FMGE 2011 / MCI screening test 2011, Preparation Tips, Imp Points & Questaion Papers

HOW TO PASS FMGE / mci screening test ???

2009-05-26T23:23:00.000-07:00

FMGE ROLL NO.

Fmge Sept 2011

Mci Fmge 2011

Tricks to rem. Imp points---
1. Adrenal cortex layers and products
"Go Find Rex, Make Good Sex":
Layers:
Glomerulosa
Fasiculata
Reticulata
Respective products:
Mineralcorticoids
Glucocorticoids
Sex hormones (androgens)
Alternatively for layers: GFR
(Glomerular Filtration Rate, convenient since adrenal glands are atop kidney).

2. Adrenoceptors: vasomotor function of alpha vs. beta
ABCD:
Alpha = Constrict.
Beta = Dilate.

3. Amino Acids:The ten essential amino acids:
"PVT TIM HALL
Phenylalanine, Valine,Threonine,
Tryptophan Isoleucine, Methionine
Histidine, Arginine, Lysine, Leucine,

4. Antibiotics contraindicated during pregnancy MCAT:
Metronidazole
Chloramphenicol
Aminoglycoside
Tetracycline

5. ABC'S of the aortic arch!
Aortic arch gives off the Bracheiocephalic trunk,
the left Common Carotid, and the left
Subclavian artery

6. Asthma:
management of acute severe "O SHIT":
Oxygen (high dose: >60%)
Salbutamol (5mg via oxygen-driven nebuliser)
Hydrocortisone (or prednisolone)
Ipratropium bromide (if life threatening)
Theophylline (or preferably aminophylline-if life threatening)

7. B vitamin names
"Tu Ro Na Pyare Cutte":
• In increasing order: Thiamine (B1) Riboflavin (B2) Niacin (B3) Pyridoxine (B6) Cobalamin (B12)

8. Betablockers: cardioselective betablockers
"Betablockers Acting Exclusively At Myocardium"
• Cardioselective betablockers are:
· Betaxolol
· Acebutelol
· Esmolol
· Atenolol
· Metoprolol

9. Branches of the Brachial Plexus (In order from most lateral to most medial)
My Aunt Raped My Uncle

Musculocutaneous, Axillary, Radial, Median, Ulnar

10. Bronchopulmonary segments of right lung
"A PALM Seed Makes Another Little Palm":
• In order from superior to inferior:
1. Apical
2. Posterior
3. Anterior
4. Lateral
5. Medial
6. Superior
7. Medial basal
8. Anterior basal
9. Lateral basal
10. Posterior basal

11. Prolactin and oxytocin: functions
PROlactin stimulates the mammary glands to PROduce milk.
Oxytocin stimulates the mammary glands to Ooze (release) milk.

12. Radial n. innervates the BEST!!!!
Brachioradialis
Extensors
Supinator
Triceps

13. RNA viruses: negative stranded
"Always Bring Polymerase Or Fail Replication":
Arena
Bunya
Paramyxo
Orthomyxo
Filo
Rhabdo
• Note: Negative RNA viruses need there own polymerase.

14. WBC Count: "Never Let Mom Eat Beans" and "60, 30, 6, 3, 1"
Neutrophils 60%
Lymphocytes 30%
Monocytes 6%
Eosinophils 3%
Basophils 1:

15. Weights of children with age
Newborn 3 kg
6 mos 6 kg (2x birth wt at 6 mos)
1 yr 10 kg (3x birth wt at 1 yr)
3 yrs 15 kg (odd yrs, add 5 kg until 11 yrs)
5 yrs 20 kg
7 yrs 25 kg
9 yrs 30 kg
11 yrs 35 kg (add 10 kg thereafter)
13 yrs 45 kg
15 yrs 55 kg
17 yrs 65 kg

ABC'S of the aortic arch!
Aortic arch gives off the
Bracheiocephalic trunk,
left Common Carotid,
left Subclavian artery

Branches Of External Carotid Artery
Sneh Lta's Powdered Face Often Attracts Medical Students.

S= Superior Thyroid
L= Lingual
P= Posterior Auricular
F= Facial
O= Occipital
A= Ascending Pharyngeal
M= Maxillary
S= Superficial Temporal

BRANCHES OF SUBCLAVIAN ARTERY ARE 5
VIT. C&D (Read as Vitamin C & D)
V = Vertebral artery
I = Internal Thoracic artery
T = Thyrocervical Trunk
C = Costocervical trunk ( from first br of left subclavian a. but arises from 2 branch of right side)
D= Dorsal scapular artery (branch of third part)

The branches of the Axillary Artery are: Sally Thompson Loves Sex And Pot pie.
Superior Thoracic, Thoracoacromial, Lateral Thoracic, Subscapular, Anterior Circumflex Humeral, Posterior Circumflex Humeral, and Profunda Brachii.

Brachial plexus
Rohit Tu Dekh Cold Beers:
Roots, Trunks, Divisions, Cords, Branches
Branches of the Brachial Plexus (In order from most lateral to most medial)
My Aunt Raped My Uncle
Musculocutaneous, Axillary, Radial, Median, Ulnar

Branches of the Facial Nerve
Ten Zebras Bought My Car
Temporal, Zygomatic, Buccal, Masseteric, Cervical

Orbital Bones- FLEZMS
Frontal, Lacrimal, Ethmoid, Zygomatic, Maxilla, Sphenoid

8 carpal bones
Starting from the thumb,
sneh lata tinde paka tere tinde kacche hain
Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate.

TARSAL BONES
Tarzon Call Can Navi LIM3C
1. Talus
2. Calcaneus
3. Cuboid
4. Navicular
5. Lateral cuneiform
6. Intermediate cuneiform
7. Medial cuneiform

ESSENCIAL AMINO ACID :- PVT. TIM HALL
P-henylalanine V-valine T-threonine T-tryptophan I-Isoleucine M-ethionine H-histidine A-arginine L-lysine L-leucine

AUDITORY PATHWAY :- ECOLI MT
E-8TH NERVE
C-COCHLEAR NUCLEI
O-SUPERIOR OLIVARY NUCLEUS
L-LATERAL LAMINISCUS
I-INFERIOR COLLICULUS
M-MEDIAL GENICULATE BODY
T-SUP TEMPORAL GYRUS

H. Pylori treatment regimen (rough guidelines)
TOMB:
· Tetracycline
· Omeprazole
· Metronidazole
· Bismuth

RNA enveloped viruses
FORT PR ABC
· Flavivirus/ Filo, Orthomyxo, Retro, Toga
· Paramyxo, Rhabdo
· Arena, Bunya, Corona

Acute inflammation features :- SLIPR:
Swelling, Loss of function, Increased heat, Pain, Redness

Tetrology of Fallot :-"don't DROP the baby":
· Defect (VSD)
· Right ventricular hypertrophy
· Overriding aorta
· Pulmonary stenosis

Anti-arrythmics: for AV nodes :- "Do Block AV":
Digoxin
B-blockers
Adenosine
Verapamil

The cranial bones are the PEST OF 6
Parietal Ethmoid Sphenoid Temporal Occipital Frontal

Layers of the epidermis
Grand son grate living Child.
Brent Spiner Gained Lieutenant Commander
Germinativum or Basal, Spinosum, Granulosum, Lucidum, Corneum

Medical history: disease checklist :- MJ THREADS:
Myocardial infarction Jaundice Tuberculosis Hypertension Rheumatic fever/ Rheumatoid arthritis Epilepsy Asthma Diabetes Strokes

Pain history checklist
"On Days Feeling Low Character, Run a Seven Pace Race":
1. Onset
2. Duration
3. Frequency
4. Location
5. Character
6. Radiation
7. Severity
8. Precipitating factors
9. Relieving factors

Dementia: some common causes
DEMENTIA:
Diabetes
Ethanol
Medication
Environmental (eg CO poisoning)
Nutritional
Trauma
Infection
Alzheimer's

followed by shoulder rotation and delivery of the fetal body!
1. Every - Engagement
2. Damn - Descent
3. Female -Flexion
4. I -Internal Rotation
5. Eat -Extension
6. Returns-Restitution
7. Eagerly-External Rotation

Basic Amino Acids = "HAL"
Histidine, Arginine, Lysine.

Types of waves in EEG
BATS Drink Blood
pt awake & eyes Open— Beta
Pt awake but eyes Closed— Alpha
Stage I ----------------------- Theta
Stage II------------------------- Spindle & k complex
Stage III & IV ------------------- Delta
REM sleep ----------------------- Beta

Food poisoning: bugs inducing
"Eating Contaminated Stuff Causes Very Big Smelly Vomit":
· E. coli O157-H7 [undercooked meat, esp. hamburgers]
· Clostridium botulinum [canned foods]
· Salmonella [poultry, meat, eggs]
· Clostridium perfringens [reheated meat]
· Vibrio parahaemolyticus [seafood]
· Bacillus cereus [reheated rice]
· Staphylococcus aureus [meats, mayo, custard]
· Vibrio vulnificus [seafood]

Lower Leg Bones
Can't tell your tib from your fib?
The TIBia is the Thick, Inner Bone. The FibuLa is Finer, Fluted, and Lateral

Size in c.m. :- DUEDS StAR BAG
· DUEDS (25): Duodenum, Ureter , Esophagus, ……………… Descending colon, Sigmoid colon
· StAR (13) : Stomach, Ascending colon, Rectum
· BAG (8) : Bile duct, Appendices, Gallbladder

OPENING OF CRANIAL NERVES
Carebiun Optic 4 Super Stylo Internal 3 Jug Hae
1- Cribriform plate of ethmoid
2- Optic canal
3- Superior orbital fissure
4- Superior orbital fissure
5- (S R O ) Superior orbital fissure f.Rotundum, f.Oval
6- Superior orbital fissure
7- f. Stylohoidus
8- Internal acoustic meatus
9- Jugular formen
10- Jugular formen
11- Jugular formen
12- Hypoglossal canal

Muscle Physiology
•Muscle form 40 to 50% of body mass.
•About 600 muscles are identified.
Classification of Muscles:
•Depending on striations: Striated(Skeletal & Cardiac) & Nonstriated(smooth)
•Depending on Control: voluntary(Skeletal) & Involuntary(Cardiac & smooth)
•Depending on situation: Skeletal, Cardiac & Smooth.
•Muscle fiber or cell has a length b/w 1 – 4cm (Average 3cm) & diameter from 10 – 100microns.
•1 myofibril contains 1500 myosin filaments & 3000 actin filaments
•Sarcomere is the structural & functional unit of skeletal muscle.
Length – 2.5 to 3.2 mm.
Sarcomere lies b/w two ‘Z’ lines
•Each myofibril consists of alternate light (I or J band) & dark band (A or Q band).
•Each sarcomere consist of thin (Actin) & thick (myosin) filaments.
Myosin filament is present throughout the ‘A’ band.
No movement of myosin during muscular contraction.
•Actin filaments are formed by 3 types of proteins called actin, tropomyosin & troponin.
•The skeletal muscle is formed by 75% of water, 20% of proteins & 5%of organic substances.
•Troponin: is formed by 3 subunits; Troponin I – attached to F actin; Troponin T – attached to tropomyosin; Troponin C – attached to calcium ions.
•Following are the muscle proteins; Myosin; Actin; Tropomyosin; Troponin; Actinin; Titin; Desmin; Myogen & Myoglobulin.
•There is no movement in the myosin filament during muscle contraction.
•Actin filaments slide over the myosin filament during muscle contraction.
•Tropomyosin covers the active sites of actin.
•Rheobase: this is the least possible, i.e. (minimum) strength (Voltage) of stimulus which can excite the tissue.
•Chronaxie: it is the minimum time, at which a stimulus with double the rheobasic strength (voltage) can excite the tissue.
Chronaxie of skeletal muscle is shorter than that of cardiac and smooth muscles.
Cold lengthens chronaxie. whereas vagal stimulation shortens chronaxie.
•Refractory period is the period at which the muscle does not show any response to a stimulus.
•Skeletal muscles are purely aerobic & don’t have any fuel reserve.
•Dark, light bands & troponin are absent in smooth muscle.
•The study of electrical activity of the muscle is done by electromyography.
•The muscle ruptures when it is stretched to about 3 times its equilibrium length.

Constrictions in oesophagus :
· at commencement 15 cm from incisor teeth.
· at crossing over by aortic arch 22.5 cm from incisor teeth.
· at crossing over by left principal bronchus 27.5 cm from incisor teeth.
· at its point of piercing diaphragm 40 cm from incisor teeth.

Stomach :
· Cardiac orifice — Behind left 7th costal cartilage 1" from its junction with sternum.
· Pyloric orifice — 1.2 cm (0.5") to the right of midline on transpyloric plane.
· Capacity — at birth 30 ml; adults 1500 ml.
Length of small intestine: 6 to7 metres
Length of duodenum: 10” or 25 cm
1 st part: 5 cm
2nd part: 7.5 cm
3rd part: 10 cm
4th part: 2.5 cm
Length of large gut: 1.5 metres
Anal canal
Hilum of kidney — Transpyloric plane (LI).
Kidney:Length: 11 cm, Breadth : 6 cm, Antero-posterior diameter: 3 cm
Length of Ureter : 25 cm
Length of male urethra: 18-20 cm
Spermatic cord : 9-10 cm
Length of inguinal canal: 4 cm
Testis: Length-4.5 cm, Breadth-2.5cm, Anteroposterior dr-3
Ovary: Length -3 cm, Width-1.5 cm,Thickness-1 cm
Uterus: Length-7.5 cm, Breadth-5 cm,Antero-posterior diameter-2.5 cm
Weight :30 to 40 gms
Uterine tubes: Length-10 cm
Saphenous opening — Height 1.5 to 8 cm; Width 1 to 3 cm
Femoral sheath — Length 3 to 4 cm.
Femoral canal — Length 1.25 cm.
Tendo calcaneus — Length 15 cm.

FOR GET MORE PLZ GO TO LINK BLOW----

PG PREPARATION TIPS

Mnemonics

Meticulous Nice Early Markers Obfuscate Northern Invisible Classy Symposiums

spacefem's mnemonic device generator

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some facts

2009-02-21T02:55:00.000-08:00

Coronary artery disease is the single largest cause of morbidity amongst all diseases so much so that it has been classified as having reached pandemic proportions by none less than the WHO (World Health Organisation).
http://fmge.co.cc
Over 7,0000,000 Indians have heart related diseases
1 in 3 adults, both men and women, has some form of cardiovascular disease.
In 90% of adult victims of sudden cardiac death, two or more major coronary arteries are narrowed or blocked.
http://fmge.co.cc
Brain death and permanent death start to occur in just 4-6 minutes after someone experiences cardiac arrest.
It is in the early or initial stage that the heart disease is almost certainly treatable.
The heart and brain muscles are the ones which cannot be revived once dead.
The cardiac 64 CT scan provides 3D images of the heart so detailed that the heart disease can be detected at a very early stage.
http://fmge.co.cc

Mnemonics -Easy way to remember difficult things
Hai guys
here i am giving you some Mnemonics they are sub wise use them they really help
if you find them useful let me know pls

Anatomy Mnemonics
Bones of the Wrist
Some Lovers Try Positions That They Cannot Handle Branches of the Brachial Plexus (In order from most lateral to most medial)
My Aunt Raped My Uncle

Musculocutaneous, Axillary, Radial, Median, Ulnar

Slowly Lower Tilly's Pants To The Curly Hairs

Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate

Brachial Plexus
Randy Travis Drinks Cold Beers Robert Taylor Drinks Cold Beer

Roots, Trunks, Divisions, Cords, Branches

Branches of the Brachial Plexus (In order from most lateral to most medial)
My Aunt Raped My Uncle

Musculocutaneous, Axillary, Radial, Median, Ulnar

Extraocularmotor muscles
LR6 (SO4) LR6: Lateral rectus --> VI abductens
SO4: Superior Oblique --> IV Trochlear
All other extraocularmotor muscles are CN III

Branches of the Facial Nerve
Ten Zebras Bought My Car

Temporal, Zygomatic, Buccal, Masseteric, Cervical

Innervation of phrenic nerve
c345 keeps the phrenic alive
c345 keep the diaphragm alive

Long thoracic nerve innervates serratus anterior
c5-6-7 raise your arms to heaven

Relationship of Thorasic duct to Esophagous and Azygous
The duck is between two gooses.
duck = thoracic duct 2 gooses = azyGOUS and esophaGOUS

Attachments of Pectoralis Major, Teres Major and Latissimus Drosi
A lady between tow majors.
Pectoralis major attaches to lateral lip of bicipital groove, the teres major attaches to medial lip of bicipital groove, and the latissimus dorsi attaches to the floor of bicipital groove. The "lati" is between two "majors."

Innervation of the Penis
Parasympathetic puts it up; sympathetic spurts it out.
Point Shoot Score
Parasympathetic, sympathetic, somatomotor

Lateral and Medial Pectoral Nerve
Lateral is less, medial is more.
Lateral pectoral nerves goes through pectoralis major while medial pn goes though both pectoral major and minor.

Dentition: eruption times of permanent dentition
"Mama Is In Pain, Papa Can Make Medicine":
1st Molar: 6 years
1st Incisor: 7 years
2nd Incisor: 8 years
1st Premolar: 9 years
2nd Premolar: 10 years
Canine: 11 years
2nd Molar: 12 years
3rd Molar: 18-25 years

Layers of the epidermis
Grand son grate living Child.
Brent Spiner Gained Lieutenant Commander
Germinativum or Basale, Spinosum, Granulosum, Lucidum, Corneum

Tarsal bones
"Tall Californian Navy Medcial Interns Lay Cuties":
• In order (right foot, superior to inferior, medial to lateral): Talus Calcanous Navicular Medial cuneiform Intermediate cuneiform Lateral cuneifrom Cuboid

Bronchopulmonary segments of right lung
"A PALM Seed Makes Another Little Palm":
• In order from superior to inferior: Apical Posterior Anterior Lateral Medial Superior Medial basal Anterior basal Lateral basal Posterior basal

Head & Neck
CRANIAL NERVES: I-Optic, II-Olfactory, III-Oculomotor, IV-Trochlear, V-Trigeminal, VI-Abducens, VII-Facial, VIII-Acoustic (Vestibulocochlear), IX-Glossophrayngeal, X-Vagus, XI-Spinal Accessory, XII-Hypoglossal
On Old Olympus Towering Tops, A Finn And German Viewed Some Hops (older and cleaner)
Oh Oh Oh To Touch And Feel A Girls Vagina And Hymen (newer and, well ...)

Which cranial nerve is Sensory, Motor, or Both- Some Say Marry Money, But My Brother Says Big Breasts Matter More

BRANCHES OF FACIAL NERVE: Temporal, Zygomatic, Buccal, Mandibular, Cervical
Ten Zebras Beat My Cock
Two Zulus buggered my cat –(for the sicker, amongst you!)

You have I nose. You have II eyes. (I - Olfactory; II -- Optic)

Exit of branches of trigeminal nerve from the skull S
Standing Room Only -
V1 -Superior orbital fissure, V2 -foramen Rotundum, V3 -foramen Ovale

For the order of nerves that pass through the superior orbital fissure:
"Lazy French Tarts Lie Naked in Anticipation."
(Lacrimal, Frontal, Trochlear, Lateral, Nosociliary, Internal,
Abducens)

2 Muscle of mastication- Lateral Lowers- lateral pterygoid is the one that opens the jaw
4 Muscles of Mastication MTPP( which could be read as "Empty Peepee") -masseter, temporal, lateral and medial pterygoids --

Arteries as they come off the external carotid:
Some Angry Lady Figured out PMS
Superior thyroid, Ascending pharyngeal, Lingual, Facial, Occipital, Post Auricular, Superficial temporal, Maxillary

Innervation of Extraocular motor Muscles: LR6 SO4 3
LR6--Lateral rectus--> VI abductens
SO4--Superior Oblique--> IV Trochlear
3--The remaining 4 eyeball movers = III Oculomotor

ABC'S of the aortic arch!
Aortic arch gives off the Bracheiocephalic trunk,
the left Common Carotid, and the left
Subclavian artery

BRACHIAL PLEXUS: Roots, Trunks, Divisions, Cords, Branches
Robert Taylor Drinks Cold Beer.

CERVICAL SPINAL NERVES:
c345 keeps the phrenic alive (innervation of phrenic nerve) c345 keep the diaphragm alive (innervation of diaphragm)
c5-6-7 raise your arms to heaven (nerve roots of long thoracic nerve innervate serratus anterior)

Cranial Bones
Annoying, aren't they?
The cranial bones are the PEST OF 6...

Parietal, Ethmoid,Sphenoid,Temporal,Occipital,Frontal- 6 ? (6-the number of bones!)
( another one) Old People From Texas Eat Spiders.

LOCATION OF THORACIC DUCT: The duck is between two gooses (duck = thoracic duct) 2 gooses = azyGOUS and esophaGOUS

Cartilages of the Larynx - There are 4 cartilages in the larynx whose initial letters are TEAC (also the brandname of a home stereo).
Thyroid, Epiglottis, Arytenoid, Cricoid

Abdomen-Pelvis

INNERVATION OF PENIS:
Parasympathetic puts it up; sympathetic spurts it out
Point , Shoot, Score! (erection, emmision ,ejaculation) Parasympathetic, Sympathetic , Somatomotor
"S2, 3, 4 keep the penis off the floor" Innervation of the penis by branches of the pudental nerve, derived from spinal cord levels S2-4

Structures perforating the esophagus
"At T8 you see, perforates the IVC" (inferior Vena Cava)
the "EsoVagus" pierce T10 (esophagus, vagus nerve)
T12 - red, white and blue (aorta,thoracic duct,azygous vein)

Femoral Sheath (lateral to medial) order of things in thigh -NAVEL
Nerve, Artery, Vein, Empty, Space, Lymphatics

Radial n. innervates the BEST!!!!
Brachioradialis
Extensors
Supinator
Triceps

Course of Ureters
Water runs under the bridge (uterine a. and ductus deferens)

Carotid Sheath-- VAN
Internal Jugular Vein
Common carotid Artery
Vagus Nerve

Dermatomes
C3 is a high turtleneck shirt
T4 is at the nipple
L1 is at the inguinal ligament (or L1 is IL -Inguinal ligament)
Randy Travis Drinks Cold Beer--Brachial plexus
Robert Taylor Drinks Cold Beer
Roots, Trunks, Divisions, Cords, Branches

Bones of the wrist -Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium,
Trapezoid, Capitate, Hamate

1. Slowly Lower Tilly's Pants To The Curly Hairs
2. Swifty Lower Tilly's Pants to try coitus here. (the risque version)
3.Scared Lovers Try Positions That They Can't Handle. (Classic version)

Pelvic Diaphragm
PICOLO(A) -Posterior to anterior
PIriformis
COccygeus
Levator Ani

Pelvic Splanchic-Parasympathetic
Sacral Splanchic-Sympathetic

Armies travel over bridges, the Navy travels under.
(Bridge is the ligament...reference to suprascapular artery and nerve.)

Pad, dab. Dorsal ABduct...Palmar ADduct...interosseous muscles of hand/foot.

Layers of the epidermis-Germinativum or Basale, Spinosum, Granulosum, Lucidum, Corneum

Grandpa Shagging Grandma's Love Child.

Limbic System- the 5 F’s- Feeding, Fighting, Feeling, Flight and making babiesing

The 5 sphincters found in the Alimentary Canal are APE OIL:
Anal, Pyloric, Lower Esophogeal, Oddi, and Ileocecum.

The branches of the Axillary Artery are: Sally Thompson Loves Sex And Pot pie.
Superior Thoracic, Thoracoacromial, Lateral Thoracic, Subscapular, Anterior Circumflex Humeral, Posterior Circumflex Humeral, and Profunda Brachii.

TIRE- four abdominal muscles -- transversus, internal oblique, rectus abdominus, and external oblique

Anesthesia Mnemonics

Spinal anesthesia agents
"Little Boys Prefer Toys":
Lidocaine
Bupivicaine
Procaine
Tetracaine

Xylocaine: where not to use with epinephrine
"Nose, Hose, Fingers and Toes"
• Vasoconstrictive effects of xylocaine with epinephrine are helpful in providing hemostasis while suturing. However, may cause local ischemic necrosis in distal structures such as the digits, tip of nose, penis, ears.

General anaesthesia: equipment check prior to inducing
MALES:
Masks
Airways
Laryngoscopes
Endotracheal tubes
Suction/ Stylette, bougie

Endotracheal intubation: diagnosis of poor bilateral breath sounds after intubation
DOPE:
Displaced (usually right mainstem, pyreform fossa, etc.)
Obstruction (kinked or bitten tube, mucuous plug, etc.)
Pneumothorax (collapsed lung)
Esophagus

Anesthesia machine/room check
MS MAID:
Monitors (EKG, SpO2, EtCO2, etc)
Suction
Machine check (according to ASA guidelines)
Airway equipment (ETT, laryngoscope, oral/nasal airway)
IV equipment
Drugs (emergency, inductions, NMBs, etc)

Anesthesia: quick check
SOAP:
Suction
Oxygen
Airway
Pharmacology

Anesthetics equipment check
MISMADE:
Machine check
IV supplies
Suction
Monitors
Airways
Drugs
Equipment

Failed intubation: causes
INTUBATION:
Infections of larynx
Neck mobility abnormalities
Teeth abnormalites (eg poor dentifom, loose and protuberant teeth)
Upper airway abnormalities, strictures, or swellings
Bullsneck deformities
Ankylosing spondylitis
Trauma/ TumourInexperienceOedema of upper airwayNarrowing of lower airway

Respiratory complications of anaesthesia: patients at risk
COUPLES:
COPD
Obese
Upper abdominal surgery
Prolonged bed rest
Long surgery
Elderly
Smokers
Biochemistry Mnemonics

Essential Amino Acids
PriVaTe TIM HALL
Phe, Val, Thr, Trp, Ile, Met, His, Arg, Leu, Lys

Urea Cycle
Ordinarily, Careless Crappers, Are Also Frivolous About Urination.
Ornithine, Carbamoyl, Citrulline, Arginosuccinate, Aspartate, Fumarate, Arginine, Urea.

Cell division
Prophase, metaphase, anaphase, telophase.
"People Meet And Talk."

In the Phasted State
Phosphorylate Phosphorylation cascade active when blood glucose low.
DNA expression into mature mRNA
Exons expressed, Introns in the trash.
Pyrimidines are CUT from purines.
Pyrimidines are Cytosine, Uracil, Thiamine and are one ring structures.
Purines are double ring structures.

Amino Acids:The ten essential amino acids:
"These Ten Valuable Amino Acids Have Long Preserved Life In
Man."
(Threonine, Tryptophan, Valine, Arginine, Histidine, Lysine,
Phenylalanine, Leucine, Isoleucine, Methionine)

GOAT FLAP- Eight hormones: Growth hormone, Oxytocin, Adenocorticotropin, Thyroid stimulating hormone, Follicle stimulating hormone, Leutinizing hormone (interstitial cell stimulating hormone in males), Anti-diruetic(Vasopressin), and Prolactin
(shhhh.... also Melatonin!)

Most Common's in medical science

2009-01-16T07:51:00.000-08:00

Most Common's in medical science
1° Tumor arising from bone in adults
· Multiple Myeloma
Adrenal Medullary Tumor – Adults
· Pheochromocytoma
Adrenal Medullary Tumor – Children
· Neuroblastoma
Bacterial Meningitis – adults
· Neisseria meningitidis
Bacterial Meningitis – elderly
· Strep pneumoniae
Bacterial Meningitis – newborns
· E. coli
Bacterial Meningitis – toddlers
· Hib
Bone Tumors
· Metasteses from Breast & Prostate
Brain Tumor – Child
· Medulloblastoma (cerebellum)
Brain Tumor –Adult
· Astrocytoma (including Glioblastoma Multiforme) then: mets, meningioma, Schwannoma
Breast Carcinoma
· Invasive Duct Carcinoma
Breast Mass
· Fibrocystic Change (Carcinoma is the most common is post-menopausal women)
Bug in Acute Endocarditis
· Staph aureus
Bug in debilitated, hospitalized pneumonia pt
· Klebsiella
Bug in Epiglottitis
· Hib
Bug in GI Tract
· Bacteroides (2nd – E. coli)
Bug in IV drug user bacteremia / pneumonia
· Staph aureus
Bug in PID
· N. Gonnorrhoeae
Bug in Subacute Endocarditis
· Strep Viridans
Cardiac 1° Tumor – Adults
· Myxoma “Ball Valve”
Cardiac 1° Tumor – Child
· Rhabdomyoma
Cardiac Tumor – Adults
· Metasteses
Cardiomyopathy
· Dilated (Congestive) Cardiomyopathy
Cause of 2° HTN
· Renal Disease
Cause of Addison’s
· Autoimmune (2nd – infection)
Cause of Congenital Adrenal Hyperplasia
· 21-Hydroxylase Deficiency (then, 11-)
Cause of Cushings
· Exogenous Steroid Therapy (then, 1° ACTH, Adrenal Adenoma, Ectopic ACTH)
Cause of death in Alzheimer pts
· Pneumonia
Cause of death in Diabetics
· MI
Cause of Death in SLE pts.
· Lupus Nephropathy Type IV (Diffuse Proliferative)
Cause of Dementia
· Alzheimer’s
Cause of Dementia (2nd most common)
· Multi-Infarct Dementia
Cause of food poisoning
· Staph aureus
Cause of mental retardation
· Down’s
Cause of mental retardation (2nd most common)
· Fragile X
Cause of preventable blindness
· Chlamydia
Cause of Pulmonary HTN
· COPD
Cause of SIADH
· Small Cell Carcinoma of the Lung
Chromosomal disorder
· Down’s
Congenital cardiac anomaly
· VSD (membranous > muscular)
Congenital early cyanosis
· Tetralogy of Fallot
Coronary Artery thrombosis
· LAD
Demyelinating Disease
· Multiple Sclerosis
Dietary Deficiency
· Iron
Disseminated opportunistic infection in AIDS
· CMV (Pneumocystis carinii is most common overall)
Esophageal cancer
· SCCA
Fatal genetic defect in Caucasians
· Cystic Fibrosis
Female Tumor
· Leimyoma
Form of Amyloidosis
· Immunologic (Bence Jones protein in multiple myeloma is also called the Amyloid Light Chain)
Form of Tularemia
· Ulceroglandular
Gynecologic malignancy
· Endometrial Carcinoma
Heart Murmur
· Mitral Valve Prolapse
Heart Valve in bacterial endocarditis
· Mitral
Heart Valve in bacterial endocarditis in IV drug users
· Tricuspid
Heart Valve involved in Rheumatic Fever
· Mitral then Aortic
Hereditary Bleeding Disorder
· Von Willebrand’s Disease
Liver 1° Tumor
· Hepatoma
Liver Disease
· Alcoholic Liver Disease
Location of Adult brain tumors
· Above Tentorium
Location of Childhood brain tumors
· Below Tentorium
Lysosomal Storage Disease
· Gaucher’s
Motor Neuron Disease
· ALS
Neoplasm – Child
· Leukemia
Neoplasm – Child (2nd most common)
· Medulloblastoma of brain (cerebellum)
Nephrotic Syndrome
· Membranous Glomerulonephritis
Opportunistic infection in AIDS
· PCP
Ovarian Malignancy
· Serous Cystadenoma
Ovarian Tumor
· Hamartoma
Pancreatic Tumor
· Adeno (usually in the head)
Patient with ALL / CLL / AML / CML
· ALL - Child / CLL - Adult over 60 / AML - Adult over 60 / CML - Adult 35-50
Patient with Goodpasture’s
· Young male
Patient with Reiter’s
· Male
Pituitary Tumor
· Prolactinoma (2nd – Somatotropic “Acidophilic” Adenoma)
Primary Hyperparathyroidism
· Adenomas (followed by: hyperplasia, then carcinoma)
Pt. With Hodgkin’s
· Young Male (except Nodular Sclerosis type – Female)
Pt. With Minimal Change Disease
· Young Child
Secondary Hyperparathyroidism
· Hypocalcemia of Chronic Renal Failure
Sexually transmitted disease
· Chlamydia
Site of Diverticula
· Sigmoid Colon
Site of metastasis
· Regional Lymph Nodes
Site of metastasis (2nd most common)
· Liver
Sites of atherosclerosis
· Abdominal aorta > coronary > popliteal > carotid
Skin Cancer
· Basal Cell Carcinoma
Stomach cancer
· Adeno
Testicular Tumor
· Seminoma
Thyroid Cancer
· Papillary Carcinoma
Tracheoesophageal Fistula
· Lower esophagus joins trachea / upper esophagus – blind pouch
Tumor of Infancy
· Hemangioma
Type of Hodkin’s
· Mixed Cellularity (versus: lymphocytic predominance, lymphocytic depletion, nodular sclerosis)
Type of Non-Hodgkin’s
· Follicular, small cleaved
Vasculitis (of medium & small arteries)
· Temporal Arteritis
Viral Encephalitis
· HSV

Characterstic Drug Toxicities

2009-01-16T07:45:00.000-08:00

Characterstic Drug Toxicities
Agranulocytosis
· Clozapine
Aplastic Anemia
· Chloramphenicol · NSAIDs · Benzene
Atropine-like Side Effects
· Tricyclics
Cardiotoxicity
· Doxorubicin · Daunorubicin
Cartilage Damage in children
· Fluoroquinolones (Ciprofloxacin & Norfloxacin)
Cinchonism
· Quinidine
Coronary Steal Phenomenon
· Dipyridamole
Corneal micro deposits
· Amiodarone
Cough
· ACE Inhibitors
Diabetes Insipidus
· Lithium
Disulfiram-like effect
· Metronidazole · Sulfonylureas (1st generation)
Extrapyramidal Side Effects
· Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine)
Fanconi’s Syndrome
· Tetracycline
Fatal Hepatotoxicity (necrosis)
· Valproic Acid · Halothane · Acetaminophen
Gingival Hyperplasia
· Phenytoin
Gray Baby Syndrome
· Chloramphenicol
Gynecomastia
· Cimetidine · Azoles · Spironolactone · Digitalis · Estrogen & testosterone · INH & ethionamide · Clomiphine · Phenytoin · Reserpine & Methyldopa
Hand Foot Syndrome
· 5-Flurouracil (5-FU)
Hemolytic Anemia in G6PD-deficiency
· Sulfonamides · Isoniazid · Aspirin · Ibuprofen · Primaquine
Hemorrhagic Cystitis
· Cyclophosphamide · Ifosamide (Treat by Mesna & Acetylcysteine Bladder Wash)
Hepatitis
· Isoniazid
Hot Flashes, Flushing
· Niacin · Tamoxifen · Ca++ Channel Blockers
Hypertension: Postural
· Prazocin
Hypertension: Rebound
· Clonidine withdrawal
Increased intra cranial tension ( ICT)
· Amiodarone · Hypervitaminosis A · OCP’s · Tetracycline · Quinolones
Induce CP450
· Barbiturates · Phenytoin · Carbamazepine · Rifampin
Inhibit CP450
· Cimetidine · Erythromycin · Ketoconazole · Isoniazid (INH) [remember CEKI]
Interstitial Nephritis
· Methicillin · NSAIDs (except Aspirin) · Furosemide · Sulfonamides
Milk Alkali Syndrome
· Calcium Carbonate (CaCo3)
Monday Disease
· Nitroglycerin Industrial exposure ® tolerance during week ® loss of tolerance during weekend ® headache, tach, dizziness upon re-exposure
Nephrotoxicity
· Cephaloridine · Gentamycin · Amphotericin
Orange Body Fluids
· Rifampin
Osteoporosis
· Heparin · Corticosteroids
Pancreatitis
· L-Asparginase · Glucocorticoids
Photosensitivity
· Lomefloxacin · Pefloxacin
Positive Coombs’ Test
· Methyldopa
Pulmonary Fibrosis
· Bleomycin · Amiodarone
Rabbit Syndrome (Perioral tremors)
· Phenothiazines
Red Man Syndrome
· Vancomycin (rapid IV)
Severe HTN with Tyramine
· MAOIs
SLE- Drug Induced[Anti Histone Antibody Characteristic of this]
· Chloropromazine · Hydralazine · Isoniazid · Methyldopa · Procainamide · Quinidine [ remember CHIMP -Q]
Tardive Dyskinesia
· Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine)
Tinnitus
· Aspirin · Quinidine
Torsades de Pontis
· Terfanadine

LABORATORY TESTS

2009-01-16T07:31:00.000-08:00

a-1 FETOPROTEIN (ALPHA-I-FETOPROTEIN )
Elevated in:Hepatocellular carcinoma (usually values >1000 ng/ml), germinal neoplasms (testis, ovary, mediastinum, retroperitoneum), liver disease (alcoholic cirrhosis, acute hepatitis, chronic active hepatitis), fetal anencephaly, spina bifida----------------------------------------------------------------------------------------------------ACETONE (serum or plasma)
Elevated in:DKA, starvation, isopropanol Ingestion----------------------------------------------------------------------------------------------------ACID PHOSPHATASE (serum)
Elevated in:Carcinoma of prostate, other neoplasms (breast, bone), Paget's disease, osteogenesis imperfecta, malignant invasion of bone, Gaucher's disease, multiple myeloma, myeloproliferative disorders, benign prostatic hypertrophy, prostatic palpation or surgery, hyperparathyroidism, liver disease, chronic renal failure----------------------------------------------------------------------------------------------------ALANINE AMINOTRANSFERASE (ALT, SGPT)
Elevated in:Liver disease (hepatitis, cirrhosis, Reye's syndrome), hepatic congestion, infectious mononucleosis, Ml, myocarditis, severe muscle trauma, dermatomyositis/polymyositis, muscular dystrophy, drugs (antibiotics, narcotics, antihypertensive agents, heparin, labetalol, lovastatin, NSAIDs, amiodarone, chlorpromazine, phenytoin), malignancy, renal and pulmonary infarction, convulsions, eclampsia, shock liver----------------------------------------------------------------------------------------------------ALBUMIN (serum)
Elevated in:Dehydration
Decreased in:Liver disease, nephrotic syndrome, poor nutritional status, rapid IV hydration, protein-losing enteropathies (inflammatory bowel disease), severe bums, neoplasia, chronic inflammatory diseases, pregnancy, oral contraceptives, prolonged immobilization----------------------------------------------------------------------------------------------------ALDOLASE (serum)
Elevated in:Muscular dystrophy, rhabdomyolysis, dermatomyositis/polymyositis, trichinosis, acute hepatitis and other liver diseases, Ml, prostatic carcinoma, hemorrhagic pancreatitis, gangrene, delirium tremens
Decreased in:Loss of muscle mass, late stages of muscular dystrophy----------------------------------------------------------------------------------------------------ALKALINE PHOSPHATASE (serum)
Elevated in:Biliary obstruction, cirrhosis (particularly primary biliary cirrhosis), liver disease (hepatitis, infiltrative liver diseases, fatty metamorphosis), Paget's disease of bone, osteitis deformans, rickets, osteomalacia, hypervitaminosis D, hyperparathyroidism, hyperthyroidism, ulcerative colitis, bowel perforation, bone metastases, healing fractures, bone neoplasms, acromegaly, infectious mononucleosis, CMV infections, sepsis, pulmonary infarction, CHF, hypernephroma, leukemia, myelofibrosis, multiple myeloma, drugs (estrogens, albumin, erythromycin and other antibiotics, cholestasis-producing drugs [phenothiazines])
Decreased in:Hypothyroidism, pernicious anemia, hypophosphatemia, hypervitaminosis D, malnutrition----------------------------------------------------------------------------------------------------AMMONIA (serum)
Elevated in:Hepatic failure, hepatic encephalopathy, Reye's syndrome, portacaval shunt, drugs (diuretics, polymyxin B. methicillin)
Decreased in:Drugs (neomycin, lactulose, tetracycline), renal failure----------------------------------------------------------------------------------------------------AMYLASE (serum)
Elevated in:Acute pancreatitis, pancreatic neoplasm, abscess, pseudocyst, ascites, macroamylasemia, perforated peptic ulcer, intestinal obstraction, intestinal infarction, acute cholecyshtis, appendicitis, ruptured ectopic pregnancy, salivary gland inflammation, peritonitis, burns, diabetic ketoacidosis, renal insufficiency, drugs (morphine), carcinomatosis of lung, esophagus, ovary, acute ethanol ingestion
Decreased in:Advanced chronic pancreatitis, hepatic necrosis----------------------------------------------------------------------------------------------------ANGIOTENSIN CONVERTING ENZYME (ACE level)
Elevated in:Sarcoidosis, primary biliary cirrhosis, alcoholic liver disease, hyperthyroidism, hyperparathyroidism, diabetes mellitus, amyloidosis, multiple myeloma, lung disease (asbestosis, silicosis, berylliosis, allergic alveolitis, coccidioidomycosis), Gaucher's disease, leprosy----------------------------------------------------------------------------------------------------ANION GAP
Elevated in:Lactic acidosisKetoacidosis (DKA, alcoholic starvation)Uremia (chronic renal failure)Ingestion of toxins (paraldehyde, methanol, salicylates, ethylene glycol)
Decreased in:Hypoalbum nemia, severe hypermagnesem a, IgG myeloma, littaum toxicity, lab error (falsely Decreased sodium or overestimation of bicarbonate or chloride)----------------------------------------------------------------------------------------------------ANTI-DNA
Present in:SLE, chronic active hepatitis, infectious mononucleosis, biliary cirrhosis----------------------------------------------------------------------------------------------------ANTI-STREPTOLYSIN O TITER (STREPTOZYME, ASLO titer)
Elevated in:Streptococcal upper airway infection, acute rheumatic fever, acute glomerulonephritis, increased levels of B-lipoprotein
NOTE: A fourfold increase in titer between acute and convalescent specimens is diagnostic of streptococcal upper airway infection regardless of the initial titer.----------------------------------------------------------------------------------------------------ANTIMITOCHONDRIAL ANTIBODY
Elevated in:Primary biliary cirrhosis (85-95%), chronic active hepatitis (25%-30%) cryptogenic cirrhosis (25-30%)----------------------------------------------------------------------------------------------------ANTINUCLEAR ANTIBODY (ANA)
Positive test:SLE (more significant if titer >1: 160), drugs (phenytoin, ethosuximide, pnmudone, methyldopa, hydralazine, carbamazepine, penicillin, procainamide, chlorpromazine, griseofulvin, thiazides), chronic active hepatltis, age over 60 yr (particularly age over 80), rheumatoid arthritls, scleroderma, mixed connective tissue disease, necrotizing vasculitis, Sjogren's syndrome (SS), tuberculosis, pulmonary interstitial fibrosis----------------------------------------------------------------------------------------------------ANTITHROMBIN III
Decreased in:Hereditary deficiency of antithrombin III, DIC, pulmonary embolism, cirrhosis, thrombolytic therapy, chronic liver failure, post-surgery, third trimester of pregnancy, oral contraceptives, nephrotic syndrome, IV heparin >3 days, sepsis
Elevated in:Warfarin drugs, post-MI----------------------------------------------------------------------------------------------------ASPARTATE AMINOTRANSFERASE (AST, SGOT)
Elevated in:Liver disease (hepatitis, cirrhosis, Reye's syndrome), hepatic congestion, infectious mononucleosis, MI, myocarditis, severe muscle trauma, dermatomyositis/polymyositis, muscular dystrophy, drugs (antibiotics, narcotics, antihypertensive agents, heparin, labetalol, lovastatin, NSAIDs, phenytoin, amiodarone, chlorpromazine), malignancy, renal and pulmonary infarction, convulsions, eclampsia----------------------------------------------------------------------------------------------------BASOPHIL COUNT
Elevated in:Leukemia, inflammatory processes, polycythemia vera, Hodgkin's Iymphoma, hemolytic anemia, after splenectomy, myeloid metaplasia
Decreased in:Stress, hypersensitivity reaction, steroids, pregnancy, hyperthyroidism----------------------------------------------------------------------------------------------------BILIRUBIN, DIRECT (conjugated bilirubin)
Elevated in:Hepatocellular disease, biliary obstruction, drug-induced cholestasis, hereditary disorders (Dubin-Johnson syndrome, Rotor's syndrome)----------------------------------------------------------------------------------------------------BILIRUBIN, INDIRECT (unconjugated bilirubin)
Elevated in:Hemolysis, liver disease (hepatitis cirrhosis, neoplasm), hepatic congestion secondary to congestive heart failure, heredltary dlsorders (Gilbert's disease, Crigler-Najjar syndrome)----------------------------------------------------------------------------------------------------BILIRUBIN, TOTAL
Elevated in:Liver disease (hepatitis, cirrhosis, cholangitis, neoplasm, biliary obstruction, infectious mononucleosis), hereditary disorders (Gilbert's dsease, Dubin-Johnson syndrome), drugs (steroids, diphenylhydanton, phenothiazines, penicillin, erythromycin, clindamycin, captopril, amphotericin B. sulfonamides, azathioprine, isoniazid, 5-aminosalicylic acid, allopurinol, methyldopa, indomethacin, halothane, oral contracepuves, procainamide, tolbutamide, labetalol), hemolysis, pulmonary embolism or infarct, hepatic congestion secondary to CHF----------------------------------------------------------------------------------------------------BLEEDING TIME (modified Ivy method)
Elevated in:Thrombocytopenia, capillary wall abnormalities, platelet abnormalities (Bernard-Soulier, Glamzmann's), drugs (aspirin, warfarin, antinflammatory medications, streptokinase, urokinase, dextran, B lactam antibiotics, moxalactam), DIC, cirrhosis, uremia, myeloproliferative dlsorders, Von Willebrand's----------------------------------------------------------------------------------------------------C-REACTIVE PROTEIN
Elevated in:Rheumatoid arthritis, rheumatic fever, inflammatory bowel disease, bacterial infections, Ml, oral contraceptives, third trimester of pregnancy (acute phase reactant), inflammatory and neoplastic diseases----------------------------------------------------------------------------------------------------CALCITONIN (serum)
Elevated in:Medullary carcinoma of the thyroid (particularly if level >1500 pg/ml), carcinoma of the breast, APUDomas, carcinolds, renal failure, thyroiditis----------------------------------------------------------------------------------------------------CALCIUM (serum)
Increased in:-Hyperparathyroidism, primary (due to hyperplasia or adenoma of parathyroids) or secondary-Hyperparathyroidism due to parathormone-secreting cancer -Hematologic malignancies (e.g., myeloma, lymphoma, leukemia)-Excess vitamin D intake-Bone tumor (Metastatic carcinoma (10% of patients))-Acute osteoporosis (e.g., immobilization of young patients or in Paget's disease)-Milk-alkali (Burnett's) syndrome-Idiopathic hypercalcemia of infants-Infantile hypophosphatasia-Berylliosis-Hyperthyroidism (some patients)-Cushing's syndrome (some patients)-Addison's disease (some patients)-Myxedema (some patients)-Hyperproteinemia (Sarcoidosis, -Multiple myeloma (some patients))-Thiazide drugs-Artifactual (e.g., venous stasis during blood collection, use of cork-stoppered test tubes)
Decreased in:-Hypoparathyroidism (Surgical; Idiopathic; Pseudohypoparathyroidism)-Malabsorption of calcium and vitamin D (Obstructive jaundice)-Hypoalbuminemia (Cachexia, Nephrotic syndrome, Sprue, Celiac disease, Cystic fibrosis of pancreas)-Chronic renal disease with uremia and phosphate retention-Acute pancreatitis with extensive fat necrosis-Insufficient calcium, phosphorus, and vitamin D ingestion (Bone disease (osteomalacia, rickets); Starvation; Late pregnancy)
Total serum protein should always be known for proper interpretation of serum calcium levels.
----------------------------------------------------------------------------------------------------CARBOXYHEMOGLOBIN (CARBON MONOXIDE; CO)
Elevated in:Smoking, exposure to smoking, exposure to automobile exhaust fumes malfunctioning gas-burning appliances----------------------------------------------------------------------------------------------------CARCINOEMBRYONIC ANTIGEN (CEA)
Elevated in:Colorectal carcinomas, pancreatic carcmomas, and metastatic disease usually produce higher elevations (>20 ng/ml)
Carcinomas of the esophagus, stomach, small intestine, liver, breast ovary, lung and thyroid usually produce lesser elevations
Benign conditions (smoking, inflammatory bowel disease hypothyroidism, cirrhosis, pancreatitis, infections) usually produce ievels <10 ng/ml----------------------------------------------------------------------------------------------------CAROTENE (serum)
Elevated in:Carotenemia, chronic nephritis, diabetes mellitus, hypothyroidism, nephrotic syndrome
Decreased in:Fat malabsorption, steatorrhea, pancreatic insufficiency, lack of carotenoids in diet----------------------------------------------------------------------------------------------------CEREBROSPINAL FLUID (CSF)
----------------------------------------------------------------------------------------------------CERULOPLASMIN (serum)
Elevated in:Pregnancy, estrogens, oral contraceptives, neoplastic diseases (leukemias, Hodgkin's Iymphoma, carcinomas), inflammatory states, SLE, prirnary biliary cirrhosis, rheumatoid arthritis
Decreased in:Wilson's disease (values often <10 mg/dl), nephrotic syndrome, advanced liver disease, malabsorption, total parenteral nutrition, Menkes' syndrome----------------------------------------------------------------------------------------------------CHLORIDE (serum)
Elevated in:-Dehydration, excessive infusion of normal saline-Hyperparathyroidism, renal tubular disease, metabolic acidosis, prolonged diarrhea-Drugs (ammonium chloride administration, acetazolamide, boric acid, triamterene)
Decreased in:CHF, SIADH, Addison's disease, vomiting, gastric suction, salt-losing nephritis, continuous infusion of D5W, thiazide diuretic administration, diaphoresis, diarrhea, burns----------------------------------------------------------------------------------------------------CHOLESTEROL, TOTAL
Elevated in:Primary hypercholesterolemia, biliary obstruction, diabetes melhtus, nephrotic syndrome, hypothyroidism, primary biliary cirrhosis, high cholesterol diet, third trimester of pregnancy, Ml, drugs (steroids, phenothiazines, oral contraceptives)
Decreased in:Starvation, malabsorption, sideroblastic anemia, thalassemia, abetalipoproteinemia, hyperthyroidism, Cushing's syndrome, hepatic failure, multiple myeloma, polycythemia vera, chronic myelocytic leukemia, myeloid metaplasia, Waldenstrom's macroglobulinemia, myelofibrosis----------------------------------------------------------------------------------------------------CIRCULATING ANTICOAGULANT (lupus anticoagulant)
Detected in:SLE, drug-induced lupus, long-term phenothiazine therapy, multiple myeloma, ulcerative colhis, rheumatoid arthritis, postpartum, hemophilia, neoplasms, chronic inflammatory states----------------------------------------------------------------------------------------------------COLD AGGLUTININS TITER
Elevated in:Primary atypical pneumonia (mycoplasma pneumonia), infectious mononucleosis, CMV infection
Other: hepatic cirrhosis, acquired hemolytic anemia, frostbite, multiple myeloma, Iymphoma, malaria----------------------------------------------------------------------------------------------------COMPLEMENT (C3, C4)
C3 is increased in:Acute and chronic inflammation (slightly), obstructive jaundice
C3 is decreased in:Acute glomerulonephritis, systemic lupus erythromatosis
----------------------------------------------------------------------------------------------------COOMBS, DIRECT
Positive:Autoimmune hemolytic anemia, erythroblastosis fetalis, transfusion reactions, drugs (a-methyldopa, peniecllins, tetraeyeline, sulfonamides, levodopa, cephalosporins, quinidine, insulin)
False positive:May be seen with cold agglutinins----------------------------------------------------------------------------------------------------COOMBS, INDIRECT
Positive:Acquired hemolytic anemia, incompatible cross-matched blood, anti-Rh antibodies, drugs (methyldopa, mefenamic acid, levodopa)----------------------------------------------------------------------------------------------------COPPER (serum)
Increased in:-Anemias (Pernicious anemia, Megaloblastic anemia of pregnancy, Iron deficiency anemia, Aplastic anemia, Leukemia, acute and chronic, Infection, acute and chronic, Malignant lymphoma, Hemochromatosis)-Collagen diseases (including SLE, rheumatoid arthritis, acute rheumatic fever, glomerulonephritis)-Hypothyroidism-Hyperthyroidism-Frequently associated with increased C-reactive protein
Decreased in:-Nephrosis (ceruloplasmin lost in urine)-Wilson's disease-Acute leukemia in remission-Some iron deficiency anemias of childhood (that require copper as well as iron therapy)-Kwashiorkor
----------------------------------------------------------------------------------------------------CORTISOL (plasma)
Elevated in:-Ectopic ACTH production (i.e., oat cell carcinoma of lung), loss of normal diurnal variation, pregnancy, chronic renal failure-Iatrogenic, stress, adrenal or pituitary hyperplasia or adenomas
Decreased in:Primary adrenocortical insufficiency, anterior pituitary hypofunction, secondary adrenocortical insufficiency, adrenogenital syndromes----------------------------------------------------------------------------------------------------CREATINE KINASE (CK, CPK)
Elevated in:MI, myocarditis, rhabdomyolysis, myositis, crush injury/trauma, polymyositis, dermatomyositis, vigorous exercise, muscular dystrophy, myxedema, seizures, malignant hyperthermia syndrome, IM injections, CVA, pulmonary embolism and infarction, acute dissection of aorta
Decreased in:Steroids, decreased muscle mass, connective tissue disorders, alcoholic liver disease, metastatic neoplasms----------------------------------------------------------------------------------------------------CREATINE KINASE ISOENZYMES
CK-MBElevated in: Mi, myocarditis, pericarditis, muscular dystrophy, cardiac defibrillation, cardiac surgery, extensive rhabdomyolysis, strenuous exercise (marathon runners), mixed conmective tissue disease, cardiomyopathy, hypothermia
CK-MMElevated in: crush injury, seizures, malignant hyperthermia syndrome, rhabdomyolysis, myositis, polymyositis, dermatomyositis, vigorous exercise, muscular dystrophy, IM injections, acute dissection of aorta
CK-BBElevated in: CVA, subarachnoid hemorrhage, neoplasms (prostate, Gl tract, brain, ovary, breast, lung), severe shock, bowel infarction, hypothermia----------------------------------------------------------------------------------------------------CREATININE (serum)
Elevated in:Renal insufficiency (acute and chronic), Decreased renal perfusion (hypotension, dehydration, CHF), urinary tract infection, rhabdomyolysis, ketonemiaDrugs (antibiotics [aminoglycosides, cephalosporins], hydantoin, diuretics, methyldopa)
Falsely elevated in:DKA, administration of some cephalosporins (e.g., cefoxitin, cephalothin)
Decreased in:Decreased muscle mass (including amputees and older persons), pregnancy, prolonged debilitation----------------------------------------------------------------------------------------------------CREATININE CLEARANCE
Elevated in:Pregnancy, exercise
Decreased in:Renal insufficiency, drugs (cimetidine, procainanude, antibiotics, quinidine)----------------------------------------------------------------------------------------------------CRYOGLOBULINS (serum)
Present in:Collagen-vascular diseases, CLL, hemolytic anemias, multiple myeloma, Waldenstrom's macroglobulinemia, chronic active hepatitis, Hodgkin's disease----------------------------------------------------------------------------------------------------D-XYLOSE ABSORPTION
Decreased in:Malabsorption syndrome----------------------------------------------------------------------------------------------------EOSINOPHIL COUNT
Elevated in:Allergy, parasitic infestations (trichinosis, aspergillosis, hydatidosis), angmneurotic edema, drug reactions, warfarin sensitivity, collagen-vascular diseases, acute hypereosinophilic syndrome, eosinophilic nonallergic rhinitis, myeloproliferative disorders, Hodgkin's Iymphoma, radiation therapy, NHL, L-tryptophan ingestion----------------------------------------------------------------------------------------------------ERYTHROCYTE SEDIMENTATION RATE (Westergren)
Elevated in:Collagen-vascular diseases, infections, MI, neoplasms, inflammatory states (acute phase reactant)----------------------------------------------------------------------------------------------------EXTRACTABLE NUCLEAR ANTIGEN (ENA complex, anti-RNP antibody, anti-Sm, anti-Smith)
Present in:SLE, rheumatoid arthritis, Sjogren's syndrome, MCTD----------------------------------------------------------------------------------------------------FECAL FAT, QUANTITATIVE (72 hr collection)
Elevated in:Malabsorption syndrome----------------------------------------------------------------------------------------------------FERRITIN (serum)
Elevated in:Hyperthyroidism, inflammatory states, liver disease (ferritin elevated from necrotic hepatocytes), neoplasms (neuroblastomas, Iymphomas, leukemia, breast carcinoma), iron replacement therapy, hemochromatosis
Decreased in:Iron deficiency anemia----------------------------------------------------------------------------------------------------FIBRIN DEGRADATION PRODUCT (FDP)
Elevated in:DIC, primary fibrinolysis, pulmonary embolism, severe liver disease
NOTE: The presence of rheumatoid factor may cause falsely elevated FDP----------------------------------------------------------------------------------------------------FIBRINOGEN
Elevated in:Tissue inflammation/damage (acute-phase protein reactant), oral contraceptives, pregnancy, acute infection, MI
Decreased in:DIC, hereditary afibrinogenemia, liver disease, primary or secondary fibrinolysis, cachexia----------------------------------------------------------------------------------------------------FOLATE (FOLIC ACID)
Decreased in:Folic acid deficiency (inadequate intake, malabsorption), alcoholism, drugs (methotrexate, trimethoprim, phenytoin, oral contraceptives, azulfadine), vitamin B12 deficiency (defective red cell folate absorption)----------------------------------------------------------------------------------------------------FTA-ABS (serum)(FLUORESCENT TREPONEMAL ANTIBODY)
Reactive in:Syphilis, other treponemal diseases (yaws, pinta, bejel)----------------------------------------------------------------------------------------------------GASTRIN (serum)
Elevated in:Zollinger-Ellison syndrome (gastrinoma), pernicious anemia, hyperparathyroidism, retained gastric antrum, chronic renal failure, gastric ulcer, chronic atrophic gastritis, pyloric obstruction, malignant neoplasms of the stomach, H2 blockers, omeprazole----------------------------------------------------------------------------------------------------GLOMERULAR BASEMENT MEMBRANE ANTIBODY (ANTIGLOMERULAR BASEMENT ANTIBODY)
Present in:Goodpasture's syndrome----------------------------------------------------------------------------------------------------GLUCOSE-6-PHOSPHATE DEHYDROGENASE SCREEN (blood)
Abnormal:If a deficiency is detected, quantitation of G6PD is necessary; a G6PD screen may be falsely interpreted as abnormal----------------------------------------------------------------------------------------------------GLUCOSE TOLERANCE TEST
Elevated in:Glucose intolerance, diabetes mellitus, Cushing's syndrome, acromegaly, pheochromocytoma----------------------------------------------------------------------------------------------------GLUCOSE, FASTING
Elevated in:Diabetes mellitus, stress, infections, MI, CVA, Cushing's syndrome, acromegaly, acute pancreatitis, glucagonoma, hemocbromatosis, drugs (glucocorticoids, diuretics [thiazides, loop diuretics]), glucose intolerance----------------------------------------------------------------------------------------------------GLUCOSE, POSTPRANDIAL
Elevated in:Diabetes mellitus, glucose intolerance
Decreased in:Post-gastrointestinal resection, reactive hypoglycemia, hereditary fructose intolerance, galactosemia, leucine sensitivity----------------------------------------------------------------------------------------------------GLYCATED (GLYCOSYLATED) HEMOGLOBIN (HbA1c)
Elevated in:Uncontrolled diabetes mellitus (glycated hemoglobin levels reflect the level of glucose control over the preceding 120 days)
Decreased in:Hemolytic anemias, Decreased RBC survival, pregnancy, chronic blood loss, chronic renal failure, insulinoma----------------------------------------------------------------------------------------------------HAM TEST (acid serum test)
Positive in:Paroxysmal nocturnal hemoglobinuria (PNH)
False positive in:Hereditary or acquired spherocytosis, recent transfusion with aged RBC, aplastic anemia, myeloproliferative syndromes, leukemia, hereditary dyserythropoietic anemia type II (HEMPAS)----------------------------------------------------------------------------------------------------HAPTOGLOBIN (serum)
Elevated in:Inflammation (acute phase reactant), collagen-vascular diseases, infections (acute phase reactant), drugs (androgens)
Decreased in:Hemolysis (intravascular > extravascular), megaloblastic anemia, severe liver disease, large tissue hematomas, infectious mononucleosis, drugs (oral contraceptives)----------------------------------------------------------------------------------------------------HEMATOCRIT
Elevated in:Polycythemia vera, smoking, COPD, high altitudes, dehydration, hypovolemia
Decreased in:Blood loss (GI, GU), anemia, pregnancy----------------------------------------------------------------------------------------------------HEMOGLOBIN
Elevated in:Hemoconcentration, dehydration, polycythemia vera, COPD, high altitudes, false elevations (hyperlipemic plasma, WBC >50,000 mm3), stress
Decreased in:Hemorrhage (GI, GU), anemia----------------------------------------------------------------------------------------------------HEPATITIS A ANTIBODY
Present in:Viral hepatitis A, can be IgM or IgG (if IgM, acute hepatitis A; if IgG, previous infection with hepatitis A)----------------------------------------------------------------------------------------------------HEPATITIS B SURFACE ANTIGEN (HBsAg)
Detected in:Acute viral hepatitis Type B. Chronic hepatitis B----------------------------------------------------------------------------------------------------HIGH DENSITY LIPOPROTEIN (HDL) CHOLESTEROL
Increased:Use of gemfibrozil, nicotinic acid, estrogens, regular aerobic exercise, small (1 oz) daily alcohol intake
Decreased:Deficiency of apoproteins, liver disease, probucol ingestion, Tangier diseaseNOTE: A cholesterol/HDL ratio >4.5 is associated with increased risk of coronary artery disease.----------------------------------------------------------------------------------------------------IMMUNE COMPLEX ASSAY
Detected in:Collagen-vascular disorders, glomerulonephritis, neoplastic diseases, malaria, primary biliary cirrhosis, chronic acute hepatitis, bacterial endocarditis, vasculitis----------------------------------------------------------------------------------------------------IMMUNOGLOBULINS
Elevated in:-IgA: Iymphoproliferative disorders, Berger's nephropathy, chronic infections, autoimmune disorders, liver disease-IgE: allergic disorders, parasitic infections, immunological disorders IgE myeloma-IgG: chronic granulomatous infections, infectious diseases, inflammation, myeloma, liver disease-IgM: primary biliary cirrhosis, infectious diseases (brucellosis, malaria), Waldenstrom's macroglobulinemia, liver disease
Decreased in:-IgA: nephrotic syndrome, protein-losing enteropathy, congenital deficiency, Iymphocytic leukemia, ataxia-telengiectasia, chronic eosinopulmonary disease-IgE: hypogammaglobulinemia, neoplasm (breast, bronchial, cervical) ataxia, telengiectasia-IgG: congenital or acquired deficiency, Iymphocytic leukemia, phenytoin, methylprednisolone, nephrotic syndrome, protein-losing enteropathy-IgM: congenital deficiency, Iymphocytic leukemia, nephrotic syndrome----------------------------------------------------------------------------------------------------IRON-BINDING CAPACITY (TIBC)
Elevated in:Iron deficiency anemia, pregnancy, polycythemia
Decreased in:Anemia of chronic disease, hemochromatosis, chronic liver disease, hemolytic anemias, malnutrition (protein depletion)----------------------------------------------------------------------------------------------------LACTATE (blood)
Increased in:(Without signifigant acidosis): Muscular exercise, hyperbentilation, glucaon, glycogen storage disease, severe anemia, pyruvate infusion, HCO3 infusion, glucose and insulin infusion.
(With hypoxia and acidosis): Acute hemorrage, circulatory collapse, cyanotic heart disease, severe acute CHF, acute anoxemia, extracorpeal circulation, epinephrine
(Idiopathic): Mild uremia, infections (esp. pyelonephritis), septicemia, cirrhosis, acute pancreatitis (+/-), third trimester of pregnancy, severe vascular disease, leukemia, anemia, chronic alcoholism, subacute bacterial endocarditis, poliomyelitis----------------------------------------------------------------------------------------------------LACTATE DEHYDROGENASE (LDH)
Elevated in:Infarction of myocardium, lung, kidney
Diseases of cardiopulmonary system, liver, collagen, CNS
Hemolytic anemias, megaloblastic anemias, transfusions, seizures, muscle trauma, muscular dystrophy, acute pancreatitis hypotension shock, infectious mononucleosis, inflammation, neoplasia, intestinai obstruction, hypothyroidism----------------------------------------------------------------------------------------------------LACTATE DEHYDROGENASE ISOENZYMES
Abnormal values:LDH1 > LDH2: MI (can also be seen with hemolytic anemias, pernicious anemia, folate deficiency, renal infarct)
LDH5 > LDH4: liver disease (cirrhosis, hepatitis, hepatic congestion)----------------------------------------------------------------------------------------------------LEGIONELLA TITER
Positive in:Legionnaire's disease (presumptive: > 1:256 titer; definitive: fourfold titer increase to >1: 128)----------------------------------------------------------------------------------------------------LEUKOCYTE ALKALINE PHOSPHATASE (LAP SCORE)
Elevated in:Leukemoid reactions, neutrophilia secondary to infections (except in sickle cell crisisƒ€no significant increase in LAP score), Hodgkin's disease, polycythemia vera, hairy cell leukemia, aplastic anemia, Down's syndrome, myelofibrosis
Decreased in:Acute and chronic granulocytic leukemia, thrombocytopenic purpura, paroxysmal nocturnal hemoglobinuria (PNH), hypophosphatemia, collagen disorders----------------------------------------------------------------------------------------------------LIPASE
Elevated in:Acute pancreatitis, perforated peptic ulcer, carcinoma of pancreas (early stage), pancreatic duct obstruction----------------------------------------------------------------------------------------------------LOW DENSITY LIPOPROTEIN (LDL) CHOLESTEROL
Elevated in:Primary hyperlipoproteinemia, diet high in saturated fats, acute MI, hypothyroidism, primary biliary cirrhosis, nephrosis, driabetes mellitus
Decreased in:Abetalipoproteinemia, advanced liver disease, malabsorption, malnutrition----------------------------------------------------------------------------------------------------LYMPHOCYTES
Elevated in:Chronic infections, infectious mononucleosis and other viral infections, CLL, Hodgkin's disease, ulcerative colitis, hypoadrenalism, ITP
Decreased in:AIDS, ARC, bone marrow suppression from chemotherapeutic agents or chemotherapy, aplastic anemia, neoplasms, steroids, adrenocortical hyperfunction, neurologic disorders (multiple sclerosis, myasthenia gravis, Guillain-Barre syndrome)----------------------------------------------------------------------------------------------------MAGNESIUM (serum)
Increased in:-Renal failure-Diabetic coma before treatment-Hypothyroidism-Addison's disease and after adrenalectomy-Controlled diabetes mellitus in older patients-Administration of antacids containing magnesium
Decreased in:-GI disease showing malabsorption and abnormal loss of GI fluids (e.g., nontropical sprue, small bowel resection, biliary and intestinal fistulas, abdominal irradiation, prolonged aspiration of intestinal contents, celiac disease and other causes of steatorrhea)-Acute alcoholism and alcoholic cirrhosis-Insulin treatment oof diabetic coma-Hyperthyroidism-Aldosteronism-Hyperparathyroidism-Lytic tumors of bone-Diuretic drug therapy (e.g., ethacrynic acid, furosemide)-Some cases of renal disease (e.g., glomerulonephritis, pyeloneI phritis, renal tubular acidosis)-Acute pancreatitis-Excessive lactation-Idiopathic disorders
Magnesium deficiency may cause apparently unexplained hypocalcemia and hypokalemia; the patients may have neurologic and GI symptoms
----------------------------------------------------------------------------------------------------MEAN CORPUSCULAR VOLUME (MCV)
Elevated in:Vitamin B12 deficiency, folic acid deficiency, liver disease, alcohol abuse, reticulocytosis, hypothyroidism, marrow aplasia, myelofibrosis
Decreased in:Iron deficiency, thalassemia syndrome and other hemoglobinopathies, anemia of chronic disease, sideroblastic anemia, chronic renal failure, lead poisoning----------------------------------------------------------------------------------------------------MONOCYTE COUNT
Elevated in:Viral diseases, parasites, infections, neoplasms, inflammatory bowel disease, monocytic leukemia, Iymphomas, myeloma, sarcoidosis
Decreased in:Aplastic anemia, Iymphocytic leukemia, glucocorticoid administration----------------------------------------------------------------------------------------------------NEUTROPHIL COUNT
Elevated in:Acute bacterial infections, acute MI, stress, neoplasms, myelocytic leukemia
Decreased in:Viral infections, aplastic anemias, immunosuppressive drugs, radiation therapy to bone marrow, agranulocytosis, drugs (antibiotics, antithyroidals), Iymphocytic and monocytic leukemias----------------------------------------------------------------------------------------------------OSMOLALITY, SERUM
It can be estimated by the following formula:
2([Na] + [K]) + Glucose/18 + BUN/2.8
Elevated in:Dehydration, hypernatremia, diabetes insipidus, uremia, hyperglycemia, mannitol therapy, ingestlon of toxins (ethylene glycol, methanol ethanol)
Decreased in:SIADH, hyponatremia, overhydration----------------------------------------------------------------------------------------------------pH, BLOOD
Increased in:Metabolic alkalosis, respiratory alkalosis
Decreased in:Metabolic acidosis, repiratory acidosis----------------------------------------------------------------------------------------------------PARTIAL THROMBOPLASTIN TIME (PTT), ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)
Elevated in:Heparin therapy, coagulation factor deficiency (I, II, V, VIII, IX, X, XI XII), liver disease, vitamin K deficiency, DIC, circulating anticoagulant, warfarin therapy, specific factor inhibition (PCN reaction, rheumatoid arthritis), thrombolytic therapy
NOTE: Useful to evaluate the intrinsic coagulaion system.----------------------------------------------------------------------------------------------------PHOSPHATASE, ALKALINE; see ALKALINE PHOSPHATASE PHOSPHORUS (serum)
Elevated in:Renal failure, dehydration, Addison's disease, myelogenous leukemia, hypervitaminosis D, hypoparathyroidism, pseudohypoparathyroidism, bone metastases, sarcoidosis, milk-alkali syndrome, immobilization, magnesium deficiency, transfusions, hemolysis
Decreased in:Starvation (e.g., alcoholics), DKA, TPN, continuous IV dextrose administration, vitamin D deficiency, hyperparathyroidism, pseudohyperparathyroidism, antacids containing aluminum hydroxide, insulin administration, nasogastric suctioning, vomiting, diuretics, steroids, gram-negative septicemia----------------------------------------------------------------------------------------------------PHOSPHORUS (serum)
Increased in:-Hypoparathyroidism (Idiopathic, Surgical, Pseudohypoparathyroidism)-Excess vitamin D intake-Secondary hyperparathyroidism (renal rickets)-Bone disease (Healing fractures, Multiple myeloma (some patients), Paget's disease (some patients), Osteolytic metastatic tumor in bone (some patients))-Addison's disease-Acromegaly-Childhood-Myelogenous leukemia-Acute yellow atrophy-High intestinal obstruction-Sarcoidosis (some patients)-Milk-alkali (Burnett's) syndrome (some patients)-Artifactual increase by hemolysis of blood
Decreased in-Alcoholism*-Diabetes mellitus*-Hyperalimentation*-Nutritional recovery syndrome* (rapid refeeding after prolonged starvation)-Alkalosis, respiratory (e.g., gram-negative bacteremia) or metabolic-Acute gout-Salicylate poisoning-Administration of glucose intravenously (e.g., recovery after severe burns, hyperalimentation)-Administration of anabolic steroids, androgens, epinephrine, glucagon, insulin-Acidosis (especially ketoacidosis)-Hyperparathyroidism-Renal tubular defects (e.g., Fanconi syndrome)-Hypokalemia-Hypomagnesemia-Administration of diuretics-Prolonged hypothermia (e.g., open heart surgery)-Malabsorption-Vitamin D deficiency and/or resistance, osteomalacia-Malnutrition, vomiting, diarrhea-Administration of phosphate-binding antacids*-Primary hypophosphatemia
*Indicates conditions associated with severe hypophosphatemia.
Mechanisms of hypophosphatemia are intracellular shift of phosphate, increased loss (via kidney or intestine), or decreased intestinal absorption; usually associated with prior phosphorus depletion. Often, more than one mechanism is operative.
----------------------------------------------------------------------------------------------------PLATELET COUNT
Elevated in:Neoplasms (GI tract), CML, polycythemia vera, myelofibrosis with myeloid metaplasia, infections, after splenectomy, postpartum, after hemorrhage, hemophilia, iron deficiency, pancreatitis, cirrhosis----------------------------------------------------------------------------------------------------POTASSIUM (serum)
Increased in:-Renal failure: (Acute with oliguria or anuria; Chronic end-stage with oliguria (glomerular filtration rate <3-5 ml/minute); Chronic nonoliguric associated with dehydration, obstruction, trauma, or excess potassium)-Decreased mineralocorticoid activity: (Addison's disease; Hypofunction of renin-angiotensin-aldosterone system; Pseudohypoaldosteronism; Aldosterone antagonist (e.g., spironolactone))-Increased supply of potassium: (Red blood cell hemolysis (transfusion reaction, hemolytic anemia); Excess dietary intake or rapid potassium infusion; Striated muscle (status epilepticus, periodic paralysis); Potassium-retaining drugs (e.g., triamterene); Fluid-electrolyte imbalance (e.g., dehydration, acidosis))-Laboratory artifacts (e.g., hemolysis during venipuncture, conditions associated with thrombocytosis, incomplete separation of serum and clot)
Decreased in:-Renal and adrenal conditions with metabolic alkalosis: (Administration of diuretics, Primary aidosteronism, Pseudoaldosteronism, Salt-losing nephropathy, Cushing's syndrome)-Renal conditions associated with metabolic acidosis: (Renal tubular acidosis, Diuretic phase of acute tubular necrosis, Chronic pyelonephritis, Diuresis following relief of urinary tract obstruction)-Gastrointestinal conditions: (Vomiting, gastric auctioning; Villous adenoma; Cancer of colon; Chronic laxative abuse; Zollinger-Ellison syndrome; Chronic diarrhea; Ureterosigmoidostomy)
----------------------------------------------------------------------------------------------------PROLACTIN
Elevated in:Prolactinomas (level >200 highly suggestive), drugs (phenothiazines, cimetidine, tricyclic antidepressants, metoclopramide, estrogens, antihypertensives [methyldopa], verapamil, haloperidol), postpartum, stress, hypoglycemia, hypothyroidism----------------------------------------------------------------------------------------------------PROTEIN (serum)
Elevated in:Dehydration, multiple myeloma, Waldenstrom's macroglobulinemia, sarcoidosis, collagen-vascular diseases
Decreased in:Malnutrition, low-protein diet, overhydration, malabsorption, pregnancy, severe bums, neoplasms, chronic diseases, cirrhosis, nephrosis----------------------------------------------------------------------------------------------------PROTEIN ELECTROPHORESIS (serum)
Elevated:-Albumin: dehydration-a-l: neoplastic diseases, inflammation-a-2: neoplasms, inflammation, infection, nephrotic syndrome-b: hypothyroidism, biliary cirrhosis, diabetes mellitus-y: see IMMUNOGLOBULINS
Decreased:-Albumin: malnutrition, chronic liver disease, malabsorption, nephrotic syndrome, burns, SLE-a-I: emphysema (a-l antitrypsin deficiency), nephrosis-a-2: hemolytic anemias (Decreased haptoglobin), severe hepatocellular damage-b: hypocholesterolemia, nephrosis-y: see IMMUNOGLOBULINS----------------------------------------------------------------------------------------------------PROTHROMBIN TIME (PT)
Elevated in:Liver disease, oral anticoagulants (Warfarin), heparin, factor deficiency (I, II, V, VII, X), DIC, vitamin K deficiency, afibrinogenemia, dysfibrinogenemia, drugs (salicylae, chloral hydrate, diphenylhydantoin, estrogens, antacids, phenylbutazone, quinidine, antibiotics, allopurinol, anabolic steroids)
Decreased in:Vitamin K supplementation, thrombophlebitis, drugs (gluthetimide, estrogens, griseofulvin, diphenhydramine)----------------------------------------------------------------------------------------------------PROTOPORPHYRIN (free erythrocyte)
Elevated in:Iron deficiency, lead poisoning, sideroblastic anemias, anemia of chronic disease, hemolytic anemias, erythropoietic protoporphyria----------------------------------------------------------------------------------------------------RED BLOOD CELL COUNT
Elevated in:Polycythemia vera, smokers, high altitude, cardiovascular disease, renal cell carcinoma and other erythropoietin-producing neoplasms, stress, hemoconcentration/dehydration
Decreased in:Anemias, hemolysis, chronic renal failure, hemorrhage, failure of marrow production----------------------------------------------------------------------------------------------------RED BLOOD CELL DISTRIBUTION WIDTH (RDW)
Normal RDW and...Elevated MCV: aplastic anemia, preleukemiaNormal MCV: normal, anemia of chronic disease, acute blood loss or hemolysis, CLL, CML, nonanemic enzymopathy or hemoglobinopathy
Decreased MCV: anemia of chronic disease, heterozygous thalassemia
Elevated RDW and...Elevated MCV: vitamin Bl2 deficiency, folate deficiency, immune hemolytic anemia, cold agglutinins, CLL with high count, liver disease
Normal MCV: early iron deficiency, early vitamin Bl2 deficiency, early folate deficiency, anemic globinopathy
Decreased MCV: iron deficiency, RBC fragmentation, Hb H. thalassemia intermedia----------------------------------------------------------------------------------------------------RED BLOOD CELL MASS (VOLUME)
Elevated in:Polycythemia vera, hypoxia (smokers, high altitude, cardiovascular disease), hemoglobinopathies with high 2B affinity, erythropoietin-producmg tumors (renal cell carcinoma)
Decreased in:Hemorrhage, chronic disease, failure of marrow production anemias, hemolysis----------------------------------------------------------------------------------------------------RETICULOCYTE COUNT
Elevated in:Hemolytic anemia (sickle cell crisis, thalassemia major, autoimmune hemolysls, hemorrhage, postanemia therapy (folic acid, ferrous sulfate, vitamin B12)
Decreased in:Aplastic anemia, marrow suppression (sepsis, chemotherapeutic agents radlation), hepatic cirrhosis, blood transfusion, anemias of disordered maturation (iron deficiency anemia, megaloblastic anemia, sideroblastlc anemua, anemna of chronic disease)----------------------------------------------------------------------------------------------------RHEUMATOID FACTOR
Present in titer >1:20:Rheumatoid arthritis, SLE, chronic inflammatory processes, old age, infection, liver disease----------------------------------------------------------------------------------------------------SMOOTH MUSCLE ANTIBODY (ANTI- SMOOTH MUSCLE ANTIBODY)
Present in:Chronic active hepatitis (>1:80), primary biliary cirrhosis (<1:80), infectious mononucleosis----------------------------------------------------------------------------------------------------SODIUM (serum)
Increased in:
Excess loss of water...-Conditions that cause loss via gastrointestinal tract (e.g., in vomiting), lung (hyperpnea), or skin (e.g., in excessive sweating)-Conditions that cause diuresis (Diabetes insipidus, Nephrogenic diabetes insipidus, Diabetes mellitus, Diuretic drugs, Diuretic phase of acute tubular necrosis, Diuresis following relief of urinary tract obstruction, Hypercalcemic nephropathy, Hypokalemic nephropathy)
Excess administration of sodium (iatrogenic), e.g., incorrect replacement following fluid loss.""Essential"" hypernatremia due to hypothalamic lesions
Decreased in (serum osmolality is decreased):
-Dilutional: (e.g., congestive heart failure, nephrosis, cirrhosis with ascites)-Sodium depletion: (Loss of body fluids (e.g., vomiting, diarrhea, excessive sweating) with incorrect or no therapeutic replacement, diuretic drugs (e.g., thiazides); Adrenocortical insufficiency; Salt-losing nephropathy; Inappropriate secretion of antidiuretic hormone)-Spurious (serum osmolality is normal or increased): (Hyperlipidemia; Hyperglycemia (serum sodium decreases 3 mEq/L for every increase of serum glucose of 100 mg/100 ml))
----------------------------------------------------------------------------------------------------SUCROSE HEMOLYSIS TEST (sugar water test)
Positive in:Paroxysmal nocturnal hemoglobinuria (PNH)
False positive: autoimmune hemolytic anemia, megaloblastic anemnasFalse negative: may occur with use of heparin or EDTA----------------------------------------------------------------------------------------------------T3 (TRIIODOTHYRONINE)
Decreased in:Starvation, trauma, surgery, may be an adaptive response to illness, drugs (PTU)----------------------------------------------------------------------------------------------------T3 RESIN UPTAKE (T3RU)
This test should be used only with a simultaneous measurement of serum T4 to exclude the possibility that an increased T4 is due to an increase in T4-binding globulin. Measurement of serum T-3 concentration should be done by radioimmunoassay for diagnosis of hyperthyroidism
Increased in:-Hyperthyroidism-Certain drugs (e.g., testosterone, androgens, anabolic steroids, prednisone, heparin, Dicumarol, salicylates, Butazolidin, penicillin, Dilantin)-Threatened abortion-Infants (up to about age 2 months)-Severe nephrosis-Metastatic neoplasms
Decreased in_-Hypothyroidism-Pregnancy (from about tenth week of pregnancy until up to 12th week postpartum)-Certain drugs (e.g., estrogens alone or in birth control pills, large amounts of iodine, propylthiouracil in hyperthyroidism)
Normal in:-Pregnancy with hyperthyroidism-Nontoxic goiter-Carcinoma of thyroid-Diabetes mellitus-Addison's disease-Anxiety-Certain drugs (mercurials, iodine)
Variable in:Liver disease
----------------------------------------------------------------------------------------------------T4, FREE (free thyroxine)
This determination gives corrected values in patients in whom the total thyroxine (T-4) is altered on account of changes in serum proteins or in binding sites. (Pregnancy; Drugs (e.g., androgens, estrogens, birth control pills, Dilantin); Altered levels of serum proteins (e.g., nephrosis))
This is the best single screening test for thyroid dysfunction. It is paralleled by the free thyroxine factor.
Increased in:-Hyperthyroidism-Hypothyroidism treated with thyroxine -Very ill euthyroid patients (frequently)
Decreased in:-Hypothyroidism-Hypothyroidism treated with triiodothyronine
----------------------------------------------------------------------------------------------------THROMBIN TIME (TT)
Elevated in:Thrombolytic and heparin therapy, DIC, hypofibrinogenemia, dysfibrinogenemia----------------------------------------------------------------------------------------------------THYROID STIMULATING HORMONE (TSH)
Elevated in:Hypothyroidism, drugs (haloperidol, chlorpromazme, metoclopramide, domperidone), TSH antibodies, pituitary resistance to thyroid hormone
Decreased in:Hyperthyroidism, acute medical illness, drugs (dopamine, corticosteroids, bromocriptine, levodopa, pyridoxine), hyponatremia, malnutrition
Normal in:Cushing's syndromeAcromegalyPregnancy at term
----------------------------------------------------------------------------------------------------THYROXINE-BINDING GLOBULIN (TBG)
Increased in:-Pregnancy-Excess TBG, genetic or idiopathic -Hypothyroidism (sorr-te patients)-Certain drugs (estrogens, birth control pills)-Gross iodine contamination-Acute intermittent porphyria
Decreased in:-Nephrosis and other causes of marked hypoproteinemia Deficiency of TBG, genetic or idiopathic-Certain drugs (androgenic and anabolic steroids)
An increase of TBG is associated with an increase in PBI, BEI, and T-4 by column and a decrease in T-3; converse association for decrease of TBG.----------------------------------------------------------------------------------------------------THYROXINE (T4)
Increased in:-Hyperthyroidism-Pregnancy-Certain drugs (estrogens, birth control pills, d-thyroxine, thyroid extract, TSH)
Decreased in:-Hypothyroidism-Hypoproteinemia-Certain drugs (phenytoin sodium [Dilantin], triiodothyronine, testosterone, ACTH, corticosteroids)
Not affected by:-Radiopaque substances for x-ray studies -Mercurial diuretics-Nonthyroidal iodine
----------------------------------------------------------------------------------------------------TRANSFERRIN
Elevated in:Iron deficiency anemia, oral contraceptive administration, viral hepatitis
Decreased in:Nephrotic syndrome, liver disease, hereditary deficiency, protein malnutrition, neoplasms, chronic inflammatory states, chronic illness thalassemia----------------------------------------------------------------------------------------------------TRIGLYCERIDES
Elevated in:Hyperlipoproteinemias (Types I, IIb, III, IV, V), hypothyroidism, pregnancy, estrogens, acute MI, pancreatitis, alcohol intake, nephrotic syndrome, diabetes mellitus, glycogen storage disease
Decreased in:Malnutrition, congenital abetalipoproteinemias, drugs (e.g., gemfibrozil, nicotinic acid, clofibrate) ----------------------------------------------------------------------------------------------------UREA NITROGEN (BUN)
Elevated in:-Drugs (aminoglycosides and other antibiotics, diuretics, lithium, corticosteroids), dehydration, gastrointestinal bleeding, -Decreased renal blood flow (shock, CHF, MI), renal disease (glomerulonephritis pyelonephritis, diabetic nephropathy), urinary tract obstruction (prostatic hypertrophy)
Decreased in:Liver disease, malnutrition, third trimester of pregnancy, overhydration----------------------------------------------------------------------------------------------------URIC ACID (serum)
Elevated in:Renal failure, gout, excessive cell Iysis (chemotherapeutic agents, radiation therapy, leukemia, Iymphoma, hemolytic anemia), hereditary enzyme deficiency (hypoxanthine-guanine-phosphoribosyl transferase) acidosis, myeloproliferative disorders, diet high in purines or protein drugs (diuretics, low doses of ASA, ethambutol, nicotinic acid), lead poisoning, hypothyroidism, Addison's disease, nephrogenic diabetes insipidus, active psoriasis, polycystic kidneys
Decreased in:Drugs (allopurinol, high doses of ASA, probenecid, warfarin, corticosteroid), deficiency of xanthine oxidase, SIADH, renal tubular deficits (Fanconi's syndrome), alcoholism, liver disease, diet deficient in protein or purines, Wilson's disease, hemochromatosis----------------------------------------------------------------------------------------------------URINE 5-HYDROXYINDOLE-ACETIC ACID (URINE 5-HIAA)
Elevated in:Carcinoid tumors, after ingestion of certain foods (bananas, plums, tomatoes, avocados, pineapples, eggplant, walnuts), drugs (MAO inhibitors, phenacetin, methyldopa, glycerol guaiacolate, acetaminophen,salicylates, phenothiazines, imipramine, methocarbamol, reserpine, metamphetamine)----------------------------------------------------------------------------------------------------URINE AMYLASE
Elevated in:Pancreatitis, carcinoma of the pancreas----------------------------------------------------------------------------------------------------URINE BILE (BILIRUBIN, URINE)
Abnormal:Urine bilirubin: Hepatitis (viral, toxic, drug-induced), biliary obstructionUrine urobilinogen: Hepatitis (viral, toxic, drug-induced), hemolytic jaundice, liver cell dysfunction (cirrhosis, infection, metastases)----------------------------------------------------------------------------------------------------URINE CALCIUM
Elevated in:Primary hyperparathyroidism, hypervitaminosis D, bone metastases multlple myeloma, increased calcium intake, steroids, prolonged immobilization, sarcoidosis, Paget's disease, idiopathic hypercalciuria renal tubular acidosis
Decreased in:Hypoparathyroidism, pseudohypoparathyroidism, vitamin D deficiency vitanun D-resistant rickets, diet low in calcium, drugs (thiazide diuretics, oral contraceptives), familial hypocalciuric hypercalcemia, renal osteodystrophy----------------------------------------------------------------------------------------------------URINE CATECHOLAMINES
Elevated in:Pheochromocytoma, neuroblastoma, severe stress----------------------------------------------------------------------------------------------------URINE CHLORIDE
Elevated in:Corticosteroids, Bartter's syndrome
Decreased in:Chloride depletion (vomiting, diuretics), colonic villous adenoma----------------------------------------------------------------------------------------------------URINE COPPER
Increased in:Wilson's disease----------------------------------------------------------------------------------------------------URINE CORTISOL, FREE
Elevated:Refer to CORTISOL (serum)----------------------------------------------------------------------------------------------------URINE CREATININE (24 hr)
NOTE: Useful test as an indicator of completeness of 24 hr urine collection.----------------------------------------------------------------------------------------------------URINE GLUCOSE (qualitative)
Present in:Diabetes mellitus, renal glycosuria (decreased renal threshold for glucose), glucose intolerance----------------------------------------------------------------------------------------------------URINE HEMOGLOBIN, FREE
Present in:Hemolysis (with saturation of serum haptoglobin binding capacity and renal threshold for tubular absorption of hemoglobin)----------------------------------------------------------------------------------------------------URINE HEMOSIDERIN
Present in:Paroxysmal noctumal hemoglobinuria (PNH), chronic hemolytic anemia, hemochromatosis----------------------------------------------------------------------------------------------------URINE INDICAN
Present in:Malabsorption secondary to intestinal bacterial overgrowth----------------------------------------------------------------------------------------------------URINE KETONES (semiquantitative)
Present in:DKA, alcoholic ketoacidosis, starvation, isopropanol ingestion----------------------------------------------------------------------------------------------------URINE METANEPHRINES
Elevated in:Pheochromocytoma, neuroblastoma, drugs (caffeine, phenothiazines, MAO inhibitors), stress----------------------------------------------------------------------------------------------------URINE MYOGLOBIN
Present in:Severe trauma, hyperthermia, polymyositis/demmatomyositis, carbon monoxide poisoning----------------------------------------------------------------------------------------------------URINE NITRITE
Present in:Urinary tract infections----------------------------------------------------------------------------------------------------URINE OCCULT BLOOD
Positive in:Trauma to urinary tract, renal disease (glomerulonephritis, pyelonephritis), renal or ureteral calculi, bladder lesions (carcinoma, cystitis), prostatitis, prostatic carcinoma, menstrual contamination, hematopoietic disorders (hemophilia, thrombocytopenia), anticoagulants, ASA----------------------------------------------------------------------------------------------------URINE OSMOLALITY
Elevated in:SIADH, dehydration, glycosuria, adrenal insufficiency, high-protein diet
Decreased in:Diabetes insipidus, excessive water intake, IV hydration with D5W acute renal insufficiency, glomerulonephritis----------------------------------------------------------------------------------------------------URINE pH
Elevated in:Bacteriuria, vegetarian diet, renal failure with inability to form ammonia, drugs (antibiotics, sodium bicarbonate, acetazolamide)
Decreased in:Acidosis (metabolic, respiratory), drugs (ammonium chloride, methenamine mandelate), diabetes mellitus, starvation, diarrhea----------------------------------------------------------------------------------------------------URINE POTASSIUM
Elevated in:Aldosteronism (primary, secondary), glucocorticoids, alkalosis, renal tubular acidosis, excessive dietary potassium intake
Decreased in:Acute renal failure, potassium-sparing diuretics, diarrhea, hypokalemia----------------------------------------------------------------------------------------------------URINE PROTEIN (quantitative)
Elevated in:Renal disease (glomerular, tubular, interstitial), CHF, hypertension, neoplasms of renal pelvis and bladder, multiple myeloma, Waldenstrom's macroglobulinemia----------------------------------------------------------------------------------------------------URINE SODIUM (quantitative)
Elevated in:Diuretic administration, high sodium intake, salt-losing nephritis, acutetubular necrosis, vomiting, CHF, hepatic failure. Addison's disease, SIADH, hypothyroidism----------------------------------------------------------------------------------------------------URINE SPECIFIC GRAVITY
Elevated in:Dehydration, excessive fluid losses (vomiting, diarrhea, fever) x-ray contrast media, diabetes mellitus, CHF, SIADH, adrenal insufficiency, Decreased fluid intake
Decreased in:Diabetes insipidus, renal disease (glomerulonephritis, pyelonephritis), excessive fluid intake or IV hydration----------------------------------------------------------------------------------------------------URINE VANILLYLMANDELIC ACID (VMA)
Elevated in:Pheochromocytoma, neuroblastoma, ganglioblastoma, drugs (isoproterenol, methocarbamol, levodopa, sulfonamides, chlorpromazine), severe stress, after ingestion of bananas, chocolate, vanilla, tea, coffee
Decreased in:Drugs (MAO inhibitors, reserpine, guanethidine, methyldopa)----------------------------------------------------------------------------------------------------VDRL
Positive test:Syphilis, other treponemal diseases (yaws, pinta, bejel)
NOTE: A false-positive test may be seen in patients with SLE and other autoimmune diseases, infectious mononucleosis, atypical pneumonia, malaria, leprosy.----------------------------------------------------------------------------------------------------VISCOSITY
Elevated in:Monoclonal gammopathies (Waldenstrom's macroglobulinemia, multiple myeloma), hyperfibrinogenemia, SLE, rheumatoid arthritis, polycythemia, leukemia----------------------------------------------------------------------------------------------------y-GLUTAMYL TRANSFERASE (GGT; GAMMA-GLUTAMYL TRANSFERASE )
Elevated in:Chronic alcoholic liver disease, neoplasms (hepatoma, metastatic disease to the liver, carcinoma of the pancreas), SLE, CHF, trauma, nephrotic syndrome, sepsis, cholestasis. drugs (phenytoin, barbiturates)

GUIDE TO COMMON MEDICAL TESTS [lab tests]

2009-01-16T06:51:00.000-08:00

a-1 FETOPROTEIN (ALPHA-I-FETOPROTEIN )

Elevated in:
Hepatocellular carcinoma (usually values >1000 ng/ml), germinal neoplasms (testis, ovary, mediastinum, retroperitoneum), liver disease (alcoholic cirrhosis, acute hepatitis, chronic active hepatitis), fetal anencephaly, spina bifida
----------------------------------------------------------------------------------------------------
ACETONE (serum or plasma)

Elevated in:
DKA, starvation, isopropanol Ingestion
----------------------------------------------------------------------------------------------------
ACID PHOSPHATASE (serum)

Elevated in:
Carcinoma of prostate, other neoplasms (breast, bone), Paget's disease, osteogenesis imperfecta, malignant invasion of bone, Gaucher's disease, multiple myeloma, myeloproliferative disorders, benign prostatic hypertrophy, prostatic palpation or surgery, hyperparathyroidism, liver disease, chronic renal failure
----------------------------------------------------------------------------------------------------
ALANINE AMINOTRANSFERASE (ALT, SGPT)

Elevated in:
Liver disease (hepatitis, cirrhosis, Reye's syndrome), hepatic congestion, infectious mononucleosis, Ml, myocarditis, severe muscle trauma, dermatomyositis/polymyositis, muscular dystrophy, drugs (antibiotics, narcotics, antihypertensive agents, heparin, labetalol, lovastatin, NSAIDs, amiodarone, chlorpromazine, phenytoin), malignancy, renal and pulmonary infarction, convulsions, eclampsia, shock liver
----------------------------------------------------------------------------------------------------
ALBUMIN (serum)

Elevated in:
Dehydration

Decreased in:
Liver disease, nephrotic syndrome, poor nutritional status, rapid IV hydration, protein-losing enteropathies (inflammatory bowel disease), severe bums, neoplasia, chronic inflammatory diseases, pregnancy, oral contraceptives, prolonged immobilization
----------------------------------------------------------------------------------------------------
ALDOLASE (serum)

Elevated in:
Muscular dystrophy, rhabdomyolysis, dermatomyositis/polymyositis, trichinosis, acute hepatitis and other liver diseases, Ml, prostatic carcinoma, hemorrhagic pancreatitis, gangrene, delirium tremens

Decreased in:
Loss of muscle mass, late stages of muscular dystrophy
----------------------------------------------------------------------------------------------------
ALKALINE PHOSPHATASE (serum)

Elevated in:
Biliary obstruction, cirrhosis (particularly primary biliary cirrhosis), liver disease (hepatitis, infiltrative liver diseases, fatty metamorphosis), Paget's disease of bone, osteitis deformans, rickets, osteomalacia, hypervitaminosis D, hyperparathyroidism, hyperthyroidism, ulcerative colitis, bowel perforation, bone metastases, healing fractures, bone neoplasms, acromegaly, infectious mononucleosis, CMV infections, sepsis, pulmonary infarction, CHF, hypernephroma, leukemia, myelofibrosis, multiple myeloma, drugs (estrogens, albumin, erythromycin and other antibiotics, cholestasis-producing drugs [phenothiazines])

Decreased in:
Hypothyroidism, pernicious anemia, hypophosphatemia, hypervitaminosis D, malnutrition
----------------------------------------------------------------------------------------------------
AMMONIA (serum)

Elevated in:
Hepatic failure, hepatic encephalopathy, Reye's syndrome, portacaval shunt, drugs (diuretics, polymyxin B. methicillin)

Decreased in:
Drugs (neomycin, lactulose, tetracycline), renal failure
----------------------------------------------------------------------------------------------------
AMYLASE (serum)

Elevated in:
Acute pancreatitis, pancreatic neoplasm, abscess, pseudocyst, ascites, macroamylasemia, perforated peptic ulcer, intestinal obstraction, intestinal infarction, acute cholecyshtis, appendicitis, ruptured ectopic pregnancy, salivary gland inflammation, peritonitis, burns, diabetic ketoacidosis, renal insufficiency, drugs (morphine), carcinomatosis of lung, esophagus, ovary, acute ethanol ingestion

Decreased in:
Advanced chronic pancreatitis, hepatic necrosis
----------------------------------------------------------------------------------------------------
ANGIOTENSIN CONVERTING ENZYME (ACE level)

Elevated in:
Sarcoidosis, primary biliary cirrhosis, alcoholic liver disease, hyperthyroidism, hyperparathyroidism, diabetes mellitus, amyloidosis, multiple myeloma, lung disease (asbestosis, silicosis, berylliosis, allergic alveolitis, coccidioidomycosis), Gaucher's disease, leprosy
----------------------------------------------------------------------------------------------------
ANION GAP

Elevated in:
Lactic acidosis
Ketoacidosis (DKA, alcoholic starvation)
Uremia (chronic renal failure)
Ingestion of toxins (paraldehyde, methanol, salicylates, ethylene glycol)

Decreased in:
Hypoalbum nemia, severe hypermagnesem a, IgG myeloma, littaum toxicity, lab error (falsely
Decreased sodium or overestimation of bicarbonate or chloride)
----------------------------------------------------------------------------------------------------
ANTI-DNA

Present in:
SLE, chronic active hepatitis, infectious mononucleosis, biliary cirrhosis
----------------------------------------------------------------------------------------------------
ANTI-STREPTOLYSIN O TITER (STREPTOZYME, ASLO titer)

Elevated in:
Streptococcal upper airway infection, acute rheumatic fever, acute glomerulonephritis, increased levels of B-lipoprotein

NOTE: A fourfold increase in titer between acute and convalescent specimens is diagnostic of streptococcal upper airway infection regardless of the initial titer.
----------------------------------------------------------------------------------------------------
ANTIMITOCHONDRIAL ANTIBODY

Elevated in:
Primary biliary cirrhosis (85-95%), chronic active hepatitis (25%-30%) cryptogenic cirrhosis (25-30%)
----------------------------------------------------------------------------------------------------
ANTINUCLEAR ANTIBODY (ANA)

Positive test:
SLE (more significant if titer >1: 160), drugs (phenytoin, ethosuximide, pnmudone, methyldopa, hydralazine, carbamazepine, penicillin, procainamide, chlorpromazine, griseofulvin, thiazides), chronic active hepatltis, age over 60 yr (particularly age over 80), rheumatoid arthritls, scleroderma, mixed connective tissue disease, necrotizing vasculitis, Sjogren's syndrome (SS), tuberculosis, pulmonary interstitial fibrosis
----------------------------------------------------------------------------------------------------
ANTITHROMBIN III

Decreased in:
Hereditary deficiency of antithrombin III, DIC, pulmonary embolism, cirrhosis, thrombolytic therapy, chronic liver failure, post-surgery, third trimester of pregnancy, oral contraceptives, nephrotic syndrome, IV heparin >3 days, sepsis

Elevated in:
Warfarin drugs, post-MI
----------------------------------------------------------------------------------------------------
ASPARTATE AMINOTRANSFERASE (AST, SGOT)

Elevated in:
Liver disease (hepatitis, cirrhosis, Reye's syndrome), hepatic congestion, infectious mononucleosis, MI, myocarditis, severe muscle trauma, dermatomyositis/polymyositis, muscular dystrophy, drugs (antibiotics, narcotics, antihypertensive agents, heparin, labetalol, lovastatin, NSAIDs, phenytoin, amiodarone, chlorpromazine), malignancy, renal and pulmonary infarction, convulsions, eclampsia
----------------------------------------------------------------------------------------------------
BASOPHIL COUNT

Elevated in:
Leukemia, inflammatory processes, polycythemia vera, Hodgkin's Iymphoma, hemolytic anemia, after splenectomy, myeloid metaplasia

Decreased in:
Stress, hypersensitivity reaction, steroids, pregnancy, hyperthyroidism
----------------------------------------------------------------------------------------------------
BILIRUBIN, DIRECT (conjugated bilirubin)

Elevated in:
Hepatocellular disease, biliary obstruction, drug-induced cholestasis, hereditary disorders (Dubin-Johnson syndrome, Rotor's syndrome)
----------------------------------------------------------------------------------------------------
BILIRUBIN, INDIRECT (unconjugated bilirubin)

Elevated in:
Hemolysis, liver disease (hepatitis cirrhosis, neoplasm), hepatic congestion secondary to congestive heart failure, heredltary dlsorders (Gilbert's disease, Crigler-Najjar syndrome)
----------------------------------------------------------------------------------------------------
BILIRUBIN, TOTAL

Elevated in:
Liver disease (hepatitis, cirrhosis, cholangitis, neoplasm, biliary obstruction, infectious mononucleosis), hereditary disorders (Gilbert's dsease, Dubin-Johnson syndrome), drugs (steroids, diphenylhydanton, phenothiazines, penicillin, erythromycin, clindamycin, captopril, amphotericin B. sulfonamides, azathioprine, isoniazid, 5-aminosalicylic acid, allopurinol, methyldopa, indomethacin, halothane, oral contracepuves, procainamide, tolbutamide, labetalol), hemolysis, pulmonary embolism or infarct, hepatic congestion secondary to CHF
----------------------------------------------------------------------------------------------------
BLEEDING TIME (modified Ivy method)

Elevated in:
Thrombocytopenia, capillary wall abnormalities, platelet abnormalities (Bernard-Soulier, Glamzmann's), drugs (aspirin, warfarin, antinflammatory medications, streptokinase, urokinase, dextran, B lactam antibiotics, moxalactam), DIC, cirrhosis, uremia, myeloproliferative dlsorders, Von Willebrand's
----------------------------------------------------------------------------------------------------
C-REACTIVE PROTEIN

Elevated in:
Rheumatoid arthritis, rheumatic fever, inflammatory bowel disease, bacterial infections, Ml, oral contraceptives, third trimester of pregnancy (acute phase reactant), inflammatory and neoplastic diseases
----------------------------------------------------------------------------------------------------
CALCITONIN (serum)

Elevated in:
Medullary carcinoma of the thyroid (particularly if level >1500 pg/ml), carcinoma of the breast, APUDomas, carcinolds, renal failure, thyroiditis
----------------------------------------------------------------------------------------------------
CALCIUM (serum)

Increased in:
-Hyperparathyroidism, primary (due to hyperplasia or adenoma of parathyroids) or secondary
-Hyperparathyroidism due to parathormone-secreting cancer -Hematologic malignancies (e.g., myeloma, lymphoma, leukemia)
-Excess vitamin D intake
-Bone tumor (Metastatic carcinoma (10% of patients))
-Acute osteoporosis (e.g., immobilization of young patients or in Paget's disease)
-Milk-alkali (Burnett's) syndrome
-Idiopathic hypercalcemia of infants
-Infantile hypophosphatasia
-Berylliosis
-Hyperthyroidism (some patients)
-Cushing's syndrome (some patients)
-Addison's disease (some patients)
-Myxedema (some patients)
-Hyperproteinemia (Sarcoidosis, -Multiple myeloma (some patients))
-Thiazide drugs
-Artifactual (e.g., venous stasis during blood collection, use of cork-stoppered test tubes)

Decreased in:
-Hypoparathyroidism (Surgical; Idiopathic; Pseudohypoparathyroidism)
-Malabsorption of calcium and vitamin D (Obstructive jaundice)
-Hypoalbuminemia (Cachexia, Nephrotic syndrome, Sprue, Celiac disease, Cystic fibrosis of pancreas)
-Chronic renal disease with uremia and phosphate retention
-Acute pancreatitis with extensive fat necrosis
-Insufficient calcium, phosphorus, and vitamin D ingestion (Bone disease (osteomalacia, rickets); Starvation; Late pregnancy)

Total serum protein should always be known for proper interpretation of serum calcium levels.

----------------------------------------------------------------------------------------------------
CARBOXYHEMOGLOBIN (CARBON MONOXIDE; CO)

Elevated in:
Smoking, exposure to smoking, exposure to automobile exhaust fumes malfunctioning gas-burning appliances
----------------------------------------------------------------------------------------------------
CARCINOEMBRYONIC ANTIGEN (CEA)

Elevated in:
Colorectal carcinomas, pancreatic carcmomas, and metastatic disease usually produce higher elevations (>20 ng/ml)

Carcinomas of the esophagus, stomach, small intestine, liver, breast ovary, lung and thyroid usually produce lesser elevations

Benign conditions (smoking, inflammatory bowel disease hypothyroidism, cirrhosis, pancreatitis, infections) usually produce ievels <10 ng/ml
----------------------------------------------------------------------------------------------------
CAROTENE (serum)

Elevated in:
Carotenemia, chronic nephritis, diabetes mellitus, hypothyroidism, nephrotic syndrome

Decreased in:
Fat malabsorption, steatorrhea, pancreatic insufficiency, lack of carotenoids in diet
----------------------------------------------------------------------------------------------------
CEREBROSPINAL FLUID (CSF)

----------------------------------------------------------------------------------------------------
CERULOPLASMIN (serum)

Elevated in:
Pregnancy, estrogens, oral contraceptives, neoplastic diseases (leukemias, Hodgkin's Iymphoma, carcinomas), inflammatory states, SLE, prirnary biliary cirrhosis, rheumatoid arthritis

Decreased in:
Wilson's disease (values often <10 mg/dl), nephrotic syndrome, advanced liver disease, malabsorption, total parenteral nutrition, Menkes' syndrome
----------------------------------------------------------------------------------------------------
CHLORIDE (serum)

Elevated in:
-Dehydration, excessive infusion of normal saline
-Hyperparathyroidism, renal tubular disease, metabolic acidosis, prolonged diarrhea
-Drugs (ammonium chloride administration, acetazolamide, boric acid, triamterene)

Decreased in:
CHF, SIADH, Addison's disease, vomiting, gastric suction, salt-losing nephritis, continuous infusion of D5W, thiazide diuretic administration, diaphoresis, diarrhea, burns
----------------------------------------------------------------------------------------------------
CHOLESTEROL, TOTAL

Elevated in:
Primary hypercholesterolemia, biliary obstruction, diabetes melhtus, nephrotic syndrome, hypothyroidism, primary biliary cirrhosis, high cholesterol diet, third trimester of pregnancy, Ml, drugs (steroids, phenothiazines, oral contraceptives)

Decreased in:
Starvation, malabsorption, sideroblastic anemia, thalassemia, abetalipoproteinemia, hyperthyroidism, Cushing's syndrome, hepatic failure, multiple myeloma, polycythemia vera, chronic myelocytic leukemia, myeloid metaplasia, Waldenstrom's macroglobulinemia, myelofibrosis
----------------------------------------------------------------------------------------------------
CIRCULATING ANTICOAGULANT (lupus anticoagulant)

Detected in:
SLE, drug-induced lupus, long-term phenothiazine therapy, multiple myeloma, ulcerative colhis, rheumatoid arthritis, postpartum, hemophilia, neoplasms, chronic inflammatory states
----------------------------------------------------------------------------------------------------
COLD AGGLUTININS TITER

Elevated in:
Primary atypical pneumonia (mycoplasma pneumonia), infectious mononucleosis, CMV infection

Other: hepatic cirrhosis, acquired hemolytic anemia, frostbite, multiple myeloma, Iymphoma, malaria
----------------------------------------------------------------------------------------------------
COMPLEMENT (C3, C4)

C3 is increased in:
Acute and chronic inflammation (slightly), obstructive jaundice

C3 is decreased in:
Acute glomerulonephritis, systemic lupus erythromatosis

----------------------------------------------------------------------------------------------------
COOMBS, DIRECT

Positive:
Autoimmune hemolytic anemia, erythroblastosis fetalis, transfusion reactions, drugs (a-methyldopa, peniecllins, tetraeyeline, sulfonamides, levodopa, cephalosporins, quinidine, insulin)

False positive:
May be seen with cold agglutinins
----------------------------------------------------------------------------------------------------
COOMBS, INDIRECT

Positive:
Acquired hemolytic anemia, incompatible cross-matched blood, anti-Rh antibodies, drugs (methyldopa, mefenamic acid, levodopa)
----------------------------------------------------------------------------------------------------
COPPER (serum)

Increased in:
-Anemias (Pernicious anemia, Megaloblastic anemia of pregnancy, Iron deficiency anemia, Aplastic anemia, Leukemia, acute and chronic, Infection, acute and chronic, Malignant lymphoma, Hemochromatosis)
-Collagen diseases (including SLE, rheumatoid arthritis, acute rheumatic fever, glomerulonephritis)
-Hypothyroidism
-Hyperthyroidism
-Frequently associated with increased C-reactive protein

Decreased in:
-Nephrosis (ceruloplasmin lost in urine)
-Wilson's disease
-Acute leukemia in remission
-Some iron deficiency anemias of childhood (that require copper as well as iron therapy)
-Kwashiorkor

----------------------------------------------------------------------------------------------------
CORTISOL (plasma)

Elevated in:
-Ectopic ACTH production (i.e., oat cell carcinoma of lung), loss of normal diurnal variation, pregnancy, chronic renal failure
-Iatrogenic, stress, adrenal or pituitary hyperplasia or adenomas

Decreased in:
Primary adrenocortical insufficiency, anterior pituitary hypofunction, secondary adrenocortical insufficiency, adrenogenital syndromes
----------------------------------------------------------------------------------------------------
CREATINE KINASE (CK, CPK)

Elevated in:
MI, myocarditis, rhabdomyolysis, myositis, crush injury/trauma, polymyositis, dermatomyositis, vigorous exercise, muscular dystrophy, myxedema, seizures, malignant hyperthermia syndrome, IM injections, CVA, pulmonary embolism and infarction, acute dissection of aorta

Decreased in:
Steroids, decreased muscle mass, connective tissue disorders, alcoholic liver disease, metastatic neoplasms
----------------------------------------------------------------------------------------------------
CREATINE KINASE ISOENZYMES

CK-MB
Elevated in: Mi, myocarditis, pericarditis, muscular dystrophy, cardiac defibrillation, cardiac surgery, extensive rhabdomyolysis, strenuous exercise (marathon runners), mixed conmective tissue disease, cardiomyopathy, hypothermia

CK-MM
Elevated in: crush injury, seizures, malignant hyperthermia syndrome, rhabdomyolysis, myositis, polymyositis, dermatomyositis, vigorous exercise, muscular dystrophy, IM injections, acute dissection of aorta

CK-BB
Elevated in: CVA, subarachnoid hemorrhage, neoplasms (prostate, Gl tract, brain, ovary, breast, lung), severe shock, bowel infarction, hypothermia
----------------------------------------------------------------------------------------------------
CREATININE (serum)

Elevated in:
Renal insufficiency (acute and chronic),
Decreased renal perfusion (hypotension, dehydration, CHF), urinary tract infection, rhabdomyolysis, ketonemia
Drugs (antibiotics [aminoglycosides, cephalosporins], hydantoin, diuretics, methyldopa)

Falsely elevated in:
DKA, administration of some cephalosporins (e.g., cefoxitin, cephalothin)

Decreased in:
Decreased muscle mass (including amputees and older persons), pregnancy, prolonged debilitation
----------------------------------------------------------------------------------------------------
CREATININE CLEARANCE

Elevated in:
Pregnancy, exercise

Decreased in:
Renal insufficiency, drugs (cimetidine, procainanude, antibiotics, quinidine)
----------------------------------------------------------------------------------------------------
CRYOGLOBULINS (serum)

Present in:
Collagen-vascular diseases, CLL, hemolytic anemias, multiple myeloma, Waldenstrom's macroglobulinemia, chronic active hepatitis, Hodgkin's disease
----------------------------------------------------------------------------------------------------
D-XYLOSE ABSORPTION

Decreased in:
Malabsorption syndrome
----------------------------------------------------------------------------------------------------
EOSINOPHIL COUNT

Elevated in:
Allergy, parasitic infestations (trichinosis, aspergillosis, hydatidosis), angmneurotic edema, drug reactions, warfarin sensitivity, collagen-vascular diseases, acute hypereosinophilic syndrome, eosinophilic nonallergic rhinitis, myeloproliferative disorders, Hodgkin's Iymphoma, radiation therapy, NHL, L-tryptophan ingestion
----------------------------------------------------------------------------------------------------
ERYTHROCYTE SEDIMENTATION RATE (Westergren)

Elevated in:
Collagen-vascular diseases, infections, MI, neoplasms, inflammatory states (acute phase reactant)
----------------------------------------------------------------------------------------------------
EXTRACTABLE NUCLEAR ANTIGEN (ENA complex, anti-RNP antibody, anti-Sm, anti-Smith)

Present in:
SLE, rheumatoid arthritis, Sjogren's syndrome, MCTD
----------------------------------------------------------------------------------------------------
FECAL FAT, QUANTITATIVE (72 hr collection)

Elevated in:
Malabsorption syndrome
----------------------------------------------------------------------------------------------------
FERRITIN (serum)

Elevated in:
Hyperthyroidism, inflammatory states, liver disease (ferritin elevated from necrotic hepatocytes), neoplasms (neuroblastomas, Iymphomas, leukemia, breast carcinoma), iron replacement therapy, hemochromatosis

Decreased in:
Iron deficiency anemia
----------------------------------------------------------------------------------------------------
FIBRIN DEGRADATION PRODUCT (FDP)

Elevated in:
DIC, primary fibrinolysis, pulmonary embolism, severe liver disease

NOTE: The presence of rheumatoid factor may cause falsely elevated FDP
----------------------------------------------------------------------------------------------------
FIBRINOGEN

Elevated in:
Tissue inflammation/damage (acute-phase protein reactant), oral contraceptives, pregnancy, acute infection, MI

Decreased in:
DIC, hereditary afibrinogenemia, liver disease, primary or secondary fibrinolysis, cachexia
----------------------------------------------------------------------------------------------------
FOLATE (FOLIC ACID)

Decreased in:
Folic acid deficiency (inadequate intake, malabsorption), alcoholism, drugs (methotrexate, trimethoprim, phenytoin, oral contraceptives, azulfadine), vitamin B12 deficiency (defective red cell folate absorption)
----------------------------------------------------------------------------------------------------
FTA-ABS (serum)(FLUORESCENT TREPONEMAL ANTIBODY)

Reactive in:
Syphilis, other treponemal diseases (yaws, pinta, bejel)
----------------------------------------------------------------------------------------------------
GASTRIN (serum)

Elevated in:
Zollinger-Ellison syndrome (gastrinoma), pernicious anemia, hyperparathyroidism, retained gastric antrum, chronic renal failure, gastric ulcer, chronic atrophic gastritis, pyloric obstruction, malignant neoplasms of the stomach, H2 blockers, omeprazole
----------------------------------------------------------------------------------------------------
GLOMERULAR BASEMENT MEMBRANE ANTIBODY (ANTIGLOMERULAR BASEMENT ANTIBODY)

Present in:
Goodpasture's syndrome
----------------------------------------------------------------------------------------------------
GLUCOSE-6-PHOSPHATE DEHYDROGENASE SCREEN (blood)

Abnormal:
If a deficiency is detected, quantitation of G6PD is necessary; a G6PD screen may be falsely interpreted as abnormal
----------------------------------------------------------------------------------------------------
GLUCOSE TOLERANCE TEST

Elevated in:
Glucose intolerance, diabetes mellitus, Cushing's syndrome, acromegaly, pheochromocytoma
----------------------------------------------------------------------------------------------------
GLUCOSE, FASTING

Elevated in:
Diabetes mellitus, stress, infections, MI, CVA, Cushing's syndrome, acromegaly, acute pancreatitis, glucagonoma, hemocbromatosis, drugs (glucocorticoids, diuretics [thiazides, loop diuretics]), glucose intolerance
----------------------------------------------------------------------------------------------------
GLUCOSE, POSTPRANDIAL

Elevated in:
Diabetes mellitus, glucose intolerance

Decreased in:
Post-gastrointestinal resection, reactive hypoglycemia, hereditary fructose intolerance, galactosemia, leucine sensitivity
----------------------------------------------------------------------------------------------------
GLYCATED (GLYCOSYLATED) HEMOGLOBIN (HbA1c)

Elevated in:
Uncontrolled diabetes mellitus (glycated hemoglobin levels reflect the level of glucose control over the preceding 120 days)

Decreased in:
Hemolytic anemias,
Decreased RBC survival, pregnancy, chronic blood loss, chronic renal failure, insulinoma
----------------------------------------------------------------------------------------------------
HAM TEST (acid serum test)

Positive in:
Paroxysmal nocturnal hemoglobinuria (PNH)

False positive in:
Hereditary or acquired spherocytosis, recent transfusion with aged RBC, aplastic anemia, myeloproliferative syndromes, leukemia, hereditary dyserythropoietic anemia type II (HEMPAS)
----------------------------------------------------------------------------------------------------
HAPTOGLOBIN (serum)

Elevated in:
Inflammation (acute phase reactant), collagen-vascular diseases, infections (acute phase reactant), drugs (androgens)

Decreased in:
Hemolysis (intravascular > extravascular), megaloblastic anemia, severe liver disease, large tissue hematomas, infectious mononucleosis, drugs (oral contraceptives)
----------------------------------------------------------------------------------------------------
HEMATOCRIT

Elevated in:
Polycythemia vera, smoking, COPD, high altitudes, dehydration, hypovolemia

Decreased in:
Blood loss (GI, GU), anemia, pregnancy
----------------------------------------------------------------------------------------------------
HEMOGLOBIN

Elevated in:
Hemoconcentration, dehydration, polycythemia vera, COPD, high altitudes, false elevations (hyperlipemic plasma, WBC >50,000 mm3), stress

Decreased in:
Hemorrhage (GI, GU), anemia
----------------------------------------------------------------------------------------------------
HEPATITIS A ANTIBODY

Present in:
Viral hepatitis A, can be IgM or IgG (if IgM, acute hepatitis A; if IgG, previous infection with hepatitis A)
----------------------------------------------------------------------------------------------------
HEPATITIS B SURFACE ANTIGEN (HBsAg)

Detected in:
Acute viral hepatitis Type B. Chronic hepatitis B
----------------------------------------------------------------------------------------------------
HIGH DENSITY LIPOPROTEIN (HDL) CHOLESTEROL

Increased:
Use of gemfibrozil, nicotinic acid, estrogens, regular aerobic exercise, small (1 oz) daily alcohol intake

Decreased:
Deficiency of apoproteins, liver disease, probucol ingestion, Tangier disease
NOTE: A cholesterol/HDL ratio >4.5 is associated with increased risk of coronary artery disease.
----------------------------------------------------------------------------------------------------
IMMUNE COMPLEX ASSAY

Detected in:
Collagen-vascular disorders, glomerulonephritis, neoplastic diseases, malaria, primary biliary cirrhosis, chronic acute hepatitis, bacterial endocarditis, vasculitis
----------------------------------------------------------------------------------------------------
IMMUNOGLOBULINS

Elevated in:
-IgA: Iymphoproliferative disorders, Berger's nephropathy, chronic infections, autoimmune disorders, liver disease
-IgE: allergic disorders, parasitic infections, immunological disorders IgE myeloma
-IgG: chronic granulomatous infections, infectious diseases, inflammation, myeloma, liver disease
-IgM: primary biliary cirrhosis, infectious diseases (brucellosis, malaria), Waldenstrom's macroglobulinemia, liver disease

Decreased in:
-IgA: nephrotic syndrome, protein-losing enteropathy, congenital deficiency, Iymphocytic leukemia, ataxia-telengiectasia, chronic eosinopulmonary disease
-IgE: hypogammaglobulinemia, neoplasm (breast, bronchial, cervical) ataxia, telengiectasia
-IgG: congenital or acquired deficiency, Iymphocytic leukemia, phenytoin, methylprednisolone, nephrotic syndrome, protein-losing enteropathy
-IgM: congenital deficiency, Iymphocytic leukemia, nephrotic syndrome
----------------------------------------------------------------------------------------------------
IRON-BINDING CAPACITY (TIBC)

Elevated in:
Iron deficiency anemia, pregnancy, polycythemia

Decreased in:
Anemia of chronic disease, hemochromatosis, chronic liver disease, hemolytic anemias, malnutrition (protein depletion)
----------------------------------------------------------------------------------------------------
LACTATE (blood)

Increased in:
(Without signifigant acidosis): Muscular exercise, hyperbentilation, glucaon, glycogen storage disease, severe anemia, pyruvate infusion, HCO3 infusion, glucose and insulin infusion.

(With hypoxia and acidosis): Acute hemorrage, circulatory collapse, cyanotic heart disease, severe acute CHF, acute anoxemia, extracorpeal circulation, epinephrine

(Idiopathic): Mild uremia, infections (esp. pyelonephritis), septicemia, cirrhosis, acute pancreatitis (+/-), third trimester of pregnancy, severe vascular disease, leukemia, anemia, chronic alcoholism, subacute bacterial endocarditis, poliomyelitis
----------------------------------------------------------------------------------------------------
LACTATE DEHYDROGENASE (LDH)

Elevated in:
Infarction of myocardium, lung, kidney

Diseases of cardiopulmonary system, liver, collagen, CNS

Hemolytic anemias, megaloblastic anemias, transfusions, seizures, muscle trauma, muscular dystrophy, acute pancreatitis hypotension shock, infectious mononucleosis, inflammation, neoplasia, intestinai obstruction, hypothyroidism
----------------------------------------------------------------------------------------------------
LACTATE DEHYDROGENASE ISOENZYMES

Abnormal values:
LDH1 > LDH2: MI (can also be seen with hemolytic anemias, pernicious anemia, folate deficiency, renal infarct)

LDH5 > LDH4: liver disease (cirrhosis, hepatitis, hepatic congestion)
----------------------------------------------------------------------------------------------------
LEGIONELLA TITER

Positive in:
Legionnaire's disease (presumptive: > 1:256 titer; definitive: fourfold titer increase to >1: 128)
----------------------------------------------------------------------------------------------------
LEUKOCYTE ALKALINE PHOSPHATASE (LAP SCORE)

Elevated in:
Leukemoid reactions, neutrophilia secondary to infections (except in sickle cell crisisƒ€no significant increase in LAP score), Hodgkin's disease, polycythemia vera, hairy cell leukemia, aplastic anemia, Down's syndrome, myelofibrosis

Decreased in:
Acute and chronic granulocytic leukemia, thrombocytopenic purpura, paroxysmal nocturnal hemoglobinuria (PNH), hypophosphatemia, collagen disorders
----------------------------------------------------------------------------------------------------
LIPASE

Elevated in:
Acute pancreatitis, perforated peptic ulcer, carcinoma of pancreas (early stage), pancreatic duct obstruction
----------------------------------------------------------------------------------------------------
LOW DENSITY LIPOPROTEIN (LDL) CHOLESTEROL

Elevated in:
Primary hyperlipoproteinemia, diet high in saturated fats, acute MI, hypothyroidism, primary biliary cirrhosis, nephrosis, driabetes mellitus

Decreased in:
Abetalipoproteinemia, advanced liver disease, malabsorption, malnutrition
----------------------------------------------------------------------------------------------------
LYMPHOCYTES

Elevated in:
Chronic infections, infectious mononucleosis and other viral infections, CLL, Hodgkin's disease, ulcerative colitis, hypoadrenalism, ITP

Decreased in:
AIDS, ARC, bone marrow suppression from chemotherapeutic agents or chemotherapy, aplastic anemia, neoplasms, steroids, adrenocortical hyperfunction, neurologic disorders (multiple sclerosis, myasthenia gravis, Guillain-Barre syndrome)
----------------------------------------------------------------------------------------------------
MAGNESIUM (serum)

Increased in:
-Renal failure
-Diabetic coma before treatment
-Hypothyroidism
-Addison's disease and after adrenalectomy
-Controlled diabetes mellitus in older patients
-Administration of antacids containing magnesium

Decreased in:
-GI disease showing malabsorption and abnormal loss of GI fluids (e.g., nontropical sprue, small bowel resection, biliary and intestinal fistulas, abdominal irradiation, prolonged aspiration of intestinal contents, celiac disease and other causes of steatorrhea)
-Acute alcoholism and alcoholic cirrhosis
-Insulin treatment oof diabetic coma
-Hyperthyroidism
-Aldosteronism
-Hyperparathyroidism
-Lytic tumors of bone
-Diuretic drug therapy (e.g., ethacrynic acid, furosemide)
-Some cases of renal disease (e.g., glomerulonephritis, pyeloneI phritis, renal tubular acidosis)
-Acute pancreatitis
-Excessive lactation
-Idiopathic disorders

Magnesium deficiency may cause apparently unexplained hypocalcemia and hypokalemia; the patients may have neurologic and GI symptoms

----------------------------------------------------------------------------------------------------
MEAN CORPUSCULAR VOLUME (MCV)

Elevated in:
Vitamin B12 deficiency, folic acid deficiency, liver disease, alcohol abuse, reticulocytosis, hypothyroidism, marrow aplasia, myelofibrosis

Decreased in:
Iron deficiency, thalassemia syndrome and other hemoglobinopathies, anemia of chronic disease, sideroblastic anemia, chronic renal failure, lead poisoning
----------------------------------------------------------------------------------------------------
MONOCYTE COUNT

Elevated in:
Viral diseases, parasites, infections, neoplasms, inflammatory bowel disease, monocytic leukemia, Iymphomas, myeloma, sarcoidosis

Decreased in:
Aplastic anemia, Iymphocytic leukemia, glucocorticoid administration
----------------------------------------------------------------------------------------------------
NEUTROPHIL COUNT

Elevated in:
Acute bacterial infections, acute MI, stress, neoplasms, myelocytic leukemia

Decreased in:
Viral infections, aplastic anemias, immunosuppressive drugs, radiation therapy to bone marrow, agranulocytosis, drugs (antibiotics, antithyroidals), Iymphocytic and monocytic leukemias
----------------------------------------------------------------------------------------------------
OSMOLALITY, SERUM

It can be estimated by the following formula:

2([Na] + [K]) + Glucose/18 + BUN/2.8

Elevated in:
Dehydration, hypernatremia, diabetes insipidus, uremia, hyperglycemia, mannitol therapy, ingestlon of toxins (ethylene glycol, methanol ethanol)

Decreased in:
SIADH, hyponatremia, overhydration
----------------------------------------------------------------------------------------------------
pH, BLOOD

Increased in:
Metabolic alkalosis, respiratory alkalosis

Decreased in:
Metabolic acidosis, repiratory acidosis
----------------------------------------------------------------------------------------------------
PARTIAL THROMBOPLASTIN TIME (PTT), ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)

Elevated in:
Heparin therapy, coagulation factor deficiency (I, II, V, VIII, IX, X, XI XII), liver disease, vitamin K deficiency, DIC, circulating anticoagulant, warfarin therapy, specific factor inhibition (PCN reaction, rheumatoid arthritis), thrombolytic therapy

NOTE: Useful to evaluate the intrinsic coagulaion system.
----------------------------------------------------------------------------------------------------
PHOSPHATASE, ALKALINE; see ALKALINE PHOSPHATASE PHOSPHORUS (serum)

Elevated in:
Renal failure, dehydration, Addison's disease, myelogenous leukemia, hypervitaminosis D, hypoparathyroidism, pseudohypoparathyroidism, bone metastases, sarcoidosis, milk-alkali syndrome, immobilization, magnesium deficiency, transfusions, hemolysis

Decreased in:
Starvation (e.g., alcoholics), DKA, TPN, continuous IV dextrose administration, vitamin D deficiency, hyperparathyroidism, pseudohyperparathyroidism, antacids containing aluminum hydroxide, insulin administration, nasogastric suctioning, vomiting, diuretics, steroids, gram-negative septicemia
----------------------------------------------------------------------------------------------------
PHOSPHORUS (serum)

Increased in:
-Hypoparathyroidism (Idiopathic, Surgical, Pseudohypoparathyroidism)
-Excess vitamin D intake
-Secondary hyperparathyroidism (renal rickets)
-Bone disease (Healing fractures, Multiple myeloma (some patients), Paget's disease (some patients), Osteolytic metastatic tumor in bone (some patients))
-Addison's disease
-Acromegaly
-Childhood
-Myelogenous leukemia
-Acute yellow atrophy
-High intestinal obstruction
-Sarcoidosis (some patients)
-Milk-alkali (Burnett's) syndrome (some patients)
-Artifactual increase by hemolysis of blood

Decreased in
-Alcoholism*
-Diabetes mellitus*
-Hyperalimentation*
-Nutritional recovery syndrome* (rapid refeeding after prolonged starvation)
-Alkalosis, respiratory (e.g., gram-negative bacteremia) or metabolic
-Acute gout
-Salicylate poisoning
-Administration of glucose intravenously (e.g., recovery after severe burns, hyperalimentation)
-Administration of anabolic steroids, androgens, epinephrine, glucagon, insulin
-Acidosis (especially ketoacidosis)
-Hyperparathyroidism
-Renal tubular defects (e.g., Fanconi syndrome)
-Hypokalemia
-Hypomagnesemia
-Administration of diuretics
-Prolonged hypothermia (e.g., open heart surgery)
-Malabsorption
-Vitamin D deficiency and/or resistance, osteomalacia
-Malnutrition, vomiting, diarrhea
-Administration of phosphate-binding antacids*
-Primary hypophosphatemia

*Indicates conditions associated with severe hypophosphatemia.

Mechanisms of hypophosphatemia are intracellular shift of phosphate, increased loss (via kidney or intestine), or decreased intestinal absorption; usually associated with prior phosphorus depletion. Often, more than one mechanism is operative.

----------------------------------------------------------------------------------------------------
PLATELET COUNT

Elevated in:
Neoplasms (GI tract), CML, polycythemia vera, myelofibrosis with myeloid metaplasia, infections, after splenectomy, postpartum, after hemorrhage, hemophilia, iron deficiency, pancreatitis, cirrhosis
----------------------------------------------------------------------------------------------------
POTASSIUM (serum)

Increased in:
-Renal failure: (Acute with oliguria or anuria; Chronic end-stage with oliguria (glomerular filtration rate <3-5 ml/minute); Chronic nonoliguric associated with dehydration, obstruction, trauma, or excess potassium)
-Decreased mineralocorticoid activity: (Addison's disease; Hypofunction of renin-angiotensin-aldosterone system; Pseudohypoaldosteronism; Aldosterone antagonist (e.g., spironolactone))
-Increased supply of potassium: (Red blood cell hemolysis (transfusion reaction, hemolytic anemia); Excess dietary intake or rapid potassium infusion; Striated muscle (status epilepticus, periodic paralysis); Potassium-retaining drugs (e.g., triamterene); Fluid-electrolyte imbalance (e.g., dehydration, acidosis))
-Laboratory artifacts (e.g., hemolysis during venipuncture, conditions associated with thrombocytosis, incomplete separation of serum and clot)

Decreased in:
-Renal and adrenal conditions with metabolic alkalosis: (Administration of diuretics, Primary aidosteronism, Pseudoaldosteronism, Salt-losing nephropathy, Cushing's syndrome)
-Renal conditions associated with metabolic acidosis: (Renal tubular acidosis, Diuretic phase of acute tubular necrosis, Chronic pyelonephritis, Diuresis following relief of urinary tract obstruction)
-Gastrointestinal conditions: (Vomiting, gastric auctioning; Villous adenoma; Cancer of colon; Chronic laxative abuse; Zollinger-Ellison syndrome; Chronic diarrhea; Ureterosigmoidostomy)

----------------------------------------------------------------------------------------------------
PROLACTIN

Elevated in:
Prolactinomas (level >200 highly suggestive), drugs (phenothiazines, cimetidine, tricyclic antidepressants, metoclopramide, estrogens, antihypertensives [methyldopa], verapamil, haloperidol), postpartum, stress, hypoglycemia, hypothyroidism
----------------------------------------------------------------------------------------------------
PROTEIN (serum)

Elevated in:
Dehydration, multiple myeloma, Waldenstrom's macroglobulinemia, sarcoidosis, collagen-vascular diseases

Decreased in:
Malnutrition, low-protein diet, overhydration, malabsorption, pregnancy, severe bums, neoplasms, chronic diseases, cirrhosis, nephrosis
----------------------------------------------------------------------------------------------------
PROTEIN ELECTROPHORESIS (serum)

Elevated:
-Albumin: dehydration
-a-l: neoplastic diseases, inflammation
-a-2: neoplasms, inflammation, infection, nephrotic syndrome
-b: hypothyroidism, biliary cirrhosis, diabetes mellitus
-y: see IMMUNOGLOBULINS

Decreased:
-Albumin: malnutrition, chronic liver disease, malabsorption, nephrotic syndrome, burns, SLE
-a-I: emphysema (a-l antitrypsin deficiency), nephrosis
-a-2: hemolytic anemias (
Decreased haptoglobin), severe hepatocellular damage
-b: hypocholesterolemia, nephrosis
-y: see IMMUNOGLOBULINS
----------------------------------------------------------------------------------------------------
PROTHROMBIN TIME (PT)

Elevated in:
Liver disease, oral anticoagulants (Warfarin), heparin, factor deficiency (I, II, V, VII, X), DIC, vitamin K deficiency, afibrinogenemia, dysfibrinogenemia, drugs (salicylae, chloral hydrate, diphenylhydantoin, estrogens, antacids, phenylbutazone, quinidine, antibiotics, allopurinol, anabolic steroids)

Decreased in:
Vitamin K supplementation, thrombophlebitis, drugs (gluthetimide, estrogens, griseofulvin, diphenhydramine)
----------------------------------------------------------------------------------------------------
PROTOPORPHYRIN (free erythrocyte)

Elevated in:
Iron deficiency, lead poisoning, sideroblastic anemias, anemia of chronic disease, hemolytic anemias, erythropoietic protoporphyria
----------------------------------------------------------------------------------------------------
RED BLOOD CELL COUNT

Elevated in:
Polycythemia vera, smokers, high altitude, cardiovascular disease, renal cell carcinoma and other erythropoietin-producing neoplasms, stress, hemoconcentration/dehydration

Decreased in:
Anemias, hemolysis, chronic renal failure, hemorrhage, failure of marrow production
----------------------------------------------------------------------------------------------------
RED BLOOD CELL DISTRIBUTION WIDTH (RDW)

Normal RDW and...
Elevated MCV: aplastic anemia, preleukemiaNormal MCV: normal, anemia of chronic disease, acute blood loss or hemolysis, CLL, CML, nonanemic enzymopathy or hemoglobinopathy

Decreased MCV: anemia of chronic disease, heterozygous thalassemia

Elevated RDW and...
Elevated MCV: vitamin Bl2 deficiency, folate deficiency, immune hemolytic anemia, cold agglutinins, CLL with high count, liver disease

Normal MCV: early iron deficiency, early vitamin Bl2 deficiency, early folate deficiency, anemic globinopathy

Decreased MCV: iron deficiency, RBC fragmentation, Hb H. thalassemia intermedia
----------------------------------------------------------------------------------------------------
RED BLOOD CELL MASS (VOLUME)

Elevated in:
Polycythemia vera, hypoxia (smokers, high altitude, cardiovascular disease), hemoglobinopathies with high 2B affinity, erythropoietin-producmg tumors (renal cell carcinoma)

Decreased in:
Hemorrhage, chronic disease, failure of marrow production anemias, hemolysis
----------------------------------------------------------------------------------------------------
RETICULOCYTE COUNT

Elevated in:
Hemolytic anemia (sickle cell crisis, thalassemia major, autoimmune hemolysls, hemorrhage, postanemia therapy (folic acid, ferrous sulfate, vitamin B12)

Decreased in:
Aplastic anemia, marrow suppression (sepsis, chemotherapeutic agents radlation), hepatic cirrhosis, blood transfusion, anemias of disordered maturation (iron deficiency anemia, megaloblastic anemia, sideroblastlc anemua, anemna of chronic disease)
----------------------------------------------------------------------------------------------------
RHEUMATOID FACTOR

Present in titer >1:20:
Rheumatoid arthritis, SLE, chronic inflammatory processes, old age, infection, liver disease
----------------------------------------------------------------------------------------------------
SMOOTH MUSCLE ANTIBODY (ANTI- SMOOTH MUSCLE ANTIBODY)

Present in:
Chronic active hepatitis (>1:80), primary biliary cirrhosis (<1:80), infectious mononucleosis
----------------------------------------------------------------------------------------------------
SODIUM (serum)

Increased in:

Excess loss of water...
-Conditions that cause loss via gastrointestinal tract (e.g., in vomiting), lung (hyperpnea), or skin (e.g., in excessive sweating)
-Conditions that cause diuresis (Diabetes insipidus, Nephrogenic diabetes insipidus, Diabetes mellitus, Diuretic drugs, Diuretic phase of acute tubular necrosis, Diuresis following relief of urinary tract obstruction, Hypercalcemic nephropathy, Hypokalemic nephropathy)

Excess administration of sodium (iatrogenic), e.g., incorrect replacement following fluid loss.
""Essential"" hypernatremia due to hypothalamic lesions

Decreased in (serum osmolality is decreased):

-Dilutional: (e.g., congestive heart failure, nephrosis, cirrhosis with ascites)
-Sodium depletion: (Loss of body fluids (e.g., vomiting, diarrhea, excessive sweating) with incorrect or no therapeutic replacement, diuretic drugs (e.g., thiazides); Adrenocortical insufficiency; Salt-losing nephropathy; Inappropriate secretion of antidiuretic hormone)
-Spurious (serum osmolality is normal or increased): (Hyperlipidemia; Hyperglycemia (serum sodium decreases 3 mEq/L for every increase of serum glucose of 100 mg/100 ml))

----------------------------------------------------------------------------------------------------
SUCROSE HEMOLYSIS TEST (sugar water test)

Positive in:
Paroxysmal nocturnal hemoglobinuria (PNH)

False positive: autoimmune hemolytic anemia, megaloblastic anemnas
False negative: may occur with use of heparin or EDTA
----------------------------------------------------------------------------------------------------
T3 (TRIIODOTHYRONINE)

Decreased in:
Starvation, trauma, surgery, may be an adaptive response to illness, drugs (PTU)
----------------------------------------------------------------------------------------------------
T3 RESIN UPTAKE (T3RU)

This test should be used only with a simultaneous measurement of serum T4 to exclude the possibility that an increased T4 is due to an increase in T4-binding globulin. Measurement of serum T-3 concentration should be done by radioimmunoassay for diagnosis of hyperthyroidism

Increased in:
-Hyperthyroidism
-Certain drugs (e.g., testosterone, androgens, anabolic steroids, prednisone, heparin, Dicumarol, salicylates, Butazolidin, penicillin, Dilantin)
-Threatened abortion
-Infants (up to about age 2 months)
-Severe nephrosis
-Metastatic neoplasms

Decreased in_
-Hypothyroidism
-Pregnancy (from about tenth week of pregnancy until up to 12th week postpartum)
-Certain drugs (e.g., estrogens alone or in birth control pills, large amounts of iodine, propylthiouracil in hyperthyroidism)

Normal in:
-Pregnancy with hyperthyroidism
-Nontoxic goiter
-Carcinoma of thyroid
-Diabetes mellitus
-Addison's disease
-Anxiety
-Certain drugs (mercurials, iodine)

Variable in:
Liver disease

----------------------------------------------------------------------------------------------------
T4, FREE (free thyroxine)

This determination gives corrected values in patients in whom the total thyroxine (T-4) is altered on account of changes in serum proteins or in binding sites. (Pregnancy; Drugs (e.g., androgens, estrogens, birth control pills, Dilantin); Altered levels of serum proteins (e.g., nephrosis))

This is the best single screening test for thyroid dysfunction. It is paralleled by the free thyroxine factor.

Increased in:
-Hyperthyroidism
-Hypothyroidism treated with thyroxine -Very ill euthyroid patients (frequently)

Decreased in:
-Hypothyroidism
-Hypothyroidism treated with triiodothyronine

----------------------------------------------------------------------------------------------------
THROMBIN TIME (TT)

Elevated in:
Thrombolytic and heparin therapy, DIC, hypofibrinogenemia, dysfibrinogenemia
----------------------------------------------------------------------------------------------------
THYROID STIMULATING HORMONE (TSH)

Elevated in:
Hypothyroidism, drugs (haloperidol, chlorpromazme, metoclopramide, domperidone), TSH antibodies, pituitary resistance to thyroid hormone

Decreased in:
Hyperthyroidism, acute medical illness, drugs (dopamine, corticosteroids, bromocriptine, levodopa, pyridoxine), hyponatremia, malnutrition

Normal in:
Cushing's syndrome
Acromegaly
Pregnancy at term

----------------------------------------------------------------------------------------------------
THYROXINE-BINDING GLOBULIN (TBG)

Increased in:
-Pregnancy
-Excess TBG, genetic or idiopathic -Hypothyroidism (sorr-te patients)
-Certain drugs (estrogens, birth control pills)
-Gross iodine contamination
-Acute intermittent porphyria

Decreased in:
-Nephrosis and other causes of marked hypoproteinemia Deficiency of TBG, genetic or idiopathic
-Certain drugs (androgenic and anabolic steroids)

An increase of TBG is associated with an increase in PBI, BEI, and T-4 by column and a decrease in T-3; converse association for decrease of TBG.
----------------------------------------------------------------------------------------------------
THYROXINE (T4)

Increased in:
-Hyperthyroidism
-Pregnancy
-Certain drugs (estrogens, birth control pills, d-thyroxine, thyroid extract, TSH)

Decreased in:
-Hypothyroidism
-Hypoproteinemia
-Certain drugs (phenytoin sodium [Dilantin], triiodothyronine, testosterone, ACTH, corticosteroids)

Not affected by:
-Radiopaque substances for x-ray studies -Mercurial diuretics
-Nonthyroidal iodine

----------------------------------------------------------------------------------------------------
TRANSFERRIN

Elevated in:
Iron deficiency anemia, oral contraceptive administration, viral hepatitis

Decreased in:
Nephrotic syndrome, liver disease, hereditary deficiency, protein malnutrition, neoplasms, chronic inflammatory states, chronic illness thalassemia
----------------------------------------------------------------------------------------------------
TRIGLYCERIDES

Elevated in:
Hyperlipoproteinemias (Types I, IIb, III, IV, V), hypothyroidism, pregnancy, estrogens, acute MI, pancreatitis, alcohol intake, nephrotic syndrome, diabetes mellitus, glycogen storage disease

Decreased in:
Malnutrition, congenital abetalipoproteinemias, drugs (e.g., gemfibrozil, nicotinic acid, clofibrate)
----------------------------------------------------------------------------------------------------
UREA NITROGEN (BUN)

Elevated in:
-Drugs (aminoglycosides and other antibiotics, diuretics, lithium, corticosteroids), dehydration, gastrointestinal bleeding,
-Decreased renal blood flow (shock, CHF, MI), renal disease (glomerulonephritis pyelonephritis, diabetic nephropathy), urinary tract obstruction (prostatic hypertrophy)

Decreased in:
Liver disease, malnutrition, third trimester of pregnancy, overhydration
----------------------------------------------------------------------------------------------------
URIC ACID (serum)

Elevated in:
Renal failure, gout, excessive cell Iysis (chemotherapeutic agents, radiation therapy, leukemia, Iymphoma, hemolytic anemia), hereditary enzyme deficiency (hypoxanthine-guanine-phosphoribosyl transferase) acidosis, myeloproliferative disorders, diet high in purines or protein drugs (diuretics, low doses of ASA, ethambutol, nicotinic acid), lead poisoning, hypothyroidism, Addison's disease, nephrogenic diabetes insipidus, active psoriasis, polycystic kidneys

Decreased in:
Drugs (allopurinol, high doses of ASA, probenecid, warfarin, corticosteroid), deficiency of xanthine oxidase, SIADH, renal tubular deficits (Fanconi's syndrome), alcoholism, liver disease, diet deficient in protein or purines, Wilson's disease, hemochromatosis
----------------------------------------------------------------------------------------------------
URINE 5-HYDROXYINDOLE-ACETIC ACID (URINE 5-HIAA)

Elevated in:
Carcinoid tumors, after ingestion of certain foods (bananas, plums, tomatoes, avocados, pineapples, eggplant, walnuts), drugs (MAO inhibitors, phenacetin, methyldopa, glycerol guaiacolate, acetaminophen,salicylates, phenothiazines, imipramine, methocarbamol, reserpine, metamphetamine)
----------------------------------------------------------------------------------------------------
URINE AMYLASE

Elevated in:
Pancreatitis, carcinoma of the pancreas
----------------------------------------------------------------------------------------------------
URINE BILE (BILIRUBIN, URINE)

Abnormal:
Urine bilirubin: Hepatitis (viral, toxic, drug-induced), biliary obstruction
Urine urobilinogen: Hepatitis (viral, toxic, drug-induced), hemolytic jaundice, liver cell dysfunction (cirrhosis, infection, metastases)
----------------------------------------------------------------------------------------------------
URINE CALCIUM

Elevated in:
Primary hyperparathyroidism, hypervitaminosis D, bone metastases multlple myeloma, increased calcium intake, steroids, prolonged immobilization, sarcoidosis, Paget's disease, idiopathic hypercalciuria renal tubular acidosis

Decreased in:
Hypoparathyroidism, pseudohypoparathyroidism, vitamin D deficiency vitanun D-resistant rickets, diet low in calcium, drugs (thiazide diuretics, oral contraceptives), familial hypocalciuric hypercalcemia, renal osteodystrophy
----------------------------------------------------------------------------------------------------
URINE CATECHOLAMINES

Elevated in:
Pheochromocytoma, neuroblastoma, severe stress
----------------------------------------------------------------------------------------------------
URINE CHLORIDE

Elevated in:
Corticosteroids, Bartter's syndrome

Decreased in:
Chloride depletion (vomiting, diuretics), colonic villous adenoma
----------------------------------------------------------------------------------------------------
URINE COPPER

Increased in:
Wilson's disease
----------------------------------------------------------------------------------------------------
URINE CORTISOL, FREE

Elevated:
Refer to CORTISOL (serum)
----------------------------------------------------------------------------------------------------
URINE CREATININE (24 hr)

NOTE: Useful test as an indicator of completeness of 24 hr urine collection.
----------------------------------------------------------------------------------------------------
URINE GLUCOSE (qualitative)

Present in:
Diabetes mellitus, renal glycosuria (decreased renal threshold for glucose), glucose intolerance
----------------------------------------------------------------------------------------------------
URINE HEMOGLOBIN, FREE

Present in:
Hemolysis (with saturation of serum haptoglobin binding capacity and renal threshold for tubular absorption of hemoglobin)
----------------------------------------------------------------------------------------------------
URINE HEMOSIDERIN

Present in:
Paroxysmal noctumal hemoglobinuria (PNH), chronic hemolytic anemia, hemochromatosis
----------------------------------------------------------------------------------------------------
URINE INDICAN

Present in:
Malabsorption secondary to intestinal bacterial overgrowth
----------------------------------------------------------------------------------------------------
URINE KETONES (semiquantitative)

Present in:
DKA, alcoholic ketoacidosis, starvation, isopropanol ingestion
----------------------------------------------------------------------------------------------------
URINE METANEPHRINES

Elevated in:
Pheochromocytoma, neuroblastoma, drugs (caffeine, phenothiazines, MAO inhibitors), stress
----------------------------------------------------------------------------------------------------
URINE MYOGLOBIN

Present in:
Severe trauma, hyperthermia, polymyositis/demmatomyositis, carbon monoxide poisoning
----------------------------------------------------------------------------------------------------
URINE NITRITE

Present in:
Urinary tract infections
----------------------------------------------------------------------------------------------------
URINE OCCULT BLOOD

Positive in:
Trauma to urinary tract, renal disease (glomerulonephritis, pyelonephritis), renal or ureteral calculi, bladder lesions (carcinoma, cystitis), prostatitis, prostatic carcinoma, menstrual contamination, hematopoietic disorders (hemophilia, thrombocytopenia), anticoagulants, ASA
----------------------------------------------------------------------------------------------------
URINE OSMOLALITY

Elevated in:
SIADH, dehydration, glycosuria, adrenal insufficiency, high-protein diet

Decreased in:
Diabetes insipidus, excessive water intake, IV hydration with D5W acute renal insufficiency, glomerulonephritis
----------------------------------------------------------------------------------------------------
URINE pH

Elevated in:
Bacteriuria, vegetarian diet, renal failure with inability to form ammonia, drugs (antibiotics, sodium bicarbonate, acetazolamide)

Decreased in:
Acidosis (metabolic, respiratory), drugs (ammonium chloride, methenamine mandelate), diabetes mellitus, starvation, diarrhea
----------------------------------------------------------------------------------------------------
URINE POTASSIUM

Elevated in:
Aldosteronism (primary, secondary), glucocorticoids, alkalosis, renal tubular acidosis, excessive dietary potassium intake

Decreased in:
Acute renal failure, potassium-sparing diuretics, diarrhea, hypokalemia
----------------------------------------------------------------------------------------------------
URINE PROTEIN (quantitative)

Elevated in:
Renal disease (glomerular, tubular, interstitial), CHF, hypertension, neoplasms of renal pelvis and bladder, multiple myeloma, Waldenstrom's macroglobulinemia
----------------------------------------------------------------------------------------------------
URINE SODIUM (quantitative)

Elevated in:
Diuretic administration, high sodium intake, salt-losing nephritis, acutetubular necrosis, vomiting, CHF, hepatic failure. Addison's disease, SIADH, hypothyroidism
----------------------------------------------------------------------------------------------------
URINE SPECIFIC GRAVITY

Elevated in:
Dehydration, excessive fluid losses (vomiting, diarrhea, fever) x-ray contrast media, diabetes mellitus, CHF, SIADH, adrenal insufficiency,
Decreased fluid intake

Decreased in:
Diabetes insipidus, renal disease (glomerulonephritis, pyelonephritis), excessive fluid intake or IV hydration
----------------------------------------------------------------------------------------------------
URINE VANILLYLMANDELIC ACID (VMA)

Elevated in:
Pheochromocytoma, neuroblastoma, ganglioblastoma, drugs (isoproterenol, methocarbamol, levodopa, sulfonamides, chlorpromazine), severe stress, after ingestion of bananas, chocolate, vanilla, tea, coffee

Decreased in:
Drugs (MAO inhibitors, reserpine, guanethidine, methyldopa)
----------------------------------------------------------------------------------------------------
VDRL

Positive test:
Syphilis, other treponemal diseases (yaws, pinta, bejel)

NOTE: A false-positive test may be seen in patients with SLE and other autoimmune diseases, infectious mononucleosis, atypical pneumonia, malaria, leprosy.
----------------------------------------------------------------------------------------------------
VISCOSITY

Elevated in:
Monoclonal gammopathies (Waldenstrom's macroglobulinemia, multiple myeloma), hyperfibrinogenemia, SLE, rheumatoid arthritis, polycythemia, leukemia
----------------------------------------------------------------------------------------------------
y-GLUTAMYL TRANSFERASE (GGT; GAMMA-GLUTAMYL TRANSFERASE )

Elevated in:
Chronic alcoholic liver disease, neoplasms (hepatoma, metastatic disease to the liver, carcinoma of the pancreas), SLE, CHF, trauma, nephrotic syndrome, sepsis, cholestasis. drugs (phenytoin, barbiturates)

TARGET FMGE 2009 / MCI SCREENING TEST MARCH 2009

2008-12-18T19:21:00.000-08:00

fmge sep 2008

2008-12-18T19:01:00.000-08:00

Posted: Sat Oct 04, 2008 2:46 pm Post subject: Questions FMGE -2008(Part-1,11; Set-A)

--------------------------------------------------------------------------------

Questions FMGE -2008(Part-1,11; Set-A)

1) Trendelenberg test is positive due to…..?
2) Notochord exists as….?
3) Neuroglia….?
4) Hyaline Arteriosclerosis seen in …..?
5) Which Ig crosses through placenta …..?
6) M.C cardiac lesion seen in pregnancy ……?
7) M.C valve disease due to M.I ? (Sorry, I forgot the question. It was asked in similarly)
Herd Immunity?
9) Koplik’s spots seen in ……?
10) A ? patient with hypertension & suffering from Thyroiditis, DOC ……?
11) Hypocalcemia is seen with the following?
12) Most common position of Uterus?
13) Shortest ø of pelvis is……?
14) Right base of the heart is formed by …..?
15) Right side Mid calvicle the lung ends at which rib?
16) Water supply in hilly areas?
17) Prophylaxis DOC for Meningitis?
1 Anaemia is seen with all except?
19) Dose of Folic acid during pregnancy? (prophylaxis dose)
20) Vitamin “A” dosage is given in….? (?. of doses.)
21) What is Apoptosis?
22) Extrinsic factor in blood coagulation? (PT/PTT)
23) Curschmann’s spirals are due to?
24) Bell’s palsy?
25) In Dialysis which toxicity is seen commonly?
26) TOC for Gastric ulcer?
27) Squamous non-keratinizing is seen in….? a) Tongue b) Trachea c) Oesophagus d) Vagina
2 Tumour marker CA-125 is related to pancreatic Ca &…….?
29) Bilaterally kidneys are shrunken in …….?
30) Poisoning due to ______________preserved are hair, Etc..etc….?
31) The hormone helps in milk secretion?
32) Most abundant ICF is …….?
33) Features like-Hypogonadism, Loss of Hair, Pigmentation of skin Etc..etc Deficiency due to?
34) Most common features of alcohol withdrawl?
35) Negri bodies are characteristic of ?
36) M.C opportunistic Infection in immuno compromised patient?
37) Mallory-weiss syndrome? (Mallory bodies seen with….?)
3 Sickness benefit under ESI Act is given for the following illness?
39) Glucose is reabsorbed at?
40) M.C pemphigus seen in India?

41) India ia at which stage of Demographic?
42) Urinary incontinence in Older people is due to……?
43) Breast cancer is due to all, Except?
44) Black & white colour vision is due to ………?
45) Grey colour……? ( Extremely sorry I forgot what was asked ,{Ophthalmology Q} if any one can remember please ADD)
46) Kussmaul breathing is due to or seen in ………?
47) Cellulitis is caused by…….?
4 Auer rods are seen in ……?
49) Gynaecomastia is due to drugs……..?
50) In a new born Jaundice occurs on 3-5days;its not due to ……….?
51) Transmitted by faeco-orally, Except ?
52) ß-Thalassemia inherited as ……..?
53) Foreign body inhaled usually lodges in which lung?
54) Change in blood viscosity causes ………?
55) * Question regarding Dentition? “Eruption”
56) Food poisoning 4-6 hrs organism responsible ……..?
57) Dreaming is common in which type of sleep?
5 Second heart sound is due to ……..?
59) “SAFE” ; ‘S’-stands for ……..?
60) Long term status of blood sugar explained by …….? (Ans: HbA1c ; The way the question was formed is different, any way the matter is most Important.)
61) Hyperglycemic drugs reduces weight ………..?
62) Surfactant is formed from which type of cells?
63) Spleenectomy is helpful in ……..?
64) Incineration done for which of the following?
65) Anti-gliadin antibodies are seen in?
--------------------------------------------------------------------------------

) The following are example of Apootosis Except-
a) Graft versus host disease
b) Menstrual cycle
c) Pathological atrophy following duct obstruction
d) Tumour necrosis

2) The normal tensile strength of tissue at the site of wound is gained after:
a) 1 week of wound healing
b) 2 weeks of wound healing
c) 2 months of wound healing
d) 2 years of wound healing

Ths best test for BEST Disrase

--------------------------------------------------------------------------------

Best disease is characterized by a striking accumulation of lipofuscin-like material in the macula that often results in an "egg-yolk-like" appearance. In addition, patients affected with Best's disease display an abnormal electrophysiologic sign known as a depressed Arden ratio. The electro-oculogram (EOG) is a measurement of the electric potential that normally exists across the retinal pigment epithelium. This potential normally doubles in response to bright light. However, in Best's disease, this increase does not exist. This test can be used to diagnose patients without classic macular lesions, as well as identifying patients that are unlikely to have the disease.

--------------------------------------------------------------------------------

qs of sept 2008 paper

21 trisomy asso. with
ALL
CLL
AML
CML

2) esophagus length
40
25
15
30

3)pre malignant cond. of esophagus
barrets

4)length of external aud. canal cartilagenous part
8
16
24
12

5)max. Na absorption at
PCT
DCT
LOH
CT

6)SUNRAY apearance on x ray
osteoclastoma
osteoblastoma
osteosarcoma
chondroblastoma

7)m\c tumor in spine
sec.
ewings sarcoma
oteosarcoma
m. myeloma

punched out lesion in skull
ewings sarcoma
m.myeloma
sec.
oteosarcoma
9)m\c reason for bradycardia in MI
septal MI
right vent. MI
left ventricular MI

10) S1 split seen in
RBBB
?
?
?

11)snow flake cat. (from prev.papers)

12)after injury to one eye other aslo worsen
glucoma
cat.
sym. opthalmia
?

13)qs from placenta abroptia ...bleeding per vagina tender and hard

very few qs from Obs

14) 60 year old man with left hydroceal + ???

ans. nephroma

15)lateral epicondyal fac.
non union
tardy ulnar nerve palsy
?
all

16)m\c parasitic infection in AIDS
strongiloids

17)toxin responsibel for TSS in femals
exo toxin

! in stap. aures food poisoning diarrhea occur due 2
endotoxin
vagus
exotoxin
?

19)pheochromocytoma diagnosis
24 hours urine metabolites VMA+ CA
MIBG
CT scan
surgery

20) what we use for thyroid scan
I 131
--------------------------------------------------------------------------------

Q)DRUG WHICH CAUSES REVERSIBLE GYNECOMASTIA
-CIMETEDINE
-OMEPRAZOLE
Q)DOC FOR PROPHYLAXIS OF MENINGOCOCCAL MENINGITIS--RIFAMPIN
Q)A PT WITH THROMBOCYTOPENIA.1ST IOC
*-BLEEDING TIME
-PLATELET COUNT
-PROTHROMBIN TIME
Q)MC CAUSE OF SOLITARY THYROID NODULE
-FOLLICULAR ADENOMA
Q)TUMOR MARKER4BOTH PANCREATIC &COLON CA
-CA125
-CA19
Q)A PT VID AN INFERIOR WALL MI IN SHOCK.REASON?
ANS-RIGHT VENTRICULAR INFARCTION
Q)ALL R FEATURES OF ATRIAL MYXOMA EXCEPT
-FEVER
-CLUBBING
-EMBOLI
*HYPERTENSION
Q)DOC IN SVT--ADENOSINE
Q)A FEMALE PT HAS CHEST PAIN (NON EXERTIONAL)
AUSCULTATION--MULTIPLE NON EJECTION ? ..IOC?
*ECHO
Q)A PT PESENTS WITH MI.EARLEST MARKER?
CK-MB
TROP-T
MYOGLOBIN
Q)STAPH AUREUS FOOD POISONING-CAUSE OF NAUSEA?
ANS--DIRECT VAGAL STIMULATION
Q)A Q ON WEGENERS GRANULOMATOSIS
Q)A PT ON TPN.WHAT COULD BE THE CAUSE OF MORTALITY IN THAT PT?
OPTIONS CANT RECALL,BUT I MARKED INFECTIONS DUE2CENTRAL LINE
Q)A Q ON APGAR SCORE
Q)A Q ON ARDS--DIAGNOSTIC CRITERIA

some more recalls!

Q)A PT WITH BULBAR URETRAL RUPTURE.UR 1ST MN: WUD BE
--SUPRAPUBIC CYSTOSTOMY
--FOLEY'S
--CONSERVATIVE MN
--REFER2UROLOGIST

Q)MJ MUSCLE FOR EYE INTORSION?

Q)ERYTHRODERMA IS ASSOCIATED WID A/E
--LEPROMATOUS LEPROSY
--AIR BORNE DERMATITIS

Q)DERMATITIS HERPETIFORMIS IS A/W
*ULCERATIVE COLITIS

Q)MC TYPE OF PEMPHIGUS IN INDIA?
*P.VULGARIS

Q)LA SAFE IN RF?
GALLAMINE

Q)A PT WID MYASTHENIA GRAVIS IS RESISTANT2
--*DEPOLARISING MR
--NON DEPOLARISING MR
--BOTH
--NONE

Q)A PSM Q 2FIND OUT RELATIVE RISK

Q)ANOTHER PSM Q ON PANEL DISCUSSION..Q WAS AS2VAT WAS IT ABOUT

Q)A Q ON SARCOIDOSIS(PATHO)

Q)WHICH ANTIBODY HAS BEST4 CELIAC DISEASE(SENSITIVE &SPECIFIC)?
*ANTI ENDOMYSIAL AB

Q)BEST PROGNOSTIC FACTOR 4 A/C PANCREATITIS
-*S.LIPASE

Q)A Q ON ZES--WHICH IS NOT TRUE
ONE OF THE OPTION READ--REDUCED BAO:MAO WHICH S D ANS

Q)AN OHA WHICH IS USED 2TREAT OBESITY
ANS WAS SUM BIGUANIDE GIVEN IN THE OPTIONS

Q)ANOTHER Q ON DIAB DRUG
WHICH ONE DOES'NT CAUSE HYPOGLYCEMIA
(SORRY,CANT RECALL OPTIONS)

BUT FRIENDS,,NEXT TIME DO READ A BIT ABOUT ORAL HYPOGLYCEMICS AS WELL AS SOME IMP BITS ABOUT ANTI-OBESITY DRUGS
(SEEMS NAT BOARD HAS LOST IT'S LONG LASTED LOVE 4 MALARIA,TB,N OTHER PARASITIC INFECTIONS!NOT A SINGLE Q WAS ASKED!!))

Q)DRUG USED4TREMORS IN HYPERTHYROIDISM?
--PROPRANOLOL

Q)AN EASY Q--WHICH CAUSES HYPOCALCEMIA?
ANS WAS CALCITONIN

Q)A PT ON TPN FOR A WEEK DEVELOPS FEATURES((WHICH WAS SUGGESTIVE OF ZN DEFICIENCY))..DEFICIENCY OF VAT?

Q)A Q ON NEPHROTIC SYNDROME IN CHILDREN....

Q)HYALINE ARTERIOSCLEROSIS IS SEEN IN
*BENIGN HTN

some more questions frm FMGE sept 2008

1-ring shaped ulcers seen in?
2-neurotrophic keratitis-nerve involved
3-question on sympathetic ophthalmia
4-extra capsular cataract surgery-parts of lens which are excised?
5- SAFE strategy for trachoma-S stands for?
6-rubro iridis is not seen in?
7-questions on cost benefit and cost accounting in PSM
8-central tendancy seen in-(refer biostats PSM )
9-question on odds ratio
10-complication of measles virus -encephalomelyitis
some more-
NNN Media used for- Ans-leshmania donavani
Treatment of first degree testicular cancer
Fourniers (sorry for d spelling,I don remember exactly!) gangrene seen in- Ans scrotum
Treatment Regimen for hodkgins lymphoma
Shape of tracheal cartilage-ans-horse shoe shape
Comonest congenital anomaly of trachea
Erythoderma is not seen in-?
Commonest lupus in india-
Fate of notochord-?
Mysanthia gravis is not inhibited by-depolarizing agents,non depolarizing agents,both,?
Rarest form of opportunistic fungal infection seen in AIDS-
White line of frenkel seen in-ans Scurvy
Xray sign of rickets
Splenomegaly not seen in-?
The first clinical presentation of acoustic neuroma-ans-facial nerve involvement
Stones r seen most commonly in submandibular salivary gland
The calories required by one year old child
4-5 questions on Tracheostomy
Sunray sign on xray seen in-?osteosarcoma
Tardy ulnar palsy seen in-?
Rigor mortis is due to-?
Vitreous hemorrhage on autopsy seen in poisoning of-?
One question on [bleep]-Refer Forensic Medicin
Most specific method of diagnosis of kalazar

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questions

Q.a patient with tb had decrease SERUM level of Na and k....... and has hyperpigmentation of crease of hand??...
ans.. secondary hyperaldeosteroism.
Q.MC. CAUSE OF DEATH IN INDIA?
ANS. CORONAY HEART DISEASE.
Q.CXR AP VIEWON RIGHT SIDE OF CARDIAC SILHOUTE U CAN SEE ALL EXCEPT?
ANS. SUPERIOR VENA CAVA
Q.NORMAL TO INCREASE SIZE OF KIDNEY IS SEEN ALL EXCEPT?
ANS. *CHRONOC GN
DIABETIC NEPHROPATHY
AIDS REALTED NEPHROPATHY
PKD
Q.SPLEEN IS SUPPORT BY WHICH LIGAMNET FROM UPPER SIDE?
ANS. GASTROSPLENIC LIGAMENT.
Q.STAIN FOR AMLYDOSIS
ANS. CONGO RED
Q.AUER RODS ARE SEEN IN?
AN. AML
Q.WHICH TUMOR IS MC IN DOWN SYNDROME?\
ANS MAY BE RETINOBLASTOMA (PLZ MAKE SURE FROM BOOK)

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1.Trendelenburg's test

Also known as:
Brodie-Trendelenburg test
Trendelenburg-Brodie test

Associated persons:
Sir Benjamin Collins Brodie
Friedrich Trendelenburg

Description:

Test for varicose veins. Patient lies on his back and raises his leg to empty the veins. A tourniquet is applied just below the saphenous opening. The patient is then stood up and the tourniquet removed in 60 seconds. Normally the vein should fill from below within 35 seconds with the tourniquet in situ. Earlier filling indicates incompetence of a communicating vein. If on release the veins fill rapidly from above it is due to incompetent sapheno-femoral valves.

2. Trendelenburg's test

Trendelenburg's test is a test of the saphenous and other veins.[1]
It is named for Friedrich Trendelenburg.[2][3]
It should not be confused with Trendelenburg's sign, which involves the muscles of the hip.

Trendelenburg's sign:

Trendelenburg's sign is found in people with weak abductor muscles of the hip. It is named after the German surgeon Friedrich Trendelenburg.
The Trendelenburg sign is said to be positive if, when standing on one leg, the pelvis drops on the side opposite to the stance leg. The weakness is present on the side of the stance leg. The body is not able to maintain the center of gravity on the side of the stance leg. Normally, the body shifts the weight to the stance leg, allowing the shift of the center of gravity and consequently stabilizing or balancing the body. However, in this scenario, when the patient/person lifts the opposing leg, the shift is not created and the patient/person cannot maintain balance leading to instability.

Essentially, Trendelenburg sign is caused by paralysis of the gluteus medius and minimus muscles.

Paralysis may arise due to nerve damage, namely, the superior gluteal nerve
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1.
Trendelenburg test is a standard clinical assessment of hip stability.

A positive test indicates gluteus medius weaknessand is observed when weight is supported by the affected limband the pelvis on the healthy side falls instead of rises.

This test was used in this study to compare the two approaches. Incases of minimal abductor weakness there may be a delayedpositive test. It is for this reason that an element of musclefatigue was taken into account by considering the pelvicposition at 30 seconds of single leg stance. Since gait analysisallows subtle differences to be detected compared to clinicalanalysis, it was hoped this test would be an effective measureto compare the two approaches

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2.

The notochord exists transiently during the life of most vertebrates.

A notochord is the defining characteristic of members of the phylum Chordata, a large and diverse biological group which includes all animals with spines, or backbones, along with more primitive chordates. The notochord has very large cells which are densely arranged within a protective sheath. Chordates are divided into three subphyla, depending on what form their notochords take and when they appear. At any developmental stage, a notochord acts as a form of support for the animal that possesses it, giving animals the ability to do things such as walking upright.

The most primitive group of chordates, urochordates, also called tunicates, only have a notochord in the larval stages of development. The animals in this group are pelagic, meaning that they are found in the world's oceans, and there are a number of representative species, most of whom are only known to biologists. These animals do provide an insight into the development of chordates, however, showing the notochord at an early stage of development.

The next group of chordates, cephalochordates, also called lancelets, possess a notochord into adulthood, and also live in the ocean. The notochord runs all the way along the body, even up into the head, and the animals lack a protective layer of bone such as a spine. The notochord acts as an axial support, providing a strong core for the animal. The notochord is highly flexible, but not compressible, allowing the animal to move freely without damaging the notochord.

In the highest class of chordates, the vertebrates, the notochord only exists when the animal is in an embryonic form. As the vertebrate develops, the notochord is first ensheathed in and then replaced by spinal vertebrae, protective cases of bone which cover the delicate spinal cord. The spinal column is able to support a much larger and more complex organism, and is much stronger than the notochord. This allowed early vertebrates to make the leap to the land and develop into well known species such as humans.

In all chordates, the notochord exists in some form when the animal is in a larval or embryonic stage[/size]. The development of the notochord from there helps shape what sort of animal it will turn into, whether it be a sac like tunicate or a pure bred Norwegian Fjord horse. The development of the notochord represents a major advance in evolution, as it allowed animals to get much larger and more complex, a drastic departure from simpler orders of animals which existed previously.

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3. NeuroGLIA

Glial cells, commonly called neuroglia or simply glia (Greek for "glue"), are non-neuronal cells that provide support and nutrition, maintain homeostasis, form myelin, and participate in signal transmission in the nervous system. In the human brain, glia are estimated to outnumber neurons by about 10 to 1.

Glial cells provide support and protection for neurons, the other main type of cell in the nervous system. They are thus known as the "glue" of the nervous system. The four main functions of glial cells are to surround neurons and hold them in place, to supply nutrients and oxygen to neurons, to insulate one neuron from another, and to destroy pathogens and remove dead neurons. They also modulate neurotransmission.

The supportive tissue of the nervous system, including the network of branched cells in the central nervous system (astrocytes, microglia, and oligodendrocytes) and the supporting cells of the peripheral nervous system (Schwann cells and satellite cells). Also called glia, reticulum.
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4. Hyaline arteriolosclerosis:

Hyaline arteriolosclerosis can be seen in patients with diabetes mellitus and with hypertension. Hyaline arteriolosclerosis are more common in diabetic sufferers.

5. M.C cardiac lesion seen in pregnancy -->

Mitral stenosis is the most common rheumatic valvular lesion seen in pregnancy due to its prevalence in young women.

6. M.C valve disease due to ----

Mitral valve prolapse (MVP) : is the most common forms of valve disease, affecting 6 percent of all women. In this condition one or both of the valve leaflets is enlarged or floppy, preventing the valve from closing evenly. When the valve shuts, the leaflets bulge into the left atrium. You may have heard mitral valve prolapse referred to as click-murmur syndrome from the sound the valve makes when it closes.

7. Herd Immunity:

In immunology, herd immunity refers to a situation in which a high percentage of a population is immune to a disease, essentially stopping the disease in its tracks because it cannot find new hosts. You may also hear this concept referred to as “community immunity.” The threshold for herd immunity varies, depending on the disease, with more virulent agents requiring vaccination of a higher percentage of the population to crate the desired herd immunity. In addition to being used in disease prevention, community immunity is also utilized to fight ongoing outbreaks.

Most vaccination policies are focused on creating herd immunity. Many countries require vaccinations in childhood, for example, protecting children from common diseases and ensuring that when these diseases enter the population, they cannot prey on children or adults, who have been previously vaccinated or exposed to the disease. The creation of herd immunity is especially important in crowded environments which facilitate the spread of disease, like schools.

Immunologists try to prevent the outbreak of diseases by creating herd immunity, but they are not always successful. Sometimes a disease mutates or is entirely new, or a batch of vaccinations is faulty, or a large percentage of the population fails to get vaccinated, creating a situation in which an outbreak can occur, because much of the population is vulnerable. In the event of an outbreak of a major disease, agencies like the World Health Organization can dispatch teams within days to figure out the cause of the outbreak and develop a vaccine, in the hopes of creating herd immunity to halt the outbreak in its tracks.

For some diseases, herd immunity thresholds are as low as 50%, especially when combined with good hygiene. In other instances, up to 90% of the population may need to be vaccinated to create the desired herd immunity. It is also extremely important to receive regular boosters, as some vaccines lose their efficacy over time, leaving people vulnerable to an outbreak. Herd immunity led to the eradication of smallpox, and it explains why diseases such as polio and diphtheria are rare in developed nations with established vaccination policies.

The concept of herd immunity is often used to encourage reluctant parents to vaccinate their children. In addition to ensuring that their children are protected from fully preventable diseases, childhood vaccinations also benefit society at large by creating herd immunity. Likewise, adults may be reminded to receive boosters to help protect their communities.

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9. Koplik’s spots seen in ---

Also known as: Filatov’s spots, Flindt’s spots Maculae Koplik.

Associated persons:
Nil Feodorovich Filatov
Nikolaj Flindt
Henry Koplik

Description:
Small, grain-of-sand sized, irregular, bright red spots with blue-white centres, occurring on the inside of the cheek (buccal mucosa). Seen only on measles (rubeolae) they are, by themselves, a diagnostic sign in measles. The spots usually occur briefly after the fever begins and a couple of days before the generalized rash appears. Not infrequently, the spots disappear as the eruption develops.

--------------

Koplik's spots are bluish-white spots seen on the mucous membranes of the mouth and are pathognomonic of measles.

They often appear a few days before the rash arrives and can be a useful sign to look for in children known to be exposed to the measles virus.

--------------

10. A ? patient with hypertension & suffering from Thyroiditis, DOC --

L-Thyroxine has long been the treatment drug of choice

Goals of
therapy (Rx) To bring free T4 (L-thyroxine) and TSH levels into normal range and improve symptoms. 1st choice therapy L-thyroxine.

11. Hypocalcemia is seen with the following-->

Hypocalcemia can be seen in chronic renal insufficiency.

Hypocalcemia may be seen in a number of disorders affecting the synthesis or action of PTH or vitamin D or following sequestration of calcium into a functionally inaccessible compartment.

Many of these represent chronic illnesses where hypocalcemic symptoms develop insidiously or where the complication of hypocalcemia is anticipated early and appropriate treatment initiated prior to acute decompensation.

Hypocalcemia occurs in the setting of acute systemic illness (eg, toxic shock syndrome), a finding that has been linked to elevated free fatty acids levels in this setting. It has also been associated with specific drugs, including antineoplastic agents such as doxorubicin and cytarabine and other agents such as ketoconazole, pentamidine, and foscarnet.

12.Most common position of Uterus?
The most common position is for the long axis of the uterus to lie in approximately the same axis as the pelvis, that is, with the upper part tilted forward and the lower end, the cervix, inserted into the top of the vagina. There is therefore an angle between the uterus and the vagina, the long axis of which corresponds to the lower part of the pelvis.

13. Shortest ø of pelvis is-->
The interspinous diameter is the shortest in the pelvis.

Obstetrical Pelvic Diameters
The shape and size of the bony pelvis are important factors determining the outcome of labour. The pelvic inlet is the entrance to the true pelvis. The plane of the pelvic inlet is almost circular in a normal female or gynaecoid pelvis with a slightly greater transverse than anterior-posterior diameter. The true diameter of the pelvic inlet is difficult to assess clinically. An estimate can be made from the diagonal conjugate diameter which is measured between the midpoint of the sacral promontory and the nearest point on the posterior surface of the pubic symphysis. This measure is about 1.5cm greater than the obstetrical conjugate diameter. In practice it is rarely possible to reach the promontory on clinical examination. The pelvic outlet is narrower than the pelvic inlet. The anterior-posterior diameter of the pelvic outlet is measured from the inferior border of the pubic symphysis to the sacrococcygeal joint, and is usually about 12.5cm. The transverse diameter of the pelvic outlet is measured between the ischial tuberosities and is usually about 10cm. The plane of least pelvic dimensions represents the narrowest part of the birth canal. The anteroposterior diameter extends from the inferior margin of the pubic symphysis posteriorly through a line which connects the ischial spines, the transverse diameter. Both diameters can be assessed clinically, and the interspinous diameter is the shortest in the pelvis.

14. Right base of the heart is formed by --->

The base of the heart is opposite to that of the apex is mainly formed by the left atria, but getting some contribution from the right atrium.

15. Right side Mid calvicle the lung ends at which rib --10 Rib?

The border of the right lung lies immediately inside the pleural margin from the cupola down to about the 6th costal cartilages.

It then lies about two spaces above the pleural margin:
it crosses the 6th rib in the midclavicular line and the 8th rib in the midaxillary line, and reaches the vertebral column at the level of the 10th rib.

16. Water supply in hilly areas---?

Developing springs as a source for rural water supply is ideally suited for the following situations: (a). The springs are perennial (at least discharge at the rate of 20 lpcd during peak summer) and of good water quality (to be tested for chemical and bacteriological) contamination); (b) Chance of polluting the catchment is minimum; (c) The beneficiary population lives within close proximity of the springs preferably in the down stream areas of the springs.

In the era of decentralized planning, community mobilization, resource mobilization, cost sharing, community management, cost recovery and operation and maintenance plays a significant role in the water supply schemes. In 1989, the Pazhakulam Social Service Society (PASSS) has taken the initiative for the development of natural springs as alternative safe drinking water to the communities in the remote hilly areas of Southern Kerala. The main objective of the spring development programme was to demonstrate to the Government, Non-Governmental Organizations and the people of Kerala, that it is possible to design and develop alternate delivery of drinking water through private sector initiatives. The concept of rejuvenation of springs is an alternative mechanism to increase the coverage and accessibility of safe water supply in the remote areas. PASSS has taken the leadership in demonstrating the programme since 1991 and more than 1150 springs have already been developed with the active participation of the community. The salient features of the programme is as follows:

Established water committees as the nucleus of community organization, participation and management of the programme; Capacity building and empowerment; Capital cost sharing mechanism has become mandatory;
Full O & M by water committees/community; Low cost participatory design; Panchayat institutions as a partner; Integration of water, sanitation and hygiene; Water quality monitoring; Community monitoring and follow up.

17. Prophylaxis DOC for Meningitis -->

Meningitis is an inflammation of the leptomeninges and underlying subarachnoid cerebrospinal fluid

Cephalexin/Cefazolin

PO/IV
Stable vs Staph penicillinase
Spectrum: MSSA, PSSP, most E. coli, and some Klebs
Can be dose thrice weekly in HD pts
[1.5 grams IV TIW]
DoC: surgical prophylaxis, bacterial peritonitis in CAPD pts [1 gm in the dwell bag]

--------------------

Ampicillin/Amoxicillin

Amp (IV, PO) Amox (PO)
Spectrum: PenG + H. flu and some E. coli
DoC: Listeria monocytogenes and
Enterococcus [Amp 2g IV q4h]

Dental Prophylaxis
Amox 1 gram PO x 1 prior to appt.
Integral in H. pylori regimens
ADRs
Non-allergic rashes (9%) – esp. when associated with a viral illness (mononucleosis - EBV)
Amox better tolerated PO and better absorbed (Amp must be taken on empty stomach)
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more qns from FMGE sept 08

who discovered xrays?
roentgen

which disease is X linked recessive?
Hemophlia

most common cause of death in people older than 70 yrs?
cardiovascular disease, cancer,respiratory disease?

in retinal detachment?? options were red colour, blue colour, green colour? i cant remember exactly.

in which poisoning shud the vitrous humor be preserved?

malignant pustule?
anthrax

a qn from varicocele frm surgery, i cant remember..

frnds, there were over 20 questions frm Ophthalmology and Biochemistry and many from parasitology in Microbiology ..
few questions were simple and thats all we can recollect! there were many confusing questions too...
all da best for 2009....

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Prophylaxis DOC for Meningitis?

PRESCRIPTIONS FOR PROPHYLAXIS OF MENINGITIS :
PROCEDURES FOR GGHB COMMUNITY PHARMACISTS

· Identify a prescription for meningitis prophylaxis:

Rifampicin 600mg (or 10mg/kg for children) twice daily for 2 days

or

Ciprofloxacin 500mg as a single dose (although not yet licensed for this purpose).

Establish the patient’s eligibility for exemption from prescription charge.

If not exempt via NHS, reassure the patient that a special GGHB exemption will apply.

Dispense the prescription.

Please do not collect the prescription charge.

Please submit an invoice for the prescription charge on headed notepaper to myself at GGHB Headquarters, noting patient name and date.

Submit the prescription in the non-exempt category to the PPD.

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PRESCRIPTIONS FOR PROPHYLAXIS OF MENINGOCOCCAL SEPTICAEMIA

You will be aware of the increased incidence of meningitis in recent weeks. All cases are notified to the GGHB Public Health Department. Treatment of the individual case in an acute hospital is accompanied by management of the public health implications in primary care. Typically, specialists in Communicable Disease will identify close family and friends of the patient who may require prophylactic treatment. The treatment options currently are:

Rifampicin 600mg (or 10mg/kg for children) twice daily for 2 days

or

Ciprofloxacin 500mg as a single dose (although not yet licensed for this purpose)

The options for supply of these prescriptions are as follows:

community administration programme (e.g. school, church)

hospital supply

supply through the local GEMS centre

prescription on HBP forms by the Public Health Consultant on call

prescription on GP10

The last of these is frequently the preferred option. Treatment needs to be started quickly but not urgently and both drugs need to be used cautiously in combination with other therapies. Community pharmacists can reinforce these points.

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1 Anaemia is seen with all except?

Anemia
Definition
If you have anemia, people may say you have tired blood. That's because anemia — a condition in which there aren't enough healthy red blood cells to carry adequate oxygen to your tissues — can make you feel tired.

There are many forms of anemia, each with its own cause. Anemia can be temporary or long term, and it can range from mild to severe.

Anemia is a common blood disorder. Women and people with chronic diseases are at increased risk of the condition.

If you suspect you have anemia, see your doctor. Anemia can be a sign of serious illnesses. Treatments for anemia range from taking supplements to undergoing medical procedures. You may be able to prevent some types of anemia by eating a healthy, varied diet.

Symptoms
The main symptom of most types of anemia is fatigue. Other anemia symptoms include:

•Weakness
•Pale skin
•A fast or irregular heartbeat
•Shortness of breath
•Chest pain
•Dizziness
•Cognitive problems
•Numbness or coldness in your extremities
•Headache
Initially, anemia can be so mild it goes unnoticed. But signs and symptoms increase as the condition worsens.

Causes
Blood consists of both a liquid called plasma and cells. Floating within the plasma are three types of blood cells:

•White blood cells. These blood cells fight infection.
•Platelets. These blood cells help your blood clot after a cut.
•Red blood cells (erythrocytes). These blood cells carry oxygen from your lungs, via your bloodstream, to your brain and the other organs and tissues. Your body needs a supply of oxygenated blood to function. Oxygenated blood helps give your body its energy and your skin a healthy glow.
Red blood cells contain hemoglobin — a red, iron-rich protein that gives blood its red color. Hemoglobin enables red blood cells to carry oxygen from your lungs to all parts of your body, and to carry carbon dioxide from other parts of the body to the lungs so that it can be exhaled.

Most blood cells, including red blood cells, are produced regularly in your bone marrow — a red, spongy material found within the cavities of many of your large bones. To produce hemoglobin and red blood cells, your body needs iron, protein and vitamins from the foods you eat.

Anemia is a state in which the number of red blood cells or the hemoglobin in them is below normal. When you're anemic, your body produces too few healthy red blood cells, loses too many of them or destroys them faster than they can be replaced. As a result, your blood is low on red blood cells to carry oxygen to your tissues — leaving you fatigued. Common types of anemia and their causes include:

•Iron deficiency anemia. This most common form of anemia affects about one in five women, half of pregnant women and 3 percent of men in the United States. The cause is a shortage of the element iron in your body. Your bone marrow needs iron to make hemoglobin. Without adequate iron, your body can't produce enough hemoglobin for red blood cells. The result is iron deficiency anemia.

One way your body gets needed iron is when blood cells die — the iron in them is recycled and used to produce new blood cells. So, if you lose blood, you lose iron. Women with heavy periods who lose a lot of blood each month during menstruation are at risk of iron deficiency anemia. Slow, chronic blood loss from a source within the body — such as an ulcer, a colon polyp or even colon cancer — also can lead to iron loss and iron deficiency anemia.

Your body also gets iron from the foods you eat. An iron-poor diet can lead to this anemia. In pregnant women, a growing fetus can deplete the mother's store of iron, leading to iron deficiency anemia.

•Vitamin deficiency anemias. In addition to iron, your body needs folate and vitamin B-12 to produce sufficient numbers of healthy red blood cells. A diet lacking in these and other key nutrients can cause decreased red blood cell production. People who have an intestinal disorder that affects the absorption of nutrients are prone to this type of anemia. Some people are unable to absorb vitamin B-12 for a variety of reasons and develop vitamin B-12 deficiency anemia, which is sometimes called pernicious anemia. Vitamin deficiency anemias fall into a group of anemias called megaloblastic anemias, in which the bone marrow produces large, abnormal red blood cells.
•Anemia of chronic disease. Certain chronic diseases — such as cancer, rheumatoid arthritis, Crohn's disease and other chronic inflammatory diseases — can interfere with the production of red blood cells, resulting in chronic anemia. Kidney failure also can be a cause of anemia. The kidneys produce a hormone called erythropoietin, which stimulates your bone marrow to produce red blood cells. A shortage of erythropoietin, which can result from kidney failure or be a side effect of chemotherapy, can result in a shortage of red blood cells.
•Aplastic anemia. This is a life-threatening anemia caused by a decrease in the bone marrow's ability to produce all three types of blood cells — red blood cells, white blood cells and platelets. Many times, the cause of aplastic anemia is unknown, but it's believed to often be an autoimmune disease. Some factors that can be responsible for this type of anemia include chemotherapy, radiation therapy, environmental toxins, pregnancy and lupus.
•Anemias associated with bone marrow disease. A variety of diseases, such as leukemia and myelodysplasia, a pre-leukemic condition, can cause anemia by affecting blood production in the bone marrow. The effects of these types of cancer and cancer-like disorders vary from a mild alteration in blood production to a complete, life-threatening shutdown of the blood-making process. Additionally, other cancers of the blood or bone marrow, such as multiple myeloma, myeloproliferative disorders and lymphoma, can cause anemia.
•Hemolytic anemias. This group of anemias develops when red blood cells are destroyed faster than bone marrow can replace them. Certain blood diseases can cause increased red blood cell destruction. Autoimmune disorders can cause your body to produce antibodies to red blood cells, destroying them prematurely. Certain medications, such as some antibiotics used to treat infections, also can break down red blood cells. Hemolytic anemias may cause yellowing of the skin (jaundice) and an enlarged spleen.
•Sickle cell anemia. This inherited and sometimes serious anemia, which affects mainly people of African and Arabic descent, is caused by a defective form of hemoglobin that forces red blood cells to assume an abnormal crescent (sickle) shape. These irregular-shaped red blood cells die prematurely, resulting in a chronic shortage of red blood cells. Sickle-shaped red blood cells can also block blood flow through small blood vessels in the body, producing other, often painful, symptoms.
•Other anemias. There are several other, rarer forms of anemia, such as thalassemia and anemias caused by defective hemoglobin.
Sometimes, no cause of anemia can be identified.

Risk factors
These factors place you at increased risk of anemia:

•Poor diet. Anyone — young or old — whose diet is consistently low in iron and vitamins, especially folate, is at risk of anemia. Your body needs iron, protein and vitamins to produce sufficient numbers of red blood cells.
•Intestinal disorders. Having an intestinal disorder that affects the absorption of nutrients in the small intestine — such as Crohn's disease and celiac disease — puts you at risk of anemia. Surgical removal of or surgery to the parts of the small intestine where nutrients are absorbed can lead to nutrient deficiencies and anemia.
•Menstruation. In general, women are at greater risk of iron deficiency anemia than are men. That's because women lose blood — and with it, iron — each month during menstruation.
•Pregnancy. Pregnant women are at an increased risk of iron deficiency anemia because their iron stores have to serve the increased blood volume of the mother as well as be a source of hemoglobin for the growing fetus.
•Chronic conditions. For example, if you have cancer, kidney or liver failure, or another chronic condition, you may be at risk of what's called anemia of chronic disease. These conditions can lead to a shortage of red blood cells. Slow, chronic blood loss from an ulcer or other source within the body can deplete your body's store of iron, leading to iron deficiency anemia.
•Family history. If your family has a history of an inherited anemia, you also may be at increased risk of the condition.
Certain infections, blood diseases and autoimmune disorders, exposure to toxic chemicals, and the use of some medications can affect red blood cell production and lead to anemia. Other people at risk of anemia are people with diabetes, people who are dependent on alcohol (alcohol interferes with the absorption of folic acid) and people who adhere to a strict vegetarian diet, who may not get enough iron or vitamin B-12 in their diet.

When to seek medical advice
See your doctor if you're feeling fatigued for unexplained reasons, especially if you're at risk of anemia. Some anemias, such as iron deficiency anemia, are common. But don't assume that if you're tired, you must be anemic. Fatigue has many causes besides anemia.

Some people learn that their hemoglobin is low, which indicates anemia, when they go to donate blood. Low hemoglobin may be a temporary problem remedied by eating more iron-rich foods or taking a multivitamin containing iron. However, it may also be a warning sign of blood loss in your body that may be causing you to be deficient in iron. If you're told that you can't donate blood because of low hemoglobin, ask your doctor if you should be concerned.

If you have a family history of an inherited anemia, such as sickle cell anemia, talk to your doctor and possibly a genetic counselor about your risk and what risks you may pass on to your children.

Tests and diagnosis
Doctors diagnose anemia with the help of a medical history, a physical exam and blood tests, including a complete blood count (CBC). This blood test measures levels of red blood cells and hemoglobin in your blood. Some of your blood may also be examined under a microscope to study the size, shape and color of your red blood cells, which may indicate a diagnosis. For example, in iron deficiency anemia, red blood cells are smaller and paler in color than normal. In vitamin deficiency anemias, red blood cells are enlarged and fewer in number.

If you receive a diagnosis of anemia, your doctor may order additional tests to determine the underlying cause. For example, iron deficiency anemia can result from chronic bleeding of known or unknown ulcers, benign polyps in the colon, colon cancer, tumors, or kidney failure. Your doctor may test for these and other conditions that may underlie the anemia.

Occasionally, it may be necessary to study a sample of your bone marrow to diagnose anemia.

Complications
When anemia is severe enough, it may interfere with your ability to do everyday tasks. You may be too exhausted to work or play. Although anemia is often treatable, it may take several weeks to months for red blood cell levels to return to normal after treatment. Ask your doctor what to expect from treatment.

If you've been diagnosed with anemia — it's often detected during routine blood tests — ask your doctor what treatment is necessary. Then be sure to follow through on treatment, even if you quickly start to feel better. Left unchecked, anemia can lead to a rapid or irregular heartbeat — an arrhythmia. Your heart must pump more blood to compensate for the lack of oxygen in the blood when you're anemic. This can even lead to congestive heart failure. Untreated pernicious anemia can lead to nerve damage and decreased mental function, as vitamin B-12 is important not only for healthy red blood cells but also for optimal nerve and brain function.

Some inherited anemias, such as sickle cell anemia, can be serious and lead to life-threatening complications. Losing a lot of blood quickly results in acute, severe anemia and can be fatal.

Treatments and drugs
Anemia treatment depends on the cause:

•Iron deficiency anemia. This form of anemia is treated with iron supplements, which you may need to take for several months or longer. If the underlying cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and stopped. This may involve surgery.
•Vitamin deficiency anemias. Pernicious anemia is treated with injections — often lifetime injections — of vitamin B-12. Folic acid deficiency anemia is treated with folic acid supplements.
•Anemia of chronic disease. There's no specific treatment for this type of anemia. Doctors focus on treating the underlying disease. Iron supplements and vitamins generally don't help this type of anemia. However, if symptoms become severe, a blood transfusion or injections of synthetic erythropoietin, a hormone normally produced by the kidneys, may help stimulate red blood cell production and ease fatigue.
•Aplastic anemia. Treatment for this serious anemia may include blood transfusions to boost levels of red blood cells. You may need a bone marrow transplant if your bone marrow is diseased and can't make healthy blood cells. You may need immune-suppressing medications to lessen your immune system's response and give the transplanted bone marrow a chance to start functioning again.
•Anemias associated with bone marrow disease. Treatment of these various diseases can range from simple medication to chemotherapy to bone marrow transplantation. Treatment of these types of anemia usually involves a consultation from a blood specialist (hematologist).
•Hemolytic anemias. Managing hemolytic anemias includes avoiding suspect medications, treating related infections and taking drugs that suppress your immune system, which may be attacking your red blood cells. Short courses of treatment with steroids or gamma globulin can help suppress your immune system's attack on your red blood cells. If the condition has caused an enlarged spleen, you may need to have your spleen removed. The spleen — a small organ below your rib cage on the left side — filters out and stores defective red blood cells. Certain hemolytic anemias can cause the spleen to become enlarged with damaged red blood cells.
•Sickle cell anemia. Treatment for this incurable anemia may include the administration of oxygen, pain-relieving drugs, and oral and intravenous fluids to reduce pain and prevent complications. Doctors also commonly use blood transfusions, folic acid supplements and antibiotics. A bone marrow transplant may be an effective treatment in some circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is used to treat sickle cell anemia in adults.
Prevention
Many types of anemia can't be prevented. However, you can help avoid iron deficiency anemia and vitamin deficiency anemias by eating a healthy, varied diet that includes foods rich in iron, folate and vitamin B-12.

The best sources of iron are beef and other meats. Other foods rich in iron include beans, lentils, iron-fortified cereals, dark green leafy vegetables, dried fruit, nuts and seeds. Folate, and its synthetic form, folic acid, can be found in citrus juices and fruits, dark green leafy vegetables, legumes and fortified breakfast cereals. Vitamin B-12 is plentiful in meat and dairy products. Foods containing vitamin C, such as citrus fruits, help increase iron absorption.

Eating plenty of iron-containing foods is particularly important for people who have high iron requirements, such as children — iron is needed during growth spurts — and pregnant and menstruating women. Adequate iron intake is also crucial for infants, strict vegetarians and long-distance runners.

Doctors may prescribe iron supplements or multivitamins containing iron for people with high iron requirements. But iron supplements are appropriate only when you need more iron than a balanced diet can provide. Don't assume that if you're tired that you simply need to take iron supplements. Overloading your body with iron can be dangerous.

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Anaemia is a condition in which the haemoglobin concentration in the blood is below a defined level, resulting in a reduced oxygen-carrying capacity of red blood cells.

About half of all cases of anaemia can be attributed to iron deficiency; other common causes include infections, such as malaria and schistosomiasis, and genetic factors, which result in thalassaemias and sickle-cell disease.

In its severe form, anaemia is associated with fatigue, weakness, dizziness and drowsiness. Pregnant women and children are particularly vulnerable.

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19 ) Dose of Folic acid during pregnancy?

Taking 400 micrograms of synthetic folic acid daily from fortified foods and/or supplements has been suggested.

The Recommended Dietary Allowance (RDA) for folate equivalents for pregnant women is 600-800 micrograms, twice the normal RDA of 400 micrograms for women who are not pregnant.

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Prophylaxis vs Neural Tube Defects (NTD):

The Society of Obstetricians and Gynaecologists of Canada , in its 1993 Policy Statement, recommended that all women of child bearing potential, whether planning pregnancy or not, should consider maintaining a folic acid intake of at least 0.4 mg daily, either in the diet or as a supplement.

Pregnant women with no previous history of fetal NTD and no other predisposing factors are advised to maintain an intake of at least 0.4 mg daily until 10 to 12 weeks after last menstrual period.
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20) Vitamin “A” dosage is given in….? (?. of doses.)

The World Health Organization recommends single-large-dose vitamin A supplementation for postpartum women in areas of prevalent vitamin A deficiency; neonatal dosing is under consideration.

It is safe to give fertile women, independentof their vitamin A status, as much as 10,000IU (3000 µg RE) daily at any time duringpregnancy.

21) What is Apoptosis?

Apoptosis, by contrast, is a process in which cells play an active role in their own death (which is why apoptosis is often referred to as cell suicide).

Apoptosis, or programmed cell death, is a normal component of the development and health of multicellular organisms. Cells die in response to a variety of stimuli and during apoptosis they do so in a controlled, regulated fashion.

This makes apoptosis distinct from another form of cell death called necrosis in which uncontrolled cell death leads to lysis of cells, inflammatory responses and, potentially, to serious health problems.

22) Extrinsic factor in blood coagulation? (PT/PTT)

PT, PTT, D-DIMER

This panel of tests is used to evaluate the extrinsic coagulation system. They may also aid in screening for congenital deficiencies of factors II, V, VII, X as well as deficiencies of prothrombin dysfibrinogenemia, and afibrinogenemia. Levels of PT, PTT and D-dimmer, can determine heparin effect, warfarin anticoagulant therapy, liver failure, disseminated intravascular coagulation (DIC), vitamin K deficiency. This test includes the following: prothrombin time (PT) and partial thromboplastin time (PTT), and D-dimmer.

Prothrombin time (PT)

This test is used to evaluate the adequacy of the extrinsic system and common pathway in the clotting mechanism. Prothrombin time (PT) test provides a control for long-term anticoagulant therapy that usually involves the use of a coumarin derivative (eg, Coumadin®).This therapy attempts to impede thrombus formation without the threat of mortality from hemorrhage.

Partial Thromboplastin Time

This test is used to evaluate the intrinsic coagulation system. It is also used to monitor heparin therapy, to aid in detecting classical hemophilia A, Christmas disease, and detection of congenital deficiencies of factors II, V, VIII, IX, X, XI, and XII. PTT is used to screen for the presence of dysfibrinogenemia, disseminated intravascular coagulation, liver failure, congenital hypofibrinogenemia, vitamin K deficiency, congenital deficiency of Fitzgerald factor, congenital deficiency of prekallikrein, high molecular weight kininogen, and circulatory anticoagulant.

D-DIMER

This test is a very specific confirmatory test for disseminated intravascular coagulation (DIC). This test is also used for the detection of deep vein thrombosis (DVT) and to detect acute myocardial infarction and unstable angina. The Fragment D-dimmer assess both thrombin and plasmin activity.

23) Curschmann’s spirals are due to?

Curschmann's spirals have been observed in the sputum of patients affected by lung cancer, asthma, chronic bronchitis, or in asymptomatic smokers.

Spirally twisted masses of mucus occurring in the sputum in bronchial asthma.

Curschmann's spirals:

coiled, basophilic plugs of mucus formed in the lower airways and found in sputum and tracheal washings; indicate chronic obstruction.

Curschmann's Spirals refer to parts of the desquamated epithelium seen in biopsies from asthmatic patients. They are named after German physician Heinrich Curschmann (1846-1910). They are often seen in association with eosinophilic infiltration and Charcot-Leyden crystals.

However, to date, their clinical significance and pathogenesis have not been completely explained.

24) Bell’s palsy?
WHAT IS BELL'S PALSY?
Bells palsy is a condition that causes the facial muscles to weaken or become paralyzed. It's caused by trauma to the 7th cranial nerve, and is not permanent.

WHY IS IT CALLED BELL'S PALSY?
The condition is named for Sir Charles Bell, a Scottish surgeon who studied the nerve and its innervation of the facial muscles 200 years ago.

HOW COMMON IS BELL'S PALSY?
Bells palsy is not as uncommon as is generally believed. Worldwide statistics set the frequency at approximately .02% of the population (with geographical variations). In human terms this is 1 of every 5000 people, and 40,000 Americans every year.

IS BELL'S PALSY ALWAYS ON THE SAME SIDE?
The percentage of left or right side cases is approximately equal, and remains equal for recurrences.

IS THERE ANY DIFFERENCE BECAUSE OF GENDER OR RACE?
The incidence of Bells palsy in males and females, as well as in the various races is also approximately equal. The chances of the condition being mild or severe, and the rate of recovery is also equal.

WHAT CONDITIONS CAN INCREASE THE CHANCE OF HAVING BELL'S PALSY?
Older people are more likely to be afflicted, but children are not immune to it. Children tend to recover well. Diabetics are more than 4 times more likely to develop Bells palsy than the general population. The last trimester of pregnancy is considered to be a time of increased risk for Bell's palsy. Conditions that compromise the immune system such as HIV or sarcoidosis increase the odds of facial paralysis occurring and recurring.

CAN BELL'S PALSY AFFECT BOTH SIDES OF THE FACE?
It is possible to have bilateral Bells palsy, but it's rare, accounting for less than 1% of cases. With bilateral facial palsy, it's important to rule out all other possible diagnoses with thorough diagnostic tests.

CAN BELL'S PALSY AFFECT OTHER PARTS OF THE BODY?
Bells palsy should not cause any other part of the body to become paralyzed, weak or numb. If any other areas are affected Bell's palsy is not the cause of the symptoms, and further testing must be done.

HOW DO THE SYMPTOMS OF BELL'S PALSY PROGRESS?
Very quickly. Most people either wake up to find they have Bells palsy, or have symptoms such as a dry eye or tingling around their lips that progress to classic Bell's palsy during that same day. Occasionally symptoms may take a few days to be recognizable as Bells palsy. The degree of paralysis should peak within several days of onset - never in longer than 2 weeks (3 weeks maximum for Ramsey Hunt syndrome). A warning sign may be neck pain, or pain in or behind the ear prior to palsy, but it is not usually recognized in first-time cases.

IS BELL'S PALSY CONTAGIOUS?
No, it is not contagious. People with Bells palsy can return to work and resume normal activity as soon as they feel up to it.

WHAT ABOUT RECOVERY FROM BELL'S PALSY?
Approximately 50% of Bells palsy patients will have essentially complete recoveries in a short time. Another 35% will have good recoveries in less than a year.

Regardless of the trigger, Bell's palsy is best described as an event - trauma to the nerve. As with any other injury, healing follows. The quality and duration of recovery is dependent on the severity of the initial injury. If the nerve has suffered nothing more than a mild trauma, recovery can be very fast, taking several days to several weeks. An "average" recovery is likely to take between a few weeks and a few months. The nerve regenerates at a rate of approximately 1-2 millimeters per day, and can continue to regenerate for 18 months, probably even longer. Improvement of appearance can continue beyond that time frame.

IS MUSCLE ATROPHY A CONCERN?
Not as a rule. It takes longer for the muscles to start to atrophy than it takes for most people to fully recover.

IS BELL'S PALSY LIKELY TO HAPPEN AGAIN?
The possibility of recurrence had been thought to be as high as 10 - 20%. These figures have been lowered as more has been learned about conditions that are now diagnosed as other types of facial palsies. Estimates of the rate of recurrence still vary widely, from around 4 - 14%. Most recent reports hover at 5 - 9%. The average timespan between recurrences is 10 years.

25) In Dialysis which toxicity is seen commonly?

Aluminum toxicity

Aluminum toxicity, prevalent among individuals with chronic renal failure, is associated with disabling osteomalacia, encephalopathy, and anemia.

The control of aluminum intake has included standards to limit the amount of aluminum in the dialysis fluid in addition to the use of nonaluminum containing phosphate binders.

Deferoxamine mesylate, a heavy metal chelating agent, is used to remove aluminum from the tissues of dialysis patients. Chelation therapy has resulted in improvements of clinical symptoms and bone histology. Ocular, auditory, and infectious adverse effects have occurred with the use of deferoxamine.

26) TOC for Gastric ulcer?

For people with Helicobacter pylori infection, the main goal is to get rid of the bacteria that causes the infection.

H2 receptor antagonist such as famotidine (Pepcid) or nizatidine (Axid) or a proton pump inhibitor such as omeprazole (Prilosec) or esomeprazole (Nexium) to suppress acid, combined with two antibiotics.

Those who do not have an H. pylori infection may be prescribed ulcer-healing medications such as antacids, H2 receptor antagonists, or proton pump inhibitors. Long-term treatment may be needed.

If the ulcer bleeds, endoscopy can control bleeding in most cases.

Surgery may be recommended for persons who do not respond to medicines or endoscopy. Surgical procedures for gastric ulcers include:

Vagotomy -- cuts the vagus nerve, which controls the stomach's production of gastric acid
Partial gastrectomy -- removes part of the stomach

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27) Squamous non-keratinizing is seen in….?

Squamous nonkeratinizing

Function: barrier, protection.
Location: wet surfaces: oral cavity, esophagus, and vagina.

Origin: ectoderm
• cells of basal layer (stratum germinatinum, stratum basale)

• cells of stratum spinosum

• squamous cells

Stratified squamous keratinizing (epidermis)

Function: barrier, protection.

Location: dry surfaces: skin.

Origin: ectoderm
• keratinocytes of stratum germinatinum (stratum basale)

• keratinocytes of stratum spinosum

• keratinocytes of stratum granulosum

• keratinocytes of stratum lucidum

• squames of keratin of stratum corneum

• melanocytes

Stratified cuboidal & columnar

Function: barrier, conduit.

Location: sweat gland, ducts of exocrine glands, anorectal junction.

Origin: ectoderm

Transitional

Function: barrier, distensible property.

Location: renal calyces, ureters, bladder, urethra.

Origin: mesoderm

fmge 2007

2008-12-18T10:06:00.000-08:00

diseases?
A. Trachoma

Anatomy

1.Muscle which helps to open E.tube while opening mouth(Tensor tympani, Tensor palate, _, All)

2. The order of vessels in the Intercostal space from above to below(VAN, AVN, ANV)

3. Branches of Int iliac artery except (Ovarian a., sup vesical, med rectal, inf rectal)

4. Bipolar neuron is seen in ( parasympathetic ganglion, sympa ganglion, cochlear ganglion)

5. Inversion & eversion of foot joints at- Subtalor joints

6. No of lobes in liver as per COUINAUD’s classification- (3,4,6,8)

7. Umbilical cord contains – 2 arteries & 1 vein

8. Lig Arteriosum is derived from- Ductus arteriosus

9. MI ligament preventing uterine prolapse-(cardinal, teres uteri, broad lig)

Biochemistry

10. Water soluble form of vit K(phyllaquinone, menaquinione, menadione, )

11. Single oral dose for vit D prophylaxis(50000,100000,200000 U)

12. Test for RNA detection-Northern blotting

13 .SSA-Glutamate in 6th posn in B chain by valine

14. Chitin is a polymer of-N acetyl glucosamine

15. Watson’s DNA model is –Right handed anti parallel

16. Wheat lacking in(lysine, leucine, threonine)

17. No of ATP produced by complete metabolism of pyruvate(12,15,18,30)

18. Final product of purine metabolism(uric acid, NH3+CO2)

19. T4 is formed from- Tyrosine

20. Daily required dose of Fe in an adult man(5,10,20,30)

21. Nieman pick dise due to def of-Sphingomyelinase

22. Saturated fatty acids max in(coconut oil, ground nut oil, palm oil)

23. MI indicator of protein efficacy(biol value, net protein utln, chemical score, protein efficacy ratio)

24. Dietary fibres rich in(polysaccharides, monosaccharides, non starch polysaccharides)

25. Dietary % of energy from fat should be less than(10,20,30,40)

26. Unconj bilirubinemia seen in all except(Dubin Johnson, Criggler najjar, Gilbert’s, Hemolytic anemia)

27. Source of NH3 in brain - Glutamine

28. BMR depends mainly on- body surface area

Physiology

29. Normal PH of blood- 7.36-7.44

30. Longest life span for(lymphocytes, neutrophils, monocytes)

31. Normal glomerular capillary pressure(15,25,35,45 mm Hg)

32. Ion which is not interfered at loop of Henle(Na, K, Cl, urea)

33. MC Hb in adult(Hb A1, HbA2, Hb F)

34. Feacal mass mainly derived from(indigested food, undigested food, intestinal flora, intestinal secretions)

35. Nicotinic receptors are seen in all except(adrenal medulla, NMJ, bronchial smooth muscle)

36. Anterior Pituitary secretes (ADH, oxytocin, FSH, GnRH)

37. Mucin acini cells characteristic all except(peripherally placed nucleus,distinct lumen,zymogen granules,transparent)

38. In synaptic cleft max concn of( Na, K, Ca, protein anions)

39. Charecteristic for smooth muscle cells(don’t require Ca, cant do recurrent contraction, cant do sustained contraction)

40. All or none law is obeyed by (spike potential, post synaptic potential, )

41. All carried through lat spino thalamic tract except(crude touch, pressure, pain, Temperature)

Pathology

42. Longitudinal ulcers seen in – Typhoid fever

43. Amoebic ulcer is – flask shaped

44. TB ulcer edges are- undermined

45. Crescent shaped gametocytes seen in- Falciparum malaria

46. HIV affects (CD4, CD8, CD4+double +ve, CD8+)

47. Few RBCs,few neutrophils with some degraded fibrin in lungs seen in(grey hepatisation, red hepatisation, viral pneumonia)

48. Brunner’s glands in –Deodenum

49. Organ which undergoes involution- Thymus

50. Minimal change GN, all are true except(absence of podocytes, normal glomerulus, poor response to steroids)

51. Bence Johns Protein is – light chain monoclonal

52. True about NK cells except(mediates type IV hypersensitivity, kill viruses, are large granular lymphocytes)

53. MHC is important in pathogenesis of- ? auto immune diseases

54. SLE is- Type III hypersensitivity

55. Adult polycystic kidney disease is inherited – AD

56. Which is not inherited XR(G6PD def, Duschene’s MD, Cystic fibrosis)

57. Lung Ca with worst prognosis( small cell, adeno. Squamous cell)

58. Ovarian tumours MC arises from (epithelium, germ cell, stroma)

59. Cholera toxin acts on (ADP G1, ADP Gs, _,_,)

60. FAMILIAL hypercholesterolemia due to- LDL receptor deficiency

61. Exudative pleural effusion seen in all except(CCF, Ca, Pneumonia, Nephrotic syndrome)

62. Most active form at tissue level(T3, T4, mono iod thyronin)

63. Immediate response in acute inflammation except(granuloma formation, vasodilatation, neutrophil migration)

64. Epitheloid granuloma consists mainly of(monocytes ¯ophages, T cells, B cells)

65. Invasive Ca differs from Ca in situ by (basement membrane involvement, pleomorphism, _)

66. Pleural effusion in vertical positon MC accumulates in (costo phrenic recess, oblique fissure, horizontal fissure)

Microbiology

67. Babesiosis in India MC transmitted by – Ticks

68. Q-fever is caused by- Coxiella burnetti

69. Lymes disease is caused by- Borrellia burdgofferi

70. Megaloblastic anemia caused by – Diphyllobotrum latum

71. Paragonismus westermani is commonly called – Lung fluke

72. Toxic Shock Syndrome MC caused by- Staphylococci

73. Sabin Feldman test used to Dx- TOXOPLASMOSIS

74. Bedside rapid urease test is Dx of(Proteus, H.pylori)

75. Staph.aureus is a normal inhabitant of(nose , SKIN ,throat)

76. LRTI is MC caused by (streptococci,viruses,H.influenza, mycoplasma)

77. VR media used for –V.cholera

78. Which vaccine should not be kept in freezer- DPT

79. Promastigote form of Leishmania seen in (NNN medium, spleen , Bone marrow, lymph node)

80. All are dimorphic fungi except(Cryptococcus, histoplasma, paracoccidia, blastomycoses)

81. Which is Gram +ve(fusobacterium, bacteroids, artonella, ar----lla)

Pharmacology

82. Anti TB drug causing gout- Pyrazinamide

83. Prolactine is stimulated by(TRH, ACTH, GnRH, Dopamine)

84. GH is inhibited by (Bromocriptine, glucose, exercise, sleep)

85. In a patient with hepatitis which ATT is most safe( S+E, H+E, R+E, S+H)

86. Prokinetic drug with no dopamine antagonism(metachlopramide, domperidone, mosapride, chlorpromazine)

87. Warfarin acts by inhibiting – factors II, VII, IX, X

88. Heparin induced thrombocytopenia.Tactics include all except( switch on to warfarin, cannot be substituted with LMWH, stop Heparin,_)

89. Warfarin metabolism is inhibited by( Ketoconazole, Pheno, Rifampicin, chronic alchoholism)

90. Disulfiram like rn is caused by all except(Griseofulvin, metronidazole, ciprofloxacin, erythromycin)

91. Drug not interferes with antacid( Azithromycin, Tetracyclin, Norfloxacin,Ranitidine)

92. All are B-lactam inhibitors except(Astreonam, Sulbactam, Tazactam, Clavulenic acid)

93. Penicillin is(safe in pregnancy, is 6 amino penicill acid, all are not antipseudomonal)

94. Not used as an antacid(NaHCO3, AlOH3, SiO2, MgSO4)

95. DOC in LGV- Tetracycline

96. Lactic acidosis in DM therapy caused by – Phenformin

97. Pancreatitis is a S/E of( Didanosine, Zidovudine,Zalcitabine)

98. B-blockers are used in all except( A-V block, angina, FAMILIAL TREMOR )

Forensic Medicine

99. Female can give consent for SEX if above (16, 12, 19, 21)

100. Post marteum stiffening is called –Rigor mortis

101. Most informative test in parental identification-( DNA finger print, HLA)

102. Lesion with intact SKIN but internal Pathology - Contusion

PSM

103. Rural community health centre for(30000,60000,100000,200000) population

104. Exclusive breast feeding is recommended by WHO upto( 6, 4, 3, 9 months)

105. Patient made to walk early after Surgery , this is to- reduce disability

106. Which is secondary prevention(Cx pap smear checking, vaccination , admitting disabled child in special schools)

107. Temporary contraceptive method of choice in a 37 yr well educated woman- (Diaphragm, IUCD, mala N, mala D)

108. Best protection from STD & Syphilis by – condom

109. Method used to compare cost of 2 studies- cost accounting

110. Survillance is_

111. PQLI includes- IMR, Life expectancy at 1 year, literacy

112. Test which detects TRUE NEGATIVE- Specificity

113. Disease usually not seen in a country but brought from abroad is – EXOTIC

114. Couple protection rate should be – 60%

115. Ideal couples are( just married, men 20-40 women 16-45,)

116. Fastest population growth in ( India, Kuwait, Pakistan, Srilanka)

117. A new drug not prevents a disease but reduce death due to that disease then- PREVALENCE increases

118. Socially attained behavior is( culture, custom, socialization_)

119. The upper line in growth chart is( 50 , 60, 70, 80 th percentile)

120. Who should be trained in a community for house to house surveys

121. MI factor deciding results of a clinical trial( Effective randomization, 50% Rx with placebo & 50% with drugs, Inclusion of all age groups, 100% follow up)

Ophthalmology

122. Trachoma in ( 1, 2, 3, 5 million people all over world)

123. MCC of vision loss in HIV( CMV retinitis, Toxoplasma, HIV retinitis)

124. Dendritic ulcer seen in – HERPEZ

125. Most serious complication after traumatic injury to one eye – SYMPATHETIC OPHTHALMIA

126. ROSETTE shaped cataract in – TRAUMA

127. Rx of choice in CAG ( surgical iridectomy, laser iridectomy, pilocarpine, trabeculectomy)

128. Ideal site for IOL- Posterior capsule

129. Laser used for IOL inpln- NdYAG

130. Muscle 1st to be affected in Thyroid ophthalmopathy.- INF RECTUS

131. Axial length of eye ball- 24 mm

132. 1mm increase in axial length leads to increase the power by ( 1,2,3,4 D)

133. Argyll Robertson pupil seen in – Neuro syphilis

134. Light reflex is carried through( Ciliary nerve, V, VII, )

135. Anterior Uveitis is MC assd with - HLA B 27

136. Scleritis MC assd with – RA

137. Interstitial keratitis MC seen in – Syphilis

138. MCC of Vitreous H-gge (Eale’s dse, DM , HTN)

139. Tractional RD is seen in (Vitreous loss after Surgery , DM retinopathy,_)

140. White pupillary reflex is called – Leucocoria

141. Dx test for corneal ulcer ( Flur.angiography, Alcian blue, Rose Bengal, methylene blue)

142. In DIRECT ophthalmoscopy image is magnified by ( 15, 5,10, 20 times)

143. Sup oblique muscle is supplied by - IV nerve

144. MCC of cataract blindness- (Senile, congenital, traumatic)

145. Max cones are seen in ( fovea centralis, macula lutea, blind spot)

ENT

146. Ext ear is not supplied by( GP nerve, Vagus, Great auricular nerve, Lesser occipital nerve)

147. Tonsills innervated by ( GP, Vagus, Abduscens)

148. Schwart’s sign is seen in – OTOSCLEROSIS

149. Pure tone is ( single frequency, multiple F, mixed F, F above 4000 Hz)

150. In BERA the IVth potential is from ( Cochlear ganglion, inf colliculus, MGB)

151. Bullous myringitis is seen in ( Measles, mumps,Herpez,Mycoplasma)

152. About Rhinoscleroma false is ( Cause subglottic stenosis, caused by Gm+, streptomycin useful in Rx, Mikkuliz cells & Russel bodies seen)

153. Le-Forte’s # is the # of - MAXILLA

ANAESTHESIOLOGY

154. Pin index of oxygen(5,15,25,35)

155. Laughing gas is – Nitrous oxide

156. Used for iv induction except (Bupivacaine, Thiopental Na, Ketamine, Etomidate)

Dermatology

157. Latest retinoid drug used in PSORIASIS - Adapalane

158. Isomorphism not seen in (Lichen sclerosis, Lichen planus, Vitiligo, PSORIASIS )

159. Alopecia,hyperpigmentation ,hypogonadism charecteristc for deficiency of --Zn

160. Decreased no of melanocytes seen in(Pebaldism, albinism, )

Radiology

161. Element MC used in brachytherapy of Ca Cervix- CESIUM

162. Filament in X-Ray made of- Strontium

163. Most radiosensitive organ- Bone marrow

164. Double Bubble sign in Barium meal seen in – Deodenal Atresia

165. Best method to Dx Pathology in terminal part of CBD. (USG, ERCP, PTC, CEST)

166. Investigation of choice in a person brought with traumatic paraplegia( MRI, CT, Myelography)

Psychiatry

167. DOC in OCD( Sertraline, alprazolam, chlorpromazine)

orthopaedics

168. Hill-Sachs lesion seen in – Reccurent dislocation of shoulder

169. Nerve damaged in # of shaft of humerous- Radial nerve

170. Bony ankylosis is caused by ( Septic arthritis, TB arthritis, Bechet’s dse, Psoriatic arthritis)

171. MCP joints are MC affected in – RA

172. 1st epiphysis to be ossified in elbow( Head of radius, Capitulum, Trochlea, Med condyle)

Paediatrics

173. MCC of death in TOF (bronchopneumonia, starvation, malabsorption)

174. Boy c/o haemetemesis, mild splenomegaly,no hepatomegaly.Dx ( Non cirrhotic fibrosis, chirrosis, Budd-Chiari sy)

175. Minimal fluid intake in an 8 kg boy should be ( 800, 700 ml, 1L)

176. Enuresis is normal until(5, 4, 3 1/2, 2 1/2 years)

177. Normal duration of physiologicl jaundice in a trm baby- 1 week

178. Charecteristic for achild with acute post strepto coccal GN- raised ASO& fever& Leucocytosis

Medicine

179. Nephrocalcinosis seen in –Hyper PTH

180. 45 year man c\o vomiting with food mass taken days before,foul smelling breath, occasional dysphagia to solid food. Dx(Zenkers diverticulum, Achalasia, diabetic gastroparesis, scleroderma)

181. Severity of mitral stenosis is determined by (diastolic murmur duration, mid DMD, opening snap, intensity of S1)

182. Severity of DM assessed by (HbA1C, KB level, RBS)

183. Typhoid ulcer perforation in – 3rd week

184. Normal anion gap acidosis seen in (cholera, DKA, Lactic acidosis)

185. pH=7.28,PCO2=70,HCO3=36 Dx (resp acidosis with metabolic alkalosis, resp acidosis with metb acidosis)

186. In thalassemia trait(increased HbF & HbA2, increased HbF & decreased HbA2)

187. Tetany is not seen in (Verapamil, thyroid Surgery , hyperventilation, malabsorption)

188. Down’s Sy is Dx by all except(decreased hcg, increased hcg, decreased AFP)

189. 100% O2 not effective in (TOF, DILD, Eosinophilic pneumonia)

190. Prophylaxis to a child with RHD should be given minimum till(at least 5 years after onset, life long, till 17 years)

191. Carotid massage is effective in- PSVT

192. Lung Ca MC assd with(Asbestosis, Silicosis)

193. Not premalignant(Crohn’s dse, UC, Leukoplakia, Retinitis pigmentosa)

194. Complications of DU except(Malignancy, perforation, bleed, obstruction)

195. Not a cutaneous manifestation of TB( LUPUS pernio, LUPUS vulgaris, Erythema nodosum)

196. MI in aetiology of CAD- LDL

197. MCC of ICH- (HTN, Berry aneurysm)

198. Hemodialysis is not effective in( Digoxin , salicylate, methanol, barbiturate poisoning)

199. Microangiopathic hemolytic anemia seen in – (HUS, HTN, DM , All)

200. Post exposure prophylaxis for HIV min for( 6 weeks, 4 weeks, 12 weeks, 8 weeks)

201. Vomiting,diarrhea 6 hours after food intake- Staphylococci

202. Patient c/o finger stiffness, dysphagia.Dx- Scleroderma

203. Hepatorenal syndrome charc by all except( normal intrinsic kidney , low or no proteinuria;_)

204. Best marker to assess prognosis after colon Surgery for Ca( CEA, Ca199, Ca125)

205. Rx of steroid dependant asthma(long acting B2 agonist, leucotrine antagonist, theophylline, systemic steroid)

206. Pretibial myxedema is seen in ( Thyrotoxicosis, myxedema, follicular Ca , Pappilary Ca thyroid)

207. Zn def not see n in ( Burns, TB, Renal tubular dse, malabsorption)

208. True about Pan coast Tr except(lower lobe Ca, MC adeno Ca)

209. Charecteristic of MCTD are all of the following (?except) (CNS involvement, GN, Polyarthritis, Hypocomplimentemia )

210. MC CNS involvement in HIV- Dementia

211. a –wave in JVP indicates – Atrial systole

212. Wide split fixed 2nd sound seen in – ASD

213. Anti mitochondrial Ab seen typically in – PBC

214. brain death is loss of(brain stem Fx, cortical Fx, spinal refex, corneal reflex)

215. H-gge into R internal capsule of aR handed person causes(Aphasia, R hom hemianopia, hemianopsia)

216. Spirochets can be identified by all of the follwg(?except) ( Dark field microscopy, Levaditi stain, Fontana stain, Gram stain)

217. Dressler’s syn due to- auto immune

218. Pinpoint pupil seen in all except(Imipramine, Chlorpromazine, _, None)

219. Pt with jaundice and ARF. MI in history except( TCA Rx,

sewage worker, Paracetamol poisoning, Drug abuse)

220. 45 year man c/o back pain & joint pain. In X-Ray B/L Sacroileitis. Dx. (Ankyl spondylosis, Psoriatic arthritis, RA)

221. Not a cause of Cor pulmonale( Mitral stenosis, intermittent PE, COPD, Kyphoscoliosis)

222. FAMILIAL bullous dse is equivalent to(Halvey halvey syn, Darrier’s dse, Bullous pemphigus)

223. MCC of hypovolemic shock- (H-gge, Gm-ve shock)

224. Flapping TREMOR is seen in all except( Thyrotoxicosis, Uraemia, CO2 narkosis, Hepatic failure)

225. In hemolytic anemia true except( increased haptoglobulin, BM hyperplasia, Reticulocytosis, increased unconj bilirubin)

226. Morphine is given in – LVF

227. MCA territory H-gge, not seen is( Aphasia, dysarthria, hemiparesis)

228. MI factor determining myocardial O2 consumption ( heart rate, blood volume, cardiac output, myocardial fibre tension)

229. Hypotonia seen in all except( anxiety, sleep, shock)

Surgery

230. Tinel’s sign is seen in (nerve regeneration, degeneration, both, none)

231. Thrombophlebitis seen in ( Buerger’s dse, Reynauld’s dse, AV fistula)

232. GERD is predisposed by( Smoking, Achalasia, Trunkal vagectomy, All)

233. Not premalignant( Condyloma lata, Bowen’s dse, Balanopostitis)

234. Uvula vesicae is caused by(ant lobe, post lobe, medial lobe of Prostate)

235. In Carpel tunnel syndrome,the nerve involved is – Median Nerve

236. MCC of hepatic abscess in India( amoebic absess, infected haematoma, ascending infection, secondary to cholelithiasis)

237. Multiple lytic lesions in all bones of a child of 14 years. Dx( Histiocytosis X, Neuroblastoma, Osteosarcoma, 2ory from Wilm’s Tr)

238. Dumbing syn is charec by all except(Hyperglycemia, numbness & giddiness)

239. Not a complication of Crohn”s dse( Sclerosing cholangitis, granuloma, fistula, stricture)

240. Hirshprung’s Dse MC involves (recto sigmoidal jn, Rectum, colon )

241. Hirshprung’s Dse Dx by – Rectal Biopsy

242. Thimble bladder is seen in - TB

243. Mass 15 cm away from anal orifice .Rx( Colonoscopic removal, hartman’s operation, ant resection, abd-peroneal resection)

244. Sister Joseph Nodules are seen at – Umbilicus

245. Spigelian hernia is- hernia of arcuate line

246. Pott’s puffy Tr is - OSTEOMYELITIS of skull bone

247. Grey Turner sign in – Acute pancreatitis

248. Acute pancreatitis cause all except(induce fat necrosis, hypercalcemia, increased amylase)

249. Amylase is increased in all except( A/c appendicitis, A/c pancreatitis, duodenal perforation, intestinal obstrn)

250. Rx of paralytic ileus include all except(Parasympathomimetics, NG aspiration, IVF, Electrolyte correction)

251. Painful tender & non reducable sac through inguinal canal with absent cough reflex.Dx- Strangulation

252. MC organ ruptured in blunt trauma of abdomen- spleen

253. Bornhalm’s sign seen in – AV fistula

254. Dse with least flow(Intravisceral fistula, visceral hemangioma, portal vein shunt)

255. Stones are MC seen in which salivary gland- sub mandibular

256. Major amount of unstimulated salivary secretion by(Parotids,submandibular, sublingual, small lingual glands)

257. MC mode of spread to cervical LN in TB( Haematogenous, lymphogenic, contact)

258. MC mode of spread of Gall Bladder Ca- (Transcoelomic, lymphogenic, hematogenic, Direct extension)

259. Chronic cholecystitis is assd with all except( usually palpable, MC in women, Assd wiyh GB stones, Rokitansky cells)

260. MC type of Basal cell Ca- Nodular

261. LN involved in Breast Ca except( Pre tracheal, ant axillary, parasternal, supraclavicular)

262. Sted collar abscess seen in (TB, Syphilis, Actinomycoses)

263. Which cannot be considered as a solitary noduleof thyroid(adenoma, carcinoma, physiological goiter, cyst)

264. In neck dissection above omohyoid we are removing(I,II,III level LN)

Gynaecology

265. Scaly lesions with frequent bleed around areola. Dx ( Paget’s dse, Ezcema, TB)

266. Epithelium in vagina is – squamous

267. Colposcopy used to visualize- Cervix

268. MC site of ectopic pregnancy,-(ampulla, isthmus, interstitium)

269. 43 year lady c/o prolonged and heavy bleed.O/E hyperplasia with no atypia. Rx(Estrogen, Estrogen+ progestogen, Progestron, Hysterectomy)

270. In a patient soon after 3rd stage of labour placenta fully came out, but heavy bleed. Tactics; (Massage & oxytocin, IVF, Check for placenta in uterus, check for laceration of labia)

271. Painless heavy bleed seen in ( Placenta previa, )

272. Hydramnios is complicated by all except( Atonic H-ge, obstructed labour, uterine dysfunction, Placenta abruptio)

273. Bacterial vaginosis causes(Pre term labour, abruption placenta, endometritis, Chorioamnionitis)

274. Gold standard in Dx of PID( USG, Laparoscopy, Blood leucocyte count, Anti chlamydial Ab)

275. LH:FSH ratio increased in – PCOD

276. Ovulation coincides with – LH surge

277. Exact no of weeks between LMP & EDD- (38, 39, 40 weeks)

278. Bishop’s classification is used for-_

279. Pregnant lady presnts with fulminant hepatitis. MCC( Hep A, B,C, D)

280. Advantages of median episiotomy over mediolateral are all except(H-ge, Healing, pain, extension)

281. Active tactics in labour according to –PARTOGRAM

282. Investigations to be done in a girl presented with delayed puberty( USG pelvis, FSH, Karyotyping, All)

283. Best prognostic factor in breast Ca( LN involvement, age, FAMILIAL history)

284. MC presentation( LOA, ROA, LOP, ROP)

285. Appropriate investigation of choice in Vesico-ureteric Reflux- MCU

286. Not a complication of Pseudo pancreatic cyst(H-ge into cyst, Rupture, Malignancy)

287. Pheno cause HEMOLYSIS in all of the follwg except (G6PD def, TB, Alcoholism)

288. External ear infections are MC caused by (Pseudomonas, fungi, virus, actinomyces)

289. Major site of storage of labile proteins ( liver , skel muscle, endocrine glands, exocrine glands)

290. Virus causing Rabies in man is( Street virus, wild virus,--)

fmge september 2005

2008-12-18T09:38:00.000-08:00

QUESTIONS SEPTEMBER 2005(part 1&2)
(the answers marked with question mark are not appropriate. if anyone gets the correct answer, please do the proper corrections)
1,Hydatid cyst is commonly found in
1, liver
2, lungs
3, kidney
(ans:liver )
2, Most common site of abscess formation due to Amoeba
1, liver
2, Lungs
3, kidney
(ans:liver )
3, Umblical cord has (repeated question in all previous papers)
1,2artery n 1 vein
2,2 vein n 1 art.
(Ans:2 artery n 1 vein)
4, Apoptosis
Programmed internal suicidal cell death
5, wheal and flare reaction is
1, Type 1 hyper sensitivity
2, Type 2 hyper sensitivity
3, Type 3 hyper sensitivity
4, Type 4 hyper sensitivity
(ans:Type 1 hyper sensitivity. All the anaphylactic reactions comes under type 1 hyper sensitivity)
6, Hypoglossal nerve is
1,6th nerve
2,7th nerve
3,12th nerve
4,9th nerve
(Ans:12th nerve)
7, Muscle in the inguinal canal is
1, Internal oblique
2, External oblique
3, Transverse
(ans:???transverse)
8, Total claw hand
1, ulnar and median nerve
2, ulnar nerve
3, median nerve
(ans:?ulnar and median nerve)
9,In Hansen’s disease the nerve affected is:
1, ulnar nerve
2, median nerve
3, radial nerve
(ans:ulnar nerve.Hansans disease is the other name for leprosy. the most common nerve affected in leprosy is ulna nerve.
Ref.Bailey and love. Pg37-41)
10, Complication of extra capsular FRACTURE of femur:
1, Non union
2, mal union
(ans:Non union Ref.SARP Surgery and orthopaedics pg.89)
11,eye ball moments controlled by all, EXCEPT:
1, optic nerve
2, abducens nerve
3, Trochlear nerve
4, oculomotor nerve
(ans:optic nerve.( Abducens 6th nerve moves the eye laterally,Trochlear nerve helps in moving the eye down and in,Oculomotor 3rd nerve helps for outward lateral gaze)
12, Lacrimal duct passes through, except:
1, Frontal
2, maxillary
3, zygomaticus
4, lacrimal
13, Right common carotid artery arises from:
1,Right axillary
2, Arcus aorta
3, Brachiocephalicus
(ans:Brachiocephalicus)
14, The first heart sound S1 is due to the:
1, AV closure
2, opening of aortic valve
3, closing of aortic valve
(ans:AV closure)
15, Rheumatic fever is associated with:
1, Mitral valve
2,Pulmonary valve
3,Tricuspid valve
4, Aortic valve
(ans:Mitral valve)
?15, Hernia Morgani passes through:
1,pleuro peritoneum
2,diaphragm
16, Gland of Burner is found in (Rpt in march 2005)
()ANS:Deudenum)
17, Length of Duodenum:
1,15
2,20
3,25
(ans:20-25cm, Ref. SARP BAP(biochem,Anatomy ,Physiology ) pg 77)
18, Tuberculosis commonly affects which part of the colon:
1, Transverse colon
2, Terminal colon
3, Jejunal colon
19, Unilateral breast findings with scaly SKIN around the nipple with intermittent bleeding (Rpt. In march 2005)
1, Pagets disease
2, Eczema
3,CA breast
(ans:Pagets disease)
20Simple Mastectomy includes:
1,Breast and axillary nodes
2,only breast
3, Breast +axillaries nodes+pectoralis major muscle
(ans:Only Breast, Simple Mastectomy- this means complete removal of the breast but the axilla is left undisturbed except for the region of the axillary tail which usually has attached to it a few nodes low in the anterior group. Ref.Bailey and love(20th edition) pg.733)
21, Continous Murmur is found in which arterial disease:
1,AV Fistula
2,Disecting aortic aneurysm
(ans: AV Fistula. Continuous machinery murmur is also found in Patent Ductus arteriosus PDA)
??22, which ion helps is potential:
1,Na+
2,K+
23,All of the following found in Horner’s syndrome, EXCEPT:
1,Ptosis
2,Meiosis
3, Hyperhydrosis
(ans:Hyperhydrosis, In Horners syndrome, unilateral Anhidrosis(ie,loss of sweating) is found)
24,Peau d’ Orange of Breast is due to:
1,Obstruction if lymph
2,Obstruction of ducts
3,Obstruction of arteries
4,Obstruction of Vein
(ans:Obstruction of Lymphatic vessels, Ref.Robbins Basic Pathology ,pg.354)
25,Reabsorption of Water is maximum in :
1,proximal tubules
2,Henles loop
3,collecting duct
(ans:Proximal tubules)
26,Carcinoid syndrome, ass. With except,
1,Diarhoea
2,Flushing
3,Acute appendicitis
4,cyanosis
(ans:?cyanosis)
27,Acute Pancreatitis associated with:
1,Alcoholic
2,Gall bladder stones
3,Elevated serum amalyse
4,All of the above
(ans:?all of the above)
28,Diagnosis of CA colon ,best indicated by:
1,colonoscopy
2,CT
3,Barium enema
4,x-ray
(ans:colonoscopy)
29,Radiation is less in:
1,CT
2,MRI
3,Fluroscopy
4,X-ray
(ans:MRI)
30,CA colon Marker:
(ans:CEA)
31,AFP(alpha feta protein ) is increased in:
1,Hepatic carcinoma
2,Renal carcinoma
(ans:Hepatic carcinoma)
??32,Ananencephaly is better diagnosed in which trimester:
1,1st trimester
2,2-3 trimester
33,Which of the following nerve is damaged by the FRACTURE of the shaft of the humerus:
1,Radial nerve
2,ulnar nerve
3,median nerve
(ans:Radial nerve)
??34,Inversion and Eversion is done by?
35,Supination is done by:
(ans:Radio ulnar joint)
36,FRACTURE of supracondylar of the femur affects which nerve:
1,sciatic nerve
2,poplitial nerve
37,Vein used in bypass Surgery :
1,Long saphenus vein
2,short saphenus vein
(ans:long saphenus vein)
?38,pulseless
(ans:Methionine)
39,Which is seen in RNA but not seen in DNA:
1,adenosine
2,Uracil
(ans:uracil)
40,Production of Uric acid is by:
1,Nucleic acid
2,Protein
(ans:??nucleic acid)
41,Hexose is not seen in:
1,Pentose
2,Glucose
3,Fructose
(ans:Pentose-5 ,and hexose is 8 )
42,Common complication of long bone FRACTURE :
1,Fat embolism
2,Pulmonary embolism
(ans:Fat embolism.It is the commenest complication of long bone fractures like, femur FRACTURE )
43,Definitive management for Tension pneumothorax is:
(ans:Thoracosynthesis)
44,Normal Fluid level in pericardium
1,100-150
2,50-100
3,150-200
45,polyhydroaminosis is increase in aminoitic fluid more than:
1,1000ml
2,2000ml
3,3000ml
46,HIV is associated with
1,Disseminated TB
2,Oesophageal candidiasis
3,MAI
4,all of the above
(ans:?all of the above)
47,Radiological findings of Ewings sarcoma(Rpt)
(ans:Onion Peel appearance)
48,Osteosarcoma affects:
1,Metaphysis
2,Diaphysis
3,Epiphysis
(ans:Metaphysis,Ref:SARP-Surgery and orthopaedics ,pg 51)
49& 50,,Pseudomembranous colitis is caused by:
(ans:Clostridium Difficle)
51,Diagnostic test for Enteric Fever:
1,WIDAL test
2,VDRL
(ans:WIDAL.Enteric fever is the other name for Typoid fever, and the the diagnostic tests include, (mneumonic:BASU,ie, 1st week,B-blood culture,2nd week,A-agglutination test which is called as WIDAL,3rd week S-Stool culture and 4th week,U-Urine culture)
52,Complement Fixation test is:
1,Coombs test
2,Waserman reaction
3,VDRL
4,WIDAL
53,Iron Deficiency anemia is commonly caused by (Rpt)
(ans:Hook worm )
54,Which is a pre-toxin:
1,E.coli
2,Cholera
3,SALMONELLA
4,Staph.aureus
55,Trauma to spleen is best diagnosed by:
1,USG
2,CT
(ans:?USG)
56,Post splenectomy causes:
1,Thrombocytosis
2,Thrombocytopenia
3,Thrombocytopenia and leucopenia
57,Radial nerve
1,c5,c6
2,C5,C6,T1
(ans:C5,C6.T1)
58,ST elevation is seen in:
1,Acute MI
2,Pericarditis
3,Prinze metals angina
4,all of the above
(ans:all of the above)
59,cholera vaccination is effective:
1,6 months
2,3 months
60,Hepatitis B vaccine should be given as:
1,0,1,6months
2,0,1,6 days
(ans:0,1,6 months)
61,BCG should be given:
(ans:Immediately after birth)
62,Cellular fragments od Rabies vaccine is given at:
1,Anterior Abdomen
2,Deltoid muscle
3,Medial part of thigh
63,BCG is diluted with:
1,NS
2,Distilled water
64,Vitamin A should be given at:
(ans:6-9months)
65,Cancroid is caused by:
(ans:H.Ducrei)
66,Swan Gann Catheter is used to measure:
(ans:PCWP-pulmonary capillary wedge pressure)
67,CVP denotes,pressure of:
1,Right atrium
2,Rt.Ventricle
3,Left atrium
4,Lt.Ventricle
(ans:Rt.atrium,?as the vena cava(sup. N inf.) ends in Right atrium, central venous pressure helps in determing the venous filling)
68,Tricuspid Incompetence:
1,a wave
2,Hepatic pulsation
(ans:hepatic pulsation, pulsatile liver is a feature in Tricuspid regurgitation)
69,In a patient with Diabetic nephropathy , the anti hypertensive commonly used is:
1,ACE inhibitors
2,Ca channel blockers
3,B-blockers
(ans:ACE inhibitors)
70,Microaneurysm is the most common complication of:
1,Diabetic Mellitus
2,Hypertension
(ans:Diabetic Mellitus)
71,Most common cause of blindness in India is:(Rpt. In March 2005)
(ans:Cataract)
72,Vitreous Hemorrage in Young patients is most commonly due to:
1,Diabetics mellitus
2,Retinal Detachment
3,Eales disease
(ans??Eales disease)
73,The lens used in astigmatism:
1,concave lens
2,convex lens
3,cylindrical lens
(ans:cylindrical lens)
74,seminoma is ca of:
(ans:testes)
75,Post.staphyloma:
1,myopia
2,hypermetropia
76,constriction of pupils:
1,only light reflex
2,light reflex and accommodation
3,refraction
(ans:??light reflex and accommodation)
77,??keratoconus
78,Inhaled forgeign body is seen in the:
1,Right apex
2,Right lower lobe
3,Left apex
4,Left lower lobe
(ans:?Right lower lobe)
79,Community acquired pneumonia:
1,pneumococci
2,streptococci
3,H.influenza
80,Placenta Praveica:
1,Painfull bleeding
2,severe abdominal pain
3,painless bleeding
4,all of the above
(ans:painless bleeding, only Placenta Abruptia has painfull abdominal pain with bleeding)
81,A pregnant lady in her first trimester,complaints with bleeding, on examination the OS is closed:
1,Inevitable abortion
2,Threatend abortion
(ans:Threatened abortion,since the OS is closed it should be threatened abortion, is the os is opned, it can be inevitable abortion)
82,A primigravida with hypertension, when should we induce labour:
1,35 week
2,37 week
3,40 week
4,39 week
(ans:?37 week)
83,Anti-D Rh is given for:
(Rh positive father, and Rh neg. mother)
84,for a lady in her pregnancy, to prevent Tetanus, who should be immunized:
1,Tetanus toxid to the mother
2,Tetanus toxid to the infant
3,immunoglobin to the mother
(ans:TT to the mother)
85,Treatment for ectopic pregnancy:
1,salpihigotomy
2,observation
3,D&C
86,Misoprostol is given, except
1,Missed abortion
2,To induce labour
3,menorrhagia
4,postpartum hemorrhage

87,custodial rape is judged in
1,Judicial magistrate
2,district magistrate
(ans:judicial magistrate)
88,Anti-hypertensive contratindicated in pregnancy :
1,Hydralazine
2,Methyldopa
3,Enalapril
4,Amylodopine
(ans:?enalapril)
89,which is a pro-drug:
1,enalapril
2,clonidine
(ans:?enalapril)
90,pharmocodynamics deals with:
1,Mechanism of action
2,Excretion
91,Theurapatic index:
1,efficacy
92,Le fort FRACTURE (Rpt in march 2005):
1,Maxilla
2,Mandible
(ans:Maxilla)
93,Metabolic acidosis is seen in:
(ans:Diabetic ketaacidosis,(Mneumonics:LUKD,Lactic acidosis,Uremia-renal failure,Ketoacidosis,Drugs like acetozolemide,phenformin etc,..in all these conditions, metabolic ketacidosis is seen)
94,Breast feeding is contraindicated in:
1,Mastitis
2,HIV carrier
3,Open TB
95,Condoms are more preferred because, they have:
1,Reduced side effects
2,reduced failure rates
(ans:reduced side effects)
96,Natural method of contraception::
1,Rhythm method
2,coitus interruption
3,breast feeding
4,all of the above
(ans:all of the above)
97,Infant Mortality rate is:
(ans:1000 live births)
98,Maternal mortility rate calculated as::
1,42 days after delivery
2,immediately after delivery
(ans:??42 days after delivery)
99,Total fertility rate is:
1,reproductive age of the female at 15-44
100,Eligible couple (rep. march 2005)
Recently married couple where the female is of fertile age
101,Not a grevious injury:
1,contusion of breast
2,multiple scars of face
3,FRACTURE of femur
(ans:contusion of breast)
102,Drug indicated for hyperthyroidism during pregnancy:
1,prophyltiouracil
2,carbamazipine
(ans:propylthiuracil)
103,No. of parathyroid glands:
1,4
2,6
3,2
(ans:4)
104,Features of Graves disease,except:
1,most common in male
2,TREMOR
3,pretibial myxodema
(ans:most common in males, graves disease is most commonly found among females, TREMOR , pretibial myxodema are characteristic features of graves disease)
108,Hypercholestremia is commonly associated with:
1,hypothyroidism
2,diabeticsmelitus
109,All are features of hypothyroidism except,
1,lid retraction
2,myxedema
3,bradycardia
4,dry SKIN
(ans:lid retraction, it is seen in hyperthyroidism ,ie, as exopthalmus, when the patient has exophthalmus, there is lid retraction. Rest are features of hypothyroidism)
110,Virchos triad is seen in:
1,DVT
2,Hyper coagulity
3,Abdominal visceral malignancy
111,glasscow scale in death is:
1,0
2,3
3,5
(ans:3, patient is declared death when the GCS is 3)
112,panic attack is:
1,Acute anxiety
2,chronic anxiety
113,sucidal tendency is assoiciated with:
1,depression
2,schizophrenia
3,impulsive disorder
4,all of the above
(ans:?depression or ? all of the above)
114,short acting drug(or? Bezodiazephams)
1,diazepham
2,lorezepham
3,midasolam
(ans:?diazepham or ?midazolam. both are short acting drugs, if benzodiazepham is mentioned then diazepham will be more opt. lorezepham is a long acting benzodiazepham)
115,short acting anesthetic agent used for induction:
1,thiopental
2,ketamine
3,propofol
(ans:?propofol)
121,Hypnotic drug action is:
1,rapid elimination and slow distribution
2,slow elimination and rapid distribution
122,H+ ion is eliminated by
1,lungs
2,stomach
3,kidney
(ans: ?kidney )
123,First pass metabolism:
1,oral
2,sub cutaneus
3,sub lingual
4,rectal
(ans:??sublingual)
124,lassik content
1,xenon
2,excimer
3,yog

(ans:?excimer)
125,A 40 yr old male,has a rash over the groin, with a scaly lesion on examination:
1,candidiasis
2,Malazi furfur
3,Trichophyton

126,Most common nosocomial fungal infection:
1,candidiasis
2,aspergillosis
127,superficial inguinal lymph nodes drain from except:
1,testis
2,uterus
128,EBV(ebstein barr virus) except:
1,pancreas
2,burkitts lymphoma
3,glandular fever
(ans:?pancreas)
129,antiaggrent:
(ans:asprin)
130,anticoagulant is given in all conditions except:
1,pericarditis
2,DVT
3,pulmonary embolism
(ans:pericarditis)
131,OCP(oral contraceptive pills) is contraindicated in
(ans:hepatic failure)
132,Primary colours except:
1,green
2,red
3,white
(ans:white)
133,in colour blindness
(ans:?defect in 1 or more prime colours)
134,jovel bodies seen in
?
135,Most commin utero-vesicle fistula in India:
1,obstructed labour
2,pelvic Surgery
(ans:obstructed Surgery )
136,Treatment for zollinger elison syndrome:
1,omeprezole
2,cimitedine
(ans:omeprezol, proton inhibitors are best indicated )
137,2nd stage of labour:
1,increase in contraction
2,cervix dilatation
3,all of the above
(ans:?all of the above)
138,Heamolysis:
1,vit.E
2,vit.K
(ans:vit.E)
139,Free radicals:
(ans:vit.E, vit.E,A,C are anti-oxidants.)
140,Meckels diverticulitis is ass. With:
1,increased bleeding
2,ass/ diverticulitis
141,pharyngeal pouch?
142,Reflex nephropathy is diagnosed by (Rpt in march 2005)
(ans:MCU(micturating cysto urethrogram)
143,Heamocolpus is :
(ans:imperforate hymen)
144,Height doubles at:
(ans:4 years)
145,vitamin D deficiency is:
(ans:Rickets)
146,Enteric fever is caused by:
(ans: S.thyphi)
147,Tubercular focus at apex:
1,gommus
2,simsands
148,Nutritional essential in a child noted as
1,weight for age
2,height for age
3,arm circumference
149,Tyrosin becomes essential in
1,phenylketonuria
2,thyrosinosis
150, ,In intermittent porphyria what is the urine content:
1,uroporphyrin
2,porphobilinogens
(ans:porphobilinogens,Ref:Oxford handbook of Medicine ,pg 708
151,Essential amino acids are named so:
Because they are not produced in the body
152,Enzymes are:
1,protein
2,Lipid
(ans:protein)
153,Poluunsaturated fatty acids,Except:
1,olieic acid
2,arachinic acid
154,All are bad cholesterol except:
1,HDL
2,LDL
155,MI enzymes are:
1,Tropin
2,Myoglobulin
3,LDH
4,all of the above
(ans:all of the above)
156,UTI contains microbes:
1,>10^6
>10^10
157,Which immunoglobulin is present in the breast milk:
(ans:IgA)
158,IgM denotes:
(ans:primary reaction)
159,Investigation of choice for Acute pancreatitis:
1,CT
2,USG
3,Xray
(ans:??CT)
160,What is the major side effect of streptomycin:
(ans:Ototoxicity)
161,which is of Obstructed COPD:
1,Bronchial asthma
2,Chronic bronchitis
3,bronchoectasis
4,all of the above
162.apoprotein of cholesterol:
1,apoE
2,apo A1
3,apoA2
163,Pancreatic calcification is due to:
1,alcoholism
2,Cystic fibrosis
3,idiopathic
4,heriditory
164,cholesterol is:
1,b-caratone
165,Breast milk ejection is due to:
1,oxytoxin
2,prolactin
(ans:oxytoxin,pralactin helps in secretion of milk)
166,Weight of a child triples at:
(ans:1 year)
167,recurrent laryngeal nerve supplies except:
1,cricothyroid
168,Not a solitary nodule:
1,cyst
2,adenoma
169,Cryptococcus
1,pigeon droppings
170,endemic dropsy:
1,sanginosus
171 ,in Malaria falciparum:
1,ring shaped cresents seen
172,potassium sparing drug:
1,spironolactone
2,furesemide
(ans:spironolactone,all other diuretics causes hypokalemia when given,spironolactone spares pottasium)
173,carbohydrates,proteins and fat metabolism occurs in which cycle:
1,krebs cycle
2,coherts cycle
174,pulse biferns occurs in:
1,AR
2,AS n AR
3,HOCM
4,all of the above
(ans:?all of the above)
175,Obstructive jaundice is due to:
(ans:gall stones)
176,Difference between human milk and cows milk:
1,iron deficiency
177,Post partum hemorrhage in a spontaneous delivery is due to:
(ans:uterine atony)
178,in SHOCK:
1,hypotension
2,hypoperfusion to tissues
3,hypoxia
4,all of the above
(ans:all of the above)
?179,hepatitis E
180,what is the lung findings in HIV:
1,disseminated TB
2,LUPUS vulgaris
(ans:disseminated TB)
181,Pneumoperitonium is seen in:
1,PA erect view
2,abdominal xray
182,Wilson disease is due to :
(ans:copper)
183,which is a mast cell stabilizer:
(ans:sodium chromoglycate)
184,drinking water test is done in:
1,acute congestive glaucoma
2,acute glaucoma
3,chronic glaucoma
185,osmolity
1,serum potassium
2,serum sodium
(ans?:serum sodium)
186,plaque is caused by
1,flea
2,tics
3,mites
(ans:?flea)
187,HONK (hyper osmality non ketoacidosis) occurs in:
(ans:Diabetes mellitus)
188,Mid day meals:
1/3 calories +1/2 protein
189,heamorrage leads to:
(ans:hypovolemic shock)
190,Most common stranglulation occurs in:
(ans:femoral hernia)
191,cough impulse is not seen in:
(ans:strangulation)
192,Acute appendicitis:
1,fever >42
2,anorexia,Right hypochondrial pain,fever
(ans: anorexia,Right hypochondrial pain,fever)
?193,active potential:
K+
194,Least conduction fibres:
1,C- fibres
195,Reticulocytes are found in:
(ans:hemolytic anemia,when HEMOLYSIS occurs, much of immature reticulocytes are produced in bone marrow,Ref.check kapithans ped. Book)
196,Which drug is not given in anaphylactic shock:
1,adrenalin
2,steroids
3,antibiotics
4,antihistamine
(ans:antibiotics)
197,Ovulation occurs:
1,14 days prior to next menstruation
2,14 days after menstruation
3,on 14th day
(ans:14 days prior to next menstruation:)
198,Complication in Diabetics mellitus occurs after :
1,6 years
2,8 years
3,12 years
199,glove and stockings sensory loss occurs in:
1,syringomelia
2,pheripheral neuropathy
3,all of the above
(ans:all of the above)
200,causative of sore throat:
1,Strep.pyogens
2,staphylococcus
(ans:strep. Pyogens, it is the causative for infective endocarditis)
?201,sup. Thyroid occurs frm:
1,4th branchial arch
202,DNA:
1,deoxyribose sugar
203,Mycobacterium grows in:
1,LG medium
204,Effective sterilization:
1,steam under pressure
2,hot water
205,?pasturation of milk determined by:
??methylene blue
206,Sharp instrument should be disposed in:
1,red bag
2,blue bag
(ans:?red bag)
207,term vaccine was named by:
1,Louis Pasteur
2,Jenner
208,Absence of sperms:
1,oligospermia
2,Azzospermia
(ans:azzospermia)
209,Duputryens contracture affects:
1,little finger
2,ring finger
3,middle finger
(ans:little finger)
210,GB (gullian barr syndrome) characteristic:
(ans:loss of limb reflex)
211,Co2 is carried in the plasma in the form of :
1,bicarbonate
2,carbonic acid
(ans:?bicarbonate)
212,glucose in ORS is used:
(ans:for the absorption of Na+)
213,disease caused by cotton:
(ans:bysinosis)
214,aniline dyes causes:
1,bladder Ca
2,renal ca
3,hepatic ca
(ans:bladder ca)
215,non alcoholic hepatitis,except:
1,Mallory hyaline fibrosis
2,steatis
216,COPD –all except,
1,RVF(right vent. Failure)
2,polycythemia
3,LVF(left vent. Failure)
(ans:?LVF)
217,Most common feature of essential hypertension:
1,headache
2,visual fortification
(ans:headache)
218,LVH is caused by:
(ans:essential hypertension, hypertension causes left vent. Strain)
219,Vagina is lined by:
1,Squamous cell epithelium
2,columnar cells
(ans:squamous cell)
220,Nitrates indicates:
(ans:,recent pollution)
221,first line prevention of epidemics:
1,confirmation of diagnosis
2,isolation
3,mass immunization
222,pin point pupils are seen in, except
1,datura
2,opiods
3,organophosphates
4,cerebello pontine hemarroge
(ans:datura(ectasy)
223,glomular filtration rate increases in:
1,hypertension
2,bowmen capsules pressure
3,increased osmotic pressure
224,hemorrhagic cystitis is caused by:
(ans:cyclophosphamide)
225,allopurinol:
1,inhibits the synthesis of uric acid
226,Gerotas fasia covering:
1,kidney
2,femur
227,gentamycin is not given orally because
228,which drug effects both bacterial and anerobic infections:
1,sparfloxcillin
2,pefloxacillin
3,norfloxacillin
4,ciprofloxcillin
229,Dark ground microscopy:
1,refracted light
2,polarized light
230,retained placenta causes
1,prolonged bleeding
2,sepsis
3,placental polyp
4,all of the above
(ans:all of the above)
231,exercise to increase the muscle strength:
1,isotonic
2,isometric
3,aerobic isotonic
232,Southern blot test:
1,DNA
2,RNA
3,PCR
(ans:DNA, northern blot test is for RNA, Western blot for HIV)
233,niacin is synthesized
1,tryptophan
234,Iron storage is:
1,transferring
234,In vitro fertilization:
1,artifical insemination
235,spinal cord ends at:
1,L2
2,S1
3,L1
4,S2
(ans:L2)
236,estrogen deficiency leads to:
1,osteoporosis
2,dysmenorrhea
(ans:osteoporosis, most of the post menopausal women get osteoporosis, because of estrogen def.)
237,curlings ulcer:
1,deudonal ulcers in burns
238,humoral cells are
1,B cells
2,NK cells
3,T cells
239,in leprosy
1,SKIN histocytes
2,swann cells
3,all of the above
240,bile secretion stimulation all, except:
1,vagus
?241,semicircular canal
242,cardiac output is determined by, except
1,stroke volume
2,cardiac contractility
3,cardiac rate
4,body surface area
(ans?:body surface area)
243,vessels to meninges:
1,external carotid
2,internal carotid
3,vertrebral
4,basilar
244,Artery supplied to sup. Temporal brain :
1,middle cerebral art.
245,epiphyseal plate FRACTURE is classified by
1,harris
246,?directly acting drugs except:
?dopamin
247,pharmocodynamics and pharmacokinetics:
1,nitrates
2,amiodarone
3,verapamil
4,hydralazine
248,maternal mortality
? 1 lakh
249,pneumatocoel is caused by
(ans: staph. Aureus)

fmge 2005

2008-12-18T09:26:00.000-08:00

ALL INDIA
PAPER 2005
SOLVED
QUESTIONS AND ANSWERS

ANATOMY
Q 1. The carpal tunnel contains all of the following important structures except:
A. Median nerve.
B. Flexor pollicis longus.
C. Flexor carpi radialis.
D. Flexor digitorum superficialis.
Ans. C
Q 2. The femoral ring is bounded by the following structures except:
A. Femoral vein.
B. Inguinal ligament.
C. Femoral artery.
D. Lacunar ligament.
Ans. C
Q 3. All of the following statements regarding vas deferens are true except:
A. The terminal part is dilated to form ampulla.
B. It crosses ureter in the region of ischial spine.
C. It passes lateral to inferior epigastric artery at deep inguinal ring.
D. It is separated from the base of bladder by the peritoneum.
Ans. D
Q 4. The following statements concerning chorda tympani nerve are true except that it:
A. Carries secretomotor fibers to slubmandibular gland.
B. Joins lingual nerve in infratemporal fossa
C. Is a branch of facial nerve.
D. Contains postganglionic parasympathetic fibers.
Ans. D
Q 5. The type of joint between the sacrum and coccyx is a:
A. Symphysis
B. Syostosis
C. Synchondrosis
D. Syndesmosis
Ans. A
Q 6. The prostatic urethra is characterized by all of the following geatures, except that it:
A. Is the widest and most dilatable part.
B. Presents a concavity posteriorly.
C. Lies closer to anterior surface of prostate.
D. Receives prostatic ductules along its posterior wall.
Ans. B

Q 7. The following group of lymph nodes receives lymphatics from the uterus except;
A. External iliac.
B. Internal iliac.
C. Superficial inguinal.
D. Deep inguinal
Ans. D
Q 8. All of the following physiological processes occur during the growth at the epiphyseal plate except;
A. Proliferation and hypertrophy.
B. Calcification and ossification.
C. Vasculogenesis and erosion.
D. Replacement of red bone marrow with yellow marrow.
Ans. D
Q 9. Benign prostatic hypertrophy results in obstruction of the urinary tract. The specific condition is associated with enlargement of the:
A. Entire prostate gland.
B. Lateral lobes.
C. Median lobe.
D. Posterior lobes.
Ans. C
Q 10. In an adult male, on per rectal examination, the following structures can be felt anteriorly except:
A. Internal iliac lymph nodes.
B. Bulb of the penis.
C. Prostate.
D. Seminal vesicle when enlarged.
Ans. A
Q 11. While doing thoracocentesis, it is advisable to introduce needle along:
A. Upper border of the rib.
B. Lower border of the rib.
C. In the center of the intercostals space.
D. In anterior part of intercostals space.
Ans. A
Q 12. All of the following are branches of the external carotid artery except:
A. Superior thyroid artery.
B. Anterior ethmoidal artery.
C. Occipital artery.
D. Posterior auricular artery.
Ans. B

Q 13. Barr body is found in the following phase of the cell cycle:
A. Interphase.
B. Metaplase.
C. G1 phase.
D. Telophase.
Ans. A
PHYSIOLOGY
Q 14. The type of hemoglobin that has least affinity for 2,3-diphosphoglycerate (2,3-DPG) or (2,3-BPG) is:
A. Hg A.
B. Hg F.
C. Hg B.
D. Hg A2.
Ans. B
Q 15. Cellular and flagellar movement is carried out by all of the following except:
A. Intermediate filaments.
B. Actin.
C. Tubulin.
D. Myosin.
Ans. D
Q 16. Heme is converted to bilirubin mainly in:
A. Kidney.
B. Liver
C. Spleen
D. Bone marrow.
Ans. C
Q 17. Normal CSF glucose level in a normoglycemic adult is:
A. 20-40 mg/dl
B. 40-70 mg/dl
C. 70-90 mg/dl
D. 90-110 mg/dl.
Ans. B
Q 18. Which one of the following molecules is used for cell signaling?
A. CO2
B. O2
C. NO
D. N2
Ans. C
Q 19. Osteoclasts are inhibited by:
A. Parathyroid hormone.
B. Calcitonin.
C. 1,25-dihydroxycholecalciferol.
D. Tumor necrosis factor.
Ans. B
Q 20. CO2 is primarily transported in the arterial blood as:
A. Dissolved CO2.
B. Carbonic acid
C. Carbamino-hemoglobin
D. Bicarbonate.
Ans. D
Q 21. Both vitamin K and C are involved in:
A. The synthesis of clotting factors.
B. Post translational modifications.
C. Antioxidant mechanisms.
D. The microsomal hydroxylation reactions.
Ans. B
Q 22. The main site of bicarbonate reabsorption is:
A. Proximal convoluted tubule.
B. Distal convoluted tubule.
C. Cortical collecting duct.
D. Medullary collecting duct.
Ans. A
Q 23. The membrane protein, clathrin is involved in:
A. Cell motility.
B. Receptor-mediated endocytosis.
C. Exocytosis.
D. Cell shape.
Ans. B
Q 24. The parvocellular pathway from lateral geniculate nucleus to visual cortex is most sensitive for the stimulus of:
A. Color contrast.
B. Luminance contrast.
C. Temporal grequency.
D. Saccadic eye movements.
Ans. A
Q 25. The fibers from the contralateral nasal hemiretina project to the following layers of the lateral geniculate nucleus:
A. Layers 2, 3 & 5.
B. Layers 1, 2 & 6.
C. Layers 1, 4 & 6.
D. Layers 4, 5 & 6.
Ans. C
Q 26. All endothelial cells produce thrombomodulin except those found in:
A. Hepatic circulation
B. Cutaneous circulation
C. Cerebral microcirculation.
D. Renal circulation.
Ans. C
Q 27. SA node acts as a pacemaker of the heart because of the fact that it:
A. Is capable of generating impulses spontaneously.
B. Has rich sympathetic innervations.
C. Has poor cholinergic innervations.
D. Generates impulses at the highest rate.
Ans. D
Q 28. The first physiological response to high environmental temperature is:
A. Sweating
B. Vasodilatation.
C. Decrease heat production.
D. Non-shivering thermogenesis.
Ans. B
Q 29. All of the following factors normally increase the length of the ventricular cardiac muscle fibres except:
A. Increased venous tone.
B. Increased total blood volume.
C. Increased negative intrathoracic pressure.
D. Lying-to-standing change in posture.
Ans. D
Q 30. The vasodilatation produced by carbon dioxide is maximum in one of the following:
A. Kidney.
B. Brain.
C. Liver.
D. Heart.
Ans. B
Q 31. Which one of the following statements regarding water reabsorption in the tubules?
A. The bulk of water reabsorption occurs secondary to Na+ reabsorption.
B. Majority of facultative reabsorption occurs in proximal tubule.
C. Obligatory reabsorption is ADH dependent.
D. 20% of water is always reabsorbed irrespective of water balance.
Ans. A
Q 32. Urinary concentrating ability of the kidney is increased by:
A. ECF volume contraction.
B. Increase in RBF.
C. Reduction of medullary hyperosmolarity.
D. Increase in CFR.
Ans. A
Q 33. Distribution of blood flow is mainly regulated by the:
A. Arteries.
B. Arterioles.
C. Capillaries.
D. Venules.
Ans. B
Q 34. In which of the following a reduction in arterial oxygen tension occurs?
A. Anaemia.
B. CO poisoning.
C. Moderate exercise.
D. Hypoventilation.
Ans. D
Q 35. With which one of the following lower motor neuron lesions are associated?
A. Flaccid paralysis.
B. Hyperactive stretch reflex.
C. Spasticity.
D. Muscular incorrdination.
Ans. A
Q 36. Which of the following statements can be regarded as primary action of inhibin?
A. It inhibits secretion of prolactin.
B. It stimulates synthesis of estradiol.
C. It stimulates secretion of TSH.
D. It inhibits secretion of FSH.
Ans. D
BIOCHEMISTRY
Q 37. The predominant isozyme of LDH in cardiac muscle is:
A. LD-1
B. LD-2
C. LD-3
D. LD-5
Ans. A
Q 38. All of the following hormones have cell surface receptors except:
A. Adrenalin
B. Growth hormone.
C. Insulin
D. Thyroxine.
Ans. D
Q 39. Fluoride, used in the collection of blood samples for glucose estimation, inbibits the enzyme:
A. Glucokinase.
B. Hexokinase.
C. Enolase.
D. Glucose-6-phosphatase.
Ans. C
Q 40. Enzymes that move a molecular group from one molecule to another are known as:
A. Ligases.
B. Oxido-reductases.
C. Transferases.
D. Dipeptidases.
Ans. C
Q 41. The amino acid residue having an imino side chain is:
A. Lysine.
B. Histidine.
C. Tyrosine.
D. Proline.
Ans. D
MICROBIOLOGY
Q 42. A woman with infertility receives an ovary transplant from her sister who is an identical twin. What type of graft it is?
A. Xenograft
B. Autograft
C. Allograft
D. Isograft.
Ans. D
Q 43. Virus mediated transfer of host DNA from one cell to another is known as:
A. Transduction.
B. Transformation.
C. Transcription.
D. Integration.
Ans. A
Q 44. In the small intestine, cholera toxin acts by:
A. ADP-ribosylation of the G regulatory protein.
B. Inhibition of adenyl cyclase.
C. Activation of GTPase.
D. Active absorption of NaCl.
Ans. A
Q 45. HIV can be detected and confirmed by:
A. Polymerase chain reaction (PCR)
B. Reverse transcriptase - PCR
C. Real time PCR
D. Mimic PCR.
Ans. B
Q 46. With reference to infections with Escherichia coli the following are true except:
A. Enteroaggregative E. coli is associated with pwesistent diarrhoea.
B. Enterohemorrhagic E.coli can cause haemolytic uraemic syndrome.
C. Enteroinvasive E. coli produces a disease similar to salmonellosis.
D. Enterotoxigenic E.coli is a common cause of travelers diarrhoea.
Ans. C
Q 47. The following statements are true regarding melioidosis except:
A. It is caused by Burkholderia mallei.
B. The agent is a grain negative aerobic bacteria.
C. Bipolar staining of the aetiological agent is seen with methylene blue stain.
D. The most common form of melioidosis is pulmonary infection.
Ans. A
Q 48. The following bacteria are most often associated with acute neonatal meningitis except:
A. Escherichia coli.
B. Streptococcus agalactiae.
C. Neisseria meningitidis.
D. Listeria monocytogenes.
Ans. C
Q 49. All of the following Vibrio sp. are halophilic, except:
A. V. cholerae.
B. V. parahaemolyticus.
C. V. alginolyticus.
D. V. fluvialis.
Ans. A
Q 50. All of the following organisms are known to survive intracellularly except:
A. Neisseria meningitides.
B. Salmonella typhi.
C. Streptococcus pyogenes.
D. Legionella pneumophila.
Ans. C
Q 51. The capsule of Cryptococus neoformans in a CSF sample is best seen by:
A. Grams stain.
B. India ink preparation.
C. Giemsa stain.
D. Methanamine-silver stain.
Ans. B
Q 52. Viruses can be isolated from clinical samples by cultivation in the following except:
A. Tissue culture.
B. Embryonated eggs.
C. Animals.
D. Chemicaly defined media.
Ans. D
Q 53. It is true regarding the normal microbial flora present on the skin and mucous membranes that:
A. It cannot be eradicated by antimicrobial agents.
B. It is absent in the stomach due to the acidic pH.
C. It establishes in the body only after the neonatal period.
D. The flora in the small bronchi is similar to that of the trachea.
Ans. A
Q 54. An army jawan posted in a remote forest area had fever and headache. His fever was 104°F and pulse was 70 per mibn. He had an erythematous lesion of about 1 cm on the leg surrounded by small vesicles, along with generalized lymphadenopathy at the time of presentation to the referral hospital. His blood sample was collected to perform serology for the diagnosis of Rickettsial disease. Which one of the following results in Weil-Felix reaction will be diagnostic in this clinical setting:
A. High OX-2.
B. High OX-19.
C. High OX-K.
D. High OX-19 and OX-2.
Ans. C
Q 55. Adenosine deaminase (enzyme) deficiency is associated with:
A. Severe combined immunodeficiency (SCID)
B. X-linked agammaglobulinemia.
C. Transient hypogammaglobulinemia of infancy.
D. Chronic granulomatous disease.
Ans. A
Q 56. Which of the following viral infections is transmitted by tick?
A. Japanese encephalitis.
B. Dengue fever.
C. Kyasanur forest disease (KFD).
D. Yellow fever.
Ans. C
Q 57. Atypical pneumonia can be caused by the following microbial agents except:
A. Mycoplasma pneumoniae.
B. Legionella pneumophila.
C. Human Corona virus.
D. Klebsiella pneumoniae.
Ans. D
Q 58. The serum concentration of which of the following human IgG subclass is maximum?
A. IgG1.
B. IgG2.
C. IgG3.
D. IgG4.
Ans. A
Q 59. Chlamydia trachomatis is associated with the following except:
A. Endemic trachoma.
B. Inclusion conjunctivitis.
C. Lymphogranuloma venereum.
D. Community acquired pneumonia.
Ans. D
Q 60. The following statements are true regarding Clostridium perfringens except:
A. It is commonest cause of gas gangrene.
B. It is normally present in human faeces.
C. The principal toxin of C.perfringens is the alpha toxin.
D. Gas gangrene producing strains of C.perfringens produce heat resistant spores.
Ans. D
Q 61. The most common organism amongst the following that causes acute meningitis in an AIDS patients is:
A. Streptococcus pneumoniae.
B. Streptococcus agalactiae.
C. Cryptococcus neoformans.
D. Listeria monocytogenes.
Ans. C
Q 62. A bacterial disease that has been associated with the 3 “Rs” i.e., rats, ricefields, and rainfall is:
A. Leptospirosis.
B. Plague.
C. Melioidosis.
D. Rodent-bite fever.
Ans. A
Q 63. A child was diagnosed to be suffering from diarrhoea due to Campylobacter jejuni. Which of the following will be the correct environmental conditions of incubation of the culture plates of the stool sample:
A. Temperature of 42°C and microaerophilic.
B. Temperature of 42°C and 10% carbon dioxide.
C. Temperature of 37°C and microaerophilic.
D. Temperature of 37°C and 10% carbon dioxide.
Ans. A
Q 64. Which one of the following statements is true regarding Chlamydia pneumoniae:
A. Fifteen serovars have been identified as human pathogens.
B. Mode of transmission is by the airborne bird excreta.
C. The cytoplasmic inclusions present in the sputum specimen are rich in glycogen.
D. The group specific antigen is responsible for the production of complement fixing antibodies.
Ans. D
Q 65. Type I hypersensitivity is mediated by which of the following immunoglobulins?
A. IgA.
B. IgG.
C. IgM.
D. IgE.
Ans. D
PATHOLOGY
Q 66. An example of a tumour suppressor gene is:
A. Myc.
B. Fos.
C. Ras.
D. Rb.
Ans. D
Q 67. The following is not a feature of malignant transformation by cultured cells:
A. Increased cell density.
B. Increased requirement for growth factors.
C. Alterations of cytoskeletal structures.
D. Loss of anchorage.
Ans. B
Q 68. A simple bacterial test for mutagenic carcinogens is:
A. Ames test.
B. Redox test.
C. Bacteriophage.
D. Gene splicing.
Ans. A
Q 69. The classification proposed by the International Lymphoma Study Group for non-Hodgkin’s lymphoma is known as:
A. Kiel classification.
B. REAL classification.
C. WHO classification.
D. Rappaport classification.
Ans. B
Q 70. All of the following features are seen in the viral pneumonia except:
A. Presence of interstitial inflammation.
B. Predominance of alveolar exudates.
C. Bronchiolitis.
D. Multinucleate giant cells in the bronchiolar wall.
Ans. B
Q 71. Aschoff’s nodules are seen in:
A. Subacute bacterial endocarditis.
B. Libman-Sacks endocarditis.
C. Rheumatic carditis.
D. Non-bacterial thrombotic endocarditis.
Ans. C
Q 72. Pulmonary surfactant is secreted by:
A. Type I pneumoncytes.
B. Type II pneumocytes.
C. Clara cells.
D. Bronchila epithelial cells.
Ans. B
Q 73. Which one of the following conditions commonly predisposes to colonic carcinoma?
A. Ulcerative colitis.
B. Crohn’s disease.
C. Diverticular disease.
D. Ischaemic colitis.
Ans. A
Q 74. Fibrinoid necrosis may be observed in all of the following except:
A. Malignant hypertension.
B. Polyarteritis nodosa.
C. Diabetic glomerulosclerosis.
D. Aschoff’s nodule.
Ans. C
Q 75. All of the following statements are true regarding reversible cell injury, except:
A. Formation of amorphous densities in the mitochondrial matrix.
B. Diminished generation of adenosine triphosphate (ATP)
C. Formation of blebs in the plasma membrane.
D. Detachment of ribosomes from the granular endoplasmic reticulum.
Ans. A
Q 76. Which of the following statements pertaining to leukemia is correct?
A. Blasts of acute myeloid leukemia are typically sudan black negative.
B. Blasts of acute lymphoblastic leukemia are typically myeloperoxidase positive.
C. Low leucocyte alkaline phosphatase score is characteristically seen in blastic phase of chronic myeloid leukemia.
D. Tartarate resistant acid phosphatase positivity is typically seen in hairy cell leukemiA.
Ans. D
Q 77. In which of the following conditions bilateral contracted kidneys are characteristically seen?
A. Amyloidosis.
B. Diabetes mellitus.
C. Rapidly progressive (crescentic) glomerulonephritis.
D. Benign nephrosclerosis.
Ans. D
Q 78. All of the following vascular changes are observed in acute inflammation, except:
A. Vasodilation.
B. Stasis of blood.
C. Increased vascular permeability.
D. Decreased hydrostatic pressure.
Ans. D
Q 79. The subtype of Hodgkin’s disease, which is histogenetically distinct from all the other subtypes, is:
A. Lymphocyte predominant.
B. Nodular sclerosis.
C. Mixed cellularity.
D. Lymphocyte depleted.
Ans. A
Q 80. In apoptosis, Apaf-1 is activated by release of which of the following substances from the mitochondria?
A. Bcl-2
B. Bax.
C. Bcl-XL
D. Cytochrome C.
Ans. D
Q 81. Which type of amyloidosis is caused by mutation of the transthyretin protein?
A. Familial Mediterranean fever.
B. Familial amyloidotic polyneuropathy.
C. Dialysis associated amyloidosis.
D. Prion protein associated amyloidosis.
Ans. B
Q 82. In familial Mediterranean fever, the gene encoding the following protein undergoes mutation:
A. Pyrin.
B. Perforin.
C. Atrial natriuretic factor.
D. Immunoglobulin light chain.
Ans. A
Q 83. Which of the following statements is not true?
A. Patinets with IgD myeloma may present with no evident M-spike on serum electrophoresis.
B. A diagnosis of plasma cell leukemia can be made if circulating peripheral blood plasmablasts comprise 14% of peripheral blood white cells in a patient with 109/L.´ 109/L and platelet count of 88 ´white blood cell count of 11
C. In smoldering myeloma plasma cells constitute 10-30% of total bone marrow cellularity.
D. In a patient with multiple myeloma, a monoclonal light chain may be detected in both serum and urine.
Ans. B
Q 84. In-situ DNA nick end labeling can quantitate:
A. Fraction of cells in apoptotic pathways.
B. Fraction of cells in S phase.
C. p53 gene product.
D. bcr/abl gene.
Ans. A
Q 85. Which one of the following stains is specific for amyloid?
A. Periodic acid Schiff (PAS)
B. Alzerian red.
C. Congo red.
D. Von-Kossa.
Ans. C
Q 86. Which one of the following diseases characteristically causes fatty change in liver?
A. Hepatitis B virus infection.
B. Wilson’s disease.
C. Hepatitis C virus infection.
D. Chronic alcoholism.
Ans. D
Q 87. A 48-year-old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlared and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl, platelet count 237 x 109/L and total leukocyte count 40 x 109/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lumphoid cells were positive for CD19, CD5, CD20 and CD23 and were negative for CD79B and FMC-7.
The histopathological examination of the lymph node in this patient will most likely exhibit effeacement of lymph node architecture by:
A. A pseudofollicular pattern with proliferation centers.
B. A monomorphic lymphoid proliferation with a nodular pattern.
C. A predominantly follicular pattern.
D. A diffuse proliferation of medium to large lymphoid cells with high mitotic rate.
Ans. D
Q 88. Which one of the following is not a feature of liver histology in non cirrhotic portal fibrosis (NCPF).
A. Fibrosis in and around the portal tracts.
B. Thrombosis of the medium and small portal vein branches.
C. Non specific inflammatory cell infiltrates in the portal tracts.
D. Bridging fibrosis.
Ans. D
PHARMACOLOGY
Q 89. A highly ionized drug:
A. Is excreted mainly by the kidney.
B. Can cross the placental barrier easily.
C. Is well absorbed from the intestine.
D. Accumulates in the cellular lipids.
Ans. A
Q 90. Which one of the following drugs is ‘topoisomerase 1 inhibitor’?
A. Doxorubicin.
B. Irinotecan.
C. Etoposide.
D. Vincristine.
Ans. B
Q 91. The following drugs have significant drug interaction with digoxin, except:
A. Cholestyramine.
B. Thiazide diuretics.
C. Quinidine.
D. Amlodipine.
Ans. D
Q 92. One of the following is not true about nesiritide:
A. It is a brain natriuretic peptide analogue.
B. It is used in acutely decompensated heart failure.
C. It has significant oral absorption.
D. It has a short half-life.
Ans. C
Q 93. Antipsychotic drug-induced parkinsonism is treated by:
A. Anticholinergics.
B. Levodopa.
C. Selegiline.
D. Amantadine.
Ans. A
Q 94. Which one of the following is used in therapy of toxoplasmosis?
A. Artensenuate.
B. Thiacetazone.
C. Ciprofloxacin.
D. Pyrimethamine.
Ans. D
Q 95. The following statements regarding finasteride are true except:
A. It is used in the medical treatment of benign prostatic hypertrophy (BPH)
B. Impotence is well documented after its use.
C. It blocks the conversion of dihydrotestosterone to testosterone.
D. It is a 5-a reductase inhibitor.
Ans. C
Q 96. Eternacept acts by one of the following mechanisms:
A. By blocking tumor necorosis factor.
B. By blocking bradykinin synthesis.
C. By inhibiting cyclo-oxygenase-2.
D. By blocking lipoxygenase.
Ans. A
Q 97. In unconjugated hyperbilirubinemia, the risk of kernicterus increases with the use of:
A. Ceftriaxone.
B. Phenobarbitone.
C. Ampicillin.
D. Sulphonamide.
Ans. D
Q 98. All of the following are topically used sulphonamides except:
A. Sulphacetamide.
B. Sulphadiazine.
C. Silver sulphadiazine.
D. Mafenide.
Ans. B
Q 99. Oculogyric crisis is know to be produced by all of the following drugs except:
A. Trifluoperazine.
B. Atropine.
C. Perchlorperazine.
D. Perphenazine.
Ans. B
Q 100. Which of the following drugs is useful in prophylaxis of migraine?
A. Proproanolol.
B. Sumatriptan.
C. Domperidone.
D. Ergotamine.
Ans. A
Q 101. Inverse agonist of benzodiazepine receptor is:
A. Phenobarbitone.
B. Flumazenil.
C. Beta-Carboline.
D. Gabapentin.
Ans. C
Q 102. The group of antibiotics which possess additional anti-inflammatory and immunomodulatory activities is:
A. Tetracyclines.
B. Polypeptide antibiotics.
C. Fluoroquinolones.
D. Macrolides.
Ans. D
Q 103. With which of the following theophylline has an antagonistic interaction?
A. Histamine receptors.
B. Bradykinin receptors.
C. Adenosine receptors.
D. Imidazoline receptors.
Ans. C
Q 104. One of the following is not penicillinase susceptible:
A. Amoxicillin.
B. Penicillin G.
C. Piperacillin.
D. Cloxacillin.
Ans. D
Q 105. Which one of the following is best associated with lumefantrine?
A. Antimycobacterial.
B. Antifungal.
C. Antimalarial.
D. Antiamoebic.
Ans. C
Q 106. Which one of the following drugs increases gastro-intestinal motility?
A. Glycopyrrolate.
B. Atropine.
C. Neostigmine.
D. Fentanyl.
Ans. C
Q 107. Nevirapine is a:
A. Protease inhibitor.
B. Nucleoside reverse transcriptase inhibitor.
C. Non-nucleoside reverse transcriptase inhibitor.
D. Fusion inhibitor.
Ans. C
FORENSIC MEDICINE
Q 108. In a firearm injury, there is burning, blackening, toattooing around the wound, along with cherry red colour of the surrounding tissues and is cruciate in shape, the injury is:
A. Close shot entry.
B. Close contact exit.
C. Contact shot entry.
D. Distant shot entry.
Ans. C
Q 109. In methyl alcohol poisoning there is CNS depression cardiac depression and optic nerve atrophy. These effects are produced due to:
A. Formaldehyde and formic acid.
B. Acetaldehyde.
C. Pyridine.
D. Acetie acid.
Ans. A
Q 110. In chronic arsenic poisoning the following samples can be sent for laboratory examination except:
A. Nail clippings.
B. Hair samples.
C. Bone biopsy.
D. Blood sample.
Ans. D
Q 111. Which of the following statements is not correct regarding diatom?
A. Diatoms are aquatic unicellular plant.
B. Diatoms has an extracellular coat composed of magnesium.
C. Acid diagestion technique is used to extract diatoms.
D. Presence of diatoms in the femoral bone marrow is an indication of antemartem inhalation of water.
Ans. B
Q 112. In India, magistrate inquest is done in the following cases except:
A. Exhumation cases.
B. Dowry deaths within 5 years of marriage.
C. Murder cases.
D. Death of a person in police custody.
Ans. C
Q 113. At autopsy, the cyanide poisoning case will show the following features, except:
A. Characteristic bitter lemon smell.
B. Congested organs.
C. The skin may be pinkish or cherry red in colour.
D. Erosion and haemorrhages in oesophagus and stomach.
Ans. A
Q 114. The most reliable criteria in Gustafson’s method of identification is:
A. Cementum apposition.
B. Transparency of root.
C. Attrition.
D. Root resorption.
Ans. B
Q 115. The minimum age at which an individual is responsible for his criminal act is:
A. 7 years.
B. 12 years.
C. 16 years.
D. 21 years.
Ans. A
Q 116. The most reliable method of identification of an individual is:
A. Dactylography.
B. Scars.
C. Anthropometry.
D. Handwriting.
Ans. A
Q 117. The most common pattern of finger print is:
A. Arch.
B. Loop.
C. Whorl.
D. Composite.
Ans. B
PSM
Q 118. ‘Endemic disease’ means that a disease:
A. Occurs clearly in excess of normal expectancy.
B. Is constantly present in a given population group.
C. Exhibits seasonal pattern.
D. Is prevalent among animals.
Ans. B
Q 119. Which one of the following is a good index of the severity of an acute disease?
A. Cause specific death rate.
B. Case fatality rate.
C. Standardized mortality ratio.
D. Five year survival.
Ans. B
Q 120. Which one of the following statements about influence of smoking on risk of coronary heart disease (CHD) is not true?
A. Influence of smoking is independent of other risk factors for CHD.
B. Influence of smoking is only additive to other risk factors for CHD.
C. Influence of smoking is synergistic to other risk factors for CHD.
D. Influence of smoking is directly related to number of cigarettes smoked per day.
Ans. B
Q 121. Antibiotic treatment of choice for treating cholera in an adult is a single dose of:
A. Tetracycline.
B. Co-trimoxazole.
C. Doxycycline.
D. Furazolidone.
Ans. C
Q 122. All of the following statements are true about congenital rubella except:
A. It is diagnosed when the infant has IgM antibodies at birth.
B. It is diagnosed when IgG antibodies persist for more than 6 months.
C. Most common congenital defects are deafness, cardiac malformations and cataract.
D. Infection after 16 weeks of gestation results in major congenital defects.
Ans. D
Q 123. The recommended daily energy intake of an adult woman with heavy work is:
A. 1800.
B. 2100.
C. 2300.
D. 2900.
Ans. D
Q 124. All of the following methods are antilarval measures except:
A. Intermittent irrigation.
B. Paris green.
C. Gamusia affinis.
D. Malathion.
Ans. D
Q 125. All of the following are true about the herd immunity for infectious diseases except:
A. It refers to group protection beyond what is afforded by the protection of immunized individuals.
B. It is likely to be more for infections that do not have a sub-clinical phase.
C. It is affected by the presence and distribution of alternative animal hosts.
D. In the case of tetanus it does not protect the individual.
Ans. B
Q 126. The best indicator for monitoring the impact of iodine deficiency disorder control programme is:
A. Prevalence of goiter among school children.
B. Urinary iodine levels among pregnant women.
C. Neonatal hypothyroidism.
D. Iodine level in soil.
Ans. C
Q 127. What is the color-coding of bag in hospitals to dispose off human anatomical wastes such as body parts:
A. Yellow.
B. Black.
C. Red.
D. Blue.
Ans. A
Q 128. WHO defines adolescent age between:
A. 10-19 years of age.
B. 10-14 years of age.
C. 10-25 years of age.
D. 9-14 years of age.
Ans. A
Q 129. In a village having population of 1000, we found patients with certain disease. The results of a new diagnostic test on that disease are as follows.
Test result Disease
Present Absent
+ 180 400
– 20 400
What is the percent prevalence of disease?
A. 0.20
B. 2
C. 18
D. 20
Ans. D
Q 130. The following tests are used to check the efficiency of pasteurization of milk except:
A. Phosphatase test.
B. Standard plate count.
C. Coliform count.
D. Methylene blue reduction test.
Ans. D
Q 131. What will be the BMI of a male whose weight is 89 kg and height is 172 cm:
A. 27
B. 30
C. 33
D. 36
Ans. B
Q 132. The most common side effect of IUD insertion is:
A. Bleeding.
B. Pain.
C. Pelvic infection.
D. Ectopic pregnancy.
Ans. A
Q 133. For the treatment of case of class III dog bite, all of the following are correct except:
A. Give immunoglobulins for passive immunity.
B. Give ARV.
C. Immediately stitch wound under antibiotic coverage.
D. Immediately wash wound with soap and water.
Ans. C
Q 134. A 2-year-old female child was brought to a PHC with a history of cough and fever for 4 days with inability to drink for last 12 hours. On examination, the child was having weight of 5 kg and respiratory rate of 45/minute with fever. The child will be classified as suffering from:
A. Very severe disease.
B. Severe pneumonia.
C. Pneumonia.
D. No pneumonia.
Ans. A
Q 135. The information technology has revolutionized the world of medical sciences. In which of the following year the Information Technology Act was passed by the Government of India?
A. 1998.
B. 2000.
C. 2001.
D. 2003.
Ans. B
Q 136. Transplantation of Human Organs Act was passed by Government of India in:
A. 1996
B. 1993
C. 1998
D. 1994
Ans. D
Q 137. Which one of the following is not source of manager’s power?
A. Reward
B. Coercive
C. Legitimate.
D. Efferent.
Ans. D
Q 138. The standard normal distribution:
A. Is skewed to the left.
B. Has mean = 1.0
C. Has standard deviation = 0.0
D. Has variance = 1.0
Ans. D
Q 139. The PEFR of a group of 11 year old girls follow a normal distribution with mean 300 1/min and standard deviation 20 1/min:
A. About 95% of the girls have PEFR between 260 and 340 1/min.
B. The girls have healthy lungs.
C. About 5% of girls have PEFR below 260 1/min.
D. All the PEFR must be less than 340 l/min.
Ans. A
Q 140. The events A and B are mutually exclusive, so:
A. Prob (A or B) = Prob (A) + Prob (B).
B. Prob (A and B) = Prob (A). Prob (B).
C. Prob (A) = Prob (B).
D. Prob (A) + Prob (B) = 1.
Ans. D
Q 141. Total cholesterol level = a + b (calorie intake) + C (physical activity) + d (body mass index); is an example of:
A. Simple linear regression.
B. Simple curvilinear regression.
C. Multiple linear regression.
D. Multiple logistic regression.
Ans. C
Q 142. The Hb level in healthy woman has mean 13.5 g/dl and standard deviation 1.5 g/dl, what is the Z score for a woman with Hb level 15.0 g/dl:
A. 9.0
B. 10.0
C. 2.0
D. 1.0
Ans. D
Q 143. The diagnostic power of a test to correctly exclude the disease is reflected by:
A. Sensitivity
B. Specificity
C. Positive predictivity
D. Negative predictivity.
Ans. D
Q 144. Infant mortality does not include:
A. Early neonatal mortality.
B. Perinatal mortality.
C. Post neonatal mortality.
D. Late neonatal mortality.
Ans. B
Q 145. A cardiologist found a highly significant correlation coefficient (r=0.90, p=0.01) between the systolic blood pressure values and serum cholesterol values of the patients attending his clinic. Which of the following statements is a wrong interpretation of the correlation coefficient observed?
A. Since there is a high correlation, the magnitudes of both the measurements are likely to be close to each other.
B. A patient with a high level of systolic BP is also likely to have a high level of serum cholesterol.
C. A patient with a low level of systolic BP is also likely to have a low level of serum cholesterol.
D. About 80% of the variation in systolic blood pressure among his patients can be explained by their serum cholesterol values and vice a versa.
Ans. A
Q 146. The most common cancer affecting Indian urban women in Delhi, Mumbai and Chennai is:
A. Cervical cancer.
B. Ovarian cancer.
C. Breast cancer.
D. Uterine cancer.
Ans. C
MEDICINE
Q 147. The most common pathogens responsible for nosocomial pneumonias in the ICU are:
A. Gram positive organisms.
B. Gram negative organisms.
C. Mycoplasma.
D. Virus infections.
Ans. B
Q 148. The abnormal preoperative pulmonary function test in a patient with severe kyphoscoliosis includes:
A. Increased RV/TLC.
B. Reduced FEV1/FVC.
C. Reduced FEV25-75.
D. Increased FRC.
Ans. A
Q 149. Which one of the following drugs has been shown to offer protection from gastric aspiration syndrome in a patient with symptoms of reflux?
A. Ondansetron.
B. Metoclopramide.
C. Sodium citrate.
D. Atropine.
Ans. C
Q 150. Which one of the following is true of adrenal suppression due to steroid therapy?
A. It is not associated with atrophy of the adrenal glands.
B. It does not occur in patients receiving inhaled steroids.
C. It should be expected in anyone receiving > 5 mg, prednisolone daily.
D. Following cessation, the stress response normalizes after 8 weeks.
Ans. C
Q 151. A 30-year-old male patient presents with complaints of weakness in right upper and both lower limbs for last 4 months. He developed digital infarcts involving 2nd and 3rd fingers on right side and 5th finger on left lside. On examination, BP was 160/140 mmHg, all peripheral pulses were palpable and there was asymmetrical neuropathy. Investigations showed a Hb-12 gm, TLC-12000 cumm, platelets 4,30,000, ESR-49 mm. Urine examination showed proteinuria and RBC 10-15/ hpf with no casts. Which of the following is the most likely diagnosis?
A. Polyarteritis nodosa.
B. Systemic LUPUS erythematosus.
C. Wegener’s granulomatosis.
D. Mixed cryoglobulemia.
Ans. A
Q 152. Which of the following infestation leads to malabsorption?
A. Giardia lamblia.
B. Ascaris lumbricoides.
C. Necater americana.
D. Ancylostoma duodenale.
Ans. A
Q 153. All of the following can cause osteoporosis except:
A. Hyperparathyroidism.
B. Steroid use.
C. Fluorosis.
D. Thyrotoxicosis.
Ans. C
Q 154. Serum angiotensin converting enzyme may be raised in all of the following except:
A. Sarcoidosis.
B. Silicosis.
C. Berylliosis.
D. Bronchogenic carcinoma.
Ans. D
Q 155. Hypercalcemia associated with malignancy is most often mediated by:
A. Parathyroid hormone (PTH)
B. Parthyroid hormone related protein (PTHrP)
C. Interleukin-6 (IL-6)
D. Calcitonin.
Ans. B
Q 156. All of the following are the causes of relative polycythemia except:
A. Dehydration.
B. Dengue haemorrhagic fever.
C. Gaisbock syndrome.
D. High altitude.
Ans. D
Q 157. All of the following may cause ST segment elevation on EKG, except:
A. Early repolarization variant.
B. Constrictive pericarditis.
C. Ventricular aneurysm.
D. Prinzmetal angina.
Ans. B
Q 158. 5’-Nucleotidase activity is increased in:
A. Bone diseases.
B. Prostate cancer.
C. Chronic renal failure.
D. Cholestatic disorders.
Ans. D
Q 159. Bart’s hydrops fetalis is lethal because:
A. Hb Bart’s cannot bind oxygen.
-globin form insoluble precipitates.aB. The excess
C. Hb Bart’s cannot release oxygen to fetal tissues.
D. Microcytic red cells become trapped in the placenta.
Ans. C
Q 160. Cluster headache is characterized by all except:
A. Affects predominantly females.
B. Unilateral headache.
C. Onset typically in 20-50 years of life.
D. Associated with conjunctival congestion.
Ans. A
Q 161. The most sensitive test for the diagnosis of myasthenia gravis is:
A. Elevated serum ACh-receptor binding antibodies.
B. Repetitive nerve stimulation test.
C. Positive edrophonium test.
D. Measurement of jitter by single fibre electromyography.
Ans. A

Q 162. Vitamin B12 deficiency can give rise to all of the following, except:
A. Myelopathy.
B. Optic atrophy.
C. Peripheral neuropathy.
D. Myopathy.
Ans. D
Q 163. EEG is usually abnormal in all of the following except:
A. Subacute sclerosing panencephalitis.
B. Locked-in state.
C. Creutzfoldt-Jackob disease.
D. Hepatic encephalopathy.
Ans. B
Q 164. All of the following are neurologic channelopathies except:
A. Hypokalemic periodic paralysis.
B. Episodic ataxia type 1.
C. FAMILIAL hemiplegic migraine.
D. Spinocerebellar ataxia 1.
Ans. D
Q 165. Which of the following is not a neuroparasite?
A. Taenia solium.
B. Acanthamoeba.
C. Naegleria.
D. Trichinella spiralis.
Ans. D
Q 166. A 50-year-old man, an alcoholic and a smoker presents with a 3 hour history of severe retrosternal chest pain and increasing shortness of breath. He started having this pain while eating, which was constant and radiated to the back and interscapular region. He was a known hypertensive. On examination, he was cold and clammy with a heart rate of 130/min, and a BP of 80/40 mm Hg. JVP was normal. All peripheral pulses were present and equal. Breath sounds were decreased at the left lung base and chest X-ray showed left pleural effusion.
Which one of the following is the most likely diagnosis?
A. Acute aortic dissection.
B. Acute myocardial infarction.
C. Rupture of the esophagus.
D. Acute pulmonary embolism.
Ans. A
Q 167. Which of the following is a cause of reversible dementia?
A. Subacute combined degeneration.
B. Picks disease.
C. Creutzfeld-Jakob disease.
D. Alzheimer’s disease.
Ans. A
Q 168. Palpable purpura could occur in the following conditions, except:
a. Thrombocytopenia.
B. Small-vessel vasculitis.
C. Disseminated gonococcal infection.
D. Acute meningococcemia.
Ans. A
Q 169. A 59-year-old man with severe myxomatous mitral regurgitation is asymptomatic, with a left ventricular ejection fraction of 45% and an end-systolic diameter index of 2.9 cm/m2. The most appropriate treatment is:
A. Mitral valve repair of replacement.
B. No treatment.
C. ACE inhibitor therapy.
D. Digoxin and diuretic therapy.
Ans. A
Q 170. The gold standard for the diagnosis of osteoporosis is:
A. Dual energy X-ray absorptimetry.
B. Single energy X-ray absorptiometry.
C. Ultrasound.
D. Quantiative computed tomography.
Ans. A
Q 171. All of the following CSF findings are present in tuberculous meningitis, except:
A. Raised protein levels.
B. Low chloride levels.
C. Cob web formation.
D. Raised sugar levels.
Ans. D
Q 172. Which one of the following serum levels would help in distinguishing an acute liver disease from chronic liver diseae?
A. Aminotransaminase.
B. Alkaline phosphatase.
C. Bilirubin.
D. Albumin.
Ans. D
Q 173. All of the following conditions are known to cause diabetes insipidus except:
A. Multiple sclerosis.
B. Head injury.
C. Histiocytosis.
D. Viral encephalitis.
Ans. A
Q 174. Paralysis of 3rd, 4th 6th nerves with involvement of ophthalmic division of 5th nerve, localizes the lesion to:
A. Cavernous sinus.
B. Apex of orbit.
C. Brainstem.
D. Base of skull.
Ans. A
Q 175. Which one of the following is the most common location of hypertensive bleed in the brain ?
A. Putamen/external capsule.
B. Pons.
C. Ventricles.
D. Lobar white matter.
Ans. A
Q 176. In which of the following diseases, the overall survival is increased by screening procedure?
A. Prostate cancer.
B. Lung cancer.
C. Colon cancer.
D. Ovarian cancer.
Ans. C
Paediatrics
Q 177. The protective effects of breast milk are known to be associated with:
A. IgM antibodies.
B. Lysozyme.
C. Mast cells.
D. IgA antibodies.
Ans. D
Q 178. Study the following carefully:

Read the pedigree. Inheritance pattern of the disease in the family is:
A. Autosomal recessive type.
B. Autosomal dominant type.
C. X linked dominant type.
D. X linked recessive type.
Ans. D
Q 179. Diagnosis of beta thalassemia is established by:
A. NESTROFT test.
B. HbA1c estimation.
C. Hb electrophoresis.
D. Target cells in peripheral smear.
Ans. C
Q 180. Blood specimen for neonatal thyroid screening is obtained on:
A. Cord blood.
B. 24 hours after birth.
C. 48 hours after birth.
D. 72 hours after birth.
Ans. D
Q 181. A child with recurrent urinary tract infections is most likely to show:
A. Posterior urethral valves.
B. Vesicoureteric reflux.
C. Neurogenic bladder.
D. Renal and ureteric calculi.
Ans. B
Q 182. All of the following are true about manifestations of vitamin E deficiency, except:
A. Hemolytic anemia.
B. Posterior column abnormalities.
C. Cerebellar ataxia.
D. Autonomic dysfunction.
Ans. D
Q 183. Differential expression of same gene depending on parent of origin is referred to as:
A. Genomic imprinting.
B. Mosaicism.
C. Anticipation.
D. Non penetrance.
Ans. A
Q 184. The appropriate approach to a neonate presenting with vaginal bleeding on day 4 of life is:
A. Administration of vitamin K.
B. Investigation for bleeding disorder.
C. No specific therapy.
D. Administration of 10ml/kg of fresh frozen plasma over 4 hours.
Ans. C
Q 185. Which one of the following drugs is used for fetal therapy of congenital adrenal hyperplasia?
A. Hydrocortisone.
B. Prednisolone.
C. Fludrocortisone.
D. Dexamethasone.
Ans. D
Q 186. The coagulation profile in a 13-year-old girl with menorrhagia having von-Willebrands disease is:
A. Isolated prolonged PTT with a normal PT.
B. Isolated prolonged PT with a normal PTT.
C. Prolongation of both PT and PTT.
D. Prolongation of thrombin time.
Ans. A
Q 187. The chances of having an unaffected baby, when both parents have achondroplasia, are:
A. 0%
B. 25%
C. 50%
D. 100%
Ans. B
Q 188. All of the following therapies may be required in a 1 hour-old infant with severe birth asphyxia except:
A. Glucose
B. Dexamethasone.
C. Calcium gluconate.
D. Normal saline.
Ans. B
Q 189. The most common leukocytoclastic vasculitis affecting children is:
A. Takayasu disease.
B. Mucocutaneous lymph node syndrome (Kawasaki disease)
C. Henoch Schonlein purpura.
D. Polyarteritis nodosa.
Ans. C
Q 190. A four year old boy was admitted with a history of abdominal pain and fever for two months, maculopapular rash for ten days, and dry cough, dyspnea and wheezing for three days. On examination, liver and spleen were enlarged 4 cm and 3 cm respectively below the costal margins. His hemoglobin was 109/L, which´ 109/L and total leukocyte count 70 ´10.0 g/dl, platelet count 37 included 80% eosinophils. Bone marrow examination revealed a cellular marrow comprising 45% blasts and 34% eosinophils and eosinophilic precursors. The blasts stained negative for myeloperoxidase and non-specific esterase and were positive for CD19, CD10, CD22 and CD20.
Which one of the following statements in not true about this disease?
A. Eosinophils are not of the neoplastic clone.
B. t(5:14) rearrangement may be detected in blasts.
C. Peripheral blood wosinophilia may normalize with chemotherapy.
D. Inv (16) is often detected in the blasts and the eosinophils.
Ans. D
Q 191. kidney biopsy from a child with hemolytic uremic syndrome characteristically most likely presents features of:
A. Thrombotic microangiopathy.
B. Proliferative glomerulonephritis.
C. Focal segmental glomerulosclerosis.
D. Minimal change disease.
Ans. A
Q 192. One of the intestinal enzymes that is generally deficient in children following an attack of severe infectious enteritis is:
A. Lactase.
B. Trypsin.
C. Lipase.
D. Amylase.
Ans. A
Q 193. A new born presented with bloated abdomen shortly after birth with passing of less meconium. A full-thickness biopsy of the rectum was carried out. Which one of the following rectal biopsy findings is most likely to be present?
A. Fibrosis of submucosa.
B. Hyalinisation of the muscular coat.
C. Thickened muscularis propria.
D. Lack of ganglion cells.
Ans. D
Q 194. Eisenmenger syndrome is characterized by all except:
A. Return of left ventricle & right ventricle to normal size.
B. Pulmonary veins not distended.
C. Pruning of peripheral pulmonary arteries.
D. Dilatation of central pulmonary arteries.
Ans. A
Q 195. Which of the following is the most common renal cystic disease in infants is?
A. Polycystic kidnesy.
B. Simple renal cyst.
C. Unilateral renal dysplasia.
D. Calyceal cyst.
Ans. C
Q 196. The most common type of total anomalous pulmonary venous connection is:
A. Supracardiac
B. Infracardiac.
C. Mixed.
D. Cardiac.
Ans. A
Q 197. The most common cause of renal scarring in a 3 year old child is:
A. Trauma.
B. Tuberculosis.
C. Vesicoureteral reflux induced pyelonephritis.
D. Interstitial nephritis.
Ans. C
Q 198. Which one of the following is the common cause of congential hydrocephalus is?
A. Craniosynostosis.
B. Intra uterine meningitis.
C. Aqueductal stenosis.
D. Malformations of great Vein of Galen .
Ans. C
Q 199. In a child, non-functioning kidney is best diagnosed by:
A. Ultrasonography.
B. IVU.
C. DTPA renogram.
D. Creatinine clearance.
Ans. C
Q 200. The most common malignant neoplasm of infancy is:
A. Malignant teratoma.
B. Neuroblastoma.
C. Wilms’ tumor.
D. Hepatoblastoma.
Ans. B
Q 201. The most common presentation of a child with Wilms’ tumor is:
A. An asymptomatic abdominal mass.
B. Haematuria.
C. Hypertension.
D. Hemoptysis due to pulmonary secondary.
Ans. A
Psychiatry
Q 202. A 40-year-old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onset of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for having missed the alcohol drink since 2 days, Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behavior, disorientation, impaired judgment and insight.
He is most likely to be suffering from:
A. Alcoholic hallucinosis.
B. Delirium tremens.
C. Wernicke encephalopathy.
D. Korsakoff’s psychosis.
Ans. B
Q 203. A 45-year-male with a history of alcohol dependence presents with confusion nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:
A. Korsakoff’s psychosis.
B. Wernicke encephalopathy.
C. De Clerambault syndrome.
D. Delirium tremens.
Ans. B
Q 204. A 25-year-old female presents with 2 year history of repetitive, irresistible thoughts of contamination with dirt associated with repetitive hand washing. She reports these thoughts to be her own and distressing; but is not able to overcome them along with medications. She is most likely to benefit from which of the following therapies:
A. Exposure and response prevention.
B. Systematic desensitization.
C. Assertiveness training.
D. Sensate focusing.
Ans. A
Q 205. An 18 year old boy came to the Psychiatry OPD with a complaint of feeling changed from inside. He described himself as feeling strange as if he is different from his normal self. He was very tense and anxious yet could not point out the precise change in him. This phenomena is best called as:
A. Delusional mood.
B. Depersonalization.
C. Autochthonous delusion.
D. Over valued idea.
Ans. B
Q 206. The major difference between typical and atypical antipsychotics is that:
A. The latter cause minimal or no increase in prolactin.
B. The former cause tardive dyskinesia.
C. The former are available as parenteral preparations.
D. The latter cause substantial sedation.
Q 207. Dry mouth during antidepressant therapy is caused by blockade of:
A. Muscarininc acetylcholine receptors.
B. Serotonergic receptors.
C. Dopaminergic receptors.
D. GABA receptors.
Q 208. All of the following are hallucinogens, except:
A. LSD
B. Phenylcyclidine.
C. Mescaline.
D. Methylphendate.
Ans. D
Q 209. An 18 year old student complains of lack of interest in studies for last 6 months. He has frequent quarrels with his parents and has frequent headaches. The most appropriate clinical approach would be to:
A. Leave him as normal adolescent problem.
B. Rule out depression.
C. Rule out migraine.
D. Rule out an oppositional defiant disorder.
Ans. B
Q 210. Perseveration is:
A. Persistent and inappropriate repetition of the same thoughts.
B. When a patient feels very distressed about it.
C. Characteristic of schizophrenia.
D. Characteristic of obsessive compulsive disorder (OCD).
Ans. A
Q 211. One of the following usually differentiates hysterical symptoms from hypochondriacal symptoms:
A. Symptoms do not normally reflect understandable physiological or pathological mechanism.
B. Physical symptoms are prominent which are not explained by organic factors.
C. Personality traits are significant.
D. Symptoms run a chronic course.
Ans. A
Dermatology
Q 212. All of the following drugs are effective in the treatment of pityriasis versicolor except:
A. Selenium sulphide.
B. Ketoconazole.
C. Griseofulvin.
D. Clotrimazole.
Ans. C
Q 213. A 36-year-old factory worker developed itchy, annular scaly plaques in both groins. Application of a corticosteroid ointment led to temporary relief but the plaques continued to extend at the periphery. The most likely diagnosis is:
A. Erythema annulare centrifugum.
B. Granuloma annulare.
C. Annular lichen planus.
D. Tinea cruris.
Ans. D
Q 214. A 16-year-old boy presented with asymptomatic, multiple, erythematous, annular lesions with a callarette of scales at the periphery of the lesions present on the trunk. The most likely diagnosis is:
A. Pityriasis versicolor.
B. Pityriasis alba.
C. Pityriasis rosea.
D. Pityriasis rubra pilaris.
Ans. C
Q 215. The only definite indication for giving systemic corticosteroids in pustular PSORIASIS is:
A. Psoriatic enythroderma with pregnancy.
B. PSORIASIS in a patient with alcoholic cirrhosis.
C. Moderate arthritis.
D. Extensive lesions.
Ans. D
Q 216. A 40-year-old woman presents with a 2 year history of erythematous papulopustular lesions on the convexities of the face. There is a background of erythema and telangiectasia. The most likely diagnosis in the patient is:
A. Acne vulgaris.
B. Rosacea.
C. Systemic LUPUS erythematosus.
D. Polymorphic light eruption.
Ans. B
Q 217. An 8-year-old boy from Bihar presents with a 6 months history of an illdefined, hypopigmented slightly atrophic macule on the face. The most likely diagnosis is:
A. Pityriasis alba.
B. Indeterminate leprosy.
C. Morphoca.
D. Calcium deficiency.
Ans. B
Q 218. A 27-year-old sexually active male develops a vesiculobullous lesion on the glans soon after taking tablet paracetamol for fever. The lesion healed with hyperpigmentation. The most likely diagnosis is:
A. Behcet’s syndrome.
B. Herpes genitalis.
C. Fixed drug eruption.
D. Pemphigus vulgaris.
Ans. C
Surgery
Q 219. According to the Glasgow coma scale (GCS) a verbal score of 1 indicates:
A. No response.
B. Inappropriate words.
C. Incomprehensible sounds.
D. Disoriented response.
Ans. A
Q 220. Abbey-Estlander flap is used in the reconstruction of:
A. Buccal mucosa.
B. Lip.
C. Tongue.
D. Palate.
Ans. B
Q 221. In which one of the following perineural invasion in head and neck cancer is most commonly seen?
A. Adenocarcinoma.
B. Adenoid cystic carcinoma.
C. Basal cell Adenoma.
D. Squamous cell carcinoma.
Ans. B
Q 222. In which one of the following conditions the sialography is contraindicated?
A. Ductal calculus.
B. Chronic parotitis.
C. Acute parotitis.
D. Recurrrent sialadenitis.
Ans. C
Q 223. The most common site of leak in CSF rhinorrhoea is:
A. Sphenoid sinus.
B. Frontal sinus.
C. Cribriform plate.
D. Tegmen tympani.
Ans. C
Q 224. Which one of the following soft tissue sarcomas frequently metastasizes to lymph nodes?
A. Fibrosarcoma.
B. Osteosarcoma.
C. Embryonal rhabdomyosarcoma.
D. Alveolar soft part sarcoma.
Ans. C
Q 225. Lumbar sympathectomy is of value in the management of :
A. Intermittent claudication.
B. Distal ischaemia affecting the SKIN of the toes.
C. Arteriovenous fistula
D. Back pain.
Ans. B
Q 226. A blood stained discharge from the nipple indicates one of the following:
A. Breast abscess.
B. Fibroadenoma.
C. Duct papilloma.
D. Fat necrosis of breast.
Ans. C
Q 227. The earliest manifestation of increased intracranial pressure following head injury is:
A. Ipsilateral papillary dilatation.
B. Contralateral papillary dilatation.
C. Altered mental status.
D. Hemiparesis.
Ans. A
Q 228. In which of the following conditions splenectomy is not useful?
A. Hereditary spherocytosis.
B. Porphyria.
C. Thalassemia.
D. Sickle cell disease with large spleen .
Ans. None/B
Q 229. The following is ideal for the treatment with injection of sclerosing agents:
A. External hemorrhoids.
B. Internal hemorrhoids.
C. Prolapsed hemorrhoids.
D. Strangulated hemorrhoids.
Ans. B
Q 230. In which of the following locations, carcinoid tumor is most common?
A. Esophagus.
B. Stomach.
C. Small bowel.
D. Appendix.
Ans. C
Q 231. Pancreatitis, pituitary tumor and phaeochromocytoma may be associated with:
A. Medullary carcinoma of thyroid.
B. Papillary carcinoma of thyroid.
C. Anaplastic carcinoma of thyroid.
D. Follicular carcinoma of thyroid.
Ans. A
Q 232. Gardener’s syndrome is a rare herediatary disorder involving the colon. It is characterized by:
A. Polyposis colon, cancer thyroid, SKIN tumours.
B. Polyposis in jejunum, pituitary adenoma and SKIN tumours.
C. Polyposis colon, osteomas, epidermal inclusion cysts and fibrous tumorus in the SKIN .
D. Polyposis of gastrointestinal tract, cholangiocarcinoma and SKIN tumours.
Ans. C
Q 233. All of the following are true for patients of ulcerative colitis associated with primary sclerosing cholangitis (PSC), except:
A. They may develop biliary cirrhosis.
B. May have raised alkaline phosphatase.
C. Increased risk of hilar cholangiocarcinoma.
D. PSC reverts after a total colectomy.
Ans. D
Q 234. The most common complication seen in hiatus hernia is:
A. Oesophagitis.
B. Aspiration pneumonitis.
C. Volvulus.
D. Esophageal stricture.
Ans. A
Q 235. Patients of rectovaginal fistula should be initially treated with:
A. Colostomy.
B. Primary repair.
C. Colporrhaphy.
D. Anterior resection.
Ans. A
Q 236. Which of the following catheter materials is most suited for long-term use is?
A. Latex.
B. Silicone.
C. Rubber.
D. Polyurethane.
Ans. D
Q 237. Which of the following is the most troublesome source of bleeding during a radical retropubic prostatectomy?
A. Dorsal venous complex.
B. Inferior vesical pedicle.
C. Superior vesical pedicle.
D. Seminal vesicular artery.
Ans. A
Q 238. The most sensitive imaging modality for diagnosing ureteric stones in a patient with acute colic is:
A. X-ray KUB region.
B. Ultrasonogram.
C. Non contrast CT scan of the abdomen.
D. Contrast enhanced CT scan of the abdomen.
Ans. C
Q 239. Which one of the following is not used as a tumor marker in testicular tumors?
A. AFP.
B. LDH.
C. HCG.
D. CEA.
Ans. D
ORTHPAEDICS
Q 240. A young woman met with an accident and had mild quadriparesis. Her lateral X-ray cervical spine revealed C5-C6 FRACTURE dislocation. Which of the following is the best line of management?
A. Immediate anterior decompression.
B. Cervical traction followed by instrument fixation.
C. Hard cervical collar and bed rest cervical laminectomy.
D. Cervical laminectomy.
Ans. B
Q 241. Which one of the following is the investigation of choice for evaluation of suspected Perthes’ disease?
A. Plain X-ray.
B. Ultrasonography (US).
C. Computed tomography (CT).
D. Magnetic resonance imaging (MRI).
Ans. D
Q 242. Neuronal degeneration is seen in all of the following except:
A. Crush nerve injury.
B. Fetal development.
C. Senescence.
D. Neuropraxia.
Ans. D
Q 243. In Klippel-Feil syndrome, the patient has all of the following clinical features except:
A. Low hair line.
B. Bilateral neck webbing.
C. Bilateral shortness of sternomastoid muscles.
D. Gross limitations of neck movements.
Ans. C
Q 244. The most common sequelae of tuberculous spondylitis in an adolescent is:
A. Fibrous ankylosis.
B. Bony ankylosis.
C. Pathological dislocation.
D. Chronic OSTEOMYELITIS .
Ans. B
Q 245. In radionuclide imaging the most useful radio- pharmaceutical for skeletal imaging is:
A. Gallium 67 (67Ga).
B. Technetium-sulphur-colloid (99mTc-Sc).
C. Technetium-99m (99mTc).
D. Technetium-99m linked to methylene disphosphonate (99mTc-MDP).
Ans. D
Q 246. Heberden’s arthropathy affects:
A. Lumbar spine.
B. Symmetrically large joints.
C. Sacroiliac joints.
D. Distal interphalangeal joints.
Ans. D
Q 247. Subtrochanteric fractures of femur can be treated by all of the following methods except:
A. Skeletal traction on Thomas’ splint.
B. Smith Petersen nail.
C. Condylar blade plate.
D. Ender’s nail.
Ans. B
Q 248. All of the following are true about FRACTURE of the atlas vertebra, except:
A. Jefferson FRACTURE is the most common type.
B. Quadriplegia is seen in 80% cases.
C. Atlantooccipal fusion may sometimes be needed.
D. CT scans should be done for diagnosis.
Ans. D
Q 249. A 30-year-old man had road traffic accident and sustained FRACTURE of femur. Two days later he developed sudden breathlessness. The most probable cause can be:
A. Pneumonia.
B. Congestive heart failure.
C. Bronchial asthma.
D. Fat embolism.
Ans. D
Q 250. A 45-year-old was given steroids after renal transplant. After 2 years he had difficulty in walking and pain in both hips. Which one of the following is most likely cause?
A. Primary osteoarthritis.
B. Avascular necrosis.
C. Tuberculosis.
D. Aluminum toxicity.
Ans. B
Q 251. All of the following areas are commonly involved sites in pelvic FRACTURE except:
A. Pubic rami.
2. Alae of ileum.
3. Acetabula.
4. Ischial tuberosities.
Ans. D
Anaesthesia
Q 252. The laryngeal mask airway used for securing the airway of a patient in all of the following conditions except:
A. In a difficult intubation.
B. In a cardiopulmonary resuscitation.
C. In a child undergoing an elective/routine eye Surgery .
D. In a patient with a large tumor in the oral cavity.
Ans. D

Q 253. The following are used for treatment of postoperative nausea and vomiting following squint Surgery in children except:
A. Ketamine.
B. Ondansetron.
C. Propofol.
D. Dexamethasone.
Ans. A
Q 254. Which one of the following anaesthetic agents causes a rise in the intracranial pressure:
A. Sevoflurane.
B. Thiopentone sodium.
C. Lignocaine.
D. Propofol.
Ans. A
Q 255. The following modes of ventilation may be used for weaning off patients from mechanical ventilation except:
A. Controlled Mechanical ventilation (CMV).
B. Synchronized intermittent mandatory ventilation (SIMV).
C. Pressure support ventilation (PSV).
D. Assist-control ventilation (ACV).
Ans. A
Q 256. A lower segment caesarean section (LSCS) can be carried out under all the following techniques Anaesthesia except:
A. General Anaesthesia .
B. Spinal Anaesthesia .
C. Caudal Anaesthesia .
D. Combined spinal epidural.
Ans. C
Q 257. The most appropriate circuit for ventilating a spontaneonsly breathing infant during Anaesthesia is:
A. Jackson Rees modification of Ayres T piece.
B. Mapleson A or Magill’s circuit.
C. Mapleson C or Waters to and fro canister.
D. Bains circuit.
Ans. A
Q 258. All of the following are the disadvantages of anesthetic ether, except:
A. Induction is slow.
B. Irritant nature of ether increases salivary and bronchila secretions.
C. Cautery can not be used.
D. Affects blood pressure and is liable to produce arrhythmias.
Ans. D
Q 259. Which one of the following is the fastest acting inhalational agent?
A. Halothane.
B. Isoflurane.
C. Ether.
D. Sevoflurane.
Ans. D
Gynaecology AND OBSTETRICS
Q 260. Aspermia is the term used to describe:
A. Absence of semen.
B. Absence of sperm in ejaculate.
C. Absence of sperm motility.
D. Occurrence of abnormal sperm.
Ans. A
Q 261. Which of the following ultrasound marker is associated with greatest increased risk for trisomy 21 in fetus:
A. Echogenic foci in heart .
B. Hyperechogenic bowel.
C. Choroid plexus cysts.
D. Nuchal edema.
Ans. D
Q 262. The highest incidence of gestational trophoblastic disease is in:
A. Australia .
B. Asia.
C. North America.
D. Western Europe.
Ans. B
Q 263. The smallest diameter of the true pelvis is:
A. Interspinous diameter.
B. Diagonal conjugate.
C. True conjugate.
D. Intertuberous diameter.
Ans. A
Q 264. The most common pure germ cell tumor of the ovary is:
A. Choriocarcinoma.
B. Dysgerminoma.
C. Embryonal cell tumor.
D. Malignant teratoma.
Ans. B
Q 265. Infants of diabetic mother are likely to have the following cardiac anomaly:
A. Coarctation of aorta.
B. Fallot’s tetrology.
C. Ebstein’s anomaly.
D. Transposition of great arteries.
Ans. D
Q 266. Which one of the following is the ideal contraceptive for a patient with heart disease:
A. IUCD.
B. Depo-provera.
C. Diaphragm.
D. Oral contraceptive pills.
Ans. C
Q 267. The karyotype of a patient with androgen insensitivity syndrome is:
A. 46 XX.
B. 46 XY.
C. 47 XXY.
D. 45 XO.
Ans. B
Q 268. The following drug is not helpful in the treatment of ectopic pregnancy:
A. Methotrexate.
B. Misoprostol.
C. Actinomycin-D.
D. RU 486.
Ans. B
Q 269. The best period of gestation to carry out chorion villous biopsy for prenatal diagnosis is:
A. 8-10 weeks.
B. 10-12 weeks
C. 12-14 weeks.
D. 14-16 weeks.
Ans. B
Q 270. Which one of the follwing biochemical parameters is the most sensitive to detect open spina bifida?
A. Maternal serum alpha fetoprotein.
B. Amniotic fluid alpha fetoprotein.
C. Amniotic fluid acetyl cholinesterase.
D. Amniotic fluid glucohexaminase.
Ans. C
Q 271. Risk of preterm delivery is increased if cervical length is:
A. 2.5 cm.
B. 3.0 cm.
C. 3.5 cm.
D. 4.0 cm.
Ans. A
Q 272. All are the risk factors associated with macrosomia except:
A. Maternal obesity.
B. Prolonged pregnancy.
C. Previous large infant.
D. Short stature.
Ans. D
Q 273. Which of the following statements is incorrect in relation to pregnant women with epilepsy?
A. The rate of congenital malformation is increased in the offspring of women with epilepsy.
B. Seizure frequency increases in approximately 70% of women.
C. Breast feeding is safe with most anticonvulsants.
D. Folic acid supplementation may reduce the risk of neural tube defect.
Ans. B
Q 274. All are the causes of intrauterine growth retardation except:
A. Anemia.
B. Pregnancy induced hypertension.
C. Maternal heart disease.
D. Gestational diabetes.
Ans. D
Q 275. Misoprostal has been found to be effective in all of the following except:
A. Missed abortion.
B. Induction of labour.
C. Menorrhagia.
D. Prevention of post-partum hemorrhage (PPH).
Ans. C
Q 276. All of the following appear to decrease hot flushes in menopausal women except:
A. Androgens.
B. Raloxifene.
C. Isoflavones.
D. Tibolone.
Ans. B
Q 277. In a case of dysgerminoma of ovary one of the following tumor markers is likely to be raised:
A. Serum HCG.
B. Serum alphafetoprotein.
C. Serum lactic dehydrogenase.
D. Serum inhibin.
Ans. C
Q 278. Use of one of the following vaccination is absolutely contraindicated in pregnancy:
A. Hepatitis-B.
B. Cholera.
C. Rabies.
D. Yellow fever.
Ans. B/D
Q 279. The most common cause of secondary amenorrhoea in India is:
A. Endometrial tuberculosis.
B. Premature ovarian failure.
C. Polycystic ovarian syndrome.
D. Sheehan’s syndrome.
Ans. A
Ophthalmology
Q 280. In von Hippel-Lindau syndrome, the retinal vascular tumours are often associated with intracranial hemangioblastoma. Which one of the following regions is associated with such vascular abnormalities in this syndrome?
A. Optic radiation.
B. Optic tract.
C. Cerebellum.
D. Pulvinar.
Ans. C
Q 281. An 18 year old boy comes to the eye casualty with history of injury with a tennis ball. On examination there is no perforation but there is hyphaema. The most likely source of the blood is
A. Iris vessels.
B. Circulus iridis major.
C. Circulus iridis minor.
D. Short posterior ciliary vessels.
Ans. A
Q 282. A 25 year old male gives history of sudden painless loss of vision in one eye for the past 2 weeks. There is no history of trauma. On examination the anterior segment is normal but there is no fundal glow. Which one of the following is the most likely cause?
A. Vitreous haemorrhage.
B. Optic atrophy.
C. Developmental cataract.
D. Acute attack of angle closure glaucoma.
Ans. A
Q 283. The mother of a one and a half year old child gives history of a white reflex from one eye for the past 1 month. On computed tomography scan of the orbit there is calcification seen within the globe. The most likely diagnosis is:
A. Congenital cataract.
B. Retinoblastaoma.
C. Endophthalmitis.
D. Coats’ disease.
Ans. B
Q 284. Enlarged corneal nerves may be seen in all of the following except:
A. Keratoconus.
B. Herpes simplex keratitis.
C. Leprosy.
D. Neurofibromatosis.
Ans. B Q 285. Under the WHO ‘Vision 2020’ programme, the ‘SAFE’ strategy is adopted for which of the following

fmge 2004

2008-12-18T09:25:00.000-08:00

ALL INDIA
PAPER 2004
SOLVED
QUESTIONS AND ANSWERS

Anatomy
Q 1. False statement regarding pudendal nerve is:
A. Both sensory and motor
B. Derived from S2,3,4 spinal nerve roots
C. Leaves pelvis through the lesser sciatic foramen
D. It is the only somatic nerve to innervate the pelvic organs
Ans. C
Q 2. Wrong statement regarding the coronary artery is:
A. Left coronary artery is present in anterior interventricular groove
B. Usually 3 obtuse marginal arteries arise from left coronary artery
C. Posterior interventricular artery arises from right coronary artery
D. Left atrial artery is a branch of left coronary artery
Ans. B
Q 3. All are true statements regarding inguinal canal except:
A. Roof is formed by conjoint tendon
B. Deep inguinal ring is formed by transversus abdominis
C. Superficial inguinal ring is formed by external oblique muscle
D. Internal oblique forms anterior and posterior wall
Ans. B
Q 4. Right gastroepiploic artery is a branch of:
A. Left gastric
B. Coeliac trunk
C. Splenic
D. Gastroduodenal
Ans. D
Q 5. In FRACTURE of middle cranial fossa, absence of tears is due to lesion in the:
A. Trigeminal ganglion
B. Ciliary ganglion
C. Lesser petrosal nerve
D. Greater petrosal nerve
Ans. D
Q 6. Motor supply to diaphragm is by:
A. Thoracodorsal nerve
B. Phrenic nerve
C. Intercostal nerves
D. Sympathetic nerves
Ans. B
Q 7. All of the following are supplied by facial nerve except:
A. Lacrimal gland
B. Submandibular gland
C. Nasal glands
D. Parotid gland
Ans. D
Q 8. In left coronary artery thrombosis, area most likely to be involved is:
A. Anterior wall of right ventricle
B. Anterior wall of left ventricle
C. Anterior wall of right atrium
D. Inferior surface of right ventricle
Ans. B
Physiology
Q 9. Tidal volume is calculated by:
A. Inspiratory capacity minus the inspiratory reserve volume
B. Total lung capacity minus the residual volume
C. Functional residual capacity minus residual volume
D. Vital capacity minus expiratory reserve volumes
Ans. A
Q 10. Surfactant production in lungs starts at:
A. 28 weeks
B. 32 weeks
C. 34 weeks
D. 36 weeks
Ans. A
Q 11. Initiation of nerve impulse occurs at the axon hillock because:
A. It has a lower threshold than the rest of the axon
B. It is unmyelinated
C. Neurotransmitter release occurs here
D. None of the above
Ans. A
Q 12. Albumin contributes the maximum to oncotic pressure because it has:
A. High molecular weight, low concentration
B. Low molecular weight, low concentration
C. High molecular weight, high concentration
D. Low molecular weight, high concentration
Ans. D

Q 13. After 5 days of fasting a man undergoes oral GTT, true is all except:
A. GH levels are increased
B. Increased glucose tolerance
C. Decreased insulin levels
D. Glucagon levels are increased
Ans. B
Q 14. Metalloproteins help in jaundice by the following mechanism:
A. Increased glucoronyl transferase activity
B. Inhibit heme oxygenase
C. Decrease RBC lysis
D. Increase Y and Z receptors
Ans. B
Q 15. Which protein prevents contraction by covering binding sites on actin and myosin:
A. Troponin
B. Calmodulin
C. Thymosin
D. Tropomyosin
Ans. D
Q 16. Which of the following is not correct regarding capillaries:
A. Greatest cross sectional area
B. Contain 25% of blood
C. Contains less blood than veins
D. Have single layer of cells bounding the lumen
Ans. B
Q 17. A 0.5 litre blood loss in 30 minutes will lead to:
A. Increase in HR, decrease in BP
B. Slight increase in HR, normal BP
C. Decrease in HR and BP
D. Prominent increase in HR
Ans. B
Q 18. Single most important factor in control of automatic contractility of heart is:
A. Myocardial wall thickness
B. Right atrial volume
C. SA node pacemaker potential
D. Sympathetic stimulation
Ans. D
Q 19. Which of the following is not mediated through negative FEEDBACK mechanism:
A. TSH release
B. GH formation
C. Thrombin formation
D. ACTH release
Ans. C
Q 20. Force generating proteins are:
A. Myosin and myoglobin
B. Dynein and kinesin
C. Calmodulin and G protein
D. Troponin
Ans. B
Q 21. Which is true about measurement of BP with sphygmomanometer versus intraarterial pressure measurements:
A. Less than intravascular pressure
B. More than intravascular pressure
C. Equal to intravascular pressure
D. Depends upon blood flow
Ans. B
Q 22. Secondary hyperparathyroidism due to vitamin D deficiency shows:
A. Hypocalcemia
B. Hypercalcemia
C. Hypophosphatemia
D. Hyperphosphatemia
Ans. C
Q 23. Maximum absorption of water takes place in:
A. Proximal convoluted tubule
B. Distal convoluted tubule
C. Collecting duct
D. Loop of Henle
Ans. A
Biochemistry
Q 24. Basic amino acids are:
A. Aspartate and glutamate
B. Serine and glycine
C. Lysine and arginine
D. None of the above
Ans. C
Q 25. Amino acid with dissociation constant closest to physiological pH is:
A. Serine
B. Histidine
C. Threonine
D. Proline
Ans. B
Q 26. Sources of the nitrogen in urea cycle are:
A. Aspartate and ammonia
B. glutamate and ammonia
C. Arginine and ammonia
D. Uric acid
Ans. A
Q 27. If urine sample darkens on standing: the most likely condition is:
A. Phenylketonuria
B. Alkaptonuria
C. Maple syrup disease
D. Tyrosinemia
Ans. B
Q 28. A baby presents with refusal to feed, SKIN lesions, seizures, ketosis organic acids in urine with normal ammonia; likely diagnosis is:
A. Propionic aciduria
B. Multiple carboxylase deficiency
C. Maple syrup urine disease
D. Urea cycle enzyme deficiency
Ans. B
Q 29. Force not acting in an enzyme substrate complex:
A. Electrostatic
B. Covalent
C. Van der Wall
D. Hydrogen
Ans. C
Q 30. Cellular oxidation is inhibited by:
A. Cyanide
B. Carbon dioxide
C. Chocolate
D. Carbonated beverages
Ans. A
Q 31. Triple bonds are found between which base pairs:
A. A-T
B. C-G
C. A-G
D. C-T
Ans. B
Q 32. Which of the following RNA has abnormal purine bases:
A. tRNA
B. mRNA
C. rRNA
D. 16SRNA
Ans. A
Q 33. False regarding gout is:
A. Due to increased metabolism of pyrimidines
B. Due to increased metabolism of purines
C. Uric acid levels may not be elevated
D. Has a predilection for the great toe
Ans. A
Q 34. All of the following statements are true regarding lipoproteins except:
A. VLDL transports endogenous lipids
B. LDL transports lipids to the tissues.
C. Increased blood cholesterol is associated with increased LDL receptors
D. Increased HDL is associated with decreased risk of coronary disease
Ans. C
Q 35. A destitute woman is admitted to the hospital with altered sensorium and dehydration; urine analysis shows mild proteinuria and no sugar; what other test would be desirable:
A. Fouchet
B. Rothera
C. Hays
D. Benedict’s
Ans. B
Q 36. Which of these fatty acids is found exclusively in breast milk:
A. Linolaete
B. Linolenic
C. Palmitic
D. d-hexanoic
Ans. A
Q 37. Blood is not a newtonian fluid because:
A. Viscosity does not changing with velocity
B. Viscosity changes with velocity
C. Density does not change with velocity
D. Density changes with velocity
Ans. B
Microbiology
Q 38. Regarding NK cells, false statement is:
A. It is activated by IL-2
B. Expresses CD 3 receptor
C. It is a variant of large lymphocyte
D. There is antibody induced proliferation of NK cells
Ans. D
Q 39. Adenosine deaminase deficiency is seen in the following:
A. Common variable immunodeficiency.
B. Severe combined immunodeficiency
C. Chronic granulomatous disease
D. Nezelof syndrome
Ans. B
Q 40. A beta hemolytic bacteria is resistant to vancomycin, shows growth in 6.5% NaCI, is non-bile sensitive. It is likely to be:
A. Strep. agalactiae
B. Strep. pneumoniae
C. Enterococcus
D. Strep. bovis
Ans. C
Q 41. False statement about the streptococcus is:
A. M protein is responsible for production of mucoid colonies
B. M protein is the major surface protein of group A streptococci
C. Mucoid colonies are virulent
D. Endotoxin causes rash of scarlet fever
Ans. A
Q 42. Toxin involved in the streptococcal toxic shock syndrome is:
A. Pyrogenic toxin
B. Erythrogenic toxin
C. Hemolysin
D. Neurotoxin
Ans. A
Q 43. A child presents with a white patch over the tonsils; diagnosis is best made by culture in:
A. Loeffler medium
B. LJ medium
C. Blood agar
D. Tellurite medium
Ans. A
Q 44. A patient with 14 days of fever is suspected of having typhoid. What investigation should be done:
A. Blood culture
B. Widal test
C. Stool culture
D. Urine culture
Ans. B
Q 45. All are true about EHEC except:
A. Sereny test is positive
B. Fails to ferment sorbitol
C. Causes HUS
D. Elaborates shiga like exotoxin
Ans. A
Q 46. An organism grown on agar shows green coloured colonies, likely organism is:
A. Staphylococcus
B. E. coli
C. Pseudomonas
D. Peptostreptococcus
Ans. C
Q 47. Congenital syphilis can be best diagnosed by:
A. IgM FTAbs
B. IgG FTAbs
C. VDRL
D. TPI
Ans. A
Q 48. All are features of Ureaplasma urealyticum except:
A. Non gonococcal urethritis
B. Salpingitis
C. Epididymitis
D. Bacterial vaginosis
Ans. D
Q 49. Regarding HIV infection, not true is:
A. p24 is used for early diagnosis
B. Lysis of infected CD 4 cells is seen
C. Dendritic cells do not support replication
D. Macrophage is a reservoir for the virus
Ans. C
Q 50. A pregnant woman from Bihar presents with hepatic encephalopathy. The likely diagnosis:
A. Hepatitis E
B. Hepatitis B
C. Sepsis
D. Acute fatty liver of pregnancy
Ans. A
Q 51. Virus causing hemorrhagic cystitis, diarrhea and conjunctivitis is:
A. RSV
B. Rhinovirus
C. Adenovirus
D. Rotavirus
Ans. C
Q 52. Cystine lactose enzyme deficient (CLED) medium is preferred over McConkey agar in UTI because:
A. Former prevents swarming of proteus
B. Is a selective medium
C. Prevents growth of pseudomonas
D. Promotes growth of candida
Ans. A
Q 53. In which stage of filariasis are microfilaria seen in peripheral blood:
A. Tropical eosinophilia
B. Early adenolymphangitis stage
C. Late adenolymphangitis stage
D. Elephantiasis
Ans. B
Q 54. Pancreatic CA is caused by:
A. Fasciola
B. Clonorchis
C. Paragonimus
D. None
Ans. B
Q 55. All of the following are true except:
A. E.coli is an aerobe and facultative anaerobe
B. Proteus forms uric acid stones
C. E. coli is motile by peritrichate flagella
D. Proteus causes deamination of phenylalanine to phenylpyruvic acid
Ans. B
Q 56. Consumption of uncooked pork is likely to cause which of the following helminthic disease:
A. Tinea saginata
B. Tinea solium
C. Hydatid cyst
D. Trichuris trichura
Ans. B
Pathology
Q 57. Enzyme that protects the brain from free radical injury is:
A. Myeloperoxidase
B. Superoxide dismutase
C. MAO
D. Hydroxylase
Ans. B
Q 58. Autoimmune haemolytic anemia is seen in:
A. ALL B. AML
C. CLL D. CML
Ans. C
Q 59. All of following are correct about thromboxane A2 except:
A. Low dose aspirin inhibits its synthesis
B. Causes vasoconstriction in blood vessels
C. Causes broncoconstriction
D. Secreted by WBC
Ans. D
Q 60. Which of the following complications is likely to result after several units of blood have been transfused:
A. Metabolic alkalosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Respiratory acidosis
Ans. A
Q 61. The mother has sickle cell disease and father is normal. Chances of children having sickle cell disease and sickle cell trait respectively are:
A. 0 and 100%
B. 25 and 25%
C. 50 and 50%
D. 10 and 50%
Ans. A
Q 62. Father has a blood group B, mother has AB; children are not likely to have the following blood group:
A. O
B. A
C. B
D. AB
Ans. A
Q 63. Protein involved in intercellular connections is:
A. Connexin
B. Integrin
C. Adhesin
D. None of the above
Ans. A

Pharmacology
Q 64. All are reasons for reducing drug dosage in elderly except:
A. They are lean and their body mass is less
B. Have decreasing renal function with age
C. Have increased baroceptor sensitivity
D. Body water is decreased
Ans. C
Q 65. True statement regarding inverse agonists is:
A. Binds to receptor and causes intended action
B. Binds to receptor and causes opposite action
C. Binds to receptor and causes no action
D. Binds to receptor and causes submaximal action
Ans. B
Q 66. True statement regarding first order kinetics is:
A. Independent of plasma concentration
B. A constant proportion of plasma concentration is eliminated
C. T½ increases with dose
D. Clearance decreases with dose
Ans. B
Q 67. A diabetic female on INH and rifampicin for TB suffers DVT. She is started on warfarin. PT is not raised. Next step should be:
A. Long term heparin therapy
B. Replace warfarin with acecoumarin
C. Switch ethambutol for rifampin
D. Use LMW heparin
Ans. C
Q 68. Beta blocker that can be used in renal failure is:
A. Propranolol
B. Pindolol
C. Sotalol
D. Nadolol
Ans. A
Q 69. All of the following are correct about steroids except:
A. Inhibit the release of arachidonic acid from vessel wall through action of phospholipase A2
B. Bind plasma membrane receptors and following internalization influence nuclear changes
C. Inhibit vascular membrane permeability
D. Increase glucose synthesis, glycogen deposition in liver
Ans. B
Q 70. All of the following statements are true except:
A. PGs and leukotrienes are derived from arachidonic acid
B. COX I is an inducible enzyme
C. COX II is induced by cytokines at sites of inflammation.
D. Leukotrienes cause smooth muscle constriction
Ans. B
Q 71. Which of the following is a false statement:
A. IV noradrenaline increases systolic and diastolic BP and cause tachycardia
B. IV adrenaline increases systolic BP, no change or increase diastolic BP and causes tachycardia
C. IV isoproterenol causes increase in systolic BP, decreases diastolic BP and causes tachycardia
D. Dopamine improves renal function, increases cardiac output and systolic BP
Ans. A
Q 72. Digoxin is not indicated in:
A. Atrial flutter
B. Atrial fibrillation
C. High output failure
D. PSVT
Ans. C
Q 73. All of the following statements are true about theophylline except:
A. Increase in dose is required in cardiopulmonary disease
B. Increases cAMP
C. Increase in dose is required in smokers
D. Inhibits phosphodiesterase
Ans. A
Q 74. Mechanism of action of tetracycline is:
A. Binds to A site and inhibit attachment of t-RNA.
B. Inhibits peptidyl transferase
C. Causes misreading of mRNA
D. Causes termination of peptide chain elongation
Ans. A
Q 75. False statement about selegeline is:
A. It is a MAO-A inhibitor
B. Does not cause cheese reaction
C. Not useful in advanced cases of on-off phenomenon
D. It is used in parkinsonism
Ans. A
Q 76. A patient on phenytoin for treatment of seizures develops depression for which he is prescribed tricyclics. He now complains of lassitude and his Hb reads 8. Next step in managing this patient should be:
A. Chest X-ray
B. MCV should be estimated
C. GGT should be estimated
D. Bone marrow examination
Ans. B
Q 77. Which of the following drugs would be removed by dialysis?
A. Digoxin
B. Salicylates
C. Benzodiazepines
D. Organophosphates
Ans. B
Q 78. In low doses aspirin acts on:
A. Cyclooxygenase
B. Thromboxane A2
C. PGI2
D. Lipoxygenase
Ans. B
Q 79. True statement about ticlopidine is:
A. Directly interacts with platelet membrane
B. Onset of action is delayed
C. Inhibits platelet gp IIb/IIIa receptors
D. Has fibrinolytic activity
Ans. A
Q 80. All of the following statements about methotrexate are true except:
A. Folinic acid enhances the action of methotrexate
B. Methotrexate inhibit dehydrofolate reductase
C. Non proliferative cells are resistant to metho- trexate
D. Methotrexate is used in treatment of PSORIASIS
Ans. A
Q 81. Drug containing two sulfhydryl groups in a molecule:
A. BAL
B. EDTA
C. Pencillamine
D. Desferioxamine
Ans. A
Forensic Medicine
Q 82. Gettler’s test is done for death by:
A. Drowning B. Hanging
C. Bums D. Phophorus poisoning
Ans. A

Q 83. Feature indicative of antimortem drowning is:
A. Cutis anserina
B. Rigor mortis
C. Washer woman’s feet
D. Grass and weeds grasped in the hand
Ans. D
Q 84. A boy has 20 permanent teeth and 8 temporary teeth. His age is likely to be:
A. 9 years
B. 10 years
C. 11 years
D. 12 years
Ans. C
Q 85. A patient has sensation of bugs crawling all over his body. This may be effect of:
A. Cocaine
B. Alcohol
C. Cannabis
D. Benzodiazepines
Ans. A
Q 86. A person comes in contact with other. This is called:
A. Locard principle
B. Quetlet’s rule
C. Petty’s principle
D. None of the above
Ans. A
Q 87. A patient of head injury, has no relatives and requires urgent cranial decompression; Doctor should:
A. Operate without formal consent
B. Take police consent
C. Wait for relatives to take consent
D. Take magistrate consent
Ans. A
Q 88. A boy attempts suicide. He is brought to a private doctor and he is successfully cured. Doctor should:
A. Inform police
B. Not required to inform police
C. Report to magistrate
D. Refer to a psychiatrist
Ans. B
PREVENTIVE AND SOCIAL Medicine
Q 89. All are true about DOTS except:
A. Continuation phase drugs are given in a multi- blister combipack
B. Medication is to be taken in presence of a health worker
C. Alternate day treatment
D. Improves compliance
Ans. C
Q 90. Basanti a 29 years aged female from Bihar presents with active tuberculosis. She delivers baby. All of the following are indicated except:
A. Administer INH to the baby
B. Withhold breastfeeding
C. Give ATT to mother for 2 years
D. Ask mother to ensure proper disposal of sputum
Ans. B
Q 91. Under the national TB programme, for a PHC to be called a PHC-R, requisite is:
A. Microscopy
B. Microscopy plus Radiology
C. Radiology
D. None of the above
Ans. B
Q 92. A person has received complete immunization against tetanus 10 years ago, now he presents with a clean wound without any lacerations from an injury sustained 3 hours ago. He should now be given:
A. Full course of tetanus toxoid
B. Single dose of tetanus toxoid
C. Human tetanus globulin
D. Human tetanus globulin and single dose of toxoid
Ans. B
Q 93. The false statement regarding tetanus is:
A. Five doses of immunisation provide life long immunity
B. TT affords no protection in the present injury
C. TIG is useful in lacerated wound
D. TT and Ig both may be given in suspected tetanus
Ans. A
Q 94. A certain community has 100 children out of whom 28 are immunised against measles. 2 of them acquired measles simultaneously. Subsequently 14 get measles. Assuming the efficacy of the vaccine to be 100%. What is the secondary attack rate?
A. 5%
B. 10%
C. 20%
D. 21.5%
Ans. C
Q 95. A community has a population of 10,000 and a birth rate of 36 per 1000. 5 maternal deaths were reported in the current year. The MMR is:
A. 14.5
B. 13.8
C. 20
D. 5
Ans. B
Q 96. 10 babies are born in a hospital on same day. All weigh 2.8 kg each. Calculate the standard deviation:
A. Zero
B. One
C. Minus one
D. 0.28
Ans. A
Q 97. Out of 11 births in a hospital, 5 babies weighed over 2.5 kg and 5 weighed less than 2.5 kg. What value does 2.5 represent:
A. Geometric average
B. Arithmetic average
C. Median
D. Mode
Ans. C
Q 98. A man weighing 68 kg, consumes 325 gm carbohydrate, 65 gm protein and 35 gms fat in his diet. The most applicable statement here is:
A. His total calorie intake is 3000 kcal
B. The proportion of proteins, fats and carbohydrates is correct and in accordance with a balanced diet
C. He has a negative nitrogen balance
D. 30% of his total energy intake is derived from fat
Ans. B
Q 99. A country has a population of 1000 million; birth rate is 23 and death rate is 6. In which phase of the demographic cycle does this country lie:
A. Early expanding
B. Late expanding
C. Plateau
D. Declining
Ans. B
Q 100. In a population of 10,000, beta carotene was given to 6000; it was not given to the remainder. 3 out of the first group got lung cancer while 2 out of the other 4000 also got lung cancer. The best conclusion is:
A. Beta carotene and lung cancer have no relation to one another
B. The p value is not significant
C. The study is not designed properly
D. Beta carotene is associated with lung cancer
Ans. A
Q 101. A subcentre in a hilly area caters to a population of:
A. 1000
B. 2000
C. 3000
D. 5000
Ans. C
Q 102. In a community, an increase in new cases denotes:
A. Increase in incidence rate
B. Increase in prevalence rate
C. Decrease in incidence rate
D. Decrease in prevalence rate
Ans. A
Q 103. More false positive cases on screening in a community signify that the disease has:
A. High prevalence
B. High sensitivity
C. Low prevalence
D. Low sensitivity
Ans. C
Q 104. The same screening test is applied to two communities X and Y; Y shows more false +ve cases as compared to X. The possibility is:
A. High sensitivity
B. High specificity
C. Y community has high prevalence
D. Y community has low prevalence
Ans. C
Q 105. ELISA is performed on a population with low prevalence of hepatitis B. What would be the result of performing double screening ELISA tests?
A. Increased sensitivity and positive predictive value
B. Increased sensitivity and negative predictive value
C. Increased specificity and positive predictive value
D. Increased specificity and negative predictive value
Ans. C
Q 106. While testing a hypolipidemic drug, serum lipid levels were tested both before and after its use. Which test is best suited for the statistical analysis of the result:
A. Paired t-test
B. Student’s test
C. Chi square test
D. None of the above
Ans. A
Q 107. Type 1 sampling error is classified as:
A. Alpha error
B. Beta error
C. Gamma error
D. Delta error
Ans. A
Q 108. Virulence of a disease is indicated by:
A. Proportional mortality rate
B. Specific mortality rate
C. Case fatality ratio
D. Amount of GDP spent on control of disease
Ans. C
Q 109. Which of the following diseases needs not to be screened for in workers to be employed in a dye industry in Gujarat ?
A. Anemia
B. Bronchial asthma
C. Bladder cancer
D. Precancerous lesion
Ans. A
Q 110. Best test to detect iron deficiency in community is:
A. Serum transferrin
B. Serum ferritin
C. Serum iron
D. Hemoglobin
Ans. B
Q 111. Which of the following is not a complete sterilization agent:
A. Glutaraldehyde
B. Absolute alcohol
C. Hydrogen peroxide
D. Sodium hypochlorite
Ans. B
Q 112. Seasonal trend is due to:
A. Vector variation
B. Environmental factors
C. Change in herd immunity
D. All of the above
Ans. B
Medicine
Q 113. False statement about type I respiratory failure is:
A. Decreased PaO2
B. Decreased PaCO2
C. Normal PaCO2
D. Normal A-a gradient
Ans. D
Q 114. A 60 years old man presents with nonproductive cough for 4 weeks. He has grade III clubbing, and a lesion in the apical lobe on X-ray. Most likely diagnosis here is:
A. Small cell CA
B. Non-small cell CA
C. Fungal infection
D. Tuberculosis
Ans. B
Q 115. A 60 years old man is suspected of having bronchogenic CA. TB has been ruled out in this patient. What should be the next investigation:
A. CT guided FNAC
B. Bronchoscopy and biopsy
C. Sputum cytology
D. X-ray chest
Ans. B
Q 116. A man presents with fever, weight loss and cough. Mantoux reads an induration of 17 × 19 mm; sputum cytology is negative for AFB. Most likely diagnosis is:
A. Pulmonary tuberculosis
B. Fungal infection
C. Viral infection
D. Pneumonia
Ans. A
Q 117. Pulmonary edema associated with normal PCWP is observed, which of these is not a cause:
A. High altitude
B. Cocaine overdose
C. Post cardiopulmonary bypass
D. Bilateral renal artery stenosis
Ans. D
Q 118. An ABG analysis shows: pH 7.2, raised pCO2, decreased HCO3. Diagnosis is:
A. Respiratory acidosis
B. Compensated metabolic acidosis
C. Respiratory and metabolic acidosis
D. Respiratory alkalosis
Ans. C
Q 119. ABG analysis of a patient on ventilator shows decreased pCO2, normal pO2, pH 7.5. Diagnosis is:
A. Respiratory acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Metabolic acidosis
Ans. C
Q 120. In a patient of acute inferior wall MI. Best modality of treatment is:
A. IV fluids
B. Digoxin
C. Diuretics
D. Vasodilators
Ans. A
Q 121. A 26 years old asymptomatic woman is found to have arrhythmias and a systolic murmur associated with midsystolic ? . Which investigation would you use:
A. Electrophysiological testing
B. CT scan
C. Echocardiography
D. Angiography
Ans. C
Q 122. A patient complains of intermittent claudication, dizziness and headache. Most likely cardiac lesion is:
A. TOF
B. ASD
C. PDA
D. Coarctation of aorta
Ans. D
Q 123. All of the following are true about ASD except:
A. Right atrial hypertrophy
B. Left atrial hypertrophy
C. Right ventricular hypertrophy
D. Pulmonary hypertension
Ans. B
Q 124. Mitral valve vegetations do not usually embolise to:
A. Lung
B. liver
C. spleen
D. brain
Ans. A
Q 125. A woman has septic abortion done, vegetation on tricuspid valve is likely to go to:
A. Septic infarcts to lung
B. liver
C. spleen infarcts
D. Emboli to brain
Ans. A
Q 126. Kussmaul’s sign is not seen in:
A. Restrictive cardiomyopathy
B. Constrictive pericarditis
C. Cardiac tamponade
D. RV infarct
Ans. C
Q 127. A patient presents with engorged neck veins, BP 80/50 mmHg and pulse rate of 100/min following blunt trauma to the chest. Diagnosis is:
A. Pneumothorax
B. Right ventricular failure
C. Cardiac tamponade
D. Hemothorax
Ans. C
Q 128. Which of the following is not seen on hemoglobin electrophoresis in sickle cell anemia:
A. HbA
B. HbA2
C. HbF
D. HbS
Ans. A
Q 129. False statement regarding DIC is:
A. Thrombocytopenia
B. Decreased fibrinogen
C. Decreased PTT
D. Increased PT
Ans. C
Q 130. Thrombocytopenia occurs in all except:
A. Henoch Schonlein purpura
B. TTP
C. DIC
D. Leukemia
Ans. A
Q 131. A patient with an Hb of 6 g%, WBC count of 2000/cmm, has a normal different count except for having 6% blasts, platelets are reduced to 80,000/cmm; moderate splenomegaly is present. Possible diagnosis is:
A. Leukemia
B. Aplastic anemia
C. HEMOLYSIS
D. lTP
Ans. A
Q 132. A patient being investigated for anemia has a dry marrow tap; peripheral smear reveals tear drop cells. Most likely diagnosis is:
A. Leukemia
B. Lymphoma
C. Myelofibrosis
D. Polycythemia rubra vera
Ans. C
Q 133. Tumor associated with polycythemia vera is:
A. Sarcoma
B. Pituitary adenoma
C. Cerebellar haemangioblastoma
D. None of the above
Ans. C
Q 134. A young patient presents with jaundice. Total bilirubin is 21 mg%, direct is 9.6 mg%, alkaline phosphatase is 84 KA units. Diagnosis is:
A. Hemolytic jaundice
B. Viral hepatitis
C. Chronic active hepatitis
D. Obstructive jaundice
Ans. D
Q 135. A young male with gallbladder stones shows the following test results: serum bilirubin 2.5 mg%, Hb 6 g%, urine test positive for urobilinogen. Diagnosis is:
A. Hemolytic jaundice
B. Obstructive jaundice
C. Hepatocellular jaundice
D. Protoporphyria
Ans. A
Q 136. An 18 years old male presents with massive hematemesis. He has history of fever for the past 14 days for which he was managed with drugs. Moderate splenomegaly is present. Diagnosis is:
A. NSAID induced duodenal ulcer
B. Drug induced gastritis
C. Esophageal varices
D. None of the above
Ans. C
Q 137. Urinalysis shows RBC casts. Likely source is:
A. kidney
B. Ureter
C. Bladder
D. Urethra
Ans. A
Q 138. A young man develops gross hematuria 3 days after an attack of URTI. Most likely renal Pathology is:
A. Acute glomerulonephritis
B. Minimal change disease
C. IgA nephropathy
D. Membranous glomerulonephritis
Ans. C
Q 139. A patient’s CSF report reads as follows: sugar 40 mg%, protein 150 mg%, chloride 550 mg%; lymphocytosis present. The picture is suggestive of:
A. Fungal meningitis
B. Viral meningitis
C. TB meningitis
D. Leukemia
Ans. C
Q 140. Lacunar infarcts are caused by:
A. Lipohyalinosis of penetrating arteries
B. Middle carotid artery involvement
C. Emboli to anterior circulation
D. None of the above
Ans. A
Q 141. Dinesh, a 56 years aged man presents with complaints of slowness of movements, postural instability, tremors, rigidity and memory loss. Most likely diagnosis is:
A. Multi-infarct dementia
B. Alzheimer’s disease
C. Parkinsonism
D. None of the above
Ans. C
Q 142. All of the following may be seen in Wilson’s disease except:
A. Cerebellar ataxia
B. Peripheral neuropathy
C. Dysphagia
D. Chorea
Ans. B
Q 143. An elderly man presents with features of dementia, ataxia, difficulty in downward gaze and a history of frequent falls. Likely diagnosis is:
A. Parkinson disease
B. Progressive supranuclear gaze palsy
C. Alzheimer’s disease
D. None of the above.
Ans. B
Q 144. A chromosomal anomaly associated with Alzheimer’s dementia is:
A. Trisomy 18
B. Patau syndrome
C. Trisomy 21
D. Turner syndrome
Ans. C
Q 145. All are true about Huntington’s disease, except:
A. Chorea
B. Depression, apathy
C. Progressive dementia
D. Cog-wheel rigidity
Ans. D
Q 146. A 30-year-old male complains of loss of erection; he has low testosterone and high prolactin level in blood. What is the likely diagnosis:
A. Pituitary adenoma
B. Testicular failure
C. Craniopharyngioma
D. Cushing’s syndrome
Ans. A
Q 147. A patient meets with an accident with resultant transection of the pituitary stalk. What will not occur:
A. Diabetes mellitus
B. Diabetes insipidus
C. Hyperprolactinemia
D. Hypothyroidism
Ans. A
Q 148. A woman has bilateral headache that worsens with emotional stress. She has two children, both doing badly in school. Diagnosis is:
A. Migraine
B. Cluster headache
C. Tension headache
D. Trigeminal neuralgia
Ans. C
Q 149. A female aged 30 years, presents with episodic throbbing headache for past 4 years with nausea and vomiting. Most likely diagnosis is:
A. Migraine
B. Cluster headache
C. Angle closure glaucoma
D. Temporal arteritis
Ans. A
Q 150. A woman complains of headache associated with paresthesias of the right upper and lower limb. Most likely diagnosis is:
A. Trigeminal neuralgia
B. Glossopharyngeal neuralgia
C. Migraine
D. Cluster headache
Ans. C
Q 151. All of the following are features of MEN IIa, except:
A. Pituitary tumor
B. Pheochromocytoma
C. Medullary CA thyroid
D. Parathyroid adenoma
Ans. A
Q 152. A patient with Cushingoid features presents with hemoptysis. He shows no response to dexamethasone suppression test. Most likely diagnosis is:
A. Adrenal hyperplasia
B. Adrenal adenoma
C. CA lung with ectopic ACTH production
D. Pituitary microadenoma
Ans. C
Q 153. An obese patient presented in casualty in an unconscious state. His blood sugar measured 400 mg%, urine tested positive for sugar and ketones. Drug most useful in management is:
A. Glibenclamide
B. Troglitazone
C. Insulin
D. Chlorpropamide
Ans. C
Q 154. Which of the following is not associated with thymoma:
A. Red cell aplasia
B. Myasthenia gravis
C. Hypergammaglobulinemia
D. Compression of the superior mediastinum
Ans. C
Q 155. A young basketball player with height 188 cm and arm span 197 cm has a diastolic murmur best heard in second right intercostal space. Likely cause of murmur is:
A. AS
B. Coarctation of aorta
C. AR
D. MR
Ans. C
Q 156. A patient presents with arthritis, hyperpigmen- tation of SKIN and hypogonadism. Likely diagnosis is:
A. Hemochromatosis
B. Ectopic ACTH secreting tumor of lung
C. Wilson’s disease
D. Rheumatoid arthrits
Ans. A
Q 157. In myasthenia gravis, correct statement regarding thymectomy is:
A. Should be done in all cases
B. Should be done in cases with ocular involvement only
C. Not required if controlled by medical management
D. Should be done only in cases that are associated with thymoma
Ans. A
Q 158. Most common fungal infection in febrile neutropenia is:
A. Aspergillus niger
B. Candida
C. Mucormycosis
D. Aspergillus fumigatus
Ans. B
Q 159. The following group of tests should be done to optimise graft uptake in bone marrow transplant:
A. Blood grouping
B. HLA matching
C. Culture for infection
D. All of the above
Ans. B
Q 160. True statement about neurocysticercosis is:
A. Seizures due to neurocysticercosis are resistant to antiepileptic drugs
B. Albendazole is superior to praziquantel in the treatment of above condition
C. Common presentation is 6th cranial nerve palsy and hemiparesis
D. Steroids are used in the management of hydrocephalus
Ans. B
Q 161. All of the following are true regarding a patient with acid peptic disease except:
A. Misoprostol is the drug of choice in patients on NSAIDs
B. DU is preventable by the use of single night-time H2 blockers
C. Omeprazole may help ulcers refractory to H2 blockers
D. Misoprostol is DOC in pregnant patients
Ans. D
Q 162. A man presents with mass at duodenojejunal flexure invading renal papillae. Histopathology reports it as lymphoma. True statement is:
A. II E stage
B. III E stage
C. IV E stage
D. Staging cannot be done until bone marrow examination is performed
Ans. C
Q 163. A 45 years male presents with hypertension. He has sudden abnormal flinging movements in right upper and lower limbs. Most likely site of hemorrahge is:
A. Substantia nigra
B. Caudate nuclei
C. Pons
D. Subthalamic nuclei
Ans. D
Q 164. True about haemophilia A are all except:
A. PTT increased
B. PT increased
C. Clotting time is increased
D. Serum levels of factor VIII are decreased
Ans. B
Q 165. IPPV can cause:
A. Barotrauma
B. Pleural effusion
C. Increased venous return
D. None of the above
Ans. A
Q 166. Characteristic finding in CT in a TB is:
A. Exudate seen in basal cistern
B. Hydrocephalus is non communicating
C. Calcification commonly seen in cerebellum
D. Ventriculitis is a common finding
Ans. A

Q 167. Vegetations on undersurface of AV valves are found in:
A. Acute rheumatic carditis
B. Limban Sack’s endocarditis
C. Non thrombotic bacterial endocarditis
D. Chronic rheumatic carditis
Ans. B
Q 168. Triage means:
A. Sorting out of cases on availability of medical resources and severity of patient’s condition
B. Patients are divided into 3 groups
C. Severely injured patients are attended first in military camps
D. None of the above
Ans. A
PEDIATRICS
Q 169. Which of the following is not true about atrial septal defect:
A. There is a defect in region of fossa ovalis
B. Blood flow from left atrium to right atrium
C. Increased blood flow through lungs lead to pulmonary plethora
D. There is splitting of first heart sound
Ans. D
Q 170. A neonate presents with jaundice and clay white stools. On liver biopsy giant cells are seen. Most likely diagnosis is:
A. Physiological jaundice
B. Neonatal hepatitis with extra biliary atresia
C. Neonatal hepatitis with physiological jaundice
D. Extra biliary atresia
Ans. B
Q 171. A newborn has dribbling after feeds. He has respiratory distress and froth at the mouth. Diagnosis is:
A. Tracheoesophageal fistula
B. Tetralogy of Fallot
C. Respiratory distress syndrome
D. None of the above
Ans. A
Q 172. Ramu, a 8-years-old boy presents with upper GI bleeding. On examination, he is found to have splenomegaly; there are no signs of ascites, or hepatomegaly; esophageal varices are found on UGIE. Most likely diagnosis is:
A. Budd Chiari syndrome
B. Non cirrhotic portal fibrosis
C. Cirrhosis
D. Veno-occlusive disease
Ans. B
Q 173. A 5-years-old child suffering from nephrotic syndrome is responding well to steroid therapy. What would be the most likely finding on light microscopy:
A. No finding
B. Basement membrane thickening
C. Hypercellular glomeruli
D. Fusion of foot processes
Ans. A
Q 174. Most common cause of urinary obstruction in a male infant is:
A. Anterior urethral valves
B. Posterior urethral valves
C. Stone
D. Stricture
Ans. B
Q 175. A 5-years-old child presents with a calculus of size 2 cm in the upper ureter. He also complains of haematuria. USG shows no further obstruction in the urinary tract. Treatment of choice for this patient would be:
A. Ureterolithotomy
B. Endoscopic removal
C. ESWL
D. Observation
Ans. C
Q 176. A patient presents with LVH and pulmonary complications. ECG shows left axis deviation. Most likely diagnosis is:
A. TOF
B. Tricuspid atresia
C. TAPVC
D. VSD
Ans. B
Q 177. Potts shunt is anastomosis of:
A. Right subclavian artery to right pulmonary artery
B. Descending aorta to left pulmonary artery
C. Left subclavian to left pulmonary artery
D. Ascending aorta to right pulmonary artery
Ans. B
Q 178. A neonate has recurrent attacks of abdominal pain, restless, irritability and diaphoresis on feeding. Cardiac auscultation reveals a nonspecific murmur. He is believed to be at risk for MI. Likely diagnosis is:
A. ASD
B. VSD
C. TOF
D. Anomalous coronary artery
Ans. D
Q 179. A child aged 2 years presents with nonspecific symptoms suggestive of anemia. On peripheral blood smear target cells are seen. He has hypochromic microcytic picture and Hb of 6 gm%. He also has ‘a positive family history’. Next investigation of choice is:
A. Hb electrophoresis
B. Coombs’ test
C. liver function tests
D. Osmotic fragility test
Ans. A
Q 180. Most common cause of meningitis in children between 6 months to 2 years of age is:
A. Pneumococcus
B. Staphylococcus
C. H. influenzae
D. E. coli
Ans. C
Q 181. A child presents with seborrheic dermatitis, lytic skull lesions, ear discharge and hepatosplenomegaly. Likely diagnosis is:
A. Leukemia
B. Lymphoma
C. Histiocytosis X
D. Multiple myeloma
Ans. C
Q 182. Which of the following is true regarding cretinism:
A. Short limbs compared to trunk
B. Proportionate shortening
C. Short limbs and short stature
D. Short limbs and long stature
Ans. C
Q 183. Manifestations of endemic cretinism include:
A. Deafness and facial nerve involvement
B. Blindness and hypothyroidism
C. Goitre and hypothyroidism
D. Multinodular goitre and mental retardation
Ans. A
Q 184. A 10 day old male pseudohermaphrodite child with 46 XY karyotype presents with BP of 110/80 mmHg. Most likely enzyme deficiency is:
A. 21 hydroxylase
B. 17 hydroxylase
C. 11 hydroxylase
D. 3-beta hydroxylase
Ans. B
Q 185. Treatment of Kawasaki disease in children is:
A. Oral steroids
B. IV steroids
C. IV Ig
D. Mycophenolate mefentil
Ans. C
Q 186. A neonate delivered at 32 weeks, is put on a ventilator. X-ray shows ‘white out lung’ and ABG reveals PO2 of 75. Ventilator settings are on, FIO2 of 70, and rate of 50/minute. Next step to be taken should be:
A. Increase rate to 60 per minute
B. Increase FIO2 to 80
C. Continue ventilation with the same settings
D. Weaning ventilator
Ans. C
Dermatology
Q 187. A man aged 50 years presents with, alopecia, boggy scalp swelling and easily pluckable hair. Next step in establishing the diagnosis would be:
A. KOH smear
B. Culture sensitivity
C. Biopsy
D. None of the above
Ans. A
Q 188. Most common organism causing tinea capitis is:
A. Trichophyton tonsurans
B. Microsporum
C. Epidermophyton
D. Candida albicans
Ans. A
Q 189. A young man aged 19 years develops a painless penile ulcer 9 days after sexual intercourse with a professional SEX worker. Most likely diagnosis is:
A. Chancroid
B. Herpes
C. Primary chancre
D. Traumatic ulcer
Ans. C
Q 190. An infant presents with itchy lesions over the groin and prepuce. All of the following are indicated in this patient except:
A. Bathe and apply scabicidal solution
B. Treatment should be extended to all family members
C. Dispose all clothes by burning
D. Start the patient on IV antibiotics
Ans. D
Q 191. A boy aged 8 years from Tamil Nadu presents with a white, non anesthetic, nonscaly, hypopigmented macule on his face. Most likely diagnosis is:
A. Pityriasis alba
B. Pityriasis versicolor
C. Indeterminate leprosy
D. Pure neuritic leprosy
Ans. C
Q 192. A 20 years old, male patient, from jaipur presents with an erythematous lesion on the cheek with central crusting. Most likely diagnosis is:
A. SLE
B. LUPUS vulgaris
C. Chillblains
D. Cutaneous leishmaniasis
Ans. D
Q 193. A 19 year old pregnant girl presents with light brown pigmentation over the malar eminences. Most likely diagnosis is:
A. Chloasma
B. SLE
C. Melasma
D. Melanoma
Ans. A
Q 194. A girl aged 19, presents with arthritis and a photosensitive rash on the cheek. Likely diagnosis is:
A. SLE
B. Chloasma
C. Stevens Johnson syndrome
D. Lyme’s disease
Ans. A
Psychiatry
Q 195. A patient with pneumonia for 5 days is admitted to the hospital. He suddenly ceases to recognize the doctor and staff, thinks that he is in jail and complains of scorpions attacking him. He is in altered sensorium. This condition is:
A. Acute delirium
B. Acute dementia
C. Acute schizophrenia
D. Acute paranoia
Ans. A
Q 196. A person missing from home, is found wandering purposefully. He is well groomed, and denies of having any amnesia. Most likely diagnosis is:
A. Dissociative fugue
B. Dissociative amnesia
C. Schizophrenia
D. Dementia
Ans. A
Q 197. Babu, a 40 years aged male complains of sudden onset palpitations and apprehension. He is sweating for the last 10 minutes and fears of impending death. Diagnosis is:
A. Hysteria
B. Cystic fibrosis
C. Panic attack
D. Generalized anxiety disorder
Ans. C
Q 198. A lady, while driving a car meets with an accident. She was admitted in an ICU for 6 months. After being discharged, she often gets up in night and feels terrified She is afraid to sit in a car again. The diagnosis is:
A. Panic disorder
B. Phobia
C. Conversion disorder
D. Post traumatic stress disorder
Ans. D
Q 199. A patient present with waxy flexibility, negativitism and rigidity. Diagnosis is:
A. Catatonic schizophrenia
B. Paranoid schizophrenia
C. Hebephrenic schizophrenia
D. Simple schizophrenia
Ans. A
Q 200. Chandu, age 32 presents with abdominal pain and vomiting. He also complains of some psychiatric symptoms and visual hallucinations. Most likely diagnosis is:
A. Intermittent porphyria
B. Hypothyroidism
C. Hyperthyroidism
D. Hysteria
Ans. A
Q 201. Basanti 27 years aged, female thinks her nose is ugly; her idea is fixed and not shared by anyone else. Whenever she goes out of home, she hides her face with a cloth. She visits a Surgeon. Next step would be:
A. Investigate and then operate
B. Refer to psychiatrist
C. Reassure the patient
D. Immediate operation
Ans. B
Surgery
Q 202. A male aged 60 years has foul breath. He regurgitates food that is eaten 3 days ago. Likely diagnosis is:
A. Zenker’s diverticulum
B. Meckel’s diverticulum
C. Scleroderma
D. Achalasia cardia
Ans. A
Q 203. Most common site for squamous cell carcinoma esophagus is:
A. Upper third
B. Middle third
C. Lower third
D. Gastro-esophageal junction.
Ans. B
Q 204. What is true regarding congenital hypertrophic pyloric stenosis:
A. More common in girls
B. Hypochloremic alkalosis
C. Heller’s myotomy is the procedure of choice.
D. Most often manifests at birth
Ans. B
Q 205. Patient presents with recurrent duodenal ulcer of 2.5 cm size. Procedure of choice is:
A. Truncal vagotomy and antrectomy
B. Truncal vagotomy and gastrojejunostomy
C. Highly selective vagotomy
D. Laparoscopic vagotomy and gastrojejunostomy
Ans. A
Q 206. All are features of hyperplastic tuberculosis of gastrointestinal tract except:
A. Presents with a mass in RIF
B. Barium meal shows pulled up caecum
C. Most common site is ileocecal junction
D. ATT is the treatment of choice
Ans. D
Q 207. A 56 year old woman has not passed stools for the last 14 days. X-ray shows no air/fluid levels. Probable diagnosis is:
A. Paralytic ileus
B. Aganglionosis of the colon
C. Intestinal pseudo-obstruction
D. Duodenal obstruction.
Ans. C
Q 208. A man aged 60 years has history of IHD and atherosclerosis. He presents with abdominal pain and maroon stools. Most likely diagnosis is:
A. Acute intestinal obstruction
B. Acute mesenteric ischemia
C. Peritonitis
D. Appendicitis
Ans. B
Q 209. True statement regarding ‘fistula in ano’ is:
A. Posterior fistulae have straight tracks
B. High fistulae can be operated with no fear of incontinence
C. High and low divisions are made in relation to the pelvic floor
D. Intersphincteric is the most common type
Ans. D
Q 210. In a 27 year old male most common cause of a colovesical fistula would be:
A. Crohn’s disease
B. Ulcerative colitis
C. TB
D. Cancer colon
Ans. A
Q 211. Following trauma, a patient presents with a drop of blood at the tip of urinary meatus. He complains of inability to pass urine. Next step should be:
A. IVP should be done
B. MCU should be done
C. Catheterize, drain bladder and remove the catheter thereafter
D. Catheterize, drain bladder and retain the catheter thereafter
Ans. D
Q 212. Chandu, a 45 years male shows calcification on the right side of his abdomen in an AP view. In lateral view the calcification is seen to overlie the spine. Most likely diagnosis is:
A. Gallstones
B. Calcified mesenteric nodes
C. Renal stones
D. Calcified rib
Ans. C
Q 213. CA prostate commonly metastasises to the vertebrae because:
A. Valveless communication exist with Batson’s prevertebral plexus
B. Via drainage to sacral lymph node
C. Of direct spread
D. None of above
Ans. A
Q 214. Following sexual intercourse, a person develops pain in the left testes that does not get relieved on elevation of scrotum. Diagnosis is:
A. Epididymo-orchitis
B. Torsion testis
C. Fournier’s gangrene
D. Tumor testes
Ans. B
Q 215. A testicular tumor in a man aged 60 years is most likely to be:
A. Germ cell tumor
B. Sertoli cell tumor
C. Teratocarcinoma
D. Lymphoma
Ans. D
Q 216. A patient presents with bilateral proptosis, heat intolerance and palpitations. Most unlikely diagnosis here would be:
A. Hashimoto’s thyroiditis
B. Thyroid adenoma
C. Diffuse thyroid igoitre
D. Reidel’s thyroiditis
Ans. D
Q 217. A patient with long standing multinodular goitre develops hoarseness of voice. Also, the swelling undergoes sudden increase in size. Likely diagnosis is:
A. Follicular CA
B. Papillary CA
C. Medullary CA
D. Anaplastic CA
Ans. A
Q 218. A patient presents with swelling in the neck following a thyroidectomy. What is the most likely resulting complication:
A. Respiratory obstruction
B. Recurrent laryngeal nerve palsy
C. Hypovolemia
D. Hypocalcemia
Ans. A
Q 219. A patient on the same evening following thyroidectomy presents with a swelling in the neck and difficulty in breathing. Next management would be:
A. Open sutures immediately
B. Intubate oro-tracheally
C. Wait and watch
D. Administer oxygen by mask
Ans. A
Q 220. Patient presents with neck swelling and respiratory distress few hours after a thyroidectomy Surgery . Next management would be:
A. Open immediately
B. Tracheostomy
C. Wait and watch
D. Oxygen by mask
Ans. A
Q 221. A patient undergoes thyroid Surgery , following which he develops perioral tingling. Blood Ca2+ is 8.9 mEq. Next step is:
A. Vitamin D orally
B. Oral Ca2+ and vitamin D
C. Intravenous calcium gluconate and serial monitoring
D. Wait for Ca2+ to decrease to < 7.0 before taking further action
Ans. C
Q 222. A case of blunt trauma is brought to the emergency in a state of shock. He is not responding to IV crystalloids. Next step in his management would be:
A. Immediate laparotomy
B. Blood transfusion
C. Albumin transfusion
D. Abdominal compression
Ans. A
Q 223. Babu is brought to the emergency as a case of road- traffic accident. He is hypotensive. Most likely ruptured organ is:
A. spleen
B. Mesentery
C. kidney
D. Rectum
Ans. A
Q 224. A patient is brought to the emergency as a case of head injury, following a head on collision road traffic accident. His BP is 90/60 mmHg. Tachycardia is present. Most likely diagnosis is:
A. EDH
B. SDH
C. Intracranial hemorrhage
D. Intra-abdominal bleed
Ans. D
Q 225. Ulcer that may develop in burn tissue is:
A. Marjolin’s
B. Rodent
C. Melanoma
D. Curling’s
Ans. A
Q 226. An elderly man presents with history of abdominal pain. He is found to have a fusiform dilatation of the descending aorta. Likely cause is:
A. Trauma
B. Atherosclerosis
C. Right ventricular failure
D. Syphilitic aortitis
Ans. B
Q 227. All of the following are correct regarding AV fistula except:
A. Arterialization of the veins
B. Proximal compression causes increase in heart rate
C. Overgrowth of a limb
D. Causes LV enlargement and LV failure
Ans. B
Q 228. All of the following are correct about axillary vein thrombosis except:
A. May be caused by a cervical rib
B. Treated with IV anticoagulant
C. Embolectomy is done in all cases
D. May occur following excessive exercise
Ans. C
Q 229. A 80 year old patient presents with a midline tumor of the lower jaw, involving the alveolar margin. He is edentulous. Treatment of choice is:
A. Hemimandibulectomy
B. Commando operation
C. Segmental mandiblectbmy
D. Marginal mandibulectomy
Ans. C
Q 230. Most common cause of unilateral parotid swelling in a 27 year old male is:
A. Warthin’s tumor
B. Pleomorphic adenoma
C. Adenocarcinoma
D. Haemangioma
Ans. B
Q 231. A 45 year old woman presents with a hard and mobile lump in the breast. Next investigation is:
A. FNAC
B. USG
C. Mammography
D. Excision biopsy
Ans. A
Q 232. A 45 years old man presents with progressive cervical lymph nodes enlargement since 3 month. Most diagnostic investigation is:
A. X-ray soft tissue
B. FNAC
C. Lymph node biopsy
D. None of the above
Ans. C
Q 233. All of the following are true about fibrolamellar carcinoma of the liver except:
A. Equal incidence in males and females
B. Better prognosis than HCC
C. AFP levels always greater than > 1000
D. Occur in younger individuals
Ans. C
Q 234. A child presents with an expansible swelling on medial side of the nose . Likely diagnosis is:
A. Teratoma
B. Meningocele
C. Dermoid cyst
D. Lipoma
Ans. B
orthopaedics
Q 235. Following anterior dislocation of the shoulder, a patient develops weakness of flexion at elbow and lack of sensation over the lateral aspect fore arm. Nerve injured is:
A. Radial nerve
B. Musculocutaneous nerve
C. Axillary nerve
D. Ulnar nerve
Ans. B
Q 236. Babloo a 10 years old boy presents with FRACTURE of humerus. X-ray reveals a lytic lesion at the upper end. Likely condition is:
A. Unicameral bone cyst
B. Osteosarcoma
C. Osteoclastoma
D. Aneurysmal bone cyst
Ans. A
Q 237. A patient sustained injury to the upper limb 3 years back. He now presents with valgus deformity in the elbow and paresthesias over the medial border of the hand. The injury is likely to have been:
A. Supracondylar FRACTURE humerus
B. Lateral condyle FRACTURE humerus
C. Medial condyle FRACTURE humerus
D. Posterior dislocation of the humerus
Ans. B
Q 238. A woman aged 60 years suffers a fall. Her lower limb is abducted and externally rotated. Likely diagnosis is:
A. Neck of femur FRACTURE
B. Intertrochanteric femur FRACTURE
C. Posterior dislocation of hip
D. Anterior dislocation of hip
Ans. D
Q 239. Triple arthrodesis involves:
A. Calcaneocuboid, talonavicular and talocalcaneal
B. Tibiotalar, calcaneocuboid and talonavicular
C. Ankle joint, calcaneocuboid and talonavicular
D. None of the above
Ans. A
Q 240. Babu a 19 years old male has a small circumscribed sclerotic swelling over diaphysis of femur. Likely diagnosis is:
A. Osteoclastoma
B. Osteosarcoma
C. Ewing’s sarcoma
D. Osteoid osteoma
Ans. D
Q 241. Most common site of osteogenic sarcoma is:
A. Femur, upper end
B. Femur, lower end
C. Tibia, upper end
D. Tibia, lower end
Ans. B
Q 242. Involvement of PIP joint, DIP joint and the carpometacarpal joint of base of thumb with sparing the wrist is seen in:
A. Rheumatoid arthritis
B. Osteoarthritis
C. Psoriatic arthritis
D. Pseudogout
Ans. B
Q 243. The pivot test is for:
A. Anterior cruciate ligament
B. Posterior cruciate ligament
C. Medial meniscus
D. Lateral meniscus
Ans. A
Q 244. Iliotibial band contracture following polio is likely to result in:
A. Extension at hip
B. Extension at knee
C. Flexion at hip and knee
D. Extension at hip and knee
Ans. C
Anaesthesia
Q 245. All of the following agents can be given for induction of Anaesthesia in children except:
A. Halothane
B. Servoflurane
C. Morphine
D. Nitrous oxide
Ans. C
Q 246. Anaesthetic agent of choice in renal failure is:
A. Methoxyflurane
B. Isoflurane
C. Enflurane
D. None of the above
Ans. B
Q 247. A man with alcoholic liver failure requires general Anaesthesia for Surgery . Anaesthetic agent of choice is:
A. Ether
B. Halothane
C. Methoxyflurane
D. Isoflurane
Ans. D
Q 248. All of the following are true except:
A. Halothane is good as an analgesic agent
B. Halothane sensitises the heart to action of catacholamines
C. Halothane relaxes brochi & is preferred as anaesthetics
D. Halothane may cause liver cell necrosis
Ans. A
Ophthalmology
Q 249. A patient has a miotic pupil, IOP= 25, normal anterior chamber, hazy cornea and a shallow anterior chamber in fellow eye . Diagnosis is:
A. Acute anterior uveitis
B. Acute angle closure glaucoma
C. Acute open angle glaucoma
D. Senile cataract
Ans. A
Q 250. A woman complains of coloured haloes around lights in the evening, with nausea and vomiting, IOP is normal. Diagnosis is:
A. Incipient stage, glaucoma open angle
B. Prodromal stage, closed angle glaucoma
C. Migraine
D. Raised ICT
Ans. B
Q 251. Babloo, a 5 years old child, presents with large cornea, lacrimation and photophobia. Diagnosis is:
A. Megalocornea
B. Congenital glaucoma
C. Congenital cataract
D. Anterior uveitis
Ans. B
Q 252. Herpes zoster ophthalmicus causes all except:
A. Nummular keratitis
B. Vitreal haemorrhage
C. Uveitis
D. Cranial nerve palsies
Ans. B
Q 253. Bilateral ptosis is not seen in:
A. Marfan’s syndrome
B. Myaesthenia gravis
C. Myotonic dystrophy
D. Kearns-Sayre syndrome
Ans. A
Q 254. eye is deviated laterally and downwards and patient is unable to look up or medially. Likely nerve involved is:
A. Trochlear
B. Trigeminal
C. Oculomotor
D. Abducent
Ans. C
Q 255. Left sided lateral gaze is affected in lesion of:
A. Right frontal lobe
B. Right occipital lobe
C. Left occipital lobe
D. Left frontal lobe
Ans. A
Q 256. An elderly male with heart disease presents with sudden loss of vision in one eye . Examination reveals cherry red spot. Diagnosis is:
A. Central retinal vein occlusion
B. Central retinal artery occlusion
C. Amaurosis fugax
D. Acute ischemic optic neuritis
Ans. B
Q 257. Which of following, is not a feature in diabetic retinopathy on fundus examination:
A. Microaneurysms
B. Retinal hemorrhages
C. Arteriolar dilatation
D. Neovascularisation
Ans. C
Q 258. Vitamin B12 deficiency is likely to cause:
A. Bitemporal hemianopia
B. Binasal hemianopia
C. Heteronymous hemianopia
D. Centrocecal scotoma
Ans. D
Q 259. All are true regarding optic neuritis except:
A. Decreased visual acuity
B. Decreased pupillary reflex
C. Abnormal electroretinogram
D. Abnormal visual evoked response retinogram
Ans. C
Q 260. Chalky white optic disc on fundus examination is seen in all except:
A. Syphilis
B. Leber’s hereditary optic neuropathy
C. Post papilledema optic neuritis
D. Traumatic injury to the optic nerve
Ans. D
ENT
Q 261. A 3 months old child presents with intermittent stridor. Most likely cause is:
A. Laryngotracheobronchitis
B. Laryngomalacia
C. Respiratory obstruction
D. Foreign body aspiration
Ans. B
Q 262. A patient presents with facial nerve palsy following head trauma with FRACTURE of the mastoid. Best intervention here is:
A. Immediate decompression
B. Wait and watch
C. Facial sling
D. Steroids
Ans. A
Q 263. A case of Bell’s palsy on steroids shows no improvement after 2 weeks. The next step in management should be:
A. Vasodilators and ACTH
B. Physiotherapy and electrical stimulation
C. Increase steroid dosage
D. Electrophysiological nerve testing
Ans. D
Q 264. Chandu a 15 years aged boy presents with unilateral nasal blockade, mass in the cheek and epistaxis. Likely diagnosis is:
A. Nasopharyngeal CA
B. Angiofibroma
C. Inverted papilloma
D. None of the above
Ans. B
Q 265. A 40 years old diabetic presents with blackish nasal discharge and a mass in the nose . Likely diagnosis is:
A. Mucormycosis
B. Actinomycosis
C. Rhinosporiodosis
D. Histoplasmosis
Ans. A
Q 266. Most radiosensitive tumour of the following is:
A. Supraglortic CA
B. CA glottis
C. CA nasopharynx
D. Subglottic CA
Ans. C
OBSTETRICS & Gynaecology
Q 267. Rokitansky Kuster Hauser syndrome is associated with:
A. Ovarian agenesis
B. Absent fallopian tube
C. Vaginal atresia
D. Bicornuate uterus
Ans. C
Q 268. A patient of 47 XXY karyotype presents with features of hypogonadism. The likely diagnosis is:
A. Turner syndrome
B. Klinefelter syndrome
C. Edward syndrome
D. Down syndrome
Ans. B
Q 269. A girl presents with primary amenorrhea, grade V thelarche, grade II pubarche, no axillary hair. The likely diagnosis is:
A. Testicular feminization
B. Mullerian agenesis
C. Turner syndrome
D. Gonadal dysgenesis
Ans. A
Q 270. A woman presents with amenorrhea of 6 weeks duration and lump in the right iliac fossa. Investigation of choice is:
A. USG abdomen
B. Laparoscopy
C. CT scan
D. Shielded X-ray
Ans. A
Q 271. A woman presents with amenorrhea of 2 months duration lower abdominal pain, facial pallor, fainting and shock. Diagnosis is:
A. Ruptured ovarian cyst
B. Ruptured ecotopic pregnancy
C. Threatened abortion
D. Septic abortion
Ans. B
Q 272. A young woman with six weeks amenorrhea presents with mass abdomen. USG shows empty uterus. Diagnosis is:
A. Ovarian cyst
B. Ectopic pregnancy
C. Complete abortion
D. None of the above
Ans. B
Q 273. A 30 years old female, presents to the emergency with complaint of sudden severe abdominal pain. An abdominal mass is palpable on examination. Mo