein into IMV into portal vein.
■PECTIN ATE also called DENTATE LINE
■Line of differentiation b/w upper two 2rd of anal canal and lower 3rd anal canal.
■■LOWER 1/3RD
●●Embryology ==derived from ectoderm
■Lined by simple stratified squamous epithelium.
■WHITE HELTONS LINE
●●It lies below PECTIN ATE LINE in lower 1/3rd of Anal canal.
●●It separates or demarcate
●●Upper non-keratonized stratified squamous epithelium from lower part of
Keratinised strategy squamous epithelium part in lower 1/3d.
■Artery supply==Middle rectal artery (branch of internal iliac artery) and Inferior rectal artery (Internal
rectal artery ). ■■ARTERIAL THROMBI
●●LINES OF ZAHN== prominent
●Alternate dark gray layers of platelets intrspersed with lighter layers of fibrin.
■■VENOUS THROMBI
●●Mostly caused by venous stasis like hospital pts.
●● No prominent or absent lines of ZAHN.
■■POSTMORTEM CLOTS
●●Not true thrombi bcz of no attachment to vessel wall.
●●Two layered appearance
●Lower Red cell rich layer called CURRANT JELLY APPEARANCE
●CHICKEN FAT APPEARANCE =Upper poor cell layer
Regarding pigments in the body
■EXOGENOUS PIGMENTS
●●Carbon dust==Anthracosis
Silica Dust==Silicosis
Iron dust
●●Plumbism==Lead poisoning
●●Argyria==Silver poisoning and its deposition in skin & Conjunctiva.
■■ENDOGENOUS PIGMENTS
●1●BILIRUBIN
●2●MELANIN
●3●HEMOSIDERIN ==Aggregates of Ferritin.
Hemosiderin ==Insoluble form.
●Hemosiderosis== accumulation in macrophages with no parenchymal cells damage.
● HEMOCHROMATOSIS ==Accumulation in parenchymal cells with tissue damage and scarring.
☆☆HFE gene mutation is the cause
☆☆BRONZE DIABETES is caused by hemochromatosis which is TRIAD of
>>Micronodular Cirrhosis
>>DM
>>Skin Pigmentation.
●4●LIPOFUSCIN
● Also called PIGMENT of WEAR & TEAR
found due to aging process in hepatocytes and cardiomyocytes.
●BROWN ATROPHY== LIPOFUSCIN accumulation plus organ atrophy
■Vein==Inferior and middle rectal vein draining into internal pudendal vein into IVC
■HOMOCYSTINEMIA
●MCC==Folate deficiency
●second cause ==B12 DEFICIENCY
●Increase risk of CAD.
●In some countries(westren)food fortication with FOLATE of wheat ,rice etc been done to reduce risk
of CAD.
●Folate also used in Hemolytic anemias like Sickle cell disease thalasemia etc.
●Also used in Pregnancy (400--800IU).
●In case of B12 DEFICIENCY ANEMIA always avoid to first give folate bcz it worsens CNS damage.
■HOMOCYSTINUREA
●B6 deficiency bcz it's cofactor for cystathione synthase
●Congenital deficiency of cystathione synthase
■Chromium ==Cofactor for insulin
So its use in diabetes is very beneficial.
■ZINC cofactor for
●Collegenase and metallproteinases
●Carboxypeptidase A (helps in digestion ).
●Carbonic Anhydrase (Important in reabsorption of HCO3 in PCT of kidney as well as in other cells
of the body).
■Magnesium
●Cofactor for PTH synthase
●Hypomagnesemia will cause hypocalcemia and so tetany.
●While at kidney level both compete for reabsorption at a single transport protein thus
●Reabsorption of one will lead to excretion of other
CNS
BRAIN
■■PRIMARY MOTOR AREA==BMA==4.
●●Corticobulbar &Corticospinal tracts
==Pyramidal Tracts.
●●Excitatory In Function.
●●Increase Muscle Tone.
●●Infarction/Lesion cause ==Severe paralysis(Loss Of strength ) than Secondary area.
●●Most common infarction==PMA+SMA
==Complete Contralateral Paralysis.
●●Jacksonian Epileptic Seizures affect
==PMA==BMA==4.
■SECONDARY MOTOR AREA==6.
Lesions/infarction==Skilled Movements affected with little loss of strength.
●●Send Extrapyramidal tracts (EPT) to Basal Ganglia(BG) and Reticular Formation (RF).
●●Functions as inhibitory over pyramidal Tracts (PT).
●●Lesions==Increase Muscle Spasticity.
●●Muscle Spasticity greater in SMA lesions than PMA (VIP) bcz of loss of inhibition over excitatory
PMA.
■FRONTAL EYE FIELD::
●●Unilateral lesion==
==Two eyes deviate towards the side of Lesion.
==Inability to turn eyes towards opposite side.
■BROCA'S AREA
●●Left Inferior Frontal Gyrus
●●Lesion==Expressive/Fluent Aphasia.
●●Can think,Write and understand words but
●●Can not Speak.
■WERNICK SENSORY SPEECH AREA
●●Left Temporal area lesion.
●●Fluent Speech
●●Irrelevant Talking.
●●Can't understand words
■GLOBAL APHASIA
●●Both BA+WA==Involved.
■INSULA
●●Lesion==Phenomes Pronunciation difficulty.
■ANGULAR GYRUS.
●●Posterior Parietal Lobe.
●●Lesions lead to
●●Alexia==Inability to Read.
●●Agraphia==Inability to Write
■PRE--FRONTAL CORTEX
●●Functions for ideas,thinking,judgment,Emotional Feelings and personality Changes.
●●LESIONS==Lead to
●●Loss of Initiatives and judgment
●Emotion Liability
●Loss of care of dress and appearance
●●SCHIZOPHRENIA
●●Increased Number and sensitivity of D2 receptors in Prefrontal Cortex.
●●Old Obsolete Rx
●●Frontal Leukotomy & Frontal Lobectomy
Now tranquilisers have better response.
■PRIMARY SOMATOSENSORY CORTEX
●●Receives crude touch pain and temperature sensations.
■SECONDARY SENSORY CORTEX
●●Located in Superior Parietal Lobule.
●●Fine touch,proprioception and Vibration
●●Lesion leads to ASTERIOGNOSIS.
●●●Inability to appreciate Texture,Size and form.
●●e.g inability to recognize Key etc when you put it into pts hands when his/her eyes are closed.
■■PARIETAL LOBE
●●Posterior Part Lesion leads to inability to recognise opposite side of body.
■PRIMARY VISUAL AREA::
●●Walls of posterior part of Calcined sulcus.
●●Lesion of one side leads to CROSSED HOMONYMUS HEMIANOPSIA.
●●Lesion of upper half==UQHHA.
●●Lesion of lower half==LQHHA.
■Secondary Visual Area
●●Lesion== opposite side Fields Defects.
■Primary Auditory Area
●●Cochlear Sensations
■Secondary Auditory Area
●●Lesion leads to WORDS DEAFNESS called
●●ACOUSTIC VERBAL AGNOSIA
●●Inability to interpret sounds
HIPPOCAMPUS present in temporal lobes and main function is LONG TERM MEMORY
FORMATION
OLFACTION AREA is present in FRONTAL LOBE
MECHANISMS OF HEAT LOSS
CONDUCTION == only when body is attached or lying like on OT table
RADIATION == active process of heat loss from body while body is uncover.
Convection== Heat loss from body while maximum humidity is present in atmosphere.
Most potent response of the body to cold is SHIVERING
Non shivering thermogenesis is via NOR epinephrine
EOSOPHEGEAL OPENING is in LEFT CRUS of diaphragm with a sling of fibres from right crus
ref RJ LAST point goes against short snell.
#PHARMACOLOGY
#Drugs
#CVS
#DOC
■THIAZIDE DIURETICS
act
On DCT Na/Cl transporter
■Increase Ca reabsorption
■So drug of CHOICE IN idiopathic hypercalciuria.
Good in Calcium oxalate stone Treatment
Causes hypercalcemia as well
So contraindicated in PHPT or malignancy hypercalcemia
■A/E
Hypokalemia
Hyperglycemia
Hyperurecemia
Hyperlipedemia
LOOP DIURETICS
■ACTS on TAL
Na/K/2Cl transporter
USES
HTN
HF
EDEMA
HYPERCALCEMIA
A/E.
Hypokalemia
Hypovolumia
OTOTOXITY.
■CLONIDINE
ALPHA 2 AGONIST
A/E
Rebound HTN
Rx==Clonidine
Or PHENTOLAMINE
■METHYLDOPA
■VERY SAFE IN PREGNANCY FOR HTN.
A/E COOMBS POSITIVE HEMOLYTIC ANEMIA.
■HYDRALAZINE==Used for HTN in Emergencies with Isoserbide dinitrates.
■MINOXIDIL== used forMALE PATTERN BALDNESS .
Both ATRERIOLAR VASODILATORS.
■NITRUPRUSSIDE
HTN EMERGENCIES
USED IV
A/E CYANIDE POISONING
Rx== Methylene blue.
Others are also.
■DIAZOXIDE
Used in
HTN EMERGENCIES
Rx of HYPOGLYCEMIA due to INSULINOMA.
A/E.
HYPOTENSION
HYPERGLYCEMIA.
■ACEI
Used in many
Like HF
HTN
DIABETIC NEPHROPATHY DOC.
Reduces ATII in blood.
A/E
HYPERKALEMIA
TERATOGENIC EFFECTS.
COUGH better avoided in bronchospasm pts asthma copd etc.
CALCIUM CHANNEL BLOCKERS.
VERAPAMIL
DOC===SVT.
ADENOSINE
DOC for AV NODAL ARRHYTHMIA.
DOC==VASOSPASTIC ANGINA.
A/E
Increased PR interval
Bradycardia
CHB.
Constipation
Contraindicated
In Heart Block pts.
ANGINA:
Acute attack treatment is
NITRATES Sublingual,Oral,iv.
Prevention and to
decrease frequency of angina attacks
BETA BLOCKERS AND CCB
are used.
BETA BLOCKERS are CONTRAINDICATED in VASOSPASTIC ANGINA pts because they block
beta receptors in the blood vessels (coronary arteries thus alpha receptors predominate and there is
risk of vasoconstriction.thats why beta blockers are also avoided in peripheral arterial diseases and
Raynauds phenomenon).
■■DIGOXIN
POSITIVE IONOTROPHISM EFFECTS.
ECG effects.
●●INCREASE AV REFRACTORY PERIOD.
●●DECREASED QT INTERVAL
●●T WAVE FLATTENING OR T WAVE INVERSION.
TOXICITY.
causes
●PREMATURE VENTRICULAR BEATS.
esp
1:1 ration of Normal heart beat with PVB.
Called BIGEMINY.
Rx of TOXICITY
DOC== DIGOXIN ANTIBODIES /DIGIBAND.
DRUG OF CHOICE CHANDKIAN'S
Pain in MI.... Morphine
Terminal Cancer pt with pain....Morphine
Billiary collic....Morphine & pethidine
S.Aures infection....cloxacillin
Swelling on dorsum of hand with 102 fever (S.Aures)..cloxacillin
60 yrs old with Pyogenic meningitis.... Ceftriaxone
Mild heart failure as monotherapy.....ACE
Monotherapy for CCF....Captoril
Tape worm infestation....Hiclosamide ( or Niclosamide)
Asthmatic with IHD , For B.P control on OT table.... I/V Nitroprusside
Tonic clonic seizures ( after half an hout of effort with another drug)...Lorazipam
Hypertensive crisis ...Captopril
Hypercalcemia due to PTH overactivity.... Furosemide
Anterior wall MI with Pulmonary Edema...Furosemide
CLD with GI bleeding.....Inj. Terlipressin
Meningitis in elderly with no drug allergy....Penicillin
Gas Gangrene ....Penicillin
Sore throat , fever , joint pain ( R.F).......Benzyl penicillin
Vasodilator for RX of Angina that doesn't increase HR....Meraprolol
Traveler's Diarrhoea...Diphenoxylate
MRSA.....Cotrimoxazole
Itching in eyes & Keratitis (HSV) .....Trifluridine
Chest injury & rib fracture , for local anaesthesia .....Bupivacain
Motion sickness.... scopolamine ( if not given then cyclizine)
Atrial Filbrillation....Digoxin
Pulmonary Anthrax....Cipro
Metastatic pleural effusion....Bleomycin
#Important #Biochemistry points..

1)Highest cholesterol content=LDL. 2)richest in triglycerides=chylomicron.
3)Highest protein content=HDL.
4)Fat soluble vitamins= ADEK.vit a,d,e,k.
5)Vit B2 deficiency=2cs(Cheilosis,Corneal vascularization..
6)Vit B3 deficeincy=3ds(dirrhea,dementia,dermatitis)..
7)Antioxidants ACE=vit a,c,e.
8)Vit k(antiKagulant)=gamma carboxylation of factors(27910). 9)essential fatty acids=linolic acid & linolinec
acid. 10)Malnutritions::::::::
(a)kawashiorkor::protein malnutrition result from protein deficient
MEAL(M=malnutrition,E=edema,A=anemia,L=liver fatty). (b)Marasmus:::M=muscle wasting.
11)amino acids necessary for PURINE synthesis GAG(glycine,aspartate,glutamine). 12)Bloting
proceedures:::southern blot=DNA,NORTHERN blot=RNA,western blot=protein. 12)protein energy=4.1Kcal.
13)fat energy=9.1kcal.
14)highest energy compund=ATP.
15)renal failure z most common cause of vit D deficiency. 16)isoniazide therapy z most common cause of
pyridoxine(vit b6) deficiency. 17)vit c z cofactor in conversion of dopamin to norepinephrine.
18)the most common source of vit K z colonic bacteria.
19)vit b12 deficiency=homocysteinuria.
20)hypervitaminosis A=scaly dermatitis.
21)thiamine level z best monitered by=transketolase level in RBC. 22)increase carbohydrates=increase
demand of thiamine.coz thiamine z important in ATP senthesis. 23)biotin(vit b7) z used as coenzyme in fatty
acid synthesis.
24)vit b6 inovle in transamination of ALT & AST.
25)vit C(ascorbic acid) is involved in collagen synthesis.vit c deficiency result in defective collagen. 26)zinc
deficiency leads to delayed wound healing.
#Autosomaldominantdiseases
• One heterozygous parent carries a gene for the phenotypic expression of a disorder and the other
parent is normal.
• Most likely cases in Non-consanguineous matings.
• ONE HALF (1/2 ) of children are expected to inherit the gene and are themselves heterozygotes
who phenotypically manifest the gene.
• Distribution of phenotype is the same in both the sexes.
• Some examples are:
1. Achondroplasia
2. ADPKD
3. FAP
4. Familial hypercholestrolemia
5. Hereditary heemorrhagic telangectasia
6. Hereditary spherocytosis
7. Huntington disease.
8. Von wille brand disease.
9. Marfan syndrome.
10. MEN (1, 2A, 2B)
11. Neurofibramatosis type 1 & 2
12. Tuberous sclerosis
13. Von Hippel-Landau disease
14. HNPCC ( urothelial, colorectal, ovarian, Endometrial Ca)
15. MODY
16. Polydactaly
17. Osteogenesis Imperfecta
Autosomal Recessive Disorders
• Both parents are heterozygous who donot phenotypically manifest the disorder.
• One in four (1/4) of their children will be homozygous for the trait will and, in the case of disease states, will
phenotypically manifest the disorder
• One in four (1/4 ) children will not inherit the trait.
• Two (2) of the children will be hetrezygotes.
• Distribution of the disordered phenotype is the same in both the sexes.
• Some examples:
1. Albinism
2. ARPKD
3. Cystic fibrosis
4. Glycogen storaage diseases
5. Hemochromatosis
6. Kartagener syndrome
7. Mucopolysaccharidosis(except Hunter that is X-linked Recessive)
8. Phenylketonuria
9. Sickel cell anemia
10. Thalassemia
11. Wilson disease
12. Sphingolipidosis (except Fabry disease that is X-linked Recessive)
13. Galactosemia
14. Hemophilia C
15. CAH
16. @-1 Antitrypsin deficiency
17. Fanconi’s anemia
18. Barter Syndrome
19. Familial Dystonias
20. Skeletal dysplasia
21. 46 XX Pure Gonadal dysgenesis
X- Linked Recessive disorders
• Commonly more seen in Males
• Females usually must be homozygous to be affected
• Sons of heterozygous mothers have a 50 % chance of being affected
• No male –to-male transmission
• Skips genertion
• Some examples:
1. Hunter
2. Fabry disease
3. G6PD deficiency
4. Classic Hemophilia A & B
5. Lesch Nyhan Syndrome
6. Duschene Muscular Dystrophy
7. Kall man Syndrome
8. Color Blindness
9. CAIS ( Complete androgen insensitivity )
10. Ichthyosis
11. Placental Sulfatase deficiency
A brief summary of Autosomal Recessive and Autosomal Dominant
Characteristics Autosomal Recessive Autosomal Dominant
1. Onset Early Uniform(Infancy/Childhood) Variable(may be delayed into adulthood)
2. Penetrance Complete Incomplete with variable expression
3. Mutation Usually an enzyme protein Usually a structural protein or resistance
4. Requires Mutation of both alleles Mutation of 1 allele
#NEUROANATOMY Points
muscles of facial
expression have
motor innervation.
muscles.
enophthalmos.
(accommodation-
motor.
gingival.
as mental nerve.
lower teeth.
A) Lingual nerve:
as mental nerve.
D) Mental nerve:
Needle Course:
Pierces:
Lingual Nerve:
and vein.
TRIGEMINAL NUCLEI:
Trigeminal Nerve:
eye blinks.
blink.
TRIGEMINAL LESIONS:
proprioception)
Pterygoid muscle
CN VII NUCLEI:
CN VII LESIONS:
(efferent).
pelvic
CN XI LESIONS:
CN XII LESIONS:
Spinal Cord:
A) 40–45 cm long.
puncture.
cortex.
Tracts:
NERVE FIBER TYPES:
A) A Fiber:
■ Thoracolumbar
■ Craniosacral.
Cell bodies of visceral afferent fibers are located in the = dorsal root ganglia.....
#Important
NERVE INJURIES
===========
midshaft of humerus----------------------radial N & profunda brachii A
surgical neck of humerus-------------axillary N & posterior circumflex humeral A
supracondylar # of humerus-------median N
medial epicondyle of humerus---ulnar N
hook of the hamate-----------------------ulnar N (outstreched hand)
neck of femur-----------------------------------medial circumflex femoral A (avascular necrosis of head)
supacondylar # of femur--------------popliteal A
neck of fibula-----------------------------------common peroneal N
fall on the point of shoulder------upper trunk of brachial plexus
elbow is stuck(funny bone)--------ulnar nerve
fall asleep with arm over the back of chair-------------radial nerve
attempt to cut the wrist-------------------------------------------------median nerve
foot drop------------------------------deep peroneal nerve
wrist drop-----------------------------radial nerve
claw hand-----------------------------lower trunk(Klumpke's)
ulnar nerve
waiter's tip---------------------------upper trunk(Erb's)
ape or simian hand-----------median nerve
# of medial mallealus of tibia-----------------posterior tibial nerve(sensory-sole of foot;motor-intrinsic muscles
of sole )
-----------------anterior tibial artery
posterior dislocation of hip-------------sciatic nerve
MEDIAN NERVE [labourer's nerve]–C5,6,7,8,T1
Pen test
Ape thumb
Loss of opposition
Pointing index
Positive OSCHNER CLASP & BENEDICTION TEST
If you ask an Ape to pick up a pen he wont be able to do so because his opposition has been lost and he has a
pointing index,so just clasp him and do the Benediction test and find that his median N is injured!
ULNAR NERVE [muscian nerve]—C8,T1
Supply ADDuctor pollicis
Book test(Fromet sign)
Card test
Egawa’s test
Book and card are similar,similarly Fromets sign and Egawa’s test is used to test Ulnar N which supplies
adductor pollicis.
RADIAL NERVE—C5,6,7,8,T1
Wrist drop
Thumb drop
Finger drop
All the drops come under radial.
Nerve Injuries
===============================
Injury to common peroneal N——>Foot drop and inversion(Equinovarus)
Injury to superficial peroneal N—->Inversion of foot
Injury to deep peroneal N——>Foot drop
Injury to tibial N——>Dorsiflexion and everion of foot at subtalar and trans tarsal joints(Calcaneovalgus)
Tarsal tunnel syndrome —–>due to entrapment of Tibial N while passing deep to flexor retinaculum in
between med malleolus and calcaneus.
Tip: Sciatic N neutral, it divides into Tibial N and Common peroneal N which have opposite actions.
Injury to Common peroneal N causes Equinovarus(Inversion and Foot drop/plantar flexion) which is exactly
opposite to the injury to Tibial N,Calcaneovalgus(Eversion and Dorsiflexion).
#Bladder #Urethral #injuries

#Important
Remember it MUST:
Trauma to the:
Sup. wall of urinary bladder --> urine leakage into peritoneal cavity.
Ant. wall of UB --> urine leakage into Retropubic space.
Urethral rupture above the urogenital diaphragm --> urine leakage into the Retropubic space.
Urethral rupture below the urogenital diaphragm --> urine leakage within the Superficial perineal pouch.
Rupture of the Penile urethra --> urine leakage beneath the Deep Fascia of Buck (Eg: Scrotum)
Rupture of Prostatic Urethra --> Urine leaks into Deep Perineal Pouch
Rupture of Bulbar Urehtra ---> Urine leaks into Superficial Perineal Pouch
Very BRIEF but very concise Points from guyton.

#HEMATOPOISIS by
First trimester === YOLK SAC
2nd trimester ===LIVER
3RD trimester === BONE MARROW
●●Just CO-RELATING to PAEDS BOOK BY PERVEZ AKBAR says
■First 2--3 weeks HEMATOPOISIS starts in BLOOD ISLANDS of YOLK SAC and continues till 1 to 2
months.
Meaning FIRST TRIMESTER organ of erythropoisis is yolk sac as by guyton.
■First 6 months DOMINANT ORGAN of erythropoisis === LIVER which gets hold of erythropoisis after
yolk sac.
■After 6 months BONE MARROW becomes predominant organ of erythropoisis.
Meaning in 3rd trimester ERYTHROPOISIS is done by BONE MARROW and so in EXTRA - UTERINE
LIFE as well.
INFECTIVE ENDOCARDITIS PATHOGENS.

#INFECTIVE_ENDOCARDITIS
A<■>ACUTE IE.
Most common cause is STAPH AUREUS.
B<■>IE IN IVDA
Most common cause STAPH AUREUS
C<■>SUBACUTE IE.
Most common overall pathogens VIRIDANS group streptococci.
D<■>IE associated with ARTIFICIAL heart valves age <60. Most common pathogen STAPH EPIDERMIDIS.
E<■>IE associated with ARTIFICIAL heart valves age>60.Most common cause is STAPH AUREUS.
F<■>HOSPITAL ACQUIRED IE
Pts with CV LINES most common cause is STAPH AUREUS.
Pts with URINARY CATHETERS,GIT Surgery,Urinary tract surgery most common cause is
ENTEROCOCCI (strep.facium and fecalis).
G<■>IE associated with ULCERATIVE LESIONS (UC,COLON CANCER) Most common cause is
STREPTOCOCCUS BOVIS.
H<■>IE associated with DENTAL AND OROPHARYNX surgery Most common cause VIRIDANS
STREPTOCOCCI ( S.MUTANS,S.SANGUIS,S.SALIVARIUS,S.MITIS ).10% cases caused by enterococi.
I<■>IE associated with BLOOD CULTURE NEGATIVE are BARTONELLA SPECIES,COXIELA
BURNITII,BRUCELLOSIS, TROPHRYMA WHIPILII.
J<■>LIBMAN-SACKS ENDOCARDITIS associated with SLE and is sterile.
Involves most commonly mitral valve with sterile vegetations.
K<■>NON BACTERIAL THROMBOTIC ENDOCARDITIS (NBTE) also called MARANTIC
ENDOCARDITIS associated with paraneoplastic syndrome and mucing producing tumors of colon and
pancreas.
It has also sterile non destructive vegetations on MV valve.
#NEUROANATOMY Points
muscles of facial
expression have
motor innervation.
muscles.
enophthalmos.
(accommodation-
motor.
gingival.
as mental nerve.
lower teeth.
A) Lingual nerve:
as mental nerve.
D) Mental nerve:
Needle Course:
Pierces:
Lingual Nerve:
and vein.
TRIGEMINAL NUCLEI:
Trigeminal Nerve:
eye blinks.
blink.
TRIGEMINAL LESIONS:
proprioception)
Pterygoid muscle
CN VII NUCLEI:
CN VII LESIONS:
(efferent).
pelvic
CN XI LESIONS:
CN XII LESIONS:
Spinal Cord:
A) 40–45 cm long.
puncture.
cortex.
Tracts:
NERVE FIBER TYPES:
A) A Fiber:
■ Thoracolumbar
■ Craniosacral.
Cell bodies of visceral afferent fibers are located in the = dorsal root ganglia.....
200 MOST IMPORTANT MCQS WITH ANSWERS FROM PAST CPSP PAPERS.ANSWERS
AFTER EVERY 10 MCQS.
1) The auricle develops from
A) 1st branchial cleft
B) 1st branchial arch
C) 1st and 2nd branchial arch
D) 1st, 2nd and 3rd branchial arch
2) Fibro-cartilage has the predominance of collagen type
A) Ι
B) ΙΙ
C) ΙΙΙ
D) ΙV
3) Facial nerve has all the neural column as major functional components except
A) Special visceral afferent
B) General visceral efferent
C) General visceral afferent
D) Special visceral efferent
4) Fundus of gall bladder lies in the angle between lateral border of rectus abdominis and tip of ninth
costal cartilage. The vertebral level is lower border of
a) T-11
b) T-12
c) L-1
d) L-2
5) Which of the following is true
a. Left lung is heavier than right lung
b. Thoracic duct is related to mediastinal surface of right lung
c.Recurrent laryngeal nerve is related to mediastinal surface of right lung
d. Azygos vein is related to mediastinal surface of right lung
6) False regarding autonomic nervous system
A) Lateral horns of spinal cord mainly harbour cell bodies of the sympathetic nerves
B) Preganglionic para sympathetic fibers are usually longer than preganglionic sympathetic fibers
C) Occulomotor nerve carries the post-ganglionic parasympathetic fibers
D) Acetylcholine is the neurotransmitter at sympathetic and parasympathetic ganglia
7) Referred pain from the cervix is felt in the region of
A) Hypogastrium
B) Anterior genitalia
C) Medial thigh
D) Posterior thigh
8) Composite muscles include the following except
A) Pectineus
B) Adductor magnus
C) Flexor carpi ulnaris
D) Flexor pollicis brevis
9) All is true about Triangle of Doom except
A) Vas deferens lies medially
B) Testicular vessels lie laterally
C) Surgical staples are avoided here
D) Apex is directed towards superficial ring
10) All is true about zona pellucida except
A) Acellular glycoprotein membrane
B) Contributed by granulosa cells
C) Present till morula stage
D) Sperm attractant membrane turns sperm-repellent after zona reaction
1.C 2.A 3.C 4,C 5.D 6.C 7.D 8.C 9.D 10.C
11) Incorrect statement about allantois is
A) An endodermal diverticulum
B) Its mesoderm expands to form the blood vessels to serve the placenta
C) Urachus is the remnant lying in the medial umbilical ligament D) Patent allantois leads to Urachal
fistula
12) Choose the incorrect statement regarding structures constituting the anatomical angina pectoris:
a. The pain fibres from heart run in the middle and inferior cervical cardiac branches of sympathetic
trunk
b. The superficial cardiac plexus receives left superior cervical cardiac branch from vagus nerve
c. Sympathetic fibres come from cervical and upper thoracic ganglia of sympathetic trunk to carry
pain fibres
d. Thoracic splanchnic nerve carry the pain fibres from diaphragmatic surface of heart
13) All are neural crest cell derivatives except
A) Vomer bone
B) Choroid & sclera of eye
C) Tunica media of great vessels
D) Olfactory epithelium
14) A middle aged woman complains of weakness in extension and laterally rotation of her thigh.
The muscle paralysed is
A) Semimembranosus
B) Sartorius
C) Obturator internus
D) Gluteus maximus
15) Wrong statement regarding oogenesis is
A) Meiosis converts primary to secondary oocyte
B) Primary oocyte is arrested in metaphase- 1 till puberty
C) Polar body one is released 24 hours prior to ovulation
D) Ovulated cell is secondary oocyte arrested in metaphase- 2
16) A patient who has suffered severe chest trauma in an automobile accident is found to have fluid
in the right pleural space. A thoracentesis reveals the presence of chylous fluid in the pleural space,
suggesting a rupture of the thoracic duct. In which regions of
the thorax is the thoracic duct found.
a. Anterior and middle mediastinum
b. Anterior and superior mediastinum
c. Middle and superior mediastinum
d. Posterior and superior mediastinum
17) 2nd constriction in oesophagus is seen at the following site a. Where crossed by left main
bronchus
b. Crossing of aorta
c. At pharyngoesophageal junction
d. Where it pierces the diaphragm
18) All is true about development & maturation of sperms except
A) Primordial germ cells are dormant till puberty
B) Spermatogonium becomes mature sperm in 74 days
C) Progressive motility is gained in the epididymis
D) Stored in the seminal vesicle before ejaculation
19) Correct statement concerning sexual development is
A) Gonadal ridge appear at week 5
B) Absence of SRY gene leads to male phenotype
C) Testes develop later than ovaries
D) External genitalia are well developed by week 10
20) Gitter cell is
A) Microglia
B) Modified macrophage
C) Astrocyte
D) Neutrophil
11.C 12.B 13,D 14,D 15,B 16.D 17. B 18,D 19,A 20,A
21) Correct pair for type of synovial joints
A) Incudo-stapedial : Saddle
B) Spheno-vomerine : Schindylesis
C) Atlanto-occipital : Trochoid
D) Metacarpo-phalangeal : Condylar
22) Atypical synovial joint is
A) Knee
B) Temporo-mandibular
C) 1st carpo-metacarpal
D) Calcaneo-cuboid
23) All are the actions of Tensor fascia lata except
A) Hip flexion
B) Hip adduction
C) Knee flexion
D) Knee extension
24) Untrue about knee menisci is
A) Menisci are fibrocartilage
B) Are vascular structures
C) Coronary ligament connects menisci to the tibia
D) Reconstructive surgery is recommended in the central part of meniscus
25) Movements of pronation & supination occurs in all the following joints except
A) Superior radio – ulnar
B) Middle radio – ulnar
C) Inferior radio – ulnar
D) Radio – carpal
26) Incorrect statement about posterior cruciate ligament is
A) Attached to the medial femoral condyle
B) Not lined by synovial membrane
C) Prevents posterior dislocation of tibia
D) Damaged in Dash board injuries
27) Incorrect statement about Morgagni’s hernia
A) Less common than the Bochdalek variety
B) Common on right side
C) Stomach is the most common content
D) Contents herniate through Larry’s space
28) A 52-year-old man comes to the emergency department complaining of severe abdominal pain.
He is diagnosed with cancer involving the abdominal oesophagus and fundus of the stomach. Which
of the following neural structures is most likely associated with the “pain” fibers involved with this
symptom
A) Greater splanchnic nerves
B) Lumbar splanchnic nerves
C) Postganglionic fibers from the celiac ganglion
D) Nerves from spinal cord levels T1 to T4
29) Injury to the male urethra at the level of perineal membrane, causes urine to accumulate in all of
the following except
A) Superficial perineal pouch
B) Deep perineal pouch
C) Space of Retzius
D) Pouch of Douglas
30) All are true about the trigone of the urinary bladder except
A) Mucosa is tightly adherent to the underlying musculature
B) Mucosa is smooth
C) It is lined by transitional epithelium
D) It is derived from the urogenital sinus
21.B 22.B 23.B 24,D 25.B26.B 27.C 28.A 29.D 30.D
31) Supports of the uterus are all except
A) Sacro-cervical ligament
B) Round Ligament
C) Transverse cervical ligament
D) Levator ani
32) Duct of Balini is present in?
A) Kidney
B) Pancreas
C) Intestine
D) Salivary gland
33) Blood supply of breast is from all except
a. Internal mammary
b. Intercostal
c. Thoracodorsal branch of subscapular Superior
d. Thoracic
34) Cells of the adrenal medulla are derived from the same embryonic cells as those that form
A) Kidney collecting tubules
B) Preganglionic sympathetic neurons
C) Mandible
D) Thymus
35) Segmental resection was performed removing part of liver lying left of the falciform ligament. The
segments still retained in the left surgical liver are A) 2, 3 B) 1, 4 C) 2, 4 D) 1, 4, 5
36) Wrong about neuroepithelium A) Simple cuboidal epithelium B) Present in cochlea & vestibule
C) Present in nasal mucosa D) Are sensory cells for the reception of taste
37) Which of the following is least vascular structure in the Temporo-mandibular joint A) Articular
cartilage B) Posterior part of Articular disc C) Middle part of articular disc D) Mandibular fossa
38) In pemphigus vulgaris structure of desmosomes is damaged. The wrong statement is A)
Autoantibodies disrupt macula adherens B) Cadherin disruption lead to severe blistering of skin C)
Zona occludens & gap junctions are normal D) Epithelium separates from the basal lamina
39) Axillary skin glands producing viscous secretion are A) Eccrine sweat glands B) Apocrine sweat
glands C) Mucous gland
D) Holocrine sebaceous glands
40) Gall bladder is lined by A) Brush bordered columnar epithelium B) Striated columnar epithelium
C) Pseudostratified columnar cells D) Ciliated columnar cells
31.B 32.A 33.C 34.C 35.B 36.A 37.C 38.D 39.B 40.A
41) Osteoclast cells are derived from which cell type A) Monocyte B) Osteoprogenitor C) Osteoblast
D) Osteocyte
42) All of the following are examples of traction epiphysis except A) Mastoid process B) Greater
trochanter of femur C) Lesser trochanter of femur D) Deltoid tuberosity
43) A young player receives lateral blow to his knee and undergoes a twisting fall while playing
Football. Which of the following conditions has occurred A) Ruptured medial collateral ligament B)
Posterior cruciate ligament tear C) Evulsion of the intracapsular origin of popliteus D) Lateral
meniscal tear
44) Epiphysio-diaphyseal joint is A) Primary cartilaginous B) Synostosis C) Syndesmosis D)
Schindylesis
45) Flexor pollicis longus has the same innervation as of the following muscle A) Flexor digitorum
superficialis B) Palmaris longus C) Pronator teres D) Flexor digitorum profundus of middle finger
46) All of the following statements are true concerning vertebral body and spina bifida defects except
A) Missing component of ventral sclerotome can lead to scoliosis B) Failure of fusion of dorsal
sclerotome components lead to spina bifida C) Spina bifida is frequently associated with Arnold–
Chiari malformation D) Spina bifida with myeloschisis is the least severe variation
47) Gustatory cortex is situated in A) Superior Temporal Gyrus B) Inferior Frontal Gyrus C) Superior
Frontal Gyrus
D) Inferior Parietal Gyrus
48) Which of the following reach Ventro postero-medial thalamic nuclei A) Solitario-thalamic B)
Dentatothalamic C) Spinothalamic D) Medial lemniscus
49) Optic radiation arises from A) Lateral geniculate body B) Superior colliculus C) Inferior colliculus
D) Medial geniculate body
50) Which of the following is not true about thymus Lies in the anterior and superior mediastinum
Has maximum size by 5 years of age and then it regresses It is a primary lymphoid organ It also
produces hormones
41. 42.D 43.A 44.A 45.D 46.D 47.D48.A49.A 50.B
51) The accessory obturator artery is a branch of A) Inferior epigastric B) External iliac C) Internal
iliac D) Obturator
52) Afferents of cremasteric reflex are present in nerve A) Ilioinguinal B) Genitofemoral C)
Iliohypogastric D) Pudendal
53) In homonymous hemianopia due to occipital lobe infarction there is macular sparing because of
blood supply from A) Posterior cerebral B) Opposite posterior cerebral C) Middle cerebral D) Anterior
choroidal
54) Which of the following fibers don’t pass through the posterior limb of internal capsule A)
Sublentiform B) Retrolentiform C) Corticonuclear D) Dorsal column
55) Which nerve carries special visceral efferent fibers A) 3rd B) 4th C) 6th D) 7th
56) All of the following statements about the vagus nerve are true except that it A) Carries the GVE
neural column B) Carries postganglionic parasympathetic fibers
C) Innervates right two third of transverse colon D) Stimulates peristalsis & relaxes sphincters
57) The auditory pathway consists of all of the following except A) Spiral ganglion B) Superior olivary
nucleus C) Medial lemniscus D) Inferior colliculus
58) A patient has the ability to stand erect with eyes open but falls with closed eyes. The axonal
pathway lesioned is A) Dorsal spino-cerebellar B) Ventral spino-cerebellar C) Medial lemniscus D)
Spinal lemniscus
59) The centre for vertical gaze is A) Abducent nucleus B) Nucleus prepositus C) Rostral interstitial
nucleus D) Para-pontine reticular formation
60) What is incorrect regarding parasympathetic nervous system A) The Edinger-Westphal nucleus
is responsible for pupillary dilation B) Cholinergic drugs may cause frequency of micturition C)
Cholinergic activity induces salivation D) Anticholinergic drugs may cause constipation
51.A 52.B 53.C 54.C 55.D 56.B 57.C 58.C 59.C 60.A
61) Which of the following statements concerning the lateral horn of the spinal cord is true A) It
contains postganglionic parasympathetic neurons B) It gives rise to a spinothalamic tract C) It is
present at all spinal cord levels D) It gives rise to preganglionic para-sympathetic fibers
62) All of the following are features of large intestine, Except A) Large intestine secretes acidic
mucus which helps in formation of stools B) It is a site of mucocutaneous junction C) Its epithelium
contains goblet cells in large numbers D) Absorbs salt and water
63) Which of the following pathway is involved in the ability to recognize an unseen familiar object
placed in the hand A) Dorsal spinocerebellar tract B) Anterior spinothalamic tract C) Posterior
spinothalamic tract
D) Dorsal column
64) Efferents in superior cerebellar peduncle arise mostly from A) Purkinje cells B) Stellate neurons
C) Deep nuclei D) Grade III fibers
65) Not a branch of basilar artery A) Posterior cerebral artery B) Labyrinthine artery C) Posterior
inferior cerebellar artery D) Superior cerebellar artery
66) All of the following features are seen in neurons from dorsal root ganglia, except A) They have
centrally located nuclei B) They are derived from neural crest cells C) They are multipolar D)
Situated in the intervertebral foramina
67) In polio contracture of the iliotibial tract leads to all except Hip flexion and abduction Lateral
rotation of tibia Knee flexion Varus deformity at knee
68) Injection of hypertonic saline into the carotid artery causes activation of the hypothalamus via
which of the following A) Medial nucleus of the hypothalamus B) Supraoptic nucleus of
hypothalamus C) Preoptic nucleus of the hypothalamus D) Paraventricular nucleus of the
hypothalamus
69) True about sympathetic chain is A) Totally it has 31 ganglia B) Myelinated post ganglionic fibers
C) Passes from skull to coccyx D) White rami are present at all levels
70) Fibers of the accessory cuneate nucleus terminate in the A) Spinal cord B) Medulla C) Midbrain
D) Cerebellar cortex
61.D 62.A 63.D 64.C 65.C 66.C 67.D 68.C 69.C 70.D
71) Tactile discrimination from lower limb is carried by A) Ipsilateral gracile fasciculus B)
Contralateral cuneatus fasciculus C) Anterior spinothalamic tract D) Dorsal spinocerebellar tract
72) Brodmann number of Wernicke’s sensory speech area is A) 3 b B) 22 C) 39 D) 44
73) Pupillary light reflex includes all except A) Ganglion cells of retina B) Lateral geniculate body C)
Pre-tectal nucleus D) Edinger Westphal nucleus
74) Choose the incorrect statement regarding cerebellum A) Coordinates motor activity & Maintains
posture, equilibrium and muscle tone B) Middle peduncle sends dentatothalamic tract to VL thalamic
nucleus C) Dorsal spinocerebellar tract passes through Inferior peduncle D) In children, 70% of brain
tumours are found in posterior fossa, originating mostly from cerebellum
75) Pudendal nerve supplies which part of the urinary bladder? Detrusor muscle Internal sphincter
External sphincter All of the above
76) Arterial supply of motor area of cerebral cortex is by A) Anterior cerebral artery B) Middle
cerebral artery C) Posterior cerebral artery D) Anterior and middle cerebral artery
77) While doing surgery for meningioma on cerebral hemisphere, there occurred injury to left
paracentral lobule; it will lead to paresis of A) Left face B) Right neck and scapular region C) Right
leg and perineum D) Right shoulder and trunk
78) Untrue about pharyngeal arch derivatives A) Anterior 2/3 tongue develops from 1st pharyngeal
arch
B) Laryngeal cartilages are derived from 4th & 6th arch C) Branchial cyst is persistent cervical sinus
D) Buccinator is mesodermal derivative of first arch
79) Injury to which nerve during a herniorrhaphy may cause paresthesia at the root of scrotum and
base of penis. A. Ilioinguinal B. Pudendal C. Genitofemoral D. Iliohypogastric
80) True about upper end of tibia are all except Ossification centre at the upper end fuses by 20
years It gives attachment to medial collateral ligament It gives attachment to semi-membranous
Posterior aspect of patella articulates with upper end of tibia laterally
71. 72.B 73.B 74.B 75.C 76.D 77.C 78.D 79.A 80.D
81) Typical cervical vertebra can be differentiated from thoracic by all of the following except A) Oval
body B) Foramen transversarium C) Superior articular facet directed backwards & upwards D) Small
body
82) Choose the correct statement regarding the endodermal derivatives of branchial arch pouches
A) First : Tympanic antrum B) Second : Tubotympanic recess C) Third : Ultimo branchial body D)
Fourth : Inferior parathyroid
83) A newborn baby is noted to have a left unilateral cleft lip. There are no abnormalities of the
baby’s palate. Which of the following developmental defects accounts for this occurrence A) Failure
of the left lateral palatine process to fuse with the median palatine process B) Failure of the left
maxillary prominence to unite with the left medial nasal prominence C) Failure of the right and left
medial nasal prominences to merge D) Failure of the left maxillary process to fuse with the left
medial nasal process
84) A patient presents with a chief complaint of chronic nose-bleeds. To control the severity of these
nosebleeds, his physician decides to ligate the sphenopalatine artery. From which of the following
arteries does the sphenopalatine artery arise A) External carotid B) Facial C) Maxillary D)
Ophthalmic
85) A thyroid mass usually moves with swallowing because the thyroid gland is enclosed by which of
the following fascia A) Carotid sheath B) Investing layer of the deep cervical fascia C) Pretracheal
fascia D) Prevertebral fascia
86) All of the following pass behind ischial spine except Obturator nerve Pudendal nerve Internal
pudendal vessels Nerve to obturator internus
87) Subdural haemorrhage has occurred due to venous bleeds. Which veins are involved A)
Bridging B) Middle meningeal C) Subarachnoid D) Pterygoid
88) Obstruction to the flow of CSF at the aqueduct of Sylvius will most likely lead to the enlargement
of which ventricles? A) Only lateral ventricle B) Only third ventricle C) Both lateral and third ventricles
D) Fourth ventricle
89) Cuneus is separated from the lingual gyrus by the sulcus A) Rhinal B) Parieto-occipital C)
Calcarine D) Collateral
90) Transverse arch of foot is maintained by A. Flexor digitorum brevis B. Adductor hallucis C.
Abductor hallucis brevis D. Peroneus brevis
81.C 82.A 83.B 84.C 85.C 86.A 87.A 88.C 89.C 90.B
91) Following are the pairs describing skull foramina and the nerves related. Choose the correct pair
A) Foramen rotundum: Mandibular nerve B) Foramen ovale: Maxillary nerve C) Foramen spinosum:
ophthalmic nerve D) Internal acoustic meatus: Nerves intermedius
92) Kiesselbach’s area has been damaged in a fist fight. The main artery to the area is A) Anterior
ethmoidal B) Posterior ethmoidal
C) Spheno-palatine D) Greater palatine
93) Nerve carrying sense of taste from circumvallate papillae placed on the anterior 2/3 of the
tongue is: A) Chorda tympani B) Lingual C) Glossopharyngeal D) Vagus
94) Muscles of the anterior compartment of the leg are innervated primarily by A. Deep peroneal
nerve B. Superficial peroneal nerve C. Sural nerve D. Saphenous nerve
95) The following statements concerning chorda tympani nerve are true except that it A) Carries
secretomotor fibers to the parotid gland B) Joins lingual nerve in infratemporal fossa C) Is a branch
of facial nerve D) Contains preganglionic parasympathetic fibers
96) In the fracture of middle cranial fossa, loss of taste sensations from palate would be due to
lesion in A) Trigeminal ganglion B) Deep petrosal nerve C) Greater petrosal nerve D) Cervical
ganglion
97) A patient has a dry eye and reduced nasal secretions. The location of a lesion might be in the A)
Otic ganglion B) Sphenopalatine ganglion C) Ciliary ganglion D) Superior cervical ganglion
98) Contraction of the tensor tympani and the stapedius prevents damage to the eardrum and inner
ear. These muscles are controlled by which of the following nerves A) Tympanic and chorda tympani
nerve B) Trigeminal and facial nerves C) Facial and auditory nerves D) Trigeminal and accessory
nerves
99) A patient arrives in the emergency room after having suffered severe head trauma in a
motorcycle accident. Radiographic studies of the head reveal a basilar skull fracture in the region of
the foramen ovale. Which of the following functional losses would most likely be related to this injury
A) Loss of abduction of the eye
B) Loss of sensation over the forehead C) Loss of sensation over the zygoma D) Paralysis of
anterior belly of digastric
100) All is true about accessory nerve except A) Cranial part belongs to SVE column B) Spinal part
supplies sternomastoid and trapezius C) Cranial part supplies all pharyngeal muscles except
palatopharyngeus D) Cranial part supplies all palatal muscles except tensor veli palate
91.D 92.C 93.C 94.A 95.A 96.C 97.B 98.B 99.D 100.C
101) The subtalar joint is formed between Talus, malleoli and lower tibia Talus and calcaneum Talus
and navicular Calcaneum and cuboid
102) Pain felt between great toe and 2nd toe is due to involvement of which nerve root A. L5 B. S1
C. S2 D. S3
103) A benign tumour in the pterygoid canal would spare which of the following nerve fibers A)
Postganglionic parasympathetic fibers B) Taste fibers from the palate C) Postganglionic sympathetic
fibers D) General visceral afferent (GVA) fibers
104) A patient with crocodile tears syndrome has spontaneous lacrimation during eating due to
misdirection of regenerating autonomic nerve fibers. Which of the following nerves has been injured
A) Facial nerve proximal to the geniculate ganglion B) Chorda tympani in the infratemporal fossa C)
Facial nerve at the stylomastoid foramen D) Lacrimal nerve
105) Excessive contraction of following muscle causes dislocation of jaw A) Temporalis B) Lateral
pterygoid C) Medial pterygoid D) Zygomaticus Major
106) Medial medullary syndrome is commonly due to lesion of the artery A) Posterior inferior
cerebellar B) Anterior inferior cerebellar C) Vertebral
D) Basilar
107) Safety muscle of larynx A) Lateral cricoarytenoid B) Posterior cricoarytenoid C) Thyroarytenoid
D) Cricothyroid
108) Extradural haematoma occurs commonly due to the rupture of a vessel , which passes through
A) Foramen rotundum B) Foramen spinosum C) Foramen lacerum D) Inferior orbital fissure
109) If a patient is unable to tense the vocal cords during high pitch singing, which of the following
muscles is paralyzed A) Lateral cricoarytenoid muscle B) Cricothyroid muscle C) Posterior
cricoarytenoid muscle D) Thyroarytenoid muscle
110) Lymph from heel and lateral aspect of foot first drains into A. Popliteal lymph nodes B. Deep
inguinal C. Superficial inguinal D. Obturator node
101.B 102.A 103.A 104.A 105.B 106.C 107.B 108.B 109.B110.A
111) A patient is unable to invert the foot, indicating lesions of which of the following nerves
Superficial and deep peroneal Deep peroneal and tibial Superficial peroneal and tibial Medial and
lateral plantar
112) Which of the following cranial nerves exit/enter through the foramina in posterior cranial fossa
A) 3rd to 12th B) 4th to 12th C) 5th to 12th D) 7th to 12th
113) The narrowest part of ureter is A. Uretero pelvic Junction B. Iliac vessel crossing C. Pelvic
ureter D. Uretero vesical junction
114) The cranial nerve with the longest intra-cranial course is A) Abducens nerve B) Trochlear nerve
C) Optic nerve D) Trigeminal nerve
115) Which of the following is not supplied by hypoglossal nerve A) Genio-hyoid B) Thyrohyoid C)
Genio-glossus D) Palato-glossus
116) Hemivertebra is a defect of A) Body B) Transverse process C) Spine D) Posterior vertebral
arches
117) A newborn baby has a prominent defect at the base of his spine through which his meninges
and spinal cord protrude. A failure of which of the following processes is the most common cause of
this type of defect A) Development of primary vertebral ossification centers B) Development of the
pedicle C) Development of the superior articular process D) Fusion of the vertebral arches
118) True regarding common bile duct is all except A. Opens 10 cm distal to the pylorus B. Lies
anterior to I.V.C. C. Portal vein lies posterior to it D. Usually opens into duodenum separate from the
main pancreatic duct
119) These ventral spinal rootlets are less prone to injury during decompressive operations because
they are longer and exit in a more oblique direction A) C5 B) C6 C) T5 D) L5
120) The cardiac jelly formed around the heart tube during early development, contributes to the
formation of A) Pericardium B) Mesocardium C) Myocardium D) Endocardium
111.B 112.D 113.D 114.B 115.D 116.A 117.D 118.D 119.D 120.D
121) Absence of conotruncal septum gives rise to A) Tetralogy of Fallot B) Patent truncus arteriosus
C) Transposition of great vessels D) Coarctation of aorta
122) Intercostobrachial nerve is a branch of thoracic nerve A) First B) Second
C) Third D) Fourth
123) True about right phrenic nerve is A) Arise from the dorsal rami of C3,4,5 B) Descends posterior
to the hilum of lungs C) Supplies diaphragmatic peritoneum D) Passes through oesophageal
opening
124) A patient has aspiration pneumonitis develops chest pain with dullness on percussion in area
medial to the medial border of scapula on the elevation of arm. Which part of lung is most likely to be
affected A) Right medial basal lobe B) Right superior lobe C) Right apical lobe D) Right Posterior
basal lobe
125) Ligamentum arteriosum attachment is between A) Left pulmonary artery and arch of aorta B)
Arch and descending thoracic aorta C) Ascending and descending thoracic aorta D) Pulmonary
trunk and left principal bronchus
126) Middle part of interventricular septum is supplied by the artery A) Posterior interventricular B)
Left anterior descending C) Circumflex artery D) Acute marginal artery
127) All are hybrid muscles except A) Brachioradialis B) Pectoralis major C) Brachialis D) Flexor
digitorum profundus
128) In C-5,6 lesion following pair of muscles may not be paralyzed A) Coraco-brachialis B) Biceps
brachii C) Brachialis D) Brachio-radialis
129) All of the following muscles strictly receive nerve supply from anterior interosseous nerve
except A) Pronator quadratus B) Flexor pollicis longus C) Flexor digitorum profundus of index finger
D) Flexor digitorum profundus of middle finger
130) Following pairs describe the muscles producing flexion at elbow joint & their respective nerve.
Choose the wrong pair A) Biceps brachii: Musculocutaneous nerve
B) Brachioradialis: Median nerve C) Flexor carpi ulnaris: Ulnar nerve D) Flexor carpi radialis: Median
nerve
121.B 122.B 123.C 124.C 125.A 126.B 127.A 128.A 129.D 130.B
131) During knife fight a person gets injured in the neck region and presents to emergency
department with weakness in raising right arm above head. On further examination winging of right
scapula is noted. The injury has damaged A) Spinal accessory nerve B) Long thoracic nerve of Bell
C) Suprascapular nerve D) Dorsal scapular nerve
132) The weight of the upper limb is transmitted to the axial skeleton by A) Coracoclavicular
ligament B) Coracoacromial ligament C) Costoclavicular ligament D) Coracohumeral ligament
133) Regarding the anatomical snuffbox which of the following is true A) Abductor Pollicis longus
forms the posterior wall B) Abductor pollicis longus and Extensor Pollicis brevis form the lateral wall
C) Basilic vein forms the roof D) Floor is formed by Extensor carpi radialis longus and brevis
134) Ante-verted Position of uterus is maintained by ligament A. Cardinal B. Uterosacral C. Pubo-
cervical D. Round
135) A patient is brought to the emergency with history of trauma to his right upper limb. Extension
of metacarpo-phalangeal is lost. There is no wrist drop and extension of IP joint is normal. The most
likely nerve involved is A) Ulnar nerve B) Median nerve C) Radial nerve D) Posterior interosseous
nerve
136) All of the following are features of musculocutaneous nerve injury at axilla except A) Loss of
flexion at shoulder B) Loss of flexion at elbow C) Loss of supination of forearm D) Loss of sensation
on radial side of forearm
137) If the greater tuberosity of the humerus is lost which of the following movements will be affected
A) Adduction and flexion
B) Abduction and lateral rotation C) Medial rotation and adduction D) Flexion and medial rotation
138) C8,T1 supplies following muscles except A) Extensor indicis B) 3rd & 4th lumbrical(s) C)
Abductor pollicis brevis D) Palmar interossei
139) Sensory innervation of index finger is by A) T2 B) Tl C) C8 D) C7
140) Attached to radial styloid process is A) Brachioradialis B) Pronator quadratus C) Pronator teres
D) Lateral collateral ligament
131.A 132.A 133.B 134.B 135.D 136.A 137.B 138.A 139.D 140.D
141) Injury to radial nerve at wrist leads to A) Wrist drop B) Sensory loss on dorsum of 1st web
space C) Paralysis of adductor pollicis D) Loss of supination in extended position
142) Injury of ulnar nerve at the wrist would cause all except A) Paralysis of 3rd and 4th lumbrical(s)
B) Paralysis of dorsal interossei C) Adductor pollicis paralysis D) Flexor pollicis brevis paralysis
143) Which bronchopulmonary segment is not present in the left lung A) Antero-basal B) Postero-
basal C) Medial basal D) Lateral basal
144) A 56-year-old man is undergoing a cardiac operation. During the procedure, a ligature is
passed into the transverse pericardial sinus. Which of the following vascular structures can now be
easily secured by tying the ligature, thus stopping the flow of blood A) Superior vena cava and
inferior vena cava B) Superior vena cava and right pulmonary veins
C) Aorta and superior vena cava D) Aorta and pulmonary trunk
145) True about lumbricals is A) Flex IP joints and extends MCP joint B) 1st and 2nd supplied by
radial nerve C) 3 and 4 supplied by superficial branch of ulnar D) Origin from tendons of flexor
digitorum profundus
146) Which is true about axillary artery A) Pectoralis major divides it into three parts B)
Thoracoacromial is a branch of 2nd part C) Superior thoracic is a branch of 3rd part D) Subscapular
is a branch of 1st part
147) All are true except A) Midpalmar space communicates with facial sheath of third lumbrical B)
Midpalmar space communicates with forearm space C) Thenar space communicates with fascial
sheath of first lumbrical D) Midpalmar space drained through 3/4th web space
148) Posterior interosseous nerve runs under which compartment of extensor retinaculum A) 1st B)
2nd C) 3rd D) 4th
149) Pronation is lost in lesions of A) Median nerve B) Ulnar nerve C) Radial nerve D) Posterior
interosseous nerve
150) Supinator has the same innervation as of the following muscle A) Biceps brachii B) Pronator
quadratus C) Extensor digitorum D) Brachioradialis
141.B 142.D 143.C 144.D 145.D 146.B 147.B 148.D 149.A 150.C
151) A patient arrives in the emergency room after having attempted suicide by lacerating his wrist.
No major artery was damaged, but the nerve that is immediately lateral to the flexor digitorum
superficialis tendon is cut. Which of the following actions will no longer be possible A) Abduction of
the second digit B) Adduction of the second digit
C) Flexion at the interphalangeal joint of the thumb D) Opposition of the thumb
152) True statement about upper half of anal canal is A. Insensitive to pain B. Drained by superficial
inguinal lymph node C. Lined by squamous epithelium D. Supplied by superior mesenteric artery
153) de Quervain’s disease is characterized by A) Compression of the median nerve at the wrist B)
Stenosing tenovaginitis of peroneus tendon C) Compression of ulnar nerve at the wrist D) Stenosing
vaginitis of abductor pollicis longus and extensor pollicis brevis
154) A patient came with history of fall and on examination there was tenderness between the
extensor pollicis longus and brevis. The likely lesion is A) Scaphoid # B) 1st metacarpal # C) Lower
end of radius # D) Trapezoid #
155) All is true about splenic artery except A) Is a branch of celiac artery B) Lies along superior
border of pancreas C) Is an end artery D) Runs in Spleno-renal ligament
156) At birth, an infant presents with a stomach that has herniated into the diaphragm. Where is the
defect that resulted in the herniation A) Oesophageal hiatus B) Pleuroperitoneal membrane C)
Septum transversum D) Right crus
157) The greater omentum is derived from which of the following embryonic structures A) Dorsal
mesogastrium B) Pericardio-peritoneal canal C) Pleuro-pericardial membranes D) Ventral mesentery
158) Regarding Gastroschisis and omphalocele, which one is false A) Intestinal obstruction is
common in gastroschisis B) Liver is the content of omphalocele C) Gastroschisis is associated with
multiple anomalies D) Umbilical cord is attached in normal position in gastroschisis
159) Vitelline vein forms A) Ligamentum venosum B) Ligamentum teres C) Portal vein D) Superior
vena cava
160) Ventral pancreatic bud forms A) Head of pancreas and uncinate process B) Head and body of
pancreas C) Inferior part of pancreas D) Tail of pancreas
151.D 152.A 153.D 154.A 155.C 156.B 157.A 158.C 159.C 160.A
161) An infant presents with gastroschisis at birth. Which of the following applies to this condition a)
It is also seen in patients with aganglionic megacolon b) It results from herniation at the site of
regression of the right umbilical vein c) It is caused by a failure of recanalization of the midgut part of
the duodenum d) It is caused by failure of the midgut to return to the abdominal cavity after
herniation into the umbilical stalk
162) Which of the following structure in glomerulus has pores? Parietal epithelial cell Basement
membrane Capillary endothelium B + C
163) Untrue about Hirschsprung disease A) Occurs due to non-migration of neural crest cells B)
Developmental failure Auerbach and Meissner’s plexus in the gut C) Distal large intestine is
aperistaltic and spastic D) Absent sympathetic activity in the affected region
164) Untrue about ureteric bud A) Endodermal derivative B) Arises from Wolffian duct C) Forms
collecting tubules D) Penetrates metanephric tissue
165) Following statements describe the development of diaphragm. Choose the incorrect statement
A) The dorsal mesentery of the oesophagus gives rise to the crura B) Defect in the pleuro-peritoneal
membrane leads to Morgagni’s hernia C) Body wall contributes for the peripheral muscular
component D) The septum transversum descends to T8 from C3-5 following rapid growth of neural
tube
166) Following are the boundaries of epiploic foramen except A) Free margin of lesser omentum B)
Inferior vena cava C) Quadrate lobe of liver D) Right adrenal
167) A 38-year-old woman with a history of heartburn suddenly experiences excruciating pain in the
epigastric region of the abdomen. Surgery is performed immediately upon admission to the
emergency room. There is evidence of a ruptured ulcer in the posterior wall of the stomach. Where
will a surgeon first find the stomach contents A) Pouch of Morrison B) Cul-de-sac of Douglas C)
Omental bursa D) Paracolic gutter
168) Most common muscle to be congenitally absent is A) Pectoralis major B) Teres minor C)
Semimembranosus D) Gastrocnemius
169) All is true about Trochlear nerve except A) Longest intracranial course B) Arise from dorsal
aspect C) Supplies ipsilateral superior oblique D) Arises from out side the common tendinous ring
170) Urogenital diaphragm is contributed by all except A) Sphincter urethra B) Perineal body C)
Colles’ fascia D) Perineal membrane
161.B 162.C 163.D 164,A 165.B 166.C 167.C 168.A 169.C 170.C
171) All are the contents of deep perineal pouch except A) Bulb/Root of penis B) Dorsal nerve of
penis C) Sphincter urethra D) Bulbo urethral glands
172) Which of the following is not a content of the pudendal canal A. Pudendal nerve B. Internal
pudendal artery C. Internal pudendal vein D. Nerve to obturator internus
173) All of the following arteries supply medulla except a. Post inferior cerebellar b. Basilar c.
Anterior spinal d. Bulbar
174) GALT (Gut Associated Lymphoid tissue) is present in a. Submucosa b. Lamina propria c.
Muscularis mucosa d. Adventitia/Serosa
175) Most common site of subclavian artery stenosis is in part A. 1st B. 2nd C. 3rd D. Terminal
176) Spongy part of the male urethra drains via which lymph nodes A) Superficial inguinal B)
External Iliac C) Deep inguinal D) Aortic
177) Which structure is just lateral to anterior perforated substance A) Uncus B) Limen insulae C)
3rd Ventricle D) Optic chiasma
178) Auerbach’s ganglia in the muscularis externa contain the autonomic neurons bodies of the type
A) Pre-ganglionic sympathetic B) Pre-ganglionic para-sympathetic C) Post-ganglionic sympathetic
D) Post-ganglionic para-sympathetic
179) Popliteal pulse is not felt clearly because A) It is not over prominent bone B) Pulse is weak C) It
is deep seated D) It is both deep seated and not over prominent bone
180) Chief Cells are found in a) Fundus b) Pit c) Neck d) Body
171.A 172.D 173.D 174.B 175.A 176.C 177.B 178.D 179.C 180.A
181) Thoracic duct receives tributaries from all the following except A) Bilateral ascending lumbar
ducts B) Bilateral descending thoracic ducts C) Left upper intercostal ducts
D) Right bronchomediastinal lymphatic trunk
182) Which of the following structures does not penetrate perineal membrane A. Dorsal N of penis
B. Dorsal Artery of penis C. Internal pudendal artery D. Urethra
183) All the following are branches of cavernous part of Internal carotid artery except A) Ophthalmic
Artery B) Branches to cavernous sinus C) Hypophyseal artery D) Meningeal artery
184) Venous return of lower limb on standing from the supine posture depends on all except A)
Deep fascia sleeve B) Arterial pressure C) Valves of perforators D) Calf muscle contraction
185) Which of the following movements doesn’t not happen in abduction of shoulder A) Medial
rotation of scapula B) Elevation of humerus C) Rotation of Clavicle at the sterno clavicular joint D)
Rotation at the axis of acromioclavicular joint
186) Which of the following brainstem nuclei is not derived from alar plate A) Dentate B) Inferior
olivary C) Hypoglossal D) Substantia nigra
187) Sternocleidomastoid is not supplied by the artery A) Superior thyroid B) Thyrocervical trunk C)
Occipital D) Post auricular
188) Trendelenburg test is positive due to injury to the nerve A) Superior gluteal B) Inferior gluteal C)
Obturator D) Tibial
189) Mitral cells are present in A. Kidney B. Mitral valve C. Olfactory tract D. Optic nerve
190) All are seen in Horner’s syndrome except A) Heterochromia iridis B) Ptosis C) Miosis D)
Apparent exophthalmos
181.D 182.A 183.A 184.B 185.A 186.C 187.B 188.A 189.C 190.D
191) All the true about inguinal canal except A) Conjoint tendon forms part of the posterior wall B)
Superficial ring is found in external oblique aponeurosis C) Deep ring is an opening in transversalis
abdominis D) Internal oblique forms both anterior and posterior wall
192) All of the followings are true regarding the pudendal nerve, except A) Sensory and motor B)
Derived from S2, 3, 4 C) Comes out through the lesser sciatic foramen D) Main nerve supply of
pelvic organs
193) Left spinal lemniscus contains which fibers? A) Ipsilateral pain touch temperature B) Ipsilateral
position vibration sense C) Contralateral position vibration sense D) Contralateral pain touch
temperature
194) A missile hits the body just above the pubic ramus through the ant abdominal wall it will pierce
which of the following structure A. Urinary bladder B. Spinal cord C. Left renal vein D. Abdominal
aorta
195) What is false regarding dentate line A) Glands of Morgagni open below the line B) Anal glands
open at the line C) Dentate line lies 2 cm(s) above the anal verge. D) Transitional epithelium lies
above the dentate line
196) Boundaries of ovarian fossa are A. Posterior obliterated umbilical artery B. Ureter posteriorly C.
Uterine tube anteriorly D. Internal iliac artery laterally
197) Teratomas may arise from the aberrant migration of A) Epiblast B) Hypoblast C)
Cytotrophoblast D) Syncytiotrophoblast
198) The following statements are true about Cauda equina syndrome except A) Spinal segments
affected are L-3 to Co B) Saddle shaped Anaesthesia is observed C) Knee and ankle reflexes are
lost D) Bladder/bowel & sexual functions are damaged severely
199) Superior rectal vein continues as A. Superior mesenteric B. Inferior mesenteric C. Internal iliac
D. External iliac
200) In a patient with a tumor in superior mediastinum compressing the superior vena cava, all of the
following veins would serve as alternate pathways for the blood to return to the right atrium, except
A) Lateral thoracic vein B) Internal thoracic vein C) Hemiazygos vein D) Vertebral venous plexus
191.C 192.D 193.D 194.A 195.D 196.B 197.A 198.D 199.B 200.D
#Controversial
CPSP MCQS with Answers and Full Explanation
Q1: In kidney select the correct order of arteries:
a) Renal artery > Arcuate artery >Interlobar artery > Efferent arteriole
b) Renal artery > Interlobular artery > Interlobar artery> Arcuate artery > Efferent arteriole
c) Renal artery > Interlobar artery > Interlobular artery > Arcuate artery > Afferent arteriole
d) Renal artery > Interlobar artery> Arcuate artery > Interlobular artery> Afferent arteriole
Correct Answer: d
Explanation:
Renal artery gives off Interlobar arteries which run between the pyramids of medulla. Interlobar
arteries give off arcuate arteries which run parallel to the junction of cortex and medulla. Arcuate
arteries give Interlobular branches into the cortex which in turn give rise to the afferent arterioles.
.
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Q2: A patient has been taking anti-tuberculous therapy for MDR-TB. His drugs regimen contains 6
drugs. The patient eventually develops difficulty in distinguishing red & green colours. Which of the
following drugs is responsible for this effect?
a) Amiodrone
b) Pyrazinamide
c) Rifampicin
d) Ethambutol
e) Ciprofloxacin
Correct Answer: d
Explanation:
Ethambutol is one of the drugs used in anti-tuberculous therapy. Optic neuritis is an important,
though rare side effect of ethambutol. If optic neuritis develops, red-green colour vision may be lost
first. This agent should probably not be used in young children in whom it may be difficult to assess
vision.
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Q3: A patient with acute blood loss, the mechanism triggered immediately would be:
a) Baroreceptor Reflex
b) Renin-angiotensin System
c) Chemoreceptor
d) CNS ischemic response
Correct Answer: a
Explanation:
Most important and quick response in severe hemorrhage such as acute blood loss is the
baroreceptor reflex. Baroreceptors are present in the aortic arch (signal transmitted via vagus nerve
to medulla) & carotid sinus (signal transmitted via glossopharyngeal nerve to medulla). Barorecptors
respond to changes in BP as following:
Hypotension àdecreased arterial pressure à decreased stretch on baroreceptors à decreased
afferent baroreceptor firing à increased efferent sympathetic firing & decreased efferent
parasympathetic stimulation à vasoconstriction, increase HR, increased contractility, increased BP.
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Q4: Captopril causes:
a) Hyperkalemia
b) Hypernatremia
c) Hypokalemia
d) Hypercalcemia
Correct Answer: a
Explanation:
Captopril is one of the ACEI (Angiotensin Converting Enzyme Inhibitor). Major side effects of ACEIs
are cough (due to increased levels of bradykinin), angioedema, hyperkalemia ,proteinuria.
Hyperkalemia with ACEI therapy occurs because:
Renin-Angiotensin system is a potent stimulator of aldosterone release. Aldosterone inturn
conserves sodium & increases the excretion of potassium. With ACEIs, the rennin-angiotensin
system is inhibited, so is aldosterone secretion, resulting in low plasma levels of aldosterone. Low
aldosterone prevents the excretion of potassium, which builds up in body resulting in hyperkalemia.
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Q5: Corneal opacities are caused by:
a) Ethambutol
b) Phenothiazines
c) Cholorquine
d) Penicillamine
Correct Answer: c
Explanation:
Chloroquine is commonly used anti-malarial used for the treatment & prevention of Malaria. One of
its important side effects occurs in the eyes. It can cause corneal deposits, lenticular deposits &
damage to the retina.
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Q6: Which of the following is an example of a pivot joint?
a) Temporomandibular Joint
b) Altanto-occipital Joint
c) Median Atlanto-axial Joint
d) Intervertebral joint
Correct Answer: c
Explanation:
Pivot Joint is type of joint in which rounded or conical surfaces of one bone fit into a ring of bone or
tendon allowing rotation. An example of this type of joint is between axis and atlas in the neck that is
the median atlanto-axial joint in which the dens (odontoid process) of axis articulates with inner
surface of the arch of atlas.
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Q7: Which of the followings is P450 inducer?
a) Isoniazid
b) Phenobarbitone
c) Ketoconazole
d) Cimetidine
Correct Answer: b
Explanation:
Phenobarbitone is one of the anticonvulsant. Anticonvulsants in general are inducers of Cytochrome
P450 system. Others inducers of P450 are: Rifampin, Griseofulvin, Carbamazepine, Phenytoin.
For inhibitors of P450 remember the Mnemonic: SICK EGgs inhibit your appetite.
S: Sulfonamides
I: Isoniazid
C: Cimetidine
K: Ketoconazole
E: Erythromycin
G: Grapefruit juice.
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Q8: Serum Gastrin levels are increased by prolonged use of:
a) H2 Receptor blockers
b) Proton Pump Inhibitors
c) Antacids
d) Anticholinergics
Correct Answer: b
Explanation:
The most appropriate answer is Proton Pump Inhibitors (PPI) because they irreversibly inhibit H+
/K+ -ATPase in stomach parietal cells. H2 blockers on the other hand cause a reversible block of
histamine H2 receptors resulting in decreased production of H+. Since the PPI are irreversible
blockers of the Proton pump they cause a more sustained decrease in H+ production. This, through
positive feedback increases the secretion of Gastrin. Generally increased acid (H+ ions) causes
decreased production of Gastrin & decreased acid (such as through PPI use) cause increase in
Gastrin secretion.
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Q9: Gastroesophageal junction competence is increased by:
a) Lying supine
b) Paralysis of the diaphragm
c) Use of Morphine
d) Use of Metoclopromide
e) Increased intra-abdominal pressure
Correct Answer: d
Explanation:
Metoclopromide is D2 receptor antagonist that increased the resting tone of GIT, increases
contractility & increases Lower esophageal junction tone. It is clinically used for Diabetic & post-
surgery gastroparesis. Toxicity includes parkinsonian effects, restlessness, drowsiness, fatigue,
depression, nausea, diarrhea. Contraindicated in patients with small bowel obstruction.
Other option under this question actually decrease the GE junction tone.
________________________________________________________________________________
__
Q10: Which of the followings cross placenta?
a) IgM
b) IgA
c) IgG
d) IgD
Correct Answer: c
Explanation:
Of all the immunoglobins only IgG is the only antibody that crosses placenta. It is main antibody in
secondary response and the most abundant one. It fixes complement, opsonized bacteria,
neutralizes bacterial toxins and viruses.
________________________________________________________________________________
____
Q11: Which of the followings is increased in first response?
a) IgM
b) IgD
c) IgE
d) IgG
Correct Answer: a
Explanation:
IgM is the antibody produced in primary response to an antigen. IgG is the main antibody in
secondary response. IgM also fixes complement but does not cross placenta.
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Q12: A woman living at a hill station has had an uncomplicated pregnancy. She is brought to the
hospital at the onset of labour. An ultrasound scan is performed which shows no fetal abnormality.
The baby can still have which of the following conditions?
a) Transposition of great vessles
b) Patent ductus arteriosis
c) Limb defects
d) Tetrology of Fallot
Correct Answer: b
Explanation:
During fetal period, the ductus arteriosus shunts blood from the right to the left. It connects the
pulmonary trunk with the aorta. Blood entering the pulmonary trunk from the right ventricle is
shunted through ductus arteriosus into aorta. As the baby is born, the circulatory changes that occur
also include closure of the ductus arteriosus. Closure of the ductus arteriosus is promoted by
increase oxygen tension (when baby starts breathing) which decrease prostaglandin (PG) synthesis.
At hill stations, the atmospheric oxygen pressure is low. A baby born and staying during the first few
days of his life under such circumstances would lead to a decrease in oxygen tension and so failure
of ductus arteriosus to close. Patency of ductus arteriosus can also be maintained by high PG levels
such with use of indomethacin (a PG synthesis inhibitor). In summary low oxygen tension and high
PG levels cause PDA.
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______
Q13: ECG of a patient shows progressively increasing PR intervals followed by dropped beat. What
is the condition?
a) Third degree heart block
b) Mobitz Type 1
c) Sinus arrhythmia
d) Mobitz Type 2
Correct Answer: b
Explanation:
Heart blocks are of three types:
First degree heart block: PR interval prolonged (>200 ms)
Second degree heart block:
Mobitz Type 1: Progressive lengthening of the PR interval until a beat is dropped (a P wave not
followed by a QRS complex).
Mobitz Type 2: Dropped beats that are not preceded by a change in the length of the PR interval
Third degree heart block: The atria & ventricles beat independently of each other.
________________________________________________________________________________
____
Q14: For good verbal communication skills which of the followings is necessary?
a) Good comprehension
b) Good vocabulary
c) Fluent Speech
d) Competence in presentation.
Correct Answer: c
Explanation:
This is one of the questions that only require common sense. So common sense tells us that fluent
speech is an absolute requirement for good communication skills. The other three options simply
don’t fit.
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___
Q15: Which of the followings is not caused by parasympathetic stimulation?
a) Micturation
b) Miosis
c) Increased GIT motility
d) Sweating
Correct Answer: d
Explanation:
Sweating is function of sympathetic stimulation rather than parasympathetic stimulation. In order to
differentiate between parasympathetic & sympathetic effect and prevent any confusion, remember
the following scenario.
You go out on a street and you are greeted to a fierce lion! In this situation you would want to:
Have your pupils fully dilated (mydriasis), so that you can see the maximum of the lion and be
prepared for an attack.
Have you heart racing(tachycardia), so that when you start running your heart is able to meet the
increased oxygen demand to the muscles
Stop your bowel and bladder movement (urinary retentions & decreased GI motility), because you
definitely don’t want to go to bathroom right now!
Increase your metabolism and sweating for optimal temperature control so that you are not feeling
cold when the lion bites you! (this is just an example to remember things)
Since you were met by a lion your response should be fright, fight or flight which is actually the
sympathetic stuff. Everything opposite to this such as miosis, bradycardia, micturation & increased
GI motility occur with parasympathetic stimulation.
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_____
Q16: Ejaculation is mediated by:
a) Sympathetic stimulation
b) Parasympathetic stimulation
c) Both a & b
d) Pudendal nerve
Correct answer: d
Explanations:
Innervation of the male sexual response is as followings:
Erection: Parasympathetic nervous system (through pelvic nerve)
Emission: Sympathetic nervous system (through hypogastric nerve)
Ejaculation: visceral & somatic nerves (though pudendal nerve)
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Q17: Alpha-1 receptor stimulation causes:
a) Pupillary dilatation
b) Increased heart rate
c) Increased contractility
d) Increased gastric motility
Correct Answer: a
Explanation:
Apha-1 receptor causes
Increased smooth muscles contraction, such as in arterioles where it increases TPR & so BP
Increased pupillary muscle dilatation (mydriasis)
Increased heart rate (choice b) & increased contractility (choice c) of heart, although a function of
sympathetic system, is not mediated by alpha-1 receptors rather it is mediated by Beta-1 receptor
stimulation in heart.
Also increased gut motility (choice d) is purely a parasympathetic function.
______________________________________________________________________________
Q18: Which muscle divides the Submandibular gland into deep & superficial parts?
a) Omohyoid
b) Sternothyroid
c) Mylohyoid
d) Anterior belly of diagastric
Correct Answer: c
Explanation:
Submandibular gland lies in the floor of the mouth. It has two parts, a deep part and a superficial
part. The gland is hook shaped. It hooks around the origin of mylohyoid muscle from the mylohyoid
line on the inner suface of body of mandible. As it hooks around this muscle, the gland is itself gets
divided into a deep & superficial part.
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_____
Q19: A female with primary amenorrhea, webbed neck and a height of 141 cm. What would her
karyotype show?
a) 45 XO
b) 45 XX
c) 46 XXY
d) 47 XYY
Correct Answer: a
Explanation:
Primary amenorrhea with a webbed neck and short stature( 141cm = 4’7”)is a classical presentation
of Turner’s syndrome. The karyotype of Turner’s syndrome is 45 XO that is, one X chromosome is
absent. Other features of Turner’s yndrome include streak ovaries (ovarian dysgenesis) and
preductal coarctation of aorta. The patient is a female and has decreased estrogen and elevated
FSH & LH levels.
It is the most common cause of primary amenorrhea.
Also in such patients there is no barr body. Since barr body is actually an inactivated X
chromosome, and one X chromosome is only inactivated if one has two X chromosome. If there is
already a single X chromosome, then it is not inactivated to form barr body. For this reason in
Turner’s syndrome since there is only one X therefore there is no barr body.
________________________________________________________________________________
_____
Q20: A patient has difficulty closing his right eye and also has distorted facial appearance. He has
damage to:
a) Right facial nerve
b) Right trigeminal nerve
c) Left facial nerve
d) Left trigeminal nerve
Correct Answer: a
Explanation:
UMN Lesion:
Upper face receives bilateral Upper motor neuron (UMN) innervation while lower face receives only
contra lateral UMN innervation, so that if there is an UMN lesion ther e is contralateral paralysis of
lower face only.
LMN Lesion of Facial Nerve:
In LMN lesion of facial nerve, whole (upper plus lower) face on the ipsilateral side is affected. So if
the patient is unable to close right eye (upper face part) this definitely means that there is a LMN
lesion or in other words the facial nerve on the affected side is lesioned.
________________________________________________________________________________
___________
Q21: Dose of Gentamicin is reduced in the elderly due to:
a) Liver failure
b) Reduced renal function
c) Decreased GI absorption
d) Decreased metabolism
Correct Answer: b
Explanation:
Gentamicin is one of the Aminoglycosides. In elderly like all other body functions renal function is
also slightly reduced. For Aminoglycosides such as Gentamicin, remember the following three
important side effects:
Ototoxicity
Nephrotoxicity
Neurmuscular dysfunction
Teratogenic
Aminoglycosides are used for severe gram negative rod infections. Since they require oxygen for
their uptake, they are therefore ineffective against anaerobes.
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_________
Q22: A patient has fracture of surgical neck of humerus. Now he cannot raise his arm above his
shoulder and also has sensory loss on lateral surface of arm. Which of the following nerves is
damaged?
a) Musculocutaneous nerve
b) Axillary nerve
c) Radial nerve
d) Ulnar nerve
Correct Answer: b
Explanation:
The Axillary Nerve comes off the posterior cord of brachial plexus and has a root value of C5 & C6.
During its course it is accompanied by the posterior circumflex humeral artery and vein.
Motor Supply: Deltoid muscle (abductor at the shoulder joint), Teres Minor muscle
Sensory Supply: Skin over the lower half of deltoid muscle, shoulder joint
The nerve most commonly damaged due to fracture of surgical neck of humerus is the Axillary
nerve. It is a very commonly tested nerve. Commit it to memory. It supplies the major abductor
(unable to raise the arm above the head) of the arm – Deltoid muscle. Also there is loss of sensation
from the lower half of skin covering the deltoid (lateral aspect of arm).
________________________________________________________________________________
_
Q23: Action of Gluteus Medius and Gluteus Minimus muscle is:
a) Abduction & Medial rotation
b) Abduction & lateral rotation
c) Adduction & medial rotation
d) Adduction & lateral rotation
Correct Answer: a
Explanation:
The Gluteus Medius & Gluteus Minimus abduct the thigh when the leg is fully extended. They also
turn the thigh inward that is, medially rotate the thigh. Weakness of these two abductors of thigh
such as due to a lesion of superior gluteal nerve (which supplies these two muscles) can result in
Trendelenburg Gait.
________________________________________________________________________________
_
Q24: Thymus is derived from:
a) 4th Pharyngeal pouch
b) 2nd pharyngeal pouch
c) 3rd pharyngeal pouch
d) Tuberculum impar
Correct Answer: c
Explanation:
Derivatives of pharyngeal pouches:
1st pouch: Middle ear cavity, Eustachian tube, mastoid air cells
2nd pouch: epithelial lining of palatine tonsil
3rd pouch: inferior parathyroid gland + thymus
4th pouch: superior parathyroid gland
NOTE: It might seem strange that the inferior parathyroid glands arise from the 3rd pouch while the
superior parathyroid glands arise from the 4th pouch. But this is how it is.
________________________________________________________________________________
_
Q 25: Patient after an ischemic attack has ventricular Tachycardia. Drug of choice is:
a) Amiodrone
b) Metoprolol
c) Lidocaine
d) Verapamil
Correct Answer: c
Explanation:
Lidocaine is classified as a class Ib anti-arrhythmic drug. It is also used as a local anaesthetic. It
selectively blocks sodium channels in depolarized cardiac cells (e.g; ischemic cardiac muscle). It is
therefore considered as a first line drug in ventricular tachycardia in acute MI or after cardiac
surgery. It is given through the IV route.
Adverse effects of Lidocaine:
high concentrations may cause bradycardia, hypotension and even asystole
in 10% of patients may induce ventricular arrhythmias
GI upset with nausea and vomiting
CNS: parasthesiae, twitching and generalized tonic-clonic seizures
________________________________________________________________________________
Q26: Apex beat is located in:
a) 4th left intercostal space in midclavicular line
b) 3rd right intercostal space in midclavicular line
c) 5th right intercostal space in midclavicular line
d) 8 cm to the left of midline in the 5th intercostals space
Correct Answer: d
Explanation:
Apex beat is the point of maximum cardiac impulse.
The normal apex beat can be palpated in the precordium , in left 5th intercostal space, at the point of
intersection with the left midclavicular line. The midclavicular line lies about 8cm from the left sterna
border.
________________________________________________________________________________
Q27: Hemophilia is:
a) X-linked recessive
b) Autosomal dominant
c) Autosomal recessive
d) X-linked dominant
Correct Answer: a
Explanation:
Hemophilia is a hereditary bleeding disorder that is X-linked recessive. In this disorder there is
deficiency of Factor VIII. Lab findings in Hemophilia are:
________________________________________________________________________________
______
Q28: Patient has hemoptysis & glomerulonephritis. The most probable diagnosis is:
a) Wegner’s Granulomatosis
b) Good Pasture Syndrome
c) Diabetic glomerulopathy
d) SLE nephritis
Correct Answer: b
Explanation:
Goodpasture syndrome (GS) is the clinical entity of acute glomerulonephritis and pulmonary alveolar
hemorrhage. GS is associated with anti–glomerular basement membrane (anti-GBM) antibodies.
These anti-GBM antibodies produce a characteristic linear deposition along the glomerular
basement membrane (GBM), one way in which Goodpasture syndrome is differentiated from
Wegener granulomatosis.
Hemoptysis is the most common presenting symptom in Goodpasture syndrome (GS).
________________________________________________________________________________
________
Q29: Middle meningeal artery passes through:
a) Foramen Spinosum
b) Foramen lacerum
c) Foramen rotundum
d) Foramen Ovale
Correct Answer: a
Explanation:
The middle meningeal artery is a branch of the maxillary artery. It enters the middle cranial fossa
through the foramen spinosum.
____________________________________________________________________________
Q30: Damage to middle meningeal artery causes hematoma formation between:
a) Dura mater & arachnoid mater
b) Arachnoid mater & pia mater
c) Dura mater & clavaria
d) Pia mater & cortex
Correct Answer:
Explanation:
The middle meningeal artery is a branch of the maxillary artery. It enters the middle cranial fossa
through the foramen spinosum and divides into anterior and posterior branches:
The cranial dura mater is a thick, tough, outer covering of the brain. It consists of an outer periosteal
layer and an inner meningeal layer. The outer periosteal layer is firmly attached to the skull, is the
periosteum of the cranial cavity, and is continuous with the periosteum on the outer surface of the
skull at the foramen magnum and other intracranial foramina.
The Middle meningeal artery runs between the inner meningeal layer of dura and the the periosteal
layer which is adherent to calvaria (the bony skull). Trauma or a blow to the lateral aspect of skull
can result rupture of this artery and hematoma formation.
Such hematoma is known as an extradural hematoma.
_______________________________________
Q31: Which of the following cranial nerves carry parasympathetic fibers?
a) I,II, IV,VI
b) III,VII,IX,X
c) V,VI,VIII,XII
d) II,V,XI,X
Correct Answer: b
Explanation:
While the sympathetic nervous system has a spinal segment T2-L1 outflow, the parasympathetic
nervous system on the other hand has a cranio-caudal outflow. So the parasympathetic system
flows peripherally in 4 cranial nerves and in sacral segments of the spinal cord. The four cranial
nerves that carry the parasympathetic fibers from the CNS to the periphery are:
Oculomotor Nerve (III)
Facial Nerve (VII)
Glossopharyngeal Nerve (IX)
Vagus Nerve (X)
The preganglionic parasympathetic fibers in these nerves synapse in 4 peripheral ganglia located in
the head and neck. These nerves are related to these ganglia as follows:
Occulomotor—Ciliary Ganglion
Facial Nerve—-Pterygopalatine ganglion & submandibular ganglion
Glossopharyngeal—–Otic ganglion
(for Vagus nerve the ganglia lie in the or near the organs like thoracic & abdominal organ that it
supplies)
________________________________________________________________________________
____
Q32: Which of the followings pass through the cavernous sinus?
a) Trochlear Nerve
b) Facial Nerve
c) Abducens Nerve
d) Trigeminal Nerve
Correct Answer: c
Explanation:
The paired cavernous sinuses are against the lateral aspect of the body of the sphenoid bone on
either side of the sella turcica (see figure below). They are of great clinical importance because of
their connections and the structures that pass through them.
The cavernous sinuses receive blood not only from cerebral veins, but also from the ophthalmic
veins (from the orbit) and emissary veins (from the pterygoid plexus of veins in the infratemporal
fossa). These connections provide pathways for infections to pass from extracranial sites into
intracranial locations. In addition, because structures pass through the cavernous sinuses and are
located in the walls of these sinuses they are vulnerable to injury due to inflammation.
Structures passing through each cavernous sinus are:
the internal carotid artery;
the abducent nerve [VI].
Structures in the lateral wall of each cavernous sinus are, from superior to inferior:
the oculomotor nerve [III];
the trochlear nerve [IV];
the ophthalmic nerve [V1];
the maxillary nerve [V2].
_______________________________________________________________________________
Q33: Bromocriptine causes decreased prolactin levels by acting on:
a) Dopamine receptors
b) Cholinergic receptors
c) Adrenergic receptors
d) GABA receptors
Correct Answer: a
Explanation:
Bromocriptine is a dopamine agonist. Prolactin is one of the anterior pituitary hormone. It increases
the synthesis & secretion of dopamine from hypothalamus. Dopamine in turn inhibits the prolactin
secretion.
Dopamine agonists (e.g, Bromocriptine) inhibit prolactin secretion, while dopamine antagonists (e.g,
metoclopromide, antipsychotics) stimulate prolactin secretion.
________________________________________________________________________________
_____
Q34: Which of the following investigation is appropriate in Hemophilia?
a) PT
b) APTT
c) Bleeding time
d) Platelet count
Correct Answer: b
Explanation:
Hemophilia is an X-linked hereditary disorder due to deficiency of factor VIII (Hemophilia A) or factor
IX (Hemophilia B).
In general, defects in extrinsic coagulation cascade lead to an increased PT, and defect in intrinsic
coagulation cascade lead to an increased aPTT.
In Hemophilia (factor VIII/IX deficiency):
aPTT: raised
Platelet count: normal
Bleeding count: normal
PT is also normal because there is no deficiency in extrinsic coagulation cascade.
NOTE:
PT tests for function of factors I, II, V, VII, X
aPTT tests for function of all factors except VII & XIII
________________________________________________________________________________
_______
Q35: Drug used of mountain sickness:
a) Scopolamine
b) Frusemide
c) Acetozolamide
d) Dimenhydrinate
Correct Answer: c
Explanation:
Acetazolamide is a carbonic anhydrase inhibitor. It causes NaHCO3 diuresis & reduction in total
body HCO3 stores. Clinically it is used for Glaucoma, urinary alkalinization, metabolic alkalosis &
mountain sickness.
Toxicity results in hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulpha allergy.
________________________________________________________________________________
_
Q36: Which causes decreased gastric motility?
a) Magnesium hydroxide
b) Aluminium hydroxide
c) NaCO3
d) CaCO3
Correct Answer: b
Explanation:
To remember which causes what, remember the following mnemonic:
Alu..minimum amount of feces...
....
@Remember me in your prayers.
V V V V IMPORTANT POINTS OF #GENERALANATOMY>>>

• Flexion and extension takes place in sagittal section
• Adduction and abduction take place in coronal section
• Dermis is thinner on anterior surfaces of body as compared to posterior surfaces.
• Appendages of skin are nails, hair follicles, sebaceous and sweat glands.
• Hair follicles are invaginations of epidermis into the dermis.
• Arrector pili are the bands of smooth muscles that that connect the undersurface of hair follicle to
the superficial part of dermis. Dimpling of skin called gooseflesh is due to the the pull of the is
arrector pili muscle. It causes contraction of sebaceous gland and its secretion.
• Sebaceous glands lie within the dermis and pour their secretion, the sebem ONTO the shaft of
hairs.
• Sweat glands expand full thickness of dermis and their extremity may lie in superficial fascia. They
are the most deeply placed structure of all appandeges.
• Sebaceous glands are not present in lips, palms, sides of fingers, glans penis and clitoris, labia
minora and internal surfaces of labia majora, soles, sides of feet and sides of toes.
• Sweat glands are not present on red margins of lips, nail buds, glans penis, clitoris,
• Boil is infection of hair follicle and sebaceous gland.
• Carbuncle is staphylococcal infection of superficial fascia. It usually occurs at nape of neck and
starts as infection of hair follicle or group of follicles.
• Sebaceous cyst most frequently occurs at scalp.
• Patient of shock exhibits gooseflesh as a result of overactivity of sympethetics.
• Partial thickness burn heals from the cells of hair follicles, sebaceous and sweat glands and from
the cells of edges of burn. A burn that extends deeper than sweat gland heals slowly and only from
edges.
• Superficial fascia is devoid of adipose tissue in eyelids, auricles, penis, scrotum and clitoris
• Nerve to muscle is a mixed nerve, 60% is motor and 40% is sensory.
• Primary cartilageonus joints are those n which the bones are united by plate of hayaline cartilage.
Examples are union b/w epiphysis and diaphysis and b/w first rib and manubrium.
• Secondry cartilagenou joint are those in which the bones are joined by fibrocartilage and articular
surfaces are covered by hyaline cartilage. Example are joints b/w vertebral bodies and the
symphesis pubis.
• HILTON’s LAW. Sensory Nerve supplying the joint also supplies the muscles that cause movement
on that joint and the skin overlying the insertion of these muscles.
• In syringomylia the pain sensation is lost in joints.
• Tendons invaginate the synovial sheath from a side and are suspended by mesotendons.
Mesotendons transmit the blood vessels. In areas where wide range of movement is there these
mesotendons remain as vinulae.
• In certain areas of bodies especially the tips of fingers and toes the arteries and vein connect
directly without intervention of capillaries. These areas are called arteriovenous anastomosis
• Lymphatic vessels are absent in CNS, eyeball, internal ear, epidermis of skin, cartilage, bone.
• Preganglionic are myelinated adnd type B fibers.
• Postganglionic are nonmyelinated and type C fibers
• Two sympethetic chains end below by joining together to form a single ganglion the GANGLION
IMPAR.
• In bone the extracellular matrix is calcified.
• Flat bones are composed of outer and inner layer of compact bone called the TABLES and middle
layer of cancellous bone the DIPOLE. Scapula is irregular but is included in flat bones.
#PEARLS
#IMPORTANT
70 HIGHEST Yield Pearls:
1) Hepatitis "D" Virus has HIGHEST mortality in ALL people EXCEPT#Pregnancy.
In Pregnant women: MOST LETHAL is Hepatitis E virus.
2) "While calculating Serum Osmolality the serum Na is multiplied by 2 to account for the
accompanying ANIONS (mostly Cl- & HCO3-)."
3) Most Common cause of Metastasis to LIVER is primary cancers of Lung.
LLLLLungs send metastasis to LLLLLLiver.
4) Ketamine is the ONLY induction agent that causes Bronchodilation.
Again:
Ketamine is the ONLY induction agent that causes Bronchodilation.
5) AANNencephaly: failure of AANNterior neuropore to close.(at day 25)
SSSpinda bifida: failure of poSSSterior neuropore to close.(at day 27)
6) Muscle Spindles: Innervated by 1a fibers - cause skeletal muscle to CONTRACT.
GTOs: innervated by 1b - cause contracting muscle to RELAX
7) In SSSpontaneous pneumothorax: trachea shifts to ipSSSilateral side.
In TTTension pneumothorax: trachea deviates to conTTTralateral side.
8) Antibiotics SAFE in pregnancy:
All Penicillins.
All Cephalosporins.
All Carbapenems.
Aztreonam.
Azithromycin.
Nitrofurantoin (Avoid in last trimester bcoz can cause hemolysis in G6PD deficient fetus).
Metronidazole (SAFE in ALL trimesters).
9) MICROcytic anemia + NORMAL iron studies* = Thalassemia.
*Iron studies = Serum Ferritin, TIBC etc
10) Know the difference:
#Atopic Dermatitis: Type-1 HS (Hyper Sensitivity)
#Contact Dermatitis: Type 4 HS.
11) In CHRONIC Hepatitis:
Check serum #ALT to monitor THERAPY response (Follow-up)
Check #PT for look (rule out) Acute Liver FAILURE.
12) IN Nephron:
Maximum reabsorption of H2O take place in Proximal Convoluted Tubules, REGARDLESS to ADH
status (present or absent).
13) Generally:
Mass in ANTERIOR Mediastinum =THYMOMA.
Mass in POSTERIOR Mediastinum = NEUROGENIC TUMOR.
14) Most Common Congenital heart "#Lesion" = Bicuspid aortic valve.
Most Common Congenital heart "#Defect" = VSD.
15) Increased neural activity #before a SKILLED Voluntary movement is first seen in the "CORTICAL
ASSOCIATION AREAS".
16) Ampullary region of Uterine tube:
WIDEST part of the Fallopian.
MOST COMMON SITE of Ectopic Pregnancy &
MOST COMMON SITE of Fertilization.
17) The ONLY gynecological cancer that is staged clinically, NOT surgically is cervical cancer.
18) The ONLY hematologic disease that cause hyperchromic microcytosis is Hereditary
Spherocytosis.
19) The ONLY hematologic disease that cause iron deficiency anemia DESPITE increase RBCs is
Polycythemia Vera.
20) The MOST COMMON thyroid CA is Papillary (P-opular).
It also has P-sammoma bodies on histology.
It causes P-alpable lymph nodes (lymphatic spread)
21) ALL Quinolones lack anaerobic coverage EXCEPT Moxifloxacin.
22) COLD sensations are transmitted by myelinated "A-delta" fibers.
WARM sensations are transmitted by unmyelinated "C" fibers.
23) Sigmoid Colon:
I) MOST COMMON (MC) site of Colorectal Carcinoma.
II) MC site of Volvulus in Elderly adults (in young -> Cecum).
II) MC site of Diverticulosis.
24) Homocysteine level is ELEVATED in BOTH (Vit B 12 & Folate deficiencies) While Methylmalonic
Acid level is NORMAL in Folate & ELEVATED in B12.
25) ALL ß-blockers are safe during gestation EXCEPT atenolol.
Once more:
ALL ß-blockers are safe during gestation EXCEPT atenolol.
26) Ectopic Pregnancy:
Most Common site: Ampulla.
Most common site for Rupture: Isthmus.
27) In SIADH = Serum Osmolarity DECreased
In Water Deprivation : Serum Osmolarity HIGH or Normal (#NEVERDecreased)
28) Oral Cavity:
Premalignant CONDITIONS = Submucous Fibrosis & Lichen planus.
Premalignant LESIONS = Erythroplakia & Leukoplakia.
29) All the EXTENSION movements (Elbow, Wrist, Fingers) of Upper Limb is innervated by Radial
Nerve.
30) Treatment of Hyperthyroidism in Pregnancy:
Propylthiouracil in FIRST trimester.
Methimazole AFTER the first trimester.
[If they didn't mention Trimester in question then SELECT PropylThioUracil (PTU)]
31) Urine extravasation in:
Rupture of
Penile urethra -> SCROTUM
Bulbar -> SUPERFICIAL perenial pouch
Prostatatic urethra -> DEEP perenial pouch
32) All RNA viruses replicate in the cytoplasm of the host cell EXCEPT Influenza & HIV.
All RNA viruses are single stranded EXCEPT Reovirus.
All DNA viruses replicate in the nucleus of the host cell EXCEPT Poxvirus.
All DNA viruses are double stranded EXCEPT Parvovirus.
33) #Tamoxifen is an estrogen receptor #AGONIST in the uterus.
#Raloxifene is an estrogen receptor #ANTAGONIST in the uterus.
Tamoxifen for #PREmenopausal women with high risk for breast cancer.
Raloxifene for #POSTmenopausal women with high risk for breast cancer.
34) Isolated #6th cranial nerve palsy causes #HORIZONTAL diplopia.
Isolated #4th cranial nerve palsy causes #VERTICAL diplopia.
35) Diagnostic Test for Streptococcal #INFECTION: blood CULTURE.
Diagnostic Test for Strep infection #COMPLICATIONS (Rh. Fever/PS-GN) : ASO titre.
36) E. Coli is the:
MOST COMMON cause of Pyogenic Peritonitis (visceral perforation).
&
MOST COMMON cause of Spontaneous Bacterial Peritonitis.
37) Most Common #aspiration site is #Right #LOWER lobe (doesn't matter pt is standing, sitting,
supine or dancing)
EXCEPTION: ONLY in ONE condition it can aspirate to Middle or even Upper lobe => in right sided
position.
38) Pt CAN'T stand on his/her toes : Rupture of #ACHILLES tendon.
Pt can STAND on his/her toes but feel PAIN : Rupture of #PLANTARIS tendon.
39) The main cause of Edema in Nephrotic Syndrome is Sodium
Retention, #NOT Hypoalbuminemia.
(The Hypoalbuminemia is LESS important contributor)
40) Know the Difference:
Antibodies form #IN: Spleen.
Antibodies form #BY: Plasma Cells.
41) Q fever:
The ONLY rickettsial disease WITHOUT a #rash.
The ONLY rickettsial disease NOT needing #vector for transmission.
42) Nasal deformity + granuloma + Acid Fast Bacilli = Leprosy.
Nasal deformity + granuloma + hematuria & positive c-ANCA = Wegner’s Disease.
43) Polycystic Kidney Disease:
The most common cause of Death is #ESRD - Renal failure.
[Ruptured Berry Aneurysm (SAH) is NOT correct]
44) Chronic hepatitis B is the most common cause of HCC worldwide with
chronic hepatitis C being the most common cause in Europe.
45) Location of Melanocytes in the skin: Stratum basalis (the deepest layer of the five EPIdermis
layers.)
46) Fossa navicularis is the only part of male urethra that is NOT lined by transitional epithelium. It is
lined by non-keratinized squamous epithelium.
47) Down syndrome and Leukemia :
- Younger than 5 year old --> AML (M7 subtype)
- Older than 5 year old --> ALL
48) Respiratory Bronchioles:
- FUNCTIONALLY separate the Upper & Lower respiratory tract.
- Lymphatic channels begin at this level & flow upward.
49)
History of Asbestos exposure: Mesothelioma.
History of Smoking: Bronchogenic carcinoma.
History of BOTH (Smoking + Asbestos exposure) : Bronchogenic carcinoma.
50) The Key feature of SHOCK is TISSUE HYPOPERFUSION, not a specific level of systemic
arterial Blood Pressure.
51) The most ACCURATE noninvasive index of core temperature is Esophageal temperature.
(Esophageal > Rectal > Oral)
52) Syndromes & Congenital Heart Defect:
Down ⇒ AVSDs.
Turner ⇒ Coarctation of Aorta.
Marfan ⇒ Aortic Aneurysm.
Williams ⇒ Aortic stenosis.
Noonan ⇒ Pulmonary stenosis.
53)
X-linked recessive diseases:
Males - ALWAYS Cases, NEVER Carriers.
Females - ALWAYS Carriers, NEVER Cases.
54)
Oral Cavity:
Premalignant #conditions = Submucous Fibrosis & Lichen planus.
Premalignant #Lesions = Erythroplakia & Leukoplakia.
55)
Infarction of the pituitary as seen in Sheehans syndrome produces coagulative (#NOT liquefactive)
necrosis.
56)
The EARLIEST sign of Salicylate (Aspirin) toxicity is often Hyperventilation & Respiratory Alkalosis.
If NO such Option: Select "Tinnitus"
57)
Location of Melanocytes in the skin: Stratum basalis (the deepest layer of the five Epidermis layers)
OR in another words "Melanocytes are Present in Epidermis.
58)
The Hippocampus is the first area to be damaged during global cerebral ischemia.
59)
Embryological origin of the tongue:
Ant 2/3rd - 1st branchial arch.
Post 1/3rd - 3rd & 4th branchial arches.
Muscles - Occipital myotomes.
60)
Hypertensive arteriolar sclerosis can cause lacunar infarcts:
Pure Motor stroke - post limb of internal capsule.
Pure Sensory stroke - VPL/VPM of Thalamus.
61)
Chronic hepatitis B is the most common cause of HCC worldwide.
62)
First nerve to get affected in Cavernous Sinus Thrombosis. CN VI (Abducens)
63)
Fall on out stretched hand, most common nerve to be lesioned = Median (Lunate displacement)
64)
Regarding TB:
#ghon Complex - ONLY in #primary T.B.
#cavitation - ONLY in #secondary T.B.
Calcification, Positive PPD, Caseating granuloma - in BOTH
65)
Appendix is the Most Common site for carcinoid tumor.
Appendix is the Most Common site for carcinoid tumor.
66)
n. MMMMeninGGGGitidis ferments MMMMaltose & GGGGlucose.
n. GGGGonorrhoeae ferments ONLY GGGGlucose.
LAST but NOT the least
:: Hematology Key Concept Pearls ::
I) Microcytic Anemia with Low Ferritin & High TIBC = Iron deficiency Anemia.
II) Microcytic Anemia with High Ferritin & Low TIBC = Anemia of Chronic Disease.
III) Microcytic Anemia with High Serum Iron = Sideroblastic Anemia.
IV) Microcytic Anemia with NORMAL Iron studies = Thalassemia.
________
TIBC = Total Iron Binding Capacity
Ferritin = Stored Iron
*Tag Your Friends*
Good Luck
Some important points about #Cardiac_cycle

Kindly clear ur concept about cardiac cycle graph..mcqs must come in exam frm this cycle..i have
written imp points which usually come in exam frm this graph..
JVP
a wave 》》》atrial systole
v wave 》》》isovolumic relaxation
VENTRICULAR VOLUME
maximun blood present in ventricle is during Atrial systole
while maximum ventricle is filled by rapid inflow...
least amount of blood present in ventricle 》》reduced ejection
HEART SOUND
S1 heart sound produced during = isovolumic contraction
s2. = isvolumic relaxation
s3 = rapid ventricular filling
s4 = Atrial systole
AORTIC PRESSURE
max aortic pressure » slow ejection phase
least aortic pressure » isovolumic contraction
ECG
T wave in ecg 》》 reduced ejection
QRS just before isovolumic contraction.
#veryyyyyyyyyyImp post.
Must tag others.
GENERAL #PATHOLOGY (keys in the end)
1. Leading cause of death due to poisoning?
2. CO poisoning inhibit which enzyme?
3. Name mitochondrial toxins ?
4. Most susceptible to hypoxia in nephron?
5. Irreversible damage to neuron occurs after ----- minutes of global hypoxia?
6. Most destructive free radicals?
7. Which vitamin is the best neutralizer of free radical?
8. Marker of intermediate filament degradation?
9. Mallory bodies are present in ?
10. Acetaminophen free radicals are formed in?
11. Wear and tear pigment?
12. Hemosedrin laden macrophages present in left sides heart failure are called?
13. What is called green bile ?
14. Disordered cell growth is calle ?
15. Examples of permanent cells?
16. Most common cause of caseous necrosis?
17. Programmed cell death is called?
18. Guardian of genome is?
19. Which is specific for pancreatitis?
20. Heterophagy is seen in which cell organelle?
21. Cerebral infarct is example of?
22. What is called red bile?
23. Extrinsic pathway in apoptosis require?
24. In lead poisoning lead deposits in?
25. Only endogenous pigment?
26. Which metaplasia occurs in brain?
27. Most susceptible zone in hypoxia of hepatocyte ?
28. Oxidase reaction produce which radicals?
29. Primary lysosomes are derived from ?
30. Lewy body seen in ?
31. Most common cause of tissues hypoxia?
32. Most common site for metastatic calcification? Kidney
33. Vitamin as an antioxidant?
34. Central organ in apoptosis?
35. Caspases are involved in which phenomenon?
36. Female had silicon breast implant which was then removed , wich cells would be
numerous ?
37. Omental necrosis is of which type?
38. Superimposed infection on necrosis is called ?
39. Metaplasia of surface epithelium most commonly causes by?
40. In our country the most common cause of cell injury is ?
41. Immediate affect after injury to a vessel is ?
41. Major circulating phagocyte?
42. Most important chemical mediator of inflammation?
43. Clearance of neutrophils in acute inflammation is by?
44. Neutrophil leucocytosis is caused by?
45. The hallmark of acute inflammation is increased ?
46. Acute phase reactants mostly synthesized in?
47. Most common cause of skin abscess?
48. Hall mark of chronic inflammation?
49. Kininogen converts into bradykinin due to?
50. Prostaglandin that helps in protection of gastrointestinal mucosa is??
51. Prostacyclin is produced by?
52. Fever in inflammation is caused by ?
53. ICAM and VCAM are responsible for ?
54. Most common cause of increases permeability?
55. Chemotaxis is a feature of ?
56. Most common cause of hyperkalemia?
57. Virchows triad?
58. Pulmonary thromboembolism originate from?
59. Best indicator of tissues hypoxia?
60. Most common cause of respiratory acidosis ?
61. Cushing triad?
62.most common manifestation of septic patient is ?
63. Most important distinguishing feature if hypo volumic and septic shock is ?
64. Last mediator of endo toxic shock ?
65. Death due to embolism after accident ?
66. Severe generalized Edema is called ?
67. Which vitamin involved in synthesis of collagen?
68. Keyloid is excess of which type of collagen?
69. Corticosteroid inc which wbc?
70. The hallmark of healing?
71. The element act as cofactor in collagen synthesis is?
72. Polyclonal gammopathy is sign of ?
73. The liver contain stem cells in?
74. Most important cells for wound contraction is?
75. Resistance to tension in main function of which collagen?
76. Liver regenerates in how many days?
77. Most common cause of impaired wound healing?
78. Cells increasing in number
Is called?
79. Grading of tumor is done by?
80. Sarcoma involves which origin?
81. Down syndrome is associated with which malignancy?
82. Most common metastatic cancer to bone?
83. Barrets esophagous associated with ?
84. Bcl-2 gene associated with which tumor ?
85. Ret gene associated with which tumor?
86. Li fraumani syndrome associated with which gene?
87. Colorectal carcinoma associated with which gene?
88. TRAP is tumor marker of?
89. S-100 tumor marker of?
90. Calcitonin tumor marker of?
91. Disease associated with asbestosis?
92. Vinyl chloride associated with which disease ?
93. ACTH like peptide are secreted by which tumor?
94. Name disease associated with Psamomma bodies?
95. Most common site of metastasis ?
96. Most common cancer related death?
97. Alkylating agents associated with which malignancy?
98. Polycythemia is associated with which carcinoma?
99. CA-125 tumor marker of ?
100. HTLV-1 virus associated cancer is?
101. Rb gene associated with which 2 tumors?
102. Dysplastic navus associated with which neoplasm?
103. Cachexia is mediated by?
104. c-kit gene associated tumor is?
105. Staging of tumor is done by?
106. Malignancy of skeletal muscle is called ?
107. Term carcinoma implies which origin?
108. Tumor involving all germs layers called?
109. DPC gene associated tumor?
110. Bombesin tumor marker of?
111. Poly cystic kidney disease is which Mendelian genetic disorder?
112. Known cause of congenital anomalies are ?
113. Most common autosomal recessive disorder is ?
114. First 4 weeks of life is called which period?
115. Which disease is commonly associated with down syndrome in younger age?
116. Mitochondrial DNA disorder is associated with ------ inheritance?
117. Barr body is attached to which part of cell?
118. Most common cause of neonatal death?
119. Cataract is caused by which infection during pregnancy?
120. XXY genotype is of ??
121. Best way to identify Turner syndrome?
122. Achondroplasia is associated with ??
123. Pt with primary amenorrhea, webbed neck , short stature.... What is Karyotype?
124. Allele is which type of gene ?
125. Triple marker for Down syndrome are??
126. Scanty Barr body ??
127. Most common type of Mendelian disorder is?
128. Most common X linked disorder is ?
129. Highest caloric value is of ?
130. Beriberi is due to which vit def?
131. Most common pathogen causing congenital infection is ?
132. Vit A used in treatment of?
133. The most common source of vit k is ?
134. Name essential fatty acids?
135. Tryptophan is used in synthesis of?
136. Ionization radiation damages which part of cell?
137. Most frequent type of cancer caused by radiation?
138. Nicotine patch is in treating of??
139. Most common drowning is ?
140. What is the most important factor determining daily energy expenditure ?
141. Most common cause of death in anorexia nervosa ?
142. First hematological sign in total body radiation?
143. Most common systemic complication of IV drug abuser?
144. Which element is use in diabetes?
145. Sepsis in burn patient is due to ?
146. Goat milk lacks in?
147. Gene which is defective in obesity?
148. Rat poisons contain which derivative?
149. Corn based diets are deficient in?
150. Which current os more dangerous?
151. What metabolite of nicotine used for screening?
152. Cofactor in conversion of dopamine to nor epinephrine?
153. Most common UV B light related cancer?
154. Vomiting in bulemia nervosa produces ----------- alkalosis?
155. What complication occurs in shaken baby syndrome?
156. Which bile acid is not reabsorbed in terminal and has role in producing colorectal
cancer?
157. 1st sign of vitamin A deficiency?
158. What is least sensitive to radiation?
159. Avidin in raw eggs bind with ?
160. Ulcer that may develop in burn tissue is ?
161. Bergers disease is strongly associated with ?
162. Pellagra is due to ----deficiency?
163. Name far soluble vitamins?
164. Sarcoma is derived of ?
165. Non neoplastic tissue in foreign origin?
166. ----- is a neoplastic component and ------ is non neoplastic component?
167. Benign tumors are enclosed by fibrinous capsule except?
168. Sarcomas spread through ------- and carcinomas through-------commonly?
169. Glioblastoma multiforme seeds in??
170. Most common cancer in children is ?
171. Most common type of mutation in cancer is ?
172. Most common anemia in cancer?
173. Most common pata neoplastic syndrome?
174. Carcinoma which invade tissues but dosen't metastasize?
175. Virus cause cancer because they have ??
176. Which of the following is the most radio sensitive phase of cell cycle?
177. Most radiosensitive tumor is ?
178. Tumor involving lymph vessels is called ?
179. Slowest growing thyroid tumor?
180. Radiation usually cause cancer after -----years?
KEYS
1. CO poisoning
2. Cytochrome oxidase.
3. Alcohol and salicylate
4. Proximal tubule
5. 5 min
6. Hydroxyl free radicals
7. Vit C
8. Ubiquitine
9. Alcoholic liver disease
10. Liver
11. Lipofuschin
12. Heart failure cells
13. Biliverdin
14. Dysplasia
15. Neurons, skeletal and cardiac muscle cells
16. TB
17. Apoptosis
18. P53
19. Lipase
20. Lysosomes
21. Liquifactve infarct
22. Bilirubin
23. TNF
24. Proximal renal tubule
25. Melanin
26. No metaplasia occurs in brain
27. Zone 3
28. Superoxide free radicals
29. Golgi apparatus
30. Idiopathic parkinson disease
31. Ischemia
32. Kidney
33. Vit E
34. Mitochondria
35. Apoptosis
36. Plasma cells
37. Fat necrosis
38. Wet gangrene
39. Chronic irritation.
40. Ischemia
41. Vasoconstriction
41. Neutrophil
42. Histamine
43. Apoptosis
44. Catecholamines , corticosteroids and lithium
45. Vascular permeability.
46. Liver
47. Staph aureus
48. Tissue destruction
49. Hageman factor
50. PGE2
51. Endothelial cells
52. IL1 and TNF-a
53. Leukocyte adhesion
54. Inflammation
55. Acute inflammation
56. Renal failure
57. Endothelial injury, abnormal blood flow and hypercoagubility
58. Femoral vein
59. Mixed venous O2
60. Anxiety
61. Inc bp, HTN, bradycardia
62. Hypotension
63. Temperature
64. IL6
65. Fat embolism
66. Anasarca
67. Vit c
68. Type 3
69. Neutrophils
70. Granulation tissue
71. Zinc
72. Chronic inflammation
73. Canal of hering
74. Myocibroblasts
75. Type 1 collagen
76. 10-14 days
77. Infections
78. Hyperplasia
79. Degree of cellular differentiation on histological appearance
80. Mesenchymal
81. ALL
82. Breast
83. Esophageal adenocarcinoma
84. Follicular lymphoma
85. MEN IIA and IIB
86. P53
87. APC
88. Hairy cell leukemia
89. Melanoma, astrocytoma
90. Thyroid medullary carcinoma
91. Mesothelioma and Bronchogenic carcinoma
92. Angiosarcoma
93. Small cell lung carcinoma
94. Papillary ca of thorid, serous papillary cystadebocarcinoma of ovary, meningioma,
malignant mesothelioma
95. Lymph nodes
96. Lung carcinoma
97. Leukemia
98. RCC
99. Ovarian carcinoma
100.Adult T cell leukemia/ lymphoma
101. Retinoblastoma and osteosarcoma
102. Malignant melanoma
103. TNF-a
104. Gastrointestinal stromal tumor (GIST)
105. Degree of localization/spread based on site and size
106. Rhabdomyosarcoma
107. Epithelial origin
108. Teratoma
109. Pancreatic cancer
110. Neuroblastoma, lung and gastric cancer
111. Autosomal dominant
112. Multifacrorial
113. Hemochromatosis
114. Neonatal period
115. Alzheimer's diseas
116. Maternal
117. Nuclear membrane
118. Prematurity
119. Rubella
120. Klinefelter syndrome
121. Karyotyping
122. Inc paternal age
123. XO
124. Non identical gene
125. Dec AFP, inc HCG , dec uterine estriol
126. Controversial .. I m with Turner syndrome
127. Autosomal recessive
128. fragile X syndrome
129. Fat
130. Vit B 1( thiamine)
131. CMV
132. Acne and acute premyelocytic leukemia
133. Colonic bacteria
134. Linoleic acid and linolenic acid
135. Niacin
136. DNA
137. Acute leukemia
138. Ulcerative colitis
139. Wet drowning
140. BMR
141. Ventricular arrhythmia
142. Lymphopenia
143. Hep B
144. Chromium
145. Pseudomonas aeroginosa
146. Folate and pyridoxine
147. Leptin
148. Coumarin
149. Tryptophan and niacin
150. AC current
151. Cotinine
152. Vit C
153. Basal cell carcinoma
154. Hypokalemic metabolic alkalosis
155. Retinal hemorrhage
156. Lithocholic acid
157. Night blindness
158. Bone
159. Biotin
160. Marjolin ulcer
161. Smoking
162. Niacin deficiency
163. ADEK
164. Connective tissue
165. Choristoma
166. Parenchyma , stroma
167. Uterine leiomyoma
168. Haematogenous ,, lymphatics
169. CSF
170. Acute lymphoblastic leukemia
171. Point mutation
172. Anemia of chronic disease
173. Hypercalcemia
174. Basal cell carcinoma
175. Oncogene
176. M phase
177. Lymph node
178. Cystic hygroma
179. Papillary carcinoma
180. 5-10 years
Pearls ❤
1)Mobitz I AV block WORSENS with carotid massage, while Mobitz II AV block IMPROVES with
Carotid massage.
2)
Mobitz I AV block IMPROVES with Atropine, while Mobitz II AV block WORSENS with Atropine.
3)
Absorption of LONG chain FA=JEJUNUM
SHORT chain = COLON
4)
Max water Reabsorption = JEJUNUM
Max water + electrolytes Reabsorption = COLON
5)
DRUG with S erum Monitoring is #CYCLOSPORIN.
ANTIBIOTIC with Monitoring is #VANCOMYCIN.
Difference in the Stems.
6)
#Labetalol is the FIRST LINE drug for Pregnancy-induced Hypertension.
SELECTING Methyldopa (If Labetalol is there in options) is WRONG.
7)
Epilepsy medication associated with generalized Lymphadenopathy (pseudolymphoma): #Phenytoin
8)
Exchange Transfusion:
The Rh group should be COMPATIBLE with the MOTHER, #NOT the neonate, to avoid hemolytic
transfusion reaction.
9)
Lung Carcinoma associated with ECTOPIC Thyroid secretion - Hyperthyroidism? = Squamous Cell
Carcinoma.
10)
Regarding VITAMINS:
*Vitamin B6, B12, and folate deficiency will all have #elevated homocysteine levels.
*B12 def. will have increased MMA levels.
*B6 and folate def. will have normal MMA levels.
*B12 and folate def. will have increased MCV.
*B6 def. will have Normal MCV.
11)
#Losartan lowers uric acid levels and is the best drug for BP in gout.
12)
#Warm Immunoglobulins (IgG) cause destruction of RBCs in the #Spleen.
While
#Cold Immunoglobulins (IgM) cause destruction of#RBCs in the #Liver.
13)
The most ACCURATE noninvasive index of core temperature is Esophageal temperature.
(Esophageal >>> Rectal >>> Oral)
14)
The Key feature of SHOCK is TISSUE HYPOPERFUSION, #not a specific level of systemic arterial
Blood Pressure.
15)
MOST IMP chemical mediator of Inflammation = PG
INITIAL mediator = Histamine
16)
Fossa navicularis is the only part of male urethra that is NOT lined by transitional epithelium. It is
lined by non-keratinized squamous epithelium.
17)
An isolated cranial nerve defect, especially of VI and VII, is most often due to a peripheral and #NOT
a brain stem lesion.
18)
Down syndrome and Leukemia :
- Younger than 5 year old --> AML (M7 subtype)
- Older than 5 year old --> ALL
19)
The Fluoroquinolones are active against virtually ALL #bacterial pathogen causing diarrhea EXCEPT
for C.difficile & many Campylobacter.
20)
Hx of Asbestos exposure = Mesothelioma.
Hx of Smoking = Bronchogenic carcinoma.
Hx of Smoking + Asbestos exposure = Bronchogenic carcinoma
21)
Respiratory Bronchioles:
- FUNCTIONALLY separate the Upper & Lower respiratory tract.
- Lymphatic channels begin at this level & flow ↑.
22)
Peripheral chemoreceptors monitor PaO2 (not O2 content). Thus, there is no ventilatory response to
the hypoxia of anemia or CO poisoning.
23)
Highest TGs = Chylomicron
Highest Cholesterol = LDL
Highest phospholipids = HDL
Highest Proteins = HDL
Absent during Fasting = Chylomicrons
24)
Regarding Brain Tumor:
*Most common OVERALL = Glioblastoma Multiforme
*Most common BENIGN in CHILDREN = Meduloblastoma
*Most common MALIGNANT in CHILDREN = Pilocytic Astrocytoma
25)
ABSOLUTE #contraindications to performing a Bone Marrow Biopsy:
* Hemophilia
* Severe DIC, or other related severe bleeding disorders.
#Thrombocytopenia, REGARDLESS of severity, is #NOT a contraindication of Bone Marrow Biopsy.
26)
Most POTENT Antioxidant = GLUTATHIONE
27)
IgG = SMALLEST (in size) antibody, HIGHEST concentration in serum, One that CROSSES
placenta and antibody that is known as a WARM antibody.
28)
lgM = LARGEST in size, antibody that is mainly Intravascular, EARLIEST antibody to be synthesized
and COLD antibody.
29)
BLACK pigment gallstones: due to intravascular hemolysis.
BROWN pigment gallstones: due to biliary tract infection.
30)
Three main causes of RECTAL PROLAPSE in children of age below 2 years.
1) Cystic Fibrosis.
2) Whooping Cough.
3) Trichuriasis.
31)
END arteries are present in = Central Retinal >>> Spleen >>> Heart
32)
Vomiting in "Duodenal Atresia" vs "Pyloric Stenosis" in Neonate:
Dudenal atresia = Bilious
Pyloric stenosis = Non-Bilious
#ABG:
#Respiratoryacidosis/metabolic alkalosis
A combined respiratory acidosis / metabolic alkalosis will result in elevated PaCO2 and serum
bicarbonate. Which process is the primary disorder (e.g. primary respiratory acidosis with metabolic
compensation versus primary metabolic alkalosis with respiratory compensation) is dependent on
the pH – in an acidotic patient, the acidosis is primary (and the alkalosis is compensatory) and vice
versa.
Compensation behaves in accordance with the following rules:
#MetabolicAcidosis: As bicarbonate goes from 10 to 5, pCO2 will bottom out at 15.
pCO2 = 1.5 x [HCO3-] + 8 (or ↓ pCO2 = 1.25 x Δ[HCO3-])
#MetabolicAlkalosis: compensation here is less because CO2 is driving force for respiration.
pCO2 = 0.7 x [HCO3-] + 21 (or ↑ pCO2 = 0.75 x Δ[HCO3-])
#RespiratoryAcidosis:
Acutely: ↑ [HCO3-] = 0.1 x Δ pCO2 or ↓ pH = 0.008 x Δ pCO2 Chronically: ↑ [HCO3-] = 0.4 x Δ pCO2 or ↓
pH = 0.003 x Δ pCO2
#RespiratoryAlkalosis: Metabolic compensation will automatically be retention of chloride (i.e.,
hyperchloremic, usually referred to as “loss of bicarb” although it is the strong ion difference that matters). If
you have an anion gap, then you’ve automatically got a little bit of an acidosis on top of the compensation
(because the compensation should be a NON-gap acidotic process.
#Acutely: ↓ [HCO3-] = 0.2 x Δ pCO2 (or ↑ pH = 0.008 x Δ pCO2) Chronically: ↓ [HCO3-] = 0.4 x Δ pCO2
(or ↑ pH = 0.017 x Δ pCO2)
Q3: 1. 6 month old baby prefer/like bottle milk over breast feeding because
a. Cleft lip
b. Cleft palate
c. Nasal blockage
d. A and B
Answer: b
Now this is a bit vague question. First let’s look at the dynamics of feeding. A baby needs to generate suction
pressure to suck milk. With the closed lips around the nipple and no connection between the nose and mouth,
this pressure is easily generated by the baby. Remember that breast feeding calls for more suction pressure
than bottle feeding and therefore it’s always easier for even a normal baby to bottle feed as compared to breast
feed. Now if there is anatomical defect like cleft lip or palate, it’s very difficult for the baby to generate enough
suction pressure to draw milk while breast feeding. Bottle makes this task easier for such babies. Technically
babies with cleft lip only can still breast feed cause the gap between lips can be closed off by the nipple and
since there is no abnormal connection between the mouth and nose, enough suction pressure can still be
generated by such babies to breast feed. However babies with cleft palate or cleft lip plus palate cannot
generate pressure (due to abnormal connection between mouth and nose)and so CANNOT breast feed.
If you look at the question it’s asking about a 6 month old baby and his/her PREFERENCE. If you go right to
the basics the answer should be cleft palate or a cleft palate with a cleft lip. A cleft lip alone should not cause a
lot of problem for the baby to breast feed.
A blocked nose will cause problems with both breast feeding and bottle feeding (and not specifically breast
feeding) cause although there is no problem with suction pressure generation, the blocked nose makes it
difficult for the baby to draw breaths from nose in between suctions.
#Gynae
Anatomy Review GY02-GY03.
Vulva.
***) All of the following structures are included in the term vulva, except:
Clitoris
Urethral orifice
Labia minora
Nabothian cysts
Bartholin’s glands
Answer: D* Nabothian cysts
***) The nerve supply to the vulva is derived from all of the following nerves, except:
The pudendal nerve
The ileo-inguinal nerve
The genito-femoral nerve
The posterior cutaneous nerve to the thigh
The inferior hemorrhoidal nerve
Answer: E* The inferior hemorrhoidal nerve
Vagina.
***) All of the following are true about vagina, except:
The pH is 4
It contains no glands
Whitish non-offensive discharge is normal finding
Doderlein's bacilli is abnormal finding
Posterior wall is longer than anterior wall
Answer: D* Doderlein's bacilli is abnormal finding
***) The normal vagina in the reproductive age is characterized by all of the following, except:
Contains Doderlein’s bacilli
Lined by stratified squamous epithelium
Has a pH of 4.5
The epithelium contains secretory cells
Is divided by the cervix into four fornices
Answer: D* The epithelium contains secretory cells
***) The lining epithelium of the vagina is:
Stratified squamous epithelium
Simple columnar epithelium
Tall columnar epithelium
Transitional epithelium
Ciliated columnar epithelium
Answer: A* Stratified squamous epithelium
***) All of the following effects occur on the vagina by estrogen, except:
The vagina becomes more vascular
The vaginal epithelium grows
The vaginal glands start to secret
The epithelium cells become filled with glycogen
The glycogen is broken by Doderlein's bacilli which cause lowering of vaginal pH
Answer: C* The vaginal glands start to secret
Uterus.
***) The uterine artery is a branch of one of the following:
External iliac artery
Internal iliac artery
Common iliac artery
Middle sacral artery
Obturator artery
Answer: B* Internal iliac artery
***) The best support to the uterus is by:
The broad ligaments
Infundibulopelvic ligaments
Round ligament
Utero-ovarian ligament
Cardinal ligament
Answer: E* Cardinal ligament
***) The round ligament of the uterus terminates in one of the following:
Symphysis pubis
Iliac crest
Upper portion of labium majus
Upper portion of labium minus
Upper portion of inguinal canal
Answer: C* Upper portion of labium majus
***) Regarding lower uterine segment, all the following are true except:
It represents isthmus in non pregnant uterus
It lies between the anatomical and histological internal os
It is a passive segment compared to the upper segment which is active
In obstructed labor it can form Bandl's ring
It is the least site of rupture in obstructed labor with no previous CS scar
Answer: E* It is the least site of uterus in obstructed labor with no previous CS scar
Ovaries.
***) The left ovarian vein empties in one of the following:
Vena cava inferior
Left common iliac vein
Left internal iliac vein
Left renal vein
Left external iliac vein
Answer: D* Left renal vein
***) The most inner part of a mature Graafian follicle is:
Theca interna
Theca externa
Granular cell layer
Zona pellucida
Ovarian stroma
Answer: D* Zona pellucida
***) Maximal number of germ cells in the ovary occurs at:
20-22 weeks of intrauterine life
30 weeks of intrauterine life
Birth
Menarche
Age of 25 years
Answer: A*20-22 weeks of intrauterine life
***) Ovarian failure causes atrophic changes in all of the following, except:
Uterus
Vagina
Urethra
Bone
Rectum
Answer: C* Urethra
Menstruation GY03-GY06.
Menstrual Cycle.
***) Regarding menstrual cycle, all the following are true except:
Increasing levels of FSH from anterior pituitary gland
FSH release is influenced by gonadotropin releasing hormone from hypothalamus
FSH promotes follicular development in the ovary
Ovulation occurs 14 days from 1st day of the cycle
The endometrium undergoes proliferation during 1st half of the cycle
Answer: B* FSH release is influenced by GnRH from hypothalamus
***) In a normal menstrual cycle of 35 days duration, ovulation occurs:
Two weeks before menstrual flow
Mid cycle
Time of maximum progesterone production
Two weeks after the onset of the menstrual flow
Time of maximum prolactin production
Answer: A* Two weeks before menstrual flow
***) Severe hyperstimulation syndrome associated with gonadotropin therapy may be manifested
clinically by the following, except:
Abdominal pain
Ascites
Follicular cysts
Hypovolemic shock
Thrombo-embolic episodes
Answer: A* Abdominal pain
***) Physiologic processes that are estrogen dependent in women include all the following except:
Menses
Vaginal cornification
Hirsutism
Appearance of axillary hair
Production of cervical mucus
Answer: C* Hirsutism
Common Procedures GY09-GY12.
Dilatation and Curettage.
***) In a 38 years old woman complaining of irregular and heavy periods, the first line of
management is:
Vitamin K injections
Dilatation and curettage (D&C)
Hormone therapy
Immediate hysterectomy
Radiotherapy
Answer: B* Dilatation and curettage (D&C)
***) Complication of Dilation and Curettage D&C include all of the following, except:
Uterine perforation
Injury of the urethra
Cervical laceration
Cervical stenosis
Asherman's syndrome
Answer: B* Injury of the urethra
Laparoscopy.
***) Laparoscopy is a useful investigation to diagnose one of the following conditions:
Adenomyosis
Congenital uterine abnormalities
Premature ovarian failure
Endometriosis
Vaginal atresia
Answer: D* Endometriosis
Hysteroscopy.
***) The following are contraindications for Hysterosalpingography, except:
Uterine bleeding
Active pelvic infection
Suspected pregnancy
Bicornuate uterus
Active cervicitis
Answer: D* Bicornuate uterus
Disorders of Menstruation GY12-GY16.
Amenorrhea.
***) Concerning primary amenorrhea, all the following are true except:
Investigations include serum FSH
Is associated with karyotype 45 XO
May be due to congenital adrenal virilism (hyperplasia)
May be due to Mullerian duct fusion failure
May be due to granulous cell tumors of the ovary
Answer: E* May be due to granulous cell tumors of the ovary
***) All of the following may cause primary amenorrhea, except:
Cryptomenorrhea (imperforate hymen)
Testicular feminization syndrome
Turner's syndrome
Gonadal agenesis
Dermoid cyst of the ovary
Answer: E* Dermoid cyst of the ovary
***) Amenorrhea in a 16 years old girl may result from all of the following conditions, except:
Imperforate hymen
Androgen insensitivity syndrome (testicular feminization syndrome)
Turner's syndrome
Bicornuate uterus
Pituitary tumor
Answer: D* Bicornuate uterus
***) Absence of vagina is common in:
Congenital adrenal hyperplasia
Turner's syndrome
In Mullerian atresia with absent uterus
With absent uterus in testicular feminization syndrome
Drug induced masculinization
Answer: C* In Mullerian atresia with absent uterus
***) The following statements are true regarding hematocolpos, except:
It causes primary amenorrhea
The patient may present with urine retention
The patient may present with abdominal mass
The treatment is incision of hymen
Breasts atrophy may occur
Answer: E* Breasts atrophy may occur
***) An imperforate hymen in a girl may be associated with all of the following, except:
Retention of urine
Hematocolpos
Periodical abdominal pain
Amenorrhea
Absent uterus
Answer: E* Absent uterus
***) Concerning secondary amenorrhea, all the following are true except:
May be due to thyrotoxicosis
May be due to anorexia nervosa
Investigations include prolactin levels
Oral contraceptives can be used in treatment
Clomiphene can be given as treatment
Answer: E* Clomiphene can be given as treatment
***) All of the following may cause secondary amenorrhea, except:
Lactation (breast feeding)
Endometriosis
Pituitary failure
Early menopause
Pregnancy
Answer: B* Endometriosis
***) One of the following investigations is necessary in patients with primary amenorrhea:
Serum TSH
Serum prolactin
Dilation and Curettage
Chromosomal analysis
Hysteroscopy
Answer: D* Chromosomal analysis
***) In secondary amenorrhea, elevated FSH over 40 nmol/u, indicates:
Polycystic ovary syndrome
Ovarian failure or resistance
Pituitary failure
Anorexia nervosa
Hypothalamic amenorrhea
Answer: B* Ovarian failure or resistance
***) Raised FSH levels are found in all of the following, except:
Post menopausal woman
Turner's syndrome
Prepubertal girls
Gonadal dysgenesis
Kleinfelter's syndrome
Answer: C* Prepubertal girls
***) All of the following are true about effect of androgens on the external genitalia of a female fetus,
except:
Clitoral hypertrophy
Labia fusion to form scrotum
May give varying degrees of hypospadia
It may cause adrenogenital syndrome
It may cause closure of the Bartholin gland duct
Answer: E* It may cause closure of the Bartholin gland duct
***) Signs of virilism include all of the following, except:
Excessive body hair
Muscle development
Deepening of the voice
Clitoromegaly
Occipital balding
Answer: E* Occipital balding
***) The most common pelvic mass associated with amenorrhea in a reproductive age woman is:
Follicular cyst
Corpus luteum cyst
Benign cystic teratoma
Leiomyoma
Pregnancy
Answer: E* Pregnancy
Abnormal Uterine Bleeding.
***) The most likely cause of abnormal genital bleeding in a 13 year old girl is:
Uterine cancer
Ectopic pregnancy
Threatened abortion
Cervical cancer
Anovulation
Answer: E* Anovulation
***) Regarding dysfunctional uterine bleeding all of following are true, except:
It is an abnormal menstrual pattern
There is no organic disease in the uterus
It may cause menorrhagia
It may cause prolonged period
It is a pre-malignant condition of the endometrium
Answer: E* It is a pre-malignant condition of the endometrium
***) All of the following are true for hemorrhagic metropathia, except:
It is a condition of variable periods of amenorrhea
It occurs more common with fibroid in the uterus
Periods are heavy, continuous and painless
It is found more common nearer the menopause
It is a feature of anovular cycles in which estrogen levels are high
Answer: B* It occurs more common with fibroid in the uterus
***) The most common cause of heavy bleeding in adolescent girls is:
Uterine fibroid
Endometriosis
Dysfunctional uterine bleeding
Cervical erosion
Hypothyroidism
Answer: C* Dysfunctional uterine bleeding
***) Vaginal bleeding in the newborn female infant is most commonly due to:
Trauma
Estrogen withdrawal
Infections
Neoplasms
Hemorrhagic disease of the newborn
Answer: B* Estrogen withdrawal
***) A 4 days old female healthy baby presented to your clinic with vaginal bleeding, the most
appropriate action to do is:
Refer to gynecologist
Do PT and PTT
Reassure the parents
Do pelvic US
Give vitamins and iron
Answer: C* Reassure the parents
***) One of the following drugs is commonly used for dysfunctional uterine bleeding DUB:
Progesterone
Testosterone
Estrogen
Epsilon aminocaproic acid
Prostaglandin
Answer: A* Progesterone
***) One of the following is associated with dysfunctional uterine bleeding:
Uterine infection
Placental polyp
Cervical polyp
Polycystic ovary
Endometrial carcinoma
Answer: D* Polycystic ovary
Dysmenorrhea.
***) Regarding dysmenorrhea all of the following are true, except:
It is a painful menstruation
The spasmodic type is the primary
The congestive type is the secondary
Membranous dysmenorrhea is most uncommon
D&C is the treatment of choice
Answer: E* D&C is the treatment of choice
***) All of the following are true about spasmodic dysmenorrhea (primary), except:
The pain occurs with the onset of menstruation
The pain in colicky in nature
It may associate with nausea and vomiting
It is more common in multi parous women
The pain may radiate from lower abdomen to the inner aspects of the thighs
Answer: D* It is more common in multi parous women
***) Primary dysmenorrhea at the time of menstruation is caused by:
Uterine atony
Uterine ischemia
Ovulation
High level of estrogen
Uterine hyper contractility due to prostaglandins release
Answer: E* Uterine hyper contractility due to prostaglandins release
Postmenopausal bleeding.
***) Regarding post menopausal bleeding, all the following are true except:
May be caused by estrogen therapy
Can only occur six months after the cessation of menses
May occur due to atrophic vaginitis
Dilatation and curettage are mandatory
Rarely is due to malignant changes in the endometrium
Answer: E* Rarely is due to malignant changes in the endometrium
***) All of the following may cause postmenopausal bleeding, except:
Estrogen therapy
Atrophic changes of the vagina
Testosterone therapy
Cervical malignancy
Endometrial malignancy
Answer: C* Testosterone therapy
***) The following are causes of post menopausal bleeding, except:
May be caused by estrogen therapy
Atrophic vaginitis
Endometrial malignancy
Cervical carcinoma
May be caused by non hormone-producing ovarian tumors
Answer: E* May be caused by non hormone-producing ovarian tumors
***) Causes of post menopausal bleeding are the following, except:
Endometrial cancer
Cervical cancer
Urethral carbuncle
Ovarian tumor
Prolapse of the uterus
Answer: C*Urethral carbuncle
***) Post menopausal bleeding is managed primarily by:
Hormonal replacement
Papanicolau smear
Dilatation and curettage (D&C)
Cervical biopsy
Contraceptive pills
Answer: C* Dilatation and curettage (D&C)
***) Postmenopausal bleeding is usually caused by all the following except one:
Cervical lesions
Vaginal lesions
Hematologic disease
Gastroenterological lesions
Urinary lesions
Answer: C* Hematologic disease
Endometriosis GY16-GY17.
Endometriosis.
***) Regarding endometriosis all of the following are true, except:
The endometrium is found in situation other than the uterine cavity
It may be found in myometrium
The principle feature is menorrhagia
It may cause infertility
The treatment of choice in young age is hysterectomy
Answer: E* The treatment of choice in young age is hysterectomy
***) Concerning endometriosis, all the following are true except:
Causes deep dyspareunia
Is often asymptomatic
Is frequently pre-malignant
Often present as secondary dysmenorrhea
Rare outside the pelvis
Answer: C* Is frequently pre-malignant
***) The following are characteristics of endometriosis, except:
Period pain is congestive type
Periods may be heavy
There is intermenstrual bleeding
May cause infertility
May cause ovarian cysts
Answer: C* There is intermenstrual bleeding
***) All of the following symptoms are associated with endometriosis, except:
Dyspareunia
Dysmenorrhea
Menorrhagia
Back pains
Amenorrhea
Answer: E* Amenorrhea
***) The most common site of endometriosis externum is:
The uterus
The pouch of Douglas
The ovaries
The fallopian tubes
The cervix
Answer: C* The ovaries
***) All of the following are theories for causation of endometriosis except:
Coelomic metaplasia
Endometrial hyperplasia
Retrograde menstruation
Immunologic deficiency
lymphatic spread of endometrial fragment
Answer: B* Endometrial hyperplasia
???) Endometriosis is often associated with all the following except:
Dysmenorrhea
Dyspareunia
Infertility
Amenorrhea
Pelvic pain
Answer: D* Amenorrhea
Adenomyosis GY17-GY17.
Adenomyosis.
***) In adenomyosis the endometrial glands are localized at:
Pelvic cavity
Ovaries
Fallopian tubes
Bowels
Uterine muscle
Answer: E* Uterine muscle
Leiomyomata (Fibroids) GY17-GY19.
Leiomyomata.
***) Concerning uterine fibroids the following are true, except:
Rarely cause infertility
They are not a cause of post menopausal bleeding
May be asymptomatic during pregnancy
May undergo red degeneration during pregnancy
May cause antepartum hemorrhage
Answer: B* They are not a cause of post menopausal bleeding
***) The most common tumor of the uterine corpus is:
Adenocarcinoma
Squamous carcinoma
Leiomyoma
Sarcoma
Lymphoma
Answer: C* Leiomyoma
***) All of the following complications are associated with intramural fibroid, except:
Excessive uterine bleeding
Red degeneration during pregnancy
Fatty degeneration
Hyaline degeneration
Sarcomatous changes in 20% of cases
Answer: E* Sarcomatous changes in 20% of cases
***) The following changes may occur in a fibroid, except:
Cystic changes
Sarcomatous changes
Calcified called "womb stone"
Acute fatty degeneration
Hyaline degeneration
Answer: D* Acute fatty degeneration
***) The commonest type of bleeding encountered with uterine leiomyoma (fibroids) is:
Post coital bleeding
Menorrhagia
Metrorrhagia
Postmenopausal bleeding
Intra-abdominal bleeding
Answer: B* Menorrhagia
***) Uterine fibroid may be associated with all of the following, except:
Amenorrhea
Menorrhagia
Frequency of micturition
Infertility
Abdominal enlargement
Answer: A* Amenorrhea
***) In a 42 years old female who has menorrhagia due to a uterine fibroid, the best treatment is:
Radiotherapy
Myomectomy
Total abdominal hysterectomy
Hormonal therapy
Repeated D&C operations
Answer: B* Myomectomy
***) The most common pelvic mass in postmenopausal women is:
Follicular cyst
Corpus luteum cyst
Germ cell tumor
Leiomyoma
Endometrioma
Answer: D* Leiomyoma
***) The most common uterine neoplasm is:
Sarcoma
Adenocarcinoma
Choriocarcinoma
Adenomyosis
Leiomyoma
Answer: E* Leiomyoma
Contraception GY19-GY22.
Contraception.
***) The ideal method of contraception for a cardiac patient with mitral valve disease who desires no
more children is by:
Birth control pills
IUCD (Intra Uterine Contraceptive Device)
Laparoscopic tubal ligation
Immediate post partum tubal ligation
Tubal ligation 40 days after delivery by laparotomy
Answer: E* Tubal ligation 40 days after delivery by laparotomy
Hormonal Methods.
***) The most effective contraceptive known is:
Diaphragm
Condom (Sheath)
Synthetic progestin
Combined contraceptive pills (estrogen + progesterone)
Intrauterine device
Answer: D* Combined contraceptive pills (estrogen + progesterone)
***) About combined oral contraceptive pills one is true:
Predispose to pelvic inflammatory disease (PID)
Predispose to breast tumors
Predispose to ovarian cyst
May be used in patient with heart lesion
Less effective in patient with epilepsy on treatment
Answer: E* Less effective in patient with epilepsy on treatment
***) One of the following is contraindicated in combined oral contraceptive pills:
Multiparity
Chronic liver disease
Primary dysmenorrhea
Bronchial asthma
Endometriosis
Answer: B* Chronic liver disease
***) All of the following are contraindications for the use of combined oral contraceptive pills, except:
Liver disease
Secondary amenorrhea
Thrombo-embolic disease
Sickle cell disease
Endometriosis
Answer: E* Endometriosis
***) Absolute contraindication for oral contraceptive pills are the following, except:
Carcinoma of the breast
Heart disease
Lactating mother
Liver diseases
Thrombo-embolic disease
Answer: C* Lactating mother
***) Contraindications to birth control pills include all of the following, except:
Migraine headache
Deep vein thrombosis
Hypertension
Liver adenoma
Hirsutism
Answer: E* Hirsutism
***) All of the following are side effects of oral contraceptives, except:
Weight gain
Hypertension
Deep vein thrombosis
Strike
Hypoglycemia
Answer: E* Hypoglycemia
***) The effectiveness of oral contraceptives is reduced following interaction with the following drugs,
except:
Ampicillin
Phenobarbitone
Phenytoin
Thyroxine
Carbamazepine
Answer: D* Thyroxine
***) Regarding oral contraceptive pills, one is true:
Inhibit release of gonadotropic hormones
May lead lo thinning of cervical mucus
Lead to reduced platelet aggregation
Lead lo increased antithrombin III
Increase fallopian tube smooth muscle activity
Answer: A* Inhibit release of gonadotropic hormones
***) The use of combined oral contraceptive pills may increase the risk of one of the following
conditions:
Fibrocystic breast disease
Hepatic adenoma
Salpingitis
Ovarian cancer
Endometrial cancer
Answer: B* Hepatic adenoma
***) The most common side effect of low-dose oral contraceptive pills is:
Breakthrough bleeding
Dysmenorrhea
Nausea
Hypertension
Breast pain
Answer: A* Breakthrough bleeding
Intrauterine Device.
***) Concerning Intrauterine Contraceptive Device IUCD, choose the correct answer:
Failure rate 2-3 % women every year
Increases the incidence of cervical erosion
Increases the incidence of Candida infection
Contraindicated in patients with cervical polyp
Cryocautery to the cervix can be done while IUCD is in situ
Answer: A* Failure rate 2-3 % women every year
***) Intrauterine contraceptive devices (inert type) prevent pregnancy by all of the possible
mechanisms, except:
Increase the motility of fallopian tubes
Increase the contractility of the uterus
Causing aseptic inflammatory reaction in the endometrium
Increasing the potential space of uterine cavity
Increasing the hostility of the cervical mucus to the spermatozoid
Answer: A* Increase the motility of fallopian tubes
***) One of the following is an absolute contraindication to Intrauterine Contraceptive Device IUCD:
Uterine fibroids
Bicornuate uterus
Grand multi-parous woman
Previous caesarian section
Lactation
Answer: B* Bicornuate uterus
***) Contraindications of IUCD are the following, except:
Pregnancy
Pelvic infection
Multigravida
Dysfunctional uterine bleeding
Patient with heart disease
Answer: C* Multigravida
***) Intrauterine contraceptive device may be associated with following complications, except:
Pelvic infection
Uterine perforation
Ectopic pregnancy
Cervical erosion
Menorrhagia
Answer: D* Cervical erosion
***) The most common method of contraception in Jordan is:
Intrauterine device (IUCD)
Long acting progesterone injection (Depo-Provera)
Diaphragm
Spermicidal cream
Lactation
Answer: A* Intrauterine device (IUCD)
Infertility GY22-GY24.
Female Factors.
***) A 27 years old woman has tried unsuccessfully for 5 months to become pregnant, The
recommended investigation in this case would be:
Hormonal assay
Hysterosalpingogram (HSG)
Endometrial biopsy
Laparoscopy
None of the above
Answer: E* None of the above
***) All the following are complications of ovulatory inducers, except:
Multiple pregnancy
Ectopic pregnancy
Hypotension
Ascites
Hypoproteinemia
Answer: E* Hypoproteinemia
***) What percentage of couples in the reproductive age is unable to conceive after one year of
coitus without contraception:
1-2%
15%
30%
50%
75%
Answer: B* 15%
***) All of the following are possible indications of ovulation, except:
Increased plasma levels of progesterone in the second half of the cycle
Increased basal temperature in the second half of the cycle
Follicular stimulating hormone surge at the mid cycle
Change in the cervical mucus
Mid cycle abdominal pain
Answer: C* Follicular stimulating hormone surge at the mid cycle
***) Ovulation can be diagnosed by the following, except:
Measuring day 14 serum progesterone
Observing a rise in basal body temperature in the second half of the menstrual cycle
Study of cervical mucus
Endometrial biopsy
Day 20 serum prolactin
Answer: E* Day 20 serum prolactin
???) Ovulation can be diagnosed by all the following except one:
Measuring day 14 serum progesterone
Observing a rise in basal body temperature in the second half of the menstrual cycle
Study of the cervical mucus
Endometrial histology
Mittle schmerz (midcyclic pain)
Answer: 1* Measuring day 14 serum progesterone
***) Tests to detect ovulation include all of the following, except:
Basal body temperature
Endometrial biopsy
Estrogen level
Progesterone level
Vaginal wall cytology
Answer: C* Estrogen level
***) Induction of ovulation may be achieved by giving:
Clomiphene citrate
Cyproterone acetate
Letrozole
FSH and LH
Tamoxifen
Answer: A* Clomiphene citrate
***) Clomiphene citrate is contraindicated in one of the following:
Endometrial hyperplasia
Post pill amenorrhea
Polycystic ovary (Stein-Leventhal syndrome)
Ovarian tumors
Infrequent ovulation
Answer: D* Ovarian tumors
Male Factors.
***) Normal semen should have the following characteristics, except:
Volume 2.5-5 cc
Liquefaction in 30 minutes
Motility 60-70% after 3 hours
After 6 hours only 30% remain motile
Sperm count the average normal specimen is 10-20 million per 1 cc
Answer: E* Sperm count the average normal specimen is 10-20 million per 1 cc
***) All of the following may cause azoospermia, except:
Blockage of the ducts
Klinefelter syndrome
Orchitis due to mumps
Varicoceles
Surgical trauma to the spermatic artery
Answer: D* Varicoceles
***) Male sterilization (vasectomy) causes:
Azoospermia
Loss of libido
A decrease in the volume of the ejaculate
Impotence
Infection
Answer: A* Azoospermia
***) All of the following are causes of abnormal spermatogenesis except:
Cryptorchidism
Genetic abnormality
Varicoceles
Cold environment
Drugs
Answer: D* Cold environment
***) All of the following are causes of abnormal spermatogenesis except:
Cryptorchidism
Genetic abnormality
Varicoceles
Cold environment
Drugs
Answer: D* Swimming
Polycystic ovarian syndrome GY24-GY25.
PCOS.
***) Regarding polycystic ovary syndrome all are true, except:
Is best treated by clomiphene
Wedge resection is the treatment of choice
Absence of LH surge
Low or normal FSH
High testosterone level
Answer: A* Is best treated by clomiphene
***) Stein-Leventhal syndrome (polycystic ovary) is usually characterized by all the following, except:
Hirsutism
Infertility
Menorrhagia
Obesity
Anovulation
Answer: C* Menorrhagia
***) All of the following problems may occur with an ovarian cyst, except:
May undergo torsion
May undergo rupture
May undergo hemorrhage
Retention of urine is common
May undergo malignant changes
Answer: D* Retention of urine is common
***) Primipara 20 weeks pregnant was found to have ovarian cyst 7x7 cm, the proper treatment is:
Weekly assessment of the size of the cyst
Termination of pregnancy
Cystectomy after puerperium
Cesarean section and cystectomy after 37 completed weeks
Laparotomy and cystectomy as soon as discovered
Answer: E* Laparotomy and cystectomy as soon as discovered
***) A 65 years old woman was found to have ovarian cyst 6x6 cm, the proper treatment is:
Observation
Laparoscopy
Laparotomy and cystectomy
Hysterectomy
Treatment no need
Answer: C* Laparotomy and cystectomy
***) Regarding polycystic ovaries all are true except:
Are associated with hirsutism
Are associated with infertility
Have an increased risk of malignant change in the ovaries
Are associated with obesity
Show dense thickening of the capsule
Answer: C* Have an increased risk of malignant change in the ovaries
Gynecological Infections GY25-GY32.
Vulvovaginitis.
***) One of the following about childhood vulvovaginitis is true:
Is commonly due to staphylococcal infection
Is commonly due to monilial infection
Is caused by thread worms
Estrogen cream is of little help
Commonly requires treatment with systemic antibiotic
Answer: E* Commonly requires treatment with systemic antibiotic
***) Pruritus vulvae may be present in all of the following, except:
Monilial infection
Diabetes mellitus
Gonorrhea
Psychological problems
Leukoplakia (vulvar dystrophy)
Answer: E* Leukoplakia (vulgar dystrophy)
***) Which of the following conditions is the most likely cause of vulvovaginal symptoms in children:
Foreign body
Lichen sclerosus
Physiologic leucorrhea
Trauma
Non-specific
Answer: E* Non-specific
***) The most common skin disease affecting the vulva is:
Psoriasis
Vulval cancer
Vulval injury
Vulval abscess
Contact dermatitis
Answer: E * Contact dermatitis
***) Which of the following is most likely to cause vulval pruritus:
Anemia
Leukemia
Heart failure
Hypertension
Personal hygiene products
Answer: E * Personal hygiene products
*** The most effective treatment of vulvar pruritus associated with atrophic vulvitis is:
Antihistamines
Hydrocortisone
Alcohol injection
Tranquilizers
Topical estrogen therapy
Answer: E* Topical estrogen therapy
***) In a patient complaining of bad smelling, frothy and irritative vaginal discharge, wet smear
showed "clue cells", the causative organism is:
Candida albicans
Gardnerella vaginalis
Bacteroides
Mycoplasma
Trichomonas vaginalis
Answer: B* Gardnerella vaginalis
***) Profuse cream frothy vaginal discharge is characteristic of:
Moniliasis
Trichomoniasis
Gonorrhea
Tuberculosis
Syphilis
Answer: B* Trichomoniasis
***) Regarding vaginal candidiasis, all the following are true except:
Caused by yeast
Acid media in the vagina
Best treated by metronidazole
Commonly associated with vulvar pruritus
Patients partner may need treatment
Answer: C* Best treated by metronidazole
***) All of the following are predisposing factors for monilial infection, except:
Combined oral contraceptive pills
Diabetes mellitus
Pregnancy
Intrauterine contraceptive device
Patients on broad spectrum antibiotics
Answer: D* Intrauterine contraceptive device
***) The commonest cause of vaginal itching during pregnancy is:
Non specific vaginal infection
Trichomonal vaginal infection
Vaginal moniliasis
Gonorrhea
Cervical erosion
Answer: C* Vaginal moniliasis
***) Blood stained vaginal discharge occurs in the following, except:
Carcinoma of the cervix
Moniliasis
Cervical polyp
Senile vaginitis
Carcinoma of the body of the uterus
Answer: B* Moniliasis
***) The following might increase vaginal discharge during pregnancy except one:
Bacterial vaginitis
Candida vaginitis
Simple ovarian cyst
Physiological
Answer: D* Simple ovarian cyst
***) In vulvo-vaginal hematoma, all the following are true except:
Usually related to child birth
Is usually painless purple colored swelling
Incision and evacuation is the treatment of choice
The bleeding is usually of arterial origin
Packing is rarely necessary
Answer: C* Incision and evacuation is the treatment of choice
Sexually Transmitted Infections.
***) Sexually transmitted diseases include all of the following except:
Type II herpes hominis
Condyloma acuminate
Chlamydial infections
Tuberculosis
Answer: E* Tuberculosis
***) All of the following are sexually transmitted diseases, except:
Trichomoniasis
Candidiasis (moniliasis)
Condyloma acuminate
Gonorrhea
Syphilis
Answer: B* Candidiasis (moniliasis)
***) Gonorrhea may affect all of the following, except:
Fallopian tubes
Urethra
Vagina
Cervix
Bartholin gland
Answer: C* Vagina
***) All the following are true about Neisseria gonorrhoeae, except:
Is a Gram-negative coccus
Is a Gram-negative bacillus
Occurs in pairs
Has a capsule
Sensitive to penicillin
Answer: B* Is a Gram-negative bacillus
***) Regarding Neisseria gonorrhea culture during pregnancy, the highest positive culture is got
from:
Urethra
Cervix
Vagina
Rectum
Throat
Answer: A* Urethra
***) Identification of donovan bodies in large mononuclear cells in Gimsa-stained from vulval lotion
during pregnancy is diagnostic of:
Chancre
Chancroid
Granuloma inguinale
Lymphogranuloma venereum
Sarcoid
Answer: C* Granuloma inguinale
***) Sexually transmitted diseases include all of the following except:
Type II herpes hominis
Condyloma acuminate
Chlamydial infections
Type I herpes hominis
Answer: E* Type I herpes hominis
***) All of the following diseases are transmitted sexually, except:
Cytomegalovirus
Hepatitis B
Herpes simplex
Scabies
Granuloma annulare
Answer: D* Scabies
???) All of the following diseases are transmitted sexually, except:
Chancroid
Hepatitis B
AIDS
Gonorrhea
Pemphigoid
Answer: 5- Pemphigoid
Bartholin Gland Abscess.
***) In bartholin abscess, one of the following statements is true:
It occurs bilaterally in most cases
Treatment is by surgery (marsupialization)
It may cause infertility
The most common causing agent is staphylococcus
Antibiotic treatment is enough
Answer: B* Treatment is by surgery (marsupialization)
Pelvic Inflammatory Disease.
***) All of the following microorganisms may cause acute salpingitis, except:
Neisseria gonorrhea
Chlamydia
Bacteroids
Candida albicans
Gram negative streptococci
Answer: D* Candida albicans
***) All of the following conditions may be confused with acute salpingitis, except:
Acute appendicitis
Tubal pregnancy
Acute pyelonephritis
Bartholin's abscess
Ruptured ovarian cyst
Answer: D* Bartholin's abscess
***) Management of septic pelvic thrombophlebitis usually will include:
Bed rest and analgesics alone
Antibiotics alone
Antibiotics and heparinization
Heparinization alone
Immediate vena cava ligation
Answer: C* Antibiotics and heparinization
***) Pelvic fallopian tube adhesions causing infertility may be due to all of the following, except:
Appendicitis
A post abortion infection
A post puerperal sepsis
Adenomyosis
Pelvic endometriosis
Answer: D* Adenomyosis
***) Symptoms of PID include all of the following except:
Abdominal pain
Dyspareunia
Amenorrhea
Abnormal vaginal discharge
Fever and chills
Answer: C* Amenorrhea
***) PID differential diagnosis includes all of the following except:
Ectopic pregnancy
Endometriosis
Spontaneous abortion
Intrauterine pregnancy
Diverticulitis
Answer: D* Intrauterine pregnancy
***) About tuberculosis of the genital tract, all the following are true except:
Most commonly affects the fallopian tubes
It is transmitted by hematogenous spread
Causes infertility
Causes amenorrhea
Predisposes to endometrial carcinoma
Answer: E* Predisposes to endometrial carcinoma
Menopause GY33-GY35.
Menopause.
***) Concerning menopause the following are correct, except:
Serum androstenedione levels increase
The quantity of estrogens present increase by obesity
Therapy is rarely needed for more than 4 months
Combined estrogen and progesterone therapy is best
Withdrawal bleeding following combined therapy is not an indication for curettage
Answer: C* Therapy is rarely needed for more than 4 months
***) During menopause one of the following is true:
Serum FSH only is elevated
Serum LH only is elevated
Both FSH and LH are elevated
Serum FSH is low
Serum FSH and LH are low
Answer: C* Both FSH and LH are elevated
***) All of the following may occur in menopausal women, except:
The breast tend to decrease in size
The uterus atrophies
The endometrium hyper-atrophies
The vaginal mucosa becomes thin
The pH of the vagina rises
Answer: C* The endometrium hyper-atrophies
***) All of the following symptoms are true for menopause, except:
Irritability
Headache
Vasomotor instability
Backache
Ovulation
Answer: E* Ovulation
***) Regarding the climacteric, all the following are true except:
Headache
Palpitation
Hot flushes
Low FSH
Sweating
Answer: D* Low FSH
***) Menopause is associated with all of the following, except:
Hot flushes
Insomnia
Decreased incidence of myocardial infarction
Osteoporosis
Loss of libido
Answer: C* Decreased incidence of myocardial infarction
Urogynecology GY35-GY37.
Pelvic Prolapse.
***) Symptoms of uterine prolapse are the following, except:
Retention of urine
Backache
Vaginal discharge
Vaginal bleeding
Heaviness in the vagina
Answer: A* Retention of urine
Urinary Incontinence.
***) Concerning stress urine incontinence the following are correct, except:
Can be caused by rectocele
Is more common in multi parous
Long term antibiotic therapy will not improve it
Can be treated by anterior colporrhaphy
Can be treated by colposuspension
Answer: A* Can be caused by rectocele
Gynecological Oncology GY37-GY51.
Uterus.
***) Risk factors of endometrial carcinoma include all of the following except:
Estrogen therapy
Early menopause
Obesity
Low parity
Adenomatous hyperplasia
Answer: B* Early menopause
***) A 47 year old woman complains of heavy post-coital bleeding. The most likely origin of his
bleeding would be:
Cervical polyp
Ectropion
Carcinoma
Nabothian cyst
Infection
Answer: C* Carcinoma
***) One of the following drugs causes endometrial hyperplasia:
Progesterone hormone
Clomiphene citrate
Estrogens
Combined oral contraceptive pills
Bromocriptine
Answer: C* Estrogens
***) The most common symptom of endometrial hyperplasia is:
Vaginal discharge
Vaginal bleeding
Amenorrhea
Pelvic pain
Abdominal distention
Answer: B* Vaginal bleeding
***) Endometrial carcinoma is most common in which of the following:
10 to 25 years
25 to 30 years
30 to 40 years
40 to 50 years
More than 60 years
Answer: E* More than 60 years
***) A 69 years old postmenopausal woman is being admitted for surgical treatment of endometrial
cancer. Which of the following is the best preoperative test to look for metastasis:
Chest X-Ray
Hysterosalpingogram
Pelvic US
Intravenous pyelogram (IVP)
Barium enema
Answer: A* Chest X-Ray
***) The primary mode of treatment for endometrial carcinoma confined to the uterine body is:
External beam radiation
Intracavitary radium
Hysterectomy
Chemotherapy
Progestin therapy
Answer: C* Hysterectomy
***) All of the following are estrogen actions on the uterus, except:
It causes an active development of the myometrium
The endometrium undergoes proliferation
Stimulates the growth of the glandular component
It causes increase of cervical mucus
Has no effect on enlargement of the uterus during pregnancy
Answer: E* Has no effect on enlargement of the uterus during pregnancy
Ovaries.
***) One of the following ovarian tumors is more likely to cause hirsutism:
Theca lutein cyst
Androblastoma
Krukenberg tumor
Serous cystadenoma
Follicular cyst
Answer: B* Androblastoma
***) One of the following ovarian tumors is malignant:
Follicular cyst
Luteal cyst
Dysgerminoma
Chocolate cyst
Dermoid cyst
Answer: C* Dysgerminoma
***) Concerning dermoid cysts the following are correct, except:
Are germ cell tumors
Are bilateral in 10% of cases
Are the commonest cysts defected during pregnancy
Are malignant in less than 5% of cases
Are frequently XY (karyotype)
Answer: E* Are frequently XY (karyotype)
***) Concerning malignant ovarian tumors, all the following are true except:
Are often bilateral
Often present as an asymptomatic mass
More common post menopause
Have a good prognosis after treatment
Are mostly hormone secreting
Answer: E* Are mostly hormone secreting
***) The most frequent diagnosed type of ovarian cancer is:
Epithelial
Germ cell
Specialized stromal cell
Non-specialized stromal cell
Metastatic disease to the ovary
Answer: A* Epithelial
***) The first line of treatment for ovarian cancer is:
Radiotherapy
Surgery
Chemotherapy
Radiotherapy and chemotherapy
Observation
Answer: B* Surgery
***) The primary lesion of Krukenberg ovarian tumor is commonly in:
Large bowels
Brain
Stomach
Bone
Liver
Answer: C* Stomach
***) A 65 years old woman was found to have ovarian cyst 6x6 cm, the proper treatment is:
Observation
Laparoscopy
Laparotomy and cystectomy
Hysterectomy
Treatment no need
Answer: C* Laparotomy and cystectomy
***) Childhood neoplastic ovarian masses most commonly from:
Gonadal epithelium
Gonadal stromal
Germ cells
Sex cord
Metastatic disease
Answer: C* Germ cells
***) The most common complication of large cystic teratoma during the first trimester is:
Torsion
Rupture
Intracystic hemorrhage
Solid degeneration
Luteinization
Answer: A* Torsion
***) A medium-size ovarian cyst may be subjected to the following except:
Torsion
Necrosis
Infection
Rupture
Malignant changes if she gets pregnant
Answer: E* Malignant changes if she gets pregnant
???) The commonest malignant tumors of the ovary are:
Germ cell tumors
Epithelial tumors
Metastases from other tumors
Stomal tumors
Knikenburg tumors
Answer: B* Epithelial tumors
???) Most common neoplastic ovarian masses in postmenopausal women originate from:
Ovarian epithelium
Ovarian stroma
Ovarian germ cells
Ovarian sex cord
Metastatic disease
Answer: 1* Ovarian epithelium
???) Benign cystic teratoma (dermoid cyst) is characterized by one of the following:
It occurs bilaterally in 50% of cases
It is formed of squamous epithelium only
It is formed of squamous epithelium and sebaceous glands only
It is formed of all three germ cell layers
The commonest ovarian tumor associated with pregnancy
Answer: 1* It occurs bilaterally in 50% of cases
Cervix.
***) Regarding carcinoma of the cervix, all the following are true except:
Cervical smear is a screening method
In the early stages of the disease there are no symptoms
Cervical cancer spreads only by direct spread
Post coital bleeding can be first sign
Adenocarcinoma of the cervix account for 5% of cases
Answer: C* Cervical cancer spreads only by direct spread
***) The lining of cervical erosion is:
Squamous epithelium
Squamous epithelium with keratin
Columnar epithelium
Transitional epithelium
Cervical stroma
Answer: C* Columnar epithelium
***) The histologic differentiation between invasive carcinoma of the cervix and carcinoma in situ
depends upon one of the following:
The Papanicolau smear report
The basement membrane having been penetrated by abnormal epithelial cells
The finding of cluecells in the basement membrane
The finding of increased eosinophilic cytoplasm in the surface epithelium
The surface epithelium taking up nils blue sulfate staining
Answer: B* The basement membrane having been penetrated by abnormal epithelial cells
***) In case of cervical carcinoma in situ in 50 years old woman, the treatment of choice is:
Hysterectomy
Cervical cryo-surgery
Cervical cone-biopsy
Selective biopsy under colposcopy
Radiotherapy
Answer: A* Hysterectomy
***) One of the following is recommended for cervical cancer screening:
Aspiration from the anterior fornix
Cervical canal curettage
Aspiration from the posterior fornix
Ultrasound to the genital tract
Papanicolau (pap) smear
Answer: E* Papanicolau (pap) smear
***) Asymptomatic cervical erosion in a pregnant patient is best managed by:
Heat cautery
Pap smear and follow up
Cone biopsy
Cryocautery
Cervical amputation
Answer: B* Pap smear and follow up
***) Invasive carcinoma of the cervix commonly present with all the following, except:
Post coital bleeding
Intermenstrual bleeding
Vaginal discharge
Acyclic vaginal bleeding
Menorrhagia
Answer: E* Menorrhagia
***) The most common benign neoplasm of the cervix and endocervix is:
Leiomyoma
Endometriosis
Metastasis of uterine cancer
Metastasis of ovarian cancer
Polyps
Answer: E* Polyps
***) Often the first symptom of cervical cancer is:
Leg pain
Pain during intercourse
Vaginal bleeding
Weight loss
Vulvar pruritus
Answer: B* Pain during intercourse
???) Cervical smear is a method to detect early cancer of:
Ovarian
Endometrial
Vaginal
Cervical
Urethral
Answer: D* Cervical
Vulva.
***) The etiologic agent for vulvar cancer is:
Squamous cell hyperplasia
Atrophic dystrophy
Chronic granulomatous disease
Chronic irradiation
Unknown
Answer: E* Unknown
***) The most common symptom of vulvar cancer in elderly woman is:
Abnormal bleeding
Foul smell
Pruritus
Vulvar atrophy
Painful intercourse
Answer: C* Pruritus
***) A blue swelling on the vulva is most likely due to:
Melanoma
Varicosity
Endometriosis
Lipoma
Hemangioma
Answer: B* Varicosity
Vagina.
***) The most common histopathological finding in primary carcinoma of the vagina is:
Clear cell carcinoma
Melanoma
Squamous cell carcinoma
Sarcoma
Choriocarcinoma
Answer: C* Squamous cell carcinoma
Some of the very repeated and #importantquestions with #explaination

*The normal antero-posterior diameter of the outlet of female pelvis (from the apex of the coccyx to
the lower border of symphysis pubis) is nearest to:
a. 105 mm
b. 115mm
c. 125mm
d. 135mm
e. 145mm
________________________________________
Ans. B
1 cm = 10 mm
Antero-posterior diameter of pelvic outlet = 11.5 cm = 115 mm
....................
*Regarding urinary bladder, what is true
a. Supplied by anterior division of
internal iliac
Separated from uterus by pouch of
Douglas
c. In males has seminal vesical above and
vas deferens below
d. Lies anterior to symphysis pubis
________________________________________
Ans. A. Urinary bladder is supplied by superior + inferior vesical arteries which are branches of
anterior division of internal iliac arteries....
.....................
. Parasympathetic nerves supplying the
urinary bladder are:
a. Pelvic splanchnic nerves.
b. Superior mesenteric plexus
c. Cystic nerve
d. Inferior mesentric plexus
________________________________________
Ans. A
PARASYMPATHETIC SUPPLY
The parasympathetic nerves supplying the urinary bladder are pelvic splanchnic nerves (S1, S2, S4)
SYMPATHETIC SUPPLY
Sympathetic supply to urinary bladder comes from lower thoracic lumbar splanchnic nerves (T11 –
L2)
.................
4. In female the neck of urinary bladder is
located
a. At variable position
b. Below the urogenital diaphragm
c. Pierce the urogenital diaphragm
d. Above the urogenital diaphragm
e. Behind symphsis pubis
________________________________________
Ans. D
The neck of urinary bladder is located above the urethra. The urogenital diaphragm surrounds the
urethra; so, the neck of urinary bladder is located above the urogenital diaphragm.
............................................
1. Patient unable to void after fall, which of
the following section affected
a. L2,L3,L4. L5
b. L1, L2
c. Sl, S2, S3
d. S2, S3, S4
________________________________________
Ans. D. NOTE: The following information is extremely high yield.
DETRUSER MUSCLE
Contraction of detrusor muscle is under the control of parasympathetic fibers of pelvic splanchnic
nerves (S2, S3, S4)
INTERNAL URETHRAL SPHINCTER (SPHINCTER VESICAE)
The internal urethral sphincter is composed of smooth muscle fibers that enclose the origin of
urethra at the neck of the bladder.
It is under the control of sympathetic fibers of lower thoracic and lumbar splanchnic nerves (T12 –
L2)
EXTERNAL URETHRAL SPHINCTER (SPHINCTER URETHRAE)
It is the voluntary skeletal muscle component of urogenital diaphragm.
It is innervated by perineal branches of pudendal nerve.
MICTURITION REFLEX
As bladder fills, stretcher receptors in muscles of bladder wall are stimulated → Afferent (sensory)
impulses pass through parasympathetic fibers to S2, S3, S4 (micturition reflex center) of spinal cord
→ Efferent (motor) impulses are sent through the same nerve to detrusor muscle of the bladder →
Detruser muscle contracts
PARASYMPATHETIC NERVOUS SYSTEM
The parasympathetic nervous system facilitates micturition (and inhibits bladder filling).
SYMPATHETIC NERVOUS SYSTEM
The sympathetic nervous system inhibits micturition (and facilitates bladder filling).
SPASTIC BLADDER (AUTOMATIC BLADDER)
Lesion above the sacral segments → Loss of inhibition of parasympathetic nervous system →
Overactive parasympathetic → Detruser muscle contracts frequently → Frequent micturition
ATONIC BLADDER (AUTOMATIC BLADDER)
Lesion of the sacral segments → Parasympathetic inhibited → Loss of contraction of detrusor
muscles → Bladder fills to its capacity, with resultant continuous dribbling of urine (overflow
incontinence)
2. External urethral sphincter is present in
a. Urogenital diaphragm
b. Superficial perineal pouch
c. Pelvic diaphragm
d. Trigone of the bladder
________________________________________
Ans. A. Refer to the above MCQ.
3. Supply of sphincter urethra comes from
a. llioinguinal nerve
b. Pelvis splanchnic nerves
c. Sacral splanchnic nerves
d. Autonomic nerves
e. Pudendal nerves
________________________________________
Ans. E. refer to the above MCQ.
4. After 15 days of a section due to
Obstructed Labour ,patient developed
Urinary incontinence. Wlit is the most
likely cause
a. Vesicovaginal Fistula
b. Vesicouterine Fistula
c. Rectovesical fistula
d. All of above
________________________________________
Ans. A
5. Parasympathetic nerves supplying the
urinary bladder are:
a. Pelvic splanchnic nerves.
b. Superior mesenteric plexus
c. Cystic nerve
d. Inferior mesentric plexus
________________________________________
Ans. A. refer to the above MCQ
6. If autonomic afferent is cut off from
urinary bladder, it will result in
a. Overflow dribbling
b. Retention
c. Increase frequency
________________________________________
Ans. A. Refer to the above MCQ.
................................
Hormones produced by pituitary acidophils are Regulated by
A. Releasing hormones and release-inhibiting hormones
B. Releasing hormones and target gland hormones
C. Releasing hormones only
D. Releasing hormones, release-inhibiting hormones and target gland Hormones
E. Target gland hormones only
________________________________________
Ans. DDD
RELEASING HORMONE: The hormone which stimulates the release (secretion) of other hormones
is called releasing hormone.
RELEASE-INHIBITING HORMONE: The hormone which inhibits the release (secretion) of other
hormones is called release-inhibiting hormone.
ACIDOPHILS
• Somatotrophs are called acidophils because they stain with acidic dyes (acido = acid; phil = loving).
• Somatotrophs produce growth hormone; growth hormone secretion is regulated by:
1. Releasing hormone (i.e., GHRH, from hypothalamus)
2. Release-inhibiting hormone (i.e., somatostatin, from hypothalamus)
3. Target gland hormone (i.e., liver is target organ of growth hormone where it stimulates IGF
secretion; IGF then inhibits GH secretion).
..........................................
*During activation of a nerve cell membrane:
A. Sodium ions flow outwards
B. Potassium ions flow inwards
C. Chloride ions flow inwards
D. Proteins flow outwards
E. The membrane potential is reversed
________________________________________
Ans. E. RMP is -65mV. Upon stimulation, sodium influx occurs and polarity changes to +40 mV; this
+40 mV charge is called depolarization. So, membrane potential is temporarily reversed during
stimulation.
.....................
*caplan's syndrome usually occurs among
A. Arc welders
B. Coal workers
C. Hay farmers
D. Radar assembly workers
E. Textile workers
________________________________________
Ans. B. Coal causes PNEUMOCONIOSIS (an occupational disease of the lungs due to inhalation of
dust, characterized by inflammation, coughing, and fibrosis); pneumoconiosis may then cause
caplan’s syndrome.
....................................
Hypertrophy
A. Involves endocrine glands
B. Is always pathological
C. Is not reversible
D. Is unlimited
E results in increased DNA contents
________________________________________
Ans. E. Permanent cells (e.g, cardiac myocytes) can not divide. But when they hypertrophy, they're
making their best attempt at it. Their best attempt is to duplicate their DNA content (become 4n from
2n), but the cell doesn't actually divide. So, the nuclei of hypertrophied cells may have a higher DNA
content because the cells fail to undergo mitosis.
..........................
Ascaris lumbricoides
A. Infective larvae are passed in the faeces
B. Length is less than an inch
C. May cause appendicitis
D. May cause auto-infection
E. May cause iron deficiency anaemia
________________________________________
Ans. C. Ascaris lumbricoides is the largest of all worms. It can enter appendix and can block its
lumen, thus resulting in appendicitis. It can also cause intestinal obstruction (constipation) in children
which then requires surgery.
.................................
Mesangialization of the capillary basement membrane is most
Closely associated with
A. Alport's syndrome
B. Amyloidosis
C. Benign recurrent hematuria
D. Mem branoproliferative glomerulonephritis type 1
E. Membranoproliferative glomerulonephritis type 2
________________________________________
Ans. D. MESANGLIZATION: Mesangalization means “thickening of kidney glomerular mesangium
due to deposits”.
MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS:
Membranoproliferative glomerulonephritis ("MPGN"), also known as mesangiocapillary
glomerulonephritis, is a type of glomerulonephritis caused by deposits in the kidney glomerular
mesangium and basement membrane (GBM) thickening. It should not be confused with
membranous glomerulonephritis, a condition in where the basement membrane is thickened, but the
mesangium is not. There are three types of MPGN:
Type 1 (also called mesangiocapillary glomerulonephritis)
It is caused by immune complexes depositing in the kidney glomerular mesangium.
Type 2 (also called dense deposit disease):
It is caused by dysregulation of the alternative complement pathway (The alternative pathway of the
complement system is one of three complement pathways that opsonize and kill pathogens).
Type III:
Type III is very rare, it is characterized by a mixture of subepithelial deposits and the typical
pathological findings of Type I disease.
............................
*Diagnosed case of thyrotoxicosis came
to you with heart rate of 190b/mn.Best
treatment is
a. Digoxin
b. Lidocain
c. Verapamil
d Propanalol
________________________________________
Ans. D
- Drug of choice for atrial fibrillation is digoxin.
- However, drug of choice for hyperthyroidism-induced atrial fibrillation is beta blocker.
...........................
*If a patient fall down and has fracture of neck of fibula which nerve is most likely to be
Damaged
A. Femora:
B. Tibial
C. Sciatic
D. Common peroneal
________________________________________
Ans. D. Fracture of neck of fibula results in damage to: (1) Common peroneal (fibular) nerve (2)
Anterior tibial artery
...........................
Gas gangrene is caused by which of the following
A. Clostridum botutinum
B. Clostridum welchii
C. Closthium tetanus
________________________________________
Ans. B. Clostridium welchii is the old name for Clostridium perfringens
.....................
In children main arterial supply to head of femur is from
A. Obturator artery
B. Internal pudendal artery
C. 0; dumflex Iliac
D. Supertcial circumflex iliac artery
________________________________________
Ans. A. CHILDREN: In children, head of femur is supplied by obturator artery. ADULTS: In adults,
head of femur is mainly supplied by medial femoral circumflex artery (which is a branch of deep
femoral artery, which in turn is a branch of femoral artery).
...............................
A patient presents with dislocation of hip after an accident. Which of the following muscle
group is involved?
A. Gluteus Maximus+Minimus+Medius
B. Only Gluteus medius
C. Only Gluteus Maximus
D. Gluteus Maximus+Medius
E. Only gluteus Minimus
________________________________________
Ans. A. All the three muscles (gluteus maximus + medius + minimus) originate from pelvic bones
and are inserted into the femur.
...............................
Which of the following does not cross placenta easily
A. glucose
B. amino acid
C. IgG
D. IgM
E. CO2
________________________________________
Ans. D. Ig"M" is reserved for "M"other only.
................................
ciliary body develops from
a. neuro ectoderm
b. mesoderm
c. both neuroectoderm& mesoderm
________________________________________
Ans. C. CILIAY BODY: Epithelium of ciliary body is derived from neuroectoderm while its stroma is
derived from mesoderm.
.................................
Stimulation of ventromedial nuclei of hypothalamus causes:
A. Anorexia
B. Diabetes Insipidus
C. Hyperthermia
D. Obesity
E. Inability to thermoregulate
________________________________________
Ans. A. SATIETY CENTER: Satiety center is located in ventromedial nuclei of hypothalamus.
HUNGER CENTER: Hunger center is located in ventrolateral nuclei of hypothalamus.
.........................................
A 65 years old woman is blind on testing but denies that there is a problem with her eyesight.
Diagnose the visual defect?
A. Increased size of blind spot
B. Right homonymous hemlanopia
C. Cortical blindness
D. Hysteria
E. Arnaurosisfugus
________________________________________
Ans. is "C"
In cortical blindness, the patient usually denies visual loss (anton-babinski syndrome).
....................................
During activation of a nerve cell membrane:
A. Sodium ions flow outwards
B. Potassium ions flow inwards
C. Chloride ions flow inwards
D. Proteins flow outwards
E. The membrane potential is reversed
________________________________________
Ans is "E"
RMP is -65mV. Upon stimulation, sodium influx occurs and polarity changes to +40 mV; this +40 mV
charge is called depolarization. So, membrane potential is temporarily reversed during stimulation.
................................
Quick revision of pharma portion of Rabia ali

In form of points :
️ Drugs safe in pregnancy (diff mcqs ) :
♦️
Fluoxetine Phenobarbitone✔️ ,co amoxiclave ✔️ ✔️
♦️drugs crossing placenta

Morphine phenytoin ✔️ diAzepam ✔️
➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖
Mechanisms of action (asked one )
➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖
🔹Penicillin : cell wall synthesis inhibitor

🔹Tetracycline : inhibit protein synthesis
🔹Rifampicin : inhibit transcription
🔹Azathiopurine : inhibit both cellular n cytological immune response
🔹Cyclosporin : blocks T cell differentiation
blocks T cell maturation
Dec host response to graft
🔹Labetalol : alpha + beta blocker
🔹Clonidine : centrally acting antihypertensive , pre synaptic alpha 2 agonist in vasomotor centre of
brain ,decreases sympathetic outflow to BVs
🔹steroids,:inhibit phospholipase A 2
🔹Sulphonamides : inhibit tetrahydrofolate in bacteria
🔹Na chromoglycate :Mast cell stabiliser
🔹Neb with ipratropium : Decreases Ach release in bronchi
🔹 furosemide : - smooth muscle relaxation
- Rapid diuresis
🔹curare : inhibit nicotinic Ach receptors
🔹aspirin : IRReversibily blocks COX
🔹morphine :releases histamine
🔹heparin : inhibits clot propagation (not clot organisation ) ❌
🔹 EPO acts on stem cells ( not CFU ) ❌
🔹 digoxin increases contractility n decreases heart rate

➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖
Side effects (asked one ) ::

➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖
🔹Phenylbutazone : Aplastic anemia

🔹Streptomycin : ototoxic /hearing loss
🔹Aminoglycosides : ototoxic
🔹dipyridamole: coronary steal syndrome
🔹Thiazides : Ca Uric acid(gout)
⬆️ K,
⬆ glucose ⬇️ ⬆️
🔹Thiopentone : hypotonicity , hypersensitivity

🔹Chlorpromazine : extra pyramidal side effects (dystonia)
🔹phenytoin : granulocytopenia , hirsuitism , gingival hyperplasia , Interstitial Pneumonitis , drug
induced SLE ,Ataxia , megaloblastic anemia (folate depletion ) ,painful swollen gums
🔹Methotrexate : hepatotoxic , pul. Fibrosis , megaloblastic anemia
🔹 lithium : hypothyroidism ,renal toxicity , cardiac conduction abnormalities , nephrogenic DI ,
gastric distress ,tremors , • *narrow therapeutic index
🔹ACE inhibitors : bone marrow depression , neutropenia , proteinuria
🔹sulphonamides : g6pd hemolysis , kernicterus , Nephrotoxic
➡️
🔹Opioid poisoning :respiratory depression

🔹aminoglycosides :both renal n ototoxicity
🔹bupivicaine : cardiotoxic
🔹trazodone : priapism
🔹terbutaline : acidosis ,Fine tremors
🔹 Azathiopurine : Hepatosplenic T cell Lymphoma
🔹Didanosine : peripheral neuropathy
🔹Haloperidol : neuroleptic malignant syndrome
🔹 Na valproate : flexing tremor
🔹Adriamycin : cardiomegaly
🔹Amiodarone : thyroid dysfunction
🔹pyrizinamide : gout
🔹vancomycin :red man syndrome
🔹clindamycin : pseudo membranous colitis
🔹Trimethapan : urinary retention in elderly
🔹nitroglycerine : throbbing headache
🔹Lithium carbonate : polyuria
🔹 analgesic nephropathy features : hematuria ,sterile pyuria
🔹Thiabendazole : cholestatic jaundice
🔹methyldopa : indirect hyperbilirubinemia
🔹paracetamol poisoning : Renal papillary necrosis
🔹snerio : drug prescribed for HTN ..caused postural hypotension ,diarrhoea , problem in ejaculation
,drug was ? guanithidine
🔹eye drops given caused severe pain ,reduced vision ,drug given ? Atropine
🔹drug given for severe headache & vision impairment ,pt developed dyspnea ,drug ?
Propanolol
🔹 RTA Renal stones
➡️
➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖
🔸Granulocytopenia : phenytoin , clozapine

🔸methemoglobinemia : procaine ,
benzocaine
🔸Gynaecomastia : griseofulvin ,digoxin ,cemitidine ,spironolectone
🔸corneal opacity :coloroquine ,
phenothiazines
🔸Reflex tachycardia : nitroglycerin , CA channel blockers , pethidine > morphine
🔸pseudo membranous colitis : clindamycin
2 - amikacin + clavulinic acid
3- ceftriaxone ,cefotaxime
➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖
TREATMENTS : ‼️ ‼️
➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖
Mild CCF monotherapy ? ACE inhibitor (1 mcq) , captopril (other mcq)

🔹
CCF with IHD : diuretics + ACE inhibitor

🔹
recurrent MI : anticoagulants
🔹
Now these r confusing but all r kept in sequence

DOC for ac ventricular failure with resp distress : I/V furosemide ( other options were
🔹
dopamine , oxygen
❌ , streptokinase ) ❌ ❌
🔹acute LVF ,DOC ? I/V furosemide
🔹pt with CCF ,presents with arrythmias ,DOC ? digoxin
🔹known CCF pt presents with ectopics ,DOC ? Diuretics (treat HF it will Dec ectopics )
🔹Pt with chest pain & ventricular ectopics DOC ? Lidocaine [(it's the DOC for any kind of ventricular
arrythmias after myocardial Ischemia (evident here with chest pain )]
🔹Ventricular tachycardia after IHD : I/V lidocaine ( another mcq same snerio )
🔹DOC for Afib : digoxin
🔹hypertrophic obstructive CM ...which ca channel blocker ? Verapamil
🔹recurrent TIAs : aspirin (if intolerant,ticlodipine )
🔹 anaphylactic shock DOC : epinephrine
🔹acute asthama DOC :terbutaline (b2 agonist )
🔹partial absent seizures :ethosuxamide
🔹status epilepticus DOC to start with ? Lorazepam
🔹DOC systemic fungal infection :amphotericin
🔹ketamine hallucination Tm ? Atropine
🔹E.coli UTI DOC ? Ciprofloxacin
🔹HCV : IFN & ribavirin
🔹SAH : nimodipine
🔹DOC in OCD : clomipramine
🔹DOC CMG chorioretinitis : Gancyclovir
🔹Tapeworm (D.Latum ) : Niclosamide
🔹hookworm /pinworm : mebendazole
🔹Pul anthrax : ciprofloxacin
🔹Herpes keratoconjuctivitis : triflunidine
🔹Prinzmetal angina : diltiazem
🔹HIT : lepirudin
🔹 PIH : Methyldopa
🔹 preeclampsia : hydralazine
🔹Pseudomonas infection: ceftazidine , cefepime , cipro/ofloxacin , piperacillin/ ticarcillin ,
aminoglycosides
🔹rib fracture : bupivicaine
🔹mountain sickness : acetazolamide
🔹 motion sickness : scopolamine ,cyclizine
🔹asthamatic pt muscle relaxant to give ? Suxamethonium
🔹 asthama + IHD pt in OT ,to treat HTN ? I/V Nitroglycerin
🔹metastatic pleural effusion : bleomycin
🔹DOC ac pancreatitis :pethidine (analgesic )
🔹 terminal CA pt : morphine (analgesic )
🔹diabetic + post op gastroparesis : metoclopramide (D2 antagonist )
🔹antiemetic for cancer chemotherapy : odansetron (5 HT3 antagonist )
🔹anti psychotic induced Parkinsonism : anticholinergic (benztropine )
🔹diabetic macular edema : ranibizumab
🔹 thyrtoxicosis + HR 190 ,Tm ? Propranolol
( other options were : digoxin , lidocaine )
➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖
RANDOM : ‼️
➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖ ➖
🔹Warfarin effect increased by?? Cemitidine

🔹man with pin point pupil not responding to naloxone - Phenobarbitone
🔹therapeutic dose z measured by ? Potency
🔹bioavailability determines ? Efficacy
🔹 basic drug binds to : alpha glycoproteins
🔹following drugs promote each other's action ? Atropine n amitriptyline ✔️
🔹 Pt taking MAO inhibitors ,given barbiturates , wt will happen ? Coma

🔹Pt on MAO inhibitors , coffee HTN ➡️
🔹cotrimoxazole given ... C/O Red urine

,diagnosis ? G6pd deficiency
🔹 drug with atropine like action ? Scopolamine
🔹 digoxin toxicity increased by ?
1- hydrochlorthiazide 2- quinidine ✔️ ✔️
🔹gastric emptying decreased by ? AlSo4

🔹drug contraindicated in CLD ? Pentazocine
🔹p450 inducer ? Phenobarbitone
🔹probenecid decreases renal excretion of penicillin
🔹digoxin toxicity increased by :
Hypokalemia , alkalosis
🔹morphine given ,relieve pain in hrs ? 3-4
🔹naloxone reverses resp depression & coma in ? 30sec
🔹cough during induction of anesthesia.. Which drug was given ? Sevoflurane
🔹which 1 is synthetic mineralocorticoid ?
Fludrocortisone
🔹 hemophilic pt with pain .. Safe Analgesic ? Acetaminophen
🔹desmethyl dizepam half lyf ? 32-200 hrs
🔹which is more pungent ? Desflurane
🔹ketamine questions :
✒️a bronchodilator ✔️
contraindication : intracranial HTN

✒️
✒️hallucination treated with ? Atropine

✒️given I/M in cardiac surgery
🔹mushroom poisoning : atropine
🔹drug used with methotrexate to reduce its s/e ? Leucovorin
🔹girl with severe ulcerative colitis , wt to give ? I/V steroids
🔹 MgSO4 antidote ? CA gluconate
🔹 intrinsic heart rate determined by ?
I/V atropine + atenolol
🔹minimal GI upset : paracetamol
Max GI upset :aspirin
🔹 digoxin
-Given in : AFib , SVT , CCF , flutter
-contraindications : obstructive cardiomyopathy , high output CF
🔹Barbiturates given in kernicterus , refractory status epilepticus
, contraindicated in
Ac intermittent porphyria
🔹non barbiturate hypnotic ? Bromide
🔹 salicylate excretion increased by ? I/V. NaHCO3
🔹skin disinfection : alcohol with chlorhexidine
🔹 fluoxetine -not epileptogenic
Amitriptyline n imipramine r epileptogenic
🔹 ergotamine contraindicated in heart disease n HTN
🔹hepatic adenoma -amiodarone
🔹 drug not effective in prevention of DVT ? Aspirin (while warfarin n LMW heparin r effective )
🔹Not an I/V therapy for HYpertensive ER - nifedipine
🔹serotonin syndrome :fluoxetine + clomipramine
🔹fasciculation after muscle relaxation caused by ? Succinylcholine
List Of #Bodies
1) Negri bodies ( intracytoplasmic) – Rabies
2) Guarnieri( acidophilic intracytoplasmic) – Pox
3) Owls ( Intra – nuclear and cytoplasmic) – CMV
4) Cowdry ( intranuclear) – HSV, Measles
5) Downey type II - EBV
6) LD bodies – Substantia nigra
7) Zebra bodies (lysosomal) – Neimann Picks
8) Councilman bodies - Hepatitis
9) Psammoma bodies – Meningioma, Papillary ca. thyroid, Ovarian cystadenoma
10) Call exner bodies – Granulosa cell tumor
11) Loose bodies - Osteoarthritis
12) Russell and Dutcher bodies- Lymphoplasmacytic lymphoma
13) Schiller Duval bodies – Yo;k sac tumor (testicular)
14) Verocay – Schwanoma
15) Hunter bodies – Hashimotos thyroiditis
16) Hurthle cells – Hashimotos
17) Aschoff bodies – RHD
18) Hirano bodies – Alziemers
19) Ferruginous bodies – Asbestos bodies coated with iron
20) Schaumann bodies – Sarcoidosis
21) Asteroid bodies( satellite giant cells , cytoplasmic inclusions) – Sarcoidosis
22) Mallory bodies ( cytoskeletal intermediate filament) – Alcoholic hepatitis
23) Howel Jolly bodies( remnant of nuclear chromatin) – Severe anemia, Post splenectomy
24) Pappenheiner bodies (composed of iron) – Post splenectomy
25) Heinz bodies( denaturated Hb) - G6PD defficiency, alpha thalessemia( HbH disease)
26) Dohle bodies (aggregates of RER) - Leukocytosis
#Rapidrivision CELL CYCLE
Consists of two phases interphase and mitosis
INTERPHASE ....Chromosomes REPLICATE
INTERPHASE ....DNA REPLICATE
INTERPHASE....Barr Bodies are studied
INTERPHASE is divided into...
1.G1
2.S (SYNTHESIS Phase)
3.G2
4.Mitosis ( also called M phase & cytokinesis is a part of it )
G1...Primary Growth , Protiens , Organelles , mRNA Synthesis )
G1...Also Called growth phase
G1... Longest phase ( 8to 10 Hours)
G1 Check point...To check if DNA is damaged
S ....DNA Replicate
S....Cytotoxic & cancer drugs act here to destroy DNA
S.....5 to 6 hours
G2...Secondry growth ( between S phase & Mitosis)
G2...Short ( 3 to 4 hours)
G2 Check point... To check if DNA has replicated properly
MITOSIS / M Phase
M...Shortest (2 hours)
M... To see spindle assembly and allignment
M...nuclear content divide
M...genetic material is Chromosome (Genetic material is chromatid when NOT in M phase)
M... Divided into Prophase, prometaphase, Metaphase, AnaPhase , Telophase, Cytokinesis
PROPHASE....Spindle fibers appear Chromosome Condensation
PROPHASE...Centriole start moving to the oposite end
PROMETAPHASE....Spindle fibers attach to chromosome & chromosome movement
PROMETAPHASE....Nuclear membrane dissolve marking the begining of prometaphase
METAPHASE...Chromosome Allignment
METAPHASE.....Chromosome thickest
METAPHASE......Chromosome begin to divide
METAPHASE...Karyotyping
ANAPHASE.... Division of chromatids & sister chromatids move to opposite side
ANAPHASE....NON Disjunction
TELOPHASE...Spindle fibers disappear & Decondensation of Chromosomes
TELOPHASE...Complete divison
TELOPHASE....chromosomal study
TELOPHASE....Nuclear membrane formation
CYTOKINESIS....Cytoplasm divide
Barr Bodies....Heterochromatin
Barr Bodies....have X chromosome
Barr Bodies....seen under light microscope
Barr Bodies....ABSENT in Turner
Barr Bodies....Scanty In Turner
Barr Bodies....Diagnostic for Turner
one Barr body in Klinfelter
NO. of Barr bodies in OX .....no Barr Bodies
NO. of Barr bodies in XX... 1 Barr Body
NO. of Barr bodies in XXX....2 Barr bodies
Best Test for chromosomal abnormalities is Karyotyping
Karyopiknosis index.... Index of karyopiknotic nuclei of epithelial cells which exfoliate from vagina...
Hormonal evaluation
#MCQ with explanation

Q1: Mellaus, incus and stapes are
a. Irregular bone
b. Acessory bone
c. Short bones
d: flat bones
Answer: a
Bones are generally classified as:
1. Long bones
2. Short bones
3. Flat bones
4. Irregular bones
Long bones are simply long like sticks
Examples: humerus, radius, ulna, femur, tibia, fibula, metacarpals, metatarsals
(clavicle is classified as a modified long bone while metatarsals, metacarpals and phalanges as miniature long
bones)
short bones are kind of cuboid i.e they are roughly the same length as their width
Examples: tarsus bones, carpus bones
flat bones are flat like table tops
Examples: Canium, sternum, scapula, ribs
irregular bones have no specific shape
Example: vertebrae, hip bones, auditory ossicles (incus, malleus, stapes)
(note: auditory ossicles are commonly not classified with these bones. But they do not fit in any other category
and are best suited to be considered as irregular bones [see the image below], so the most probable answer to
this question is : irregular bones)
Sesamoid bones: are not like the other types of bones because they are in the form of nodules embedded in
tendons and joint capsules. They do not possess any periosteum
Examples of this type of bones are patella, pisiform.
HighYield Fact of the Day

#9
Histologically Gall baldder does not have a well-defined submucosa.
#8
Rubella (German Measles) in pregnancy causes congenital cataracts
#7
The most common drugs that cause Drug induced lupus are hydralazine, procainamide, quinidine, isoniazid,
diltiazem, and minocycline.
#6
Anti-histone antibodies are very sensitive (95%) for drug-induced lupus.
#5
Anti-ds-DNA is specific for SLE
#4
Erythroblastosis fetalis (Rh incompatibility) is a type II Hypersensitivity reaction.
#3
Factors that act via tyrosine kinase: Insulin, IGF (Insulin-like growth factor), PDGF (platelet derived growth
factor), EGF (endothelium derived growth factor)
#2
Drugs that cause gynecomastia: Cimitidine, Ketoconazole, Spironolactone, Digitalis, Alcohol
#1
The most commonly injured nerve due to fracture of surgical neck of humerus is the Axillary nerve. It supplies
the deltoid muscle, the teres minor muscle and skin on the lateral surface of the arm. Lesion of this nerve leads
to inability to raise the arm (abduction) & loss of sensation from lower half of skin covering the deltiod (lateral
side of arm).
Imp #AnatomicalLevels and #Buffers of Body.

Bifurcation of Common Carotid Artery is at C4
Hyoid Bone is present at the level of C3
Carotid Pulse can be palpated at C5
Thyroid Cartilage is present at C5
Esophagus begins at the level of C6
Trachea begins at the level of C6
Cricoid Cartilage is present at C6
Vertebra prominence is present at C7
Arch of aorta is present at T2
Sternal Notch is present at T2
Trachea bifurcates at T4
Sternal Angle is present at T4
Junction of superior and inferior Mediastinum is present at T4
Xiphisternal Joint is present at T9
Celiac trunk is present at T12
Conus Medullaris in adult is present at L1
Conus Medularis in newborn is present at L3
Inferior Messenteric artery is present at L3
Umblicus is present at L3 and is supplied by T10
Iliac Crest is present at L4, its lower boarder is used for Lumbur Puncture
Bifurcation of Aorta is present at L4
Sigmoid Colon begins at S1
Dural Sac ends at S2
Sigmoid Colon ends at S3
3 Important Bifurcations:
C4 = Carotids
T4 = Trachea
L4 = Aorta
Structures passing through the Diaphragm at T8 is Inferior Vena Cava, at T10 is Esophagus and at T12 is
Aorta
Major Buffers of Body:
Bicarbonate = Interstitial Fluid/Extracellular Fluid
Buffer of Blood is Bicarbonate
Buffer of RBCs is Haemoglobin
Buffer of Intra-cellular Fluid is Protein
Buffer present only in Urine is Ammonia
Buffer of Bone is Calcium Carbonate
IMPORTANT POINTS OF #BLOODPHYSIOLOGY

• Total circulating blood is 8% of total body weight
• Active bone marrow forming the blood cells is called red marrow and inactive marrow is called
yellow marrow. Inactive marrow is filled with fats.
• 75% bone marrow belongs to white blood cells producing myloid series
• Neutrophils and monocytes are produced from single precursor. There are se[arate pools for
proginators of megakaryocytes, lymphocytes, erythrocytes, eosinophils, and basophils
• Mast cells, kupffer cells, dendritic cells, osteoclasts and langerhans cells also originate from bone
marrow
• Best source of hematopoitic stem cells is umbilical cord blood
• Average half life of nutrophils in circulation is 6 hours
• Nutrophils, eosinophols and basophills are collectively called granulocytes/polymorphonuclear cells
• Eosinophils are abundant in GIT and respiratory mucosa
• Mast cells are abundant in areas rich in connective tissue eg beneath epithelium
• Monocyte leave the circulation and become macrophages in tissues. They donot reenter the
circulation.
• Pluripotent uncommitted stem cells become committed by the action of IL1, IL6 followed by
IL3(I,3,6 commits the stem cells, kind of love guru )
• Cytokines are hormone like molecules that act generally in paracrine fashion
• IL1 increases slow wave sleep and reduces apetite
• Platelets don’t have nuclei.They have half life of 4 days and life span of 8 to 10 days..
Remember the above difference between life span n half life of platelets
• Splenectomy causes increase in circulation platelets.
• Cytoplasm of platelets contains actin, myosin, glycogen, lysosomes, and two types of granules
a. Dense granules: they have nonprotein substances. They contain serotoninand ADP
b. Alpha granules: contain clotting factors, PDGF
• Platelet production is controlled by colony stimulating factor and thrombopoitin. Thrombopoitin
controls the maturation of megakaryocytes and is produced by kidney and liver.
• Osmotic fragility of RBC starts at 0.5% saline. Almost half the RBCs are lysed at 0.40 to 0.42%
saline. Complete lysis occurs at 0.35% saline.
• 2.5 % hb in adults is HbA2
• Hb F has the ability to decrease the polymerization of deoxygenated HbS. Hydroxyurea causes
HbF production and is used in treatment of HbS
• Blood group antigens are called aglutinogens
• Blood group antibodies are called agglutinins
• Blood group antigens are also present in salivery gland, saliva, kidney, pancrease, liver, lungs,
testes, semen, and amniotic fluid
• A and B antigens are actually oligosaccharides that differ in their terminal suger. In RBCs they are
mostly OLIGOSPHINGOLIPIDS and in other tissues they are glycoprotiens.(past MCQ)
• An antigen called H antigen is present in all RBCs in all individuals. In blood group A the A antigen
is attached to H antigen, in blood group B the B antigen is attached to H antigen where as in blood
group O no antign is attached to H antigen i.e terminal part of blood group O is H antigen(past
MCQ). Blood group AB has both antigens at the terminal.
• Bilirubin rarely penetrates Blood brain barrier in adults. But in neonates and fetus the BBB is
permeable to it an in erythroblastosis feotalis it causes KERNICTERUS
• If whole blood is allowed to clot and clot is removed, remaining is called serum. (plasma minus
factor 2,5,8,fibrinogen is called serum)(past MCQ)
• Serum has high serotonin level due to breakdown of platelets.
• Thrombomodulin is produced by all endothelial cells except that of microcicculation of brain
• Thombin is procoagulant in circulation blood. It becomes anticoagulant when it binds to
thrombomodulin
• Lymph has lower protein content than plasma..
#ImpPoints.
When asking for baby less than 18 months tick pcr When asking for screening tick elisa. Everywhere
else tick western blot
Less than 18 months…PCR More than 18 months…Westren blot ELISA…screening test ha
Screening: Elisa Specific: western blot Confirmatory test : western blot
AntiANA….if asked sensitivity AntiDsDNA…if asked specific or diagnostic for SLE Sjorgerns :
specific both : Anti Ssdna
Tissue for hla : granulocytes Cell for hla : leukocyte or granulocyte Anti SSB Buccal mucosa : for dna
analysis
Viral hep : alt Alcohol induced : ast Viral hepatitis….ALT>AST alcoholic hepatitis….AST>ALT
GGT…inc in various liver and biliary disease just as ALP but NOT in bone diseases. Non-alcoholic
fatty liver disease….ALT>AST For both intra as well as extrahepatic cholestatasis GGT>>>>ALP
Usually in obstruction cases AST/ALT dont raise.but they do elevate when there is associated
parenchymal injury.in that case Extrahepatic….AST Intrahepatic….ALT If GGT not in option then
choose ALP.
DIALYZING FLUID
GLUCOSE & HCO3….MORE than plasma
Na,K,Cl……..LESS than Plasma
Mg & Ca…..EQUAL to plasma
Urea ,Cr , Sulphate ,Urate…..ZERO
Phemphigus vulgaris IgG Ab against DESMOGLEIN Fatal autoimmune skin dis Oral mucosa
involved Flaccid intraepidermal bullae
Bullous Pemphigoid…IgG ab against HEMIDESMOSOMES Less severe Oral mucosa spared Tense
blisters
Bullous sub epidermal Vulgaris intra epidermal
Natural antithrombitic in body: plasminogen
PHYSIOLOGY, RANDOM PEARLS
NOTES OF FCPS PART 1 BY DR ARSLAN MAHMOOD
UPDATED OCTOBER 1, 2015 DR. JAHANGIR KHAN LEAVE A COMMENT
When asking for baby less than 18 months tick pcr When asking for screening tick elisa Baqi hr jaga
tick western blot
Less than 18 months…PCR More than 18 months…Westren blot ELISA…screening test ha
Screening: Elisa Specific: western blot Confirmatory test : western blot
AntiANA….if asked sensitivity AntiDsDNA…if asked specific or diagnostic for SLE Sjorgerns :
specific both : Anti Ssdna
Tissue for hla : granulocytes Cell for hla : leukocyte or granulocyte Anti SSB Buccal mucosa : for dna
analysis
Viral hep : alt Alcohol induced : ast Viral hepatitis….ALT>AST alcoholic hepatitis….AST>ALT
GGT…inc in various liver and biliary disease just as ALP but NOT in bone diseases. Non-alcoholic
fatty liver disease….ALT>AST For both intra as well as extrahepatic cholestatasis GGT>>>>ALP
Usually in obstruction cases AST/ALT dont raise.but they do elevate when there is associated
parenchymal injury.in that case Extrahepatic….AST Intrahepatic….ALT If GGT not in option then
choose ALP.
DIALYZING FLUID
GLUCOSE & HCO3….MORE than plasma
Na,K,Cl……..LESS than Plasma
Mg & Ca…..EQUAL to plasma
Urea ,Cr , Sulphate ,Urate…..ZERO
Phemphigus vulgaris IgG Ab against DESMOGLEIN Fatal autoimmune skin dis Oral mucosa
involved Flaccid intraepidermal bullae
Bullous Pemphigoid…IgG ab against HEMIDESMOSOMES Less severe Oral mucosa spared Tense
blisters
Bullous sub epidermal Vulgaris intra epidermal
Natural antithrombitic in body: plasminogen
Natural anticoagulant: heparin
Continous contraction without relaxation: tetanus
For hospitilzed patients heparin. For long term…like when they go home..prescribe warfarin
Striatum consists of caudate + putamen Corpus Striatum consists of caudate + lentiform Lentiform :
globus pallidus +putamen
Premalignant lesions Candidoisis Carcinoma in situ Leukoplakia Erythroplakia Leucokeratosis
nicotina palataina
Premalignant conditions Oral submucous fibrosis
Lichen planus Actinic keratosis Syphillis Discoid lupus erythromatousus Suderopenic dyspjagia
Types of amelogenesis imperfecta Hypomaturation :
Hypoplasia : inadequate maturation, enamel not formed to full normal thickness
Hypocalcifucation : no maturation occurs
Normal enamel matrix but complete loss of maturation : hypocalcified
Normal enamel matrix but inadequate maturation: hypoplastic
Oral histo points
Hutchunsons triad of congenital syphillis blindness Deafness c.n 8 Dental abnormalities: mulberry
molars , Hutchinson incisors peg lateral incicisrs
Raschkow plexus : present in cell free zone of weil . Devoid of cells except during dentinogeneseis
Cell free zone contain fibroblasts and undifferentiated mesenchymal tissue
There are no elastic fibers in pulp
True pulp stones : surrounds dentinal tubules or odontoblastic processes
False pulp stones : surround dead cells or collagen
On loss of tooth alveoler ridge atrophy occurs
Cabcelloeus /trabeculae/spony bone makes up majority of alveoler bone
New bone formation during orthodontic movement is intramembranous
Pdl is soft tissue btw tooth and pdl .2 mm wide Periodontium : cementum ,alveoler bone and pdl
Most common cells of pdl are fibroblasts
Intrusive/ extrusive forces / vertical resistance: alveoler crest fibers
Latearl resistance: horizontal
Most abundant: oblique group fibers
Only extrusive: apical grp
Intrusive and rotaional : oblique
Main resistance to masticatory forces provided by oblique group fibers
Sharpeys fibers are thicker on alveoler bone side
Few for points of dental materials :
Calcium sulfate :reactor in alginate
Sodium sulphate: accelerator in gypsum
Sodium phosphate : retarder in alginate
Cant be elactroplated : agar
Hydrocolloids : solid in liquid Emulsion: liquid in liquid Suspension and emulsions are two phase
systems
Hydrocolloids are lyosols
Temp lag btw liquefaction and gelation is hysterisis
Apexification is a method of inducing a calcified barrier at the apex of a nonvital tooth with
incomplete root formation. Apexogenesis refers to a vital pulp therapy procedure performed to
encourage physiological development and formation of the root end.
Sprue : channel through which metal or plastic is poured into a mould.
Abfraction lesions are small notches caused by stress (forces) on your teeth. Biting, chewing,
clenching and grinding put pressure on your teeth. Over time, this pressure can cause cracks and
splits in the outer layer of your teeth. This occurs in the thinnest part of your enamel, near the gumlin
Passivation : coat of base metal alloys to protect from corrosion
Autocatalytic reaction seen in : zoe
Higher the compressive strength higher will be hardness
Divestment: combination of die stone + gypsum bonded investment mixed with colloidal silica
Dicor : ceramic which is castable
Cermet : gic + silver amalgam alloy
Silver alloy admixed : spherical amalgam alloy powder mixed with type 2 gic powder done by
sintering/miracle mix
Dental investment: plaster mixed with silica
#Diseases and their #relations to face

(Veryyyy imp points)
1.Mask like facies = parkinsonism.
2. Elfin facies = william’s syndrome.
3. Moon facies = cushing’s syndrome.
4. Snarling facies = myasthenia gravis.
5. Mitral facies = mitral stenosis.
6. Ashen grey facies = myocardial infarction.
7. Mouse facies = chronic renal failure (crf)
8. Adenoid facies = adenoid hypertrophy.
9. Leonine facies = lepromatous leprosy .
10. Bird facies = pierre robin syndrome.
11. Mongoloid facies = down’s syndrome.
12. Coarse facies = most of the inborn errors
of metabolism (iem) viz. The muco-
polysaccharidoses (mps), mucolipidoses (ml),
fucosidoses
mannosidoses,sialidoses, aspartylglycosaminuria,
generalised gangliosidosis(gml ) and austin’s variant of
metachromatic leukodystrophy due to multiple sulfatase
deficiency
(mld-msd) have similar
appearing
facies:
13. Syphilitic facies = congenital syphilis
( bull dog
jaw)
14. Hatchet facies = myotonica atropathica
15. Guerilla like face = acromegaly
16. Bovine facies or cow face = cranio
fascial
dysostosis or crouzons syndrome
17. Marshall halls facies = hydrocephalus
18. Frog face = intra nasal disease
19. Bird facies = (Pierre Robin Malformation)
20. Chipmunk facies = ( Untreated β
Thalassemia
major, Bullimia nervosa, Parotid sweling.
21. Leonine facies = (Lepromatous Leprosy)
22. Adenoid facies = (Adenoid hypertrophy)
23. Torpid or Myxedematous facies =
(Myxedema)
24. Mask like or Parkinsonian facies =
(Parkinsonism
25. Acromegalic facies = (Acromegaly)
26. Cushingoid facies = (Cushing syndrome)
27. Gargoyle facies = (Hurler syndrome)
Remember in #GeneralPathology
1. Hyperplasia is an increase in the number of cells in an organ or tissue, usually resulting in
increased volume of the organ or tissue.
2. Hypertrophy refers to an increase in the size of cells, resulting in an increase in the size of the
organ.
3. Atrophy is the shrinkage in the size of the cell by loss of cell substance.
4. Metaplasia is defined as a reversible change in which one adult cell type (epithelial or mesenchymal) is
replaced by another adult cell type.
5. Cell swelling is the earliest sign of a reversible cell injury.
6. Free radical is a chemical species that have a single unpaired electron in an outer orbit.
7. Necrosis is a spectrum of morphological changes that follow cell death in a living tissue largely resulting
from the progressive degradative action of enzymes on the lethally injured cell.
8. Necrosis has six major type; coagulative, Caseous, Liquefactive, fibrinoid,gangrenous and Fat.
9. Apoptosis (Greek falling off) is defined as a pathway of programmed cell death that is aimed at a highly
regulated intracellular programme in which cells destined to death by activated enzyme that degrade the cell’s
DNA and nuclear and cytoplasmic proteins.
10. Morphologically an apoptotic cell shows: a) cell shrinkage, b) chromatin condensation c) formation of
cytoplasmic blebs and apoptotic bodies, d) phagocytosis by macrophages.
11. Apoptosis has two phases a) Initiation phase extrinsic and intrinsic pathways b)Execution phase
c)phagocytosis of dead cell
12. Genes promoting apoptosis are: bax,bak,bim
13. Genes inhibiting apoptosis are bcl 2 family.
14. Initiator caspase are 8 & 9, while executioner caspases are mainly 3 & 6.
15. Dystrophic calcification is always seen in damaged tissues while metastatic calcification may occur in
normal tissues whenever there is hyperplasia.
16. Inflammation is a complex reaction to injurious agents such as microbes and damaged, usually necrotic
cells that consists of vascular responses, migration and activation of leukocytes, and systemic reactions.
17. Inflammatory response consist of TWO main components: vascular & cellular, and divided into TWO
main patterns: Acute and Chronic.
18. Vasodilatation is one of the earliest manifestation of acute inflammation, if follows a transient
vasoconstriction of arterioles lasting few seconds.
19. Increased vascular permeability leading to the escape of a protein-rich fluid (exudate) into the
extravascular tissue in the HALL MARK of acute inflammation.
20. Formation of endothelial gaps in venules is the most common cause of vascular leakage
21. Leukocytes Adhesion molecular families have a major classes: a) Selectins (E,L & P types), b) Integrins, c)
Immunoglobulin family of adhesion molecules and d) Mucin like glycoproteins.
22. Selectins mainly involved in rolling of leukocytes, PECAM in transmigration and immunoglobulin family
in adhesions.
23. Chemotaxis is defined as uni directional migration of leukocytes towards the site of injury under chemical
gradient action.
24. Most important chemotactic agents are C5a,LTB4 and bacterial products.
25. Major opsonins are: C3b & Fc fragment of IgG proteins
26. H202-MPO-Halide systein is the most efficient bactericidal system in neutrophils.
27. Chediak-Higashi Syndrome is an autosomal recessive condition characterized by failure of fusion of
phagosome with lysosome.
28. Chronic granulomatous disease of childhood results from inherited defects in the components of NAPDH
oxidase which generates superoxide, leading to body infections.
29. Vasoactive amines are histamine and serotonin which are the main players of early inflammation.
30. Plasma Proteins are: Complement system proteins, clotting system and fibrinolytic system.
31. Prostaglandins are vasodilators.
32. MAC (C5B6789) is the membrane attack complex, which finally kills the bacteria.
33. Activated Hageman factor initiates FOUR systems involved in inflammatory responses Kinin, Clotting,
fibrinolytic and complement system
34. SRS-A (slow releasing substance of anaphylaxis) constitutes LTC4, LTD4 & LTE4 promote
vasoconstriction, bronchospasm & increased vascular permeability.
35. Lipoxins are bioactive products generated from transcellular biosynthetic mechanisms involving
neutrophils and platelets.
36. IL-1 & TNF are two of the MAJOR cytokines that mediate inflammation.
37. Major chemokines include: IL-8, MCP-1, eotaxin, MIP-1, Lymphotactin and RANTES.
38. Nitric oxide plays major role in production of vasodilation by relaxing vascular smooth muscle in ischemic
conditions.
39. The major mediators of pain are Bradykinin & Prostaglandins
40. Potent vasodilators are : Vasoactive Amines, Prostaglandins & NO.
41. Acute inflammation is defined as a rapid response to an injurious agent that serves to deliver
mediators of host defense – leukocytes and plasma proteins to the site of injury.
42. Chronic inflammation is defined as an inflammation of prolonged duration, in which active
inflammation, tissue destruction and attempts at repair are proceeding simultaneously.
43. Neutrophils are the main cells of acute inflammation (exudates) while Mononuclear cells (with
one nucleus are the main cells of chronic inflammation .Mononuclear cells include Lymphocytes,
Monocytes, Macrophages and Plasma cells.
44. Macrophages are the prima donna (main working cell) of chronic inflammation, while
lymphocytes are present in increased number.
45. Granuloma is a focus of chronic inflammation, consisting of microscopic aggregation of
macrophages that are transformed into epithelium like cells surrounded by a collar of mononuclear
leukocytes. Don’t confuse it with Granulation tissue which has capillaries, fibroblasts, and a variable
amount of inflammatory cells.
46. Classical tuberculous granulomas is composed of epithelioid cells, Langhan’s multinucleated
giant cells, caseation necrosis and collar of lymphocytes. There are two types of Granulomas:
Immune & foreign body.
47. There are 3 types of cells in the body: Continously dividing labile cells, Quiscent or stable cells
and Permanent Non-dividing cells.
48. Stem cells are cells characterized by their prolonged self renewal capacity and by the
asymmetric replication. They are of two types: embryonic & adult stem cells.
49. VEGF & fibroblast Growth factor are mainly involved in angiogenesis.
50. TGF-B is a growth inhibitor for most epithelial cells and leukocytes, potent fibrogenic agent and a
strong anti-inflammatory effect.
51. Extracellualr matrix is formed of these groups of molecules : a) fibronectin b) adhesive
glycoproteins and c) proteoglycans & hyaluronic acid.
52. Collagens is the most common protein in the animal world, with 27 types discovered so far.
Types I, II, III, V & X) are fibrillar and most common while type IV is non fibrillar.
53. Healing by 2nd intention differs from 1st intention in three ways; a) inflammatory reaction is more
intense, b) Much more granulation tissue forms and c) wound contraction phenomenon.
54. Accumulation of excessive amounts of collagen may give rise to a hypertrophic scar while if scar
tissue grows beyond the boundaries of the original wound and does not regress, it is called keloid.
55. Edema is defined as accumulation of fluid in the interstitial tissue spaces and body cavities.
56. Local increased volume of blood in a particular tissue leads to Hyperemia and congestion.
Hyperemia is an active process, resulting from augmented tissue inflow because of arteriolar dilation
while Congestion is a passive process resulting from impaired outflow from tissue.
57. Heart failure cells are hemosiderin laden macrophages seen in chronic pulmonary congestion.
58. Petechiae are minute 1 to 2 mm hemorrhages into skin, mucous membranes or serosa surfaces,
while >3 mm hemorrhages are called Purpura and more larger > 1 to 2 cm subcutaneous
hematomas are called Ecchymoses.
59. Virchow’s triad include: a) Endothelial injury b) Stasis or turbulent blood flow & c) blood
hypercoagulability.
60. Of the inherited causes of hypercoagulability, mutation in the factor V gene and prothrombin
gene are the most common.
61. Lines of Zahn are laminated lines produced by alternating pale layers of platelets admixed with
some fibrin and darker layers containing more red cells.
62. Fate of thrombus include: propagation embolization, dissolution, organization and recanalization.
63. Embolus is a detached intravascular solid, liquid or gaseous mass that is carried by the blood to
a site distant from its point of origin. The phenomenon is called embolism.
64. Infarct is an area of ischemic necrosis caused by occlusion of either the arterial supply or the
venous drainage in a particular tissue.
65. The most dominant histologic characteristic of infarction is ischemic coagulative necrosis.
66. Shock is the systemic hypoperfusion caused by reduction either in cardiac output or in the
effective circulating blood volume, and resulting in hypotension followed by impaired tissue perfusion
and cellular hypoxia.
67. Major types of shock include: cardiogenic, hypovolemic, septic, neurogenic and anaphylactic.
68. Mutation is defined as a permanent change in the DNA.
69. Marfan’s syndrome is a disorder of the connective tissue of the body, characterized by changes
in the skeleton, eyes and cvs. Mainly cause by defects in an extracellular glycoprotein Firbillin-1.
70. Ehlers-Danlos Syndrome comprise a clinically and genetically heterogenous groups of disorders
that result from some defect in the syntesis or structure of fibrillar collagen.
71. Amyloid is a pathologic proteinaceous substance deposited between cells in various tissues and
organs of the body in a wide variety of clinical settings.
72. Neoplasm is an abnormal mass, the growth of which exceeds and in uncoordinated with that of
the normal tissue and persists in the same excessive manner after cessation of the stimuli which
evoked the change.
73. Tumor has two basic components: Parenchyma & stroma, while tumors are of two types: Benign
and Malignant.
74. Benign tumors are well differentiated, grow slowly and don’t show invasion and metastases,
while Malignant tumors range from well to undifferentiated, grow fast and show invasion and
metastasis.
75. Single most important feature to differentiate benign from malignant tumor is METASTASIS.
76. Carcinomas mostly use lymphatic routes and sarcomas mostly use hematogenous routes of
spread.
77. Four types of genes are normally working in human body: a) proto-oncogens b) antioncogenes,
c) apoptotic genes and d)DNA repair genes
78. Proto-oncogenes are changed to oncogenes by three processes: mutation, translocation and
amplification.
79. Major oncogenes are; RAS, ERB-B1, RET, KIT, ABL, C-MYC & N-MYC.
80. Major antioncogenes are: RB, TP53, W.-1, NF-1, BRCA-1, APC.
81. Oncogenic viruses include; Human Papilloma virus, Hepatitis B virus, Epstein Barr virus ,Kaposi
Sarcoma Herpes viruses & Human T-Cell leukemia virus (The only oncogenic RNA virus).
82. Chemical carcinogenesis is a multistep process, divided into initiation and promotion phases.
83. Major chemical carcinogens associated as include: Asbestos with Mesothelioma, Aniline dyes
with TCC, Nitrates-Gastric carcinoma, Aflatoxin with HCC, Vinyl chloride with Angiosarcoma Liver.
84. Radiation induced malignancies include leukemias and papillary carcinoma thyroid.
85. Major paraneoplastic synbdromes include, Cushing syndrome, ADH secretion by small cell
carcinoma lung, Hypercalcemia by Squamous cell carcinoma lung, hypoglycemia by Fibrosarcoma
and HCC, Polycythemia by RCC and hypertrophia osteoarthropathy by CA lung.
86. Major tumor markers included : HCG for Choriocarcinoma, calcitonin for medullary carcinoma
thyroid, alpha fetoprotein-HCC and Non-seminomatous germ cell tumor testis, CEA-CA colon, PAP
For CA prostate, CA-125 for Ovarian CA , Ca 19-9 for CA Colon and pancreas ,CA 15-3 for CA
breast.
87. Major immunomarkers for epithelial tumors are cytokeratin, for mesenchymal tumor – vimentin,
for leukocyte origin tumor – leukocyte common antigen, S100 for neural origin tumors and for
skeletal muscle tumors – desmin.
88. Type I hypersensitivity (“anaphylactic”) or “immediate hypersensitivity”) is the result of antigen
binding to IgE on the surface of mast cells and basophils. These instantly degranulate and release
active substances into the surrounding tissue.
89. Type II cytotoxic hypersensitivity, antibodies attach to antigens on the surfaces of a cell and then
something injures or destroys the cell.
90. In type III immune-complex hypersensitivity reaction, “Soluble antigens” precipitate with
antibodies, usually this happens 2-4 hours after exposure. This sort of tissue injury is mediated by
antigen-antibody complexes (“immune complexes”).
91. Type IV Hypersensitivity reaction is called “delayed hypersensitivity”. It is mediated by sensitized
CD4+T lymphocytes which process antigens in association with class II HLA molecules and release
lymphokines.
92. Immune reactions are divided into two broad categories: A) Humoral immunity-B-cell lymphocyte
mediated via production of antibody and Often develops as a response to soluble antigens, and B)
Cellular immunity-T-Cell lymphocyte mediated. CD4+helper lymphocytes: help B cells make
antibody and also help to generate cytotoxic T cells.
93. Major histocompatibility complex is present on all nucleated cells.
94. The HLA system is a key factor in most Transplant rejection reactions. Reactions are mediated
by either T lymphocytes or by antibody.
95. Toll like receptors are membrane proteins that recognize a variety of microbe derived molecules
and stimulate innate immune responses against the microbes.
96. CD4 molecule is a high affinity receptor for HIV
97. Major autoimmune disease include Hashimoto’s thyroiditis, Rheumatoid Arthritis, Sjogren’s
syndrome, ankylosing spondylitis.
98. Gamma interferon is one of the cytokine to activate macrophages and also play major Role in
Granuloma formation.
99. Cytokines are mediators released from one cell and modulate the actions of another cell.
100. Squamous cell carcinoma is characterized by sheets, groups and clusters of pleomorphic
malignant epithelial cells with high N/C ratio,hyperchromatic nuclei and pale cytoplasm.Keratin
epithelial pearls,intercellular bridges and individual cell keratinization are seen.
101. Adenocarcinoma is characterized by back to back closely packed glands lined by pleomorphic
malignant epithelial cells with high N/C ratio,hyperchromatic nuclei and eosinophilic cytoplasm.Wall
sharing is often noted.
102. Two types of vaccines include: Live vaccines; Measles, Mumps, Rubella, Varicella, Polio etc
and Killed vaccines: Rabies, Polio, Hepatitis A.
103. Protooncogenes are converted into oncogenes.
104. p53 works by DNA repair and promoting apoptosis.
105. RB gene activates and Works in hypophosphorylated form.
106. RAS gene protooncogene protein is GTP bound and Works with GAP in cooridination with
GTPase.
107. Gliomas and BCC are highly malignant but dont usually metastasize.
108. AFB is acid fase bacillus ( Mycobacterium tuberculosis ) and called so because it resists
decolourization by Concentrated Acids.
109. Tigered lipid effect is seen in Herat.
110. Major complement proteins include :Opsonization by C3b,Chemotaxis by C5a,Anaphylatoxin
C3a, C4a, C5a Membrane breakdown and killing C5b,6,7,8,9 MAC complexEnhancement of
antibody production C3b.
111. FNAC and biopsy are key investigations to early diagnose a tumor.
112. Active Immunity is the resistance induced after contact with foreign antigens eg
microorganisms, immunization with live or killed infectious agents, exposure to microbial products
(toxins, toxoids)
Passive immunity is resistance based on antibodies preformed in another host eg administration of
antibody against tetanus, botulism, diphtheria, rabies etc.
113. Sudden death is majorly linked with embolism.
114. 24 to 48 hours post acute inflammation ,monocytes start accumulating.
115. ubiquitin proteosome pathway & autophagic vacuoles are mainly involved in atrophy.
116. Reserve stem cells are main players in metaplasia.
117. Mechanical and trophic factors are involved in hypertophy.
118. Eosinophils are players in allergic infections.
119. Sequence of events in acute inflammation is :Transient asoconstriction,vasodilation stasis,
margination, rolling, adhesion, diapedesis, chemotaxis and phagocytosis.
120. Macrophages seen as a part of reticuloendothelial system include:Osteoclasts – bone,microglia
– brain,kupffer cells – liver,alveolar macrophages – lung.Sinus histiocytes – lymph nodes.
120. Tuberculosis is the leading cause of granuloma in Pakistan.
121. Major granulomatous causes include: sarcoidosis, leprosy, cat scratch disease, fungal
infections.
122. Grading of a tumor is based on differentiation,atypia and mitoses.
123. Staging of a tumor is based on TNM – tumor,nodes,metastasis.
124. Major autosomal dominant disorders include: Skeletal – Marfan; syndrome,Nervous –
Huntington disease,neurofibromatosisGastrointestinal – familial polyposis coli,Urinary – polycystic
kidney disease,Haematopoietic – hereditary spherocytosis
125. Major intracellular accumulations are :Melanin – melanoma,bile – cholestasis,carbon –
anthracosis,copper – Wilson disease lipofuscin – aging
126. Fatty change is also known as steatosis.
127. Point mutations are often caused by chemicals or malfunction of DNA replication, exchange a
single nucleotide for another e.g RAS.
128. Giant cells are cells containing more than one nucleus.
129. Major giant cells are : Langhan giant cells – Tuberculosis,Tuton giant cells – xanthoma Warthin
finkeldey giant cells – measles,Reed Sternberg cells – Hodgkin Lymphoma ,Foreign body giant cells
– foreign body
130. IgG fixes complement and crosses placenta.
131. IgM is the most heavy antibody.
132. IgE is the allergic reaction player antibody.
133. IgA is found in secretions.
134. ABL gene is seen translocated in CML.
135. Lines of Zahn confirms a thrombus.They are alternate layers of platelets with fibrin and RBCs’
136. Psamomma bodies are lamellated bodies of dystrophic calcification seen in
meningioma,papillary carcinoma thyroid and serous ovarian malignant tumors.
137. Nuclear changes in a necrotic cell include: pyknosis, karyolysis, karryorrhexis and loss of
nucleus.
138. Macrophages get accumulated in chronic inflammation by continuous recruitment,proliferation
and immobilization.
139. Ischemic injury leads to coagulative necrosis.
140. Major sensitive cell components: maintenance of integrity of cell membrane, aerobic
respiration, protein synthesis, genetic integrity
#Hematology Key Concept Pearls

1) Microcytic Anemia with Low Ferritin & High TIBC = Iron deficiency Anemia.
2) Microcytic Anemia with High Ferritin & Low TIBC = Anemia of Chronic Disease.
3) Microcytic Anemia with High Serum Iron = Sideroblastic Anemia.
4) Microcytic Anemia with NORMAL Iron studies = Thalassemia.

Rapid Review Usmle Step 1 ND CK

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Important high yield

Very very very #imppoints

C1-C2 VERTEBRA: vocal cords

C2-oropharynx and soft palate with mouth open

level of larynx in infants-C2-C3

level of larynx in adults-C3-C6

C3-C4:bifurcation of common carotid artery

thyroid lobe superior extent-oblique line of thyroid cartilage

isthmus of thyroid gland-2nd through 4th tracheal rings

thyroid lobe inferior extent-sixth tracheal ring

spine at root of scapula-opposite third thorasic spine

jugular notch-T2&T3 vertebral junction

body of sternum-T5to T9 vertebra

greater splanchnic nerve-T5-T9 sym ganglia

apex of heart/mitral value-5th intercoastal space

base of heart/supine position-T5 to T8 vertebra

IMPORTANT POINTS FROM #ENDOCRINOLOGY

COMMONLY TESTED FACTS

#IMPORTANT CONFUSING BCQS OF #PHYSIOLOGY FROM BCQ BOOKS

THESE POINTS are #MOSTIMPORTANT regarding CONCEPT and MCQs SOLVING

#Important #Biochemistry points..

#Bladder #Urethral #injuries

Very BRIEF but very concise Points from guyton.

INFECTIVE ENDOCARDITIS PATHOGENS.

V V V V IMPORTANT POINTS OF #GENERALANATOMY>>>

Some important points about #Cardiac_cycle

Some of the very repeated and #importantquestions with #explaination

Quick revision of pharma portion of Rabia ali

Fluoxetine Phenobarbitone✔️ ,co amoxiclave ✔️ ✔️

♦️drugs crossing placenta

🔹Penicillin : cell wall synthesis inhibitor

🔹 EPO acts on stem cells ( not CFU ) ❌

🔹 digoxin increases contractility n decreases heart rate

Side effects (asked one ) ::

🔹Phenylbutazone : Aplastic anemia

🔹Thiopentone : hypotonicity , hypersensitivity

🔹Opioid poisoning :respiratory depression

🔸Granulocytopenia : phenytoin , clozapine

Mild CCF monotherapy ? ACE inhibitor (1 mcq) , captopril (other mcq)

CCF with IHD : diuretics + ACE inhibitor

Now these r confusing but all r kept in sequence

🔹Warfarin effect increased by?? Cemitidine

🔹 Pt taking MAO inhibitors ,given barbiturates , wt will happen ? Coma

🔹cotrimoxazole given ... C/O Red urine

🔹gastric emptying decreased by ? AlSo4

contraindication : intracranial HTN

✒️hallucination treated with ? Atropine

#MCQ with explanation

HighYield Fact of the Day

Imp #AnatomicalLevels and #Buffers of Body.

IMPORTANT POINTS OF #BLOODPHYSIOLOGY

#Diseases and their #relations to face

#Hematology Key Concept Pearls

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