1. A thirty year old female presented with history of progressive hearing loss,which became profound with pregnancy.The tympanogram will show which of the following curve?
a. A
b. B
c. As
d. Ad

Answer: c. As
Refrence :Rudolf pedicatrics 21st edition chapter 15.ear,nose oropharynx and larynx
This is a typical case of otosclerosis

IMMITTANCE AUDIOMETRY
Acoustic immittance is a generic term used to refer to either the opposition (impedance) or ease (admittance) of entry of acoustic energy into the middle ear transmission system. By means of a specialized earplug that seals off the external auditory canal, it is possible to measure the acoustic immittance of the ear. Contained within the earplug are a miniature speaker, air pump, and microphone. The ear normally absorbs sound energy through the tympanic membrane and middle ear structures. Impedance provides an indirect measure of this sound absorption function by measuring the reflected sound energy. The speaker delivers sound into the external auditory canal while the pressure is varied by the air pump. The microphone then detects the sound reflected back from the ear.
In tympanometry, the reflected sound is typically measured while the pressure is varied between -300 and +300 cm H2O. Several patterns of tympanograms are routinely encountered and reflect varying states of middle ear function (Fig. 15-4). A type A tympanogram is normal with the curve peaking around 0 cm H2O. A type B tympanogram is typically flat or shows only a very shallow peak. Such tympanograms are seen in cases of otitis media with effusion or ossicular fixation. A tympanic membrane perforation can also result in a “flat� tympanogram but would usually be associated with an abnormally large canal volume (also measured routinely during tympanometry). A type C tympanogram most commonly reflects a retracted tympanic membrane and shows a curve that peaks at pressures less than -150 cm H2O. Less reliably, otosclerosis (fixation of the stapes footplate) may be reflected in a type AS tympanogram (for shallow). Tympanosclerosis may also show a mild decrease in an otherwise normal curve. Last, a type AD tympanogram (for deep) shows an abnormally high peak in an otherwise normal curve and is usually associated with ossicular discontinuity or an unusually mobile or atelectatic tympanic membrane.




2. Most common site of histiocytosis x is?

a. bone
b. liver
c. skin
d. spleen

Answer:a .bone

Harshmohan 4th edition page 426

There are three sub types of histiocytosis x
a. eosinophilic granuloma :more common 60% usually presnts with solitary lytic lesion in the femur,skull,vertebra,ribs and pelvis.
b. Hand-schuller Christian disease:triad consitinng multifocal bony defects,diabetes insipidus and exopthalmos is termed hand schuller christain disease.
c. Letter seiw disease.- charectrised by hepatospleenomegaly,lymphadenopathy ,thrombocytopenia,anemia and leucopenia

From above description it is clear that most scommon site for histiocytosis x is bone.



3. An infant presented with erythematous lesion in cheek, extensor aspects of limbs,mother has history of bronchial asthma,probable diagnosis is


a. airborne contact dermatitis
b. atopic dermatitis
c. seborrhic dermatitis
d. infectious eczematoid dermatitis

Answer B.atopic dermatitis

Refrence : Dermatology and illustrated colour text by david j. gawkrodger




history of asthma in mother,erytromatous lesion in face (in infant most common site is face) are classical finding for atopic dermatitis


4. in the sample of 100 mean is 10 and standard deviation 10 calculate standard error of mean.

a.10
b. 01
c. 0.1
d. 0.01


answer c 0.1

standard error of mean = standard devation/√n where n = sample size

so here standard error of mean = 0.1



5. what is the formula of standard error of mean.

Answer :as above

6. richest source of vitamin d is

a. fish
b. milk
c. egg
d. meat

answer a.fish
refrence PSM park

fish liver oils are the richest source of vitamin d






7. which vitamin is excreted by urine??
a.vitamin a
b.citamin d
c.vitamin c
d.vitamin k

Answer vitamin c
Refrence :text book of Biochemistry vasudevan 2nd edition
Vitamin c is excreted by urine

8.most common site of heterotopic pancreatic tissue

a.stomach
b.jejunum
c.splenic hilum
d.ileum

Answer a.stomach

Refrence: medical embryology lagman

Accessory pancreatic tissue may be anywhere from the distal end of the
esophagus to the tip of the primary intestinal loop. Most frequently it lies in
the mucosa of the stomach and in Meckel’s diverticulum, where it may show all of the histological characteristics of the pancreas itself.

The other controversial question that is asked in previos exam at when does the insulin secrion starts langman embryology typically says that pancreas develops at 3 month but insulin secretion starts at 5 month


9. all are component of men type 1 except

a. meducaly carcinoma of thyroid
b. parathyroid adenoma
c. islet cell hyperplasia
d. pheochormocytoma

refrence :Harrison 16th edition page 2234

medullay thyroid carcinoma and pheochromocytoma are associated with two majot syndrome men 2a and men 2b.

men 2a is combination of mtc,hyperparathyroidism and pheochromocytoma
men 2b is the combination of mtc,pheochromocytoma mucosal neuroma ,intestinal ganglioneuroma and marfanoid features






10. most common cause of renal artery stenosis in younger patients India is?

a. fibrointimal hyperplasia
b. fibromedial hyperplasia
c. takasayu artritis
d. atherosclerosis

Answer: c takasayu arthritis

Refrence Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging, 4th Ed. 2001 By Ronald G. Grainger (Editor), David Allison (Editor), Andreas Adam (Editor), Adrian K. Dixon (Editor), Helen Carty (Editor), Alan Sprigg (Editor), Elian A. Zerhouni, Holger Pettersson By Churchill Livingstone

page 1525

Takayasu’s disease
This tends to affect younger patients, particularly from South East Asia and India. Classically it occurs with associated clinical features, but it may present with no obvious systemic illness. As its other name ‘aortoarteritis’ implies, aortic disease is essential to the diagnosis and may consist of diffuse or focal stenotic disease, occlusion, or a fusiform abdominal aortic aneurysm[38] . All the major abdominal arteries may be affected, but the renal arteries are most commonly involved, with severe ostial stenoses being typical. Occasionally, angiographic appearances very similar to this condition occur in patients from outside these geographic areas and with no history of any systemic illness.


11.1. *Vision 2020 right to sight doesn’t include
a) Cataract
b) Trachoma
c) Epidemic conjunctivitis
d) Onchocerciasis
answer c epidemic conjunctivitis

refrence arson's disease of eye 19th edition page 589

This is a global initiative launched by who in 1999.It is based on the concept that every living person has a right to sight and aims to eliminated avoidable blindness worldwide by the year 2020.

The prority areas identified under this plan include catract,childhood blindness,trachoma.,refrective error and onchocerciasis


153nephrocalcinosis is not seen in
a-sarcoidosis
b-distalRTA
c-milk alkali syndrome
d-medullary cystic kidney
ANS:c

refrence: Grainger & Allison's Diagnostic Radiology 4th edition 1583


ical necrosis following a snake bite; the calcification is predominantly in the cortex.


TABLE 70-1 -- Causes of nephrocalcinosis
Principal causes

Hyperparathyroidism, primary or secondary
idipathic hypercalciuria
renal tubular acidosis
sarcoidosis
medulary sponge kidney

rare causes



Hyperoxaluria primary or secondary to bowel disorders
Hypervitaminosis D
Milk-alkali syndrome
Osteoporosis
Myelomatosis
Hyperthyroidis
so all 4 can cause nephrocalcinosis but as milk alkali syndrome as rare cause it is the answer


in surgery for right thoracic outlet syndrome which is not seen as complication
a.Long thoracic nerve injury
b.Brachial plexus injury
c.Lymphatic fistula
d.Pneumothorax
Ans:c


refrence :
schwartz principL OF surgery 7th edition
sabiston text book of surgery 17th edition
37Technique of First Rib Resection
Clagett suggested in 1962 that the first rib was the “common denominator” in the various compression syndromes of the thoracic outlet and recommended its resection in appropriate cases. In 1966 Roos described the technique of transaxillary first rib resection, which, because of its cosmetic appeal, simplicity, and safety has become the most frequently performed operation for neurologic TOS.

With the patient in the lateral decubitus position with the arm elevated, a skin incision is made in the axillary hair line between the pectoralis major and latissimus dorsi muscles. The first rib is reached by blunt dissection in the axillary tunnel, taking care to avoid the intercostobrachial nerve. The subclavian artery and vein are identified and the subclavius muscle tendon divided. The anterior scalene muscle can now be identified and divided at the point where it inserts on the first rib anterior to the artery. At this time a digital search for anomalous bands is performed. These may originate from the C7 transverse process, from an incomplete cervical rib, from attachment to two places on the first rib, or from the middle scalene muscle. After any bands have been divided, the middle scalene muscle and the intercostal muscle attachments are pushed off the first rib. When all muscle fibers are cleared and the T1 nerve root is visualized and protected, the rib is divided and removed. The wound is irrigated with saline to detect any pneumothorax, which, if present can be treated by inserting a small chest tube into the pleural space. The tube can be removed in the recovery room if the lung is fully expanded and there is no air leak.

A number of brachial plexus injuries have been reported with this approach, and there are proponents of a supraclavicular approach that avoids any traction on the brachial plexus.

this was in schwartz now in sabiston it is written under management of thoracic outlet syndrome that

Brachial plexus injuries, vascular injuries, pleural effusion, winged scapula, and infection
are complications that may arise secondary to first rib removal.




so in sabiston winged scapula is given and we all know that winged scapula occurs in long thoracic nerve injury

so only option remaining is lymphatic fistua and that should be the answer



the question of renal artery stenosis in Indian children the option was not atheroslerosis but PAN

another question-Mutation in familial pulmonary hypertension A.BMPR-2(Bone Morphogenic Protein receptor-2)
B.troponin
C.Endothelin
D.Serotonin receptor protein