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Cavernous sinus communicates with: (A) Superior petrosal sinus, (B) Inferior petrosal sinus, (C) Superior ophthalmic vein, (D) Middle meningeal vein

Answer is A. Draining channels or communications the cavernous sinus drains: 1.into the transverse sinus through the superior petrosal sinus. 2.into the internal jugular vein through the inferior petrosal sinus and through a plexus around the internal carotid aery. 3. into the pterygoid plexus of veins through the emissary veins passing through the foramen ovals, the foramen lacerum, and the emissary sphenoidal foramen 4. In to the facial vein through the superior ophthalmic vein. 5.the right and left cavernous sinuses communicate with each other through the anterior and posterior intercavernous sinuses and through the basilar plexus of veins. Notes: all these communications are valveless and blood can flow through them in either direction Ref: BDC volume3;Sixth edition pg 195

In civil negligence, onus of proof lies on:: (A) Judicial first degree magistrate, (B) Police not below the level of sub inspector, (C) Doctor, (D) Patient

Answer is D. D i.e. Patient In case of malpractice, punishment is given by civil or criminal couQ (depending on type of negligence). Generally, the innocence of doctor is assumed and in cases where negligence is alleged, the plantiff (complainant, patient) has to establish the guilt. The patient is expected to prove that the defendant (doctor) was negligent; there fore the onus (responsibility) of proof lies on patient. But when the doctrine of res ipsa loquitor (ie thing speaks for itself) is applied such as in case of surgery on wrong patient / side / organ etc, the doctor will have to prove that what has happened is not due to his negligenceQ. This means onus of proof lies on patient in negligence (all civil & most criminal case) except in cases where doctrine of res ipsa loquitor appliesQ. Therapeutic misadventure (mischance / disaster / accident) is death or injury of a patient due to some unintentional act by doctor /nurse /hospitalQ during treatment (therapeutic), diagnosis (diagnostic) or experimental study. It provides defence against neglince because a doctor can't be held responsible for injuries resulting from adverse reaction of drug. However, the doctor must warn patient about possible side effects (eg death during surgery or transfusion). And ignorance of the possibility of reaction to drug prescribed to patient amounts to negligence (ie it is not 100% = absolute defence). At times it is not possible to explain every thing to the patient (who may be scared of procedure). Under such circumstances doctor can reveal the details to any one of close relatives of patient. This is called doctrine of therapeutic privilege. Doctrine of emergency says that doctor can provide the treatment without taking prior consent from a patient who is gravely sick, (critically ill), unconscious, or not able to understand the suggestion, or when mentally ill (IPC section 92). In emergency situation involving children, when their parents are not available, a/t doctrine of locoparentis, consent can be obtained from accompanying person (eg teacher or relative). On ceain occasions, despite all proper care given by doctor during treatment, the patient might suffer severe injuries or permanent deformity. This is k/a medical maloccurance, inevitable act or Act of God. If doctor proves this before cou, it will be an absolute defence against malpractice. Free (charity) treatment of patient does not give doctor immunity (defence) against negligenceQ. Whereas judgemental (diagnostic) error, therapeutic misadventure, medical maloccurance, calculated risk doctrine, contributory negligence (on pa of patient), product liability, and res judicata (complain already tried once in cou) provide defenses to a doctor against charges of negligence. Law does not consider doctrine of contributory negligence & consent in charges of criminal negligence; whereas these provide defence in civil negligence.

Chemical plaque control: (A) is an effective replacement for mechanical plaque control, (B) is especially recommended after periodontal surgery, (C) is best achieved using cetylpyridium chloride mouth washes, (D) is of no use

Answer is B. None

Which aery Supplies the deep cerebellar nuclei: (A) Anterior inferior cerebellar aery, (B) Anterior spinal aery, (C) Posterior cerebral aery, (D) Superior cerebellar aery

Answer is D. The superior cerebellar aery supplies the superior surface of the cerebellum and the cerebellar nuclei (dentate nucleus)

True about blood supply of scaphoid-: (A) Mainly through ulnar artery, (B) Major supply from ventral surface, (C) Major supply from dorsal surface, (D) Proximal supply in antegrade fashion

Answer is C. Ans. is 'c' i.e., Major supply from dorsal surfaceo Major blood supply (70-80%) of scaphoid comes through dorsal surface via dorsal branches of radial artery,o These dorsal vessels enter the scaphoid at or just distal to waist area and supply the proximal pole in retrograde fashion.o Proximal 2/3 rd to 3/4 scaphoid is supplied by these dorsal vesselso 20-30% of blood supply comes through palmar and superficial palmar branches of radial artery,o Distal 1/3 rd or 1/4 th and distal tubercle are supplied by these palmar vessels.

Straining and dribbling of urine in a male infant with recurrent urinary infection should lead to the suspicion of :: (A) Vesico – ureteric reflux, (B) Posterior urethral valve, (C) Pelvic ureteric junction obstruction, (D) Phimosis

Answer is B. The informations provided in this question are : Straining —> Sign of obstruction Driblling  —>  Sign of obstruction and incomplete bladder emptying. UTI May be due to urinary obstruction. All these suggest the diagnosis of obstructive uropathy, and posterior urethral valve is most common cause of obstructive uropathy.

Which protein is abundant in our body:: (A) Collagen, (B) Albumin, (C) Myoglobin, (D) Hemoglobin

Answer is A. Ans. (a) CollagenRef: Harrisons, 19th ed. pg. 2504* Collagen is the most abundant protein in the body.* Harrisons states: "The first genes cloned for connective tissues were the two genes coding for type I collagen, the most abundant protein in bones, skin, tendons, and several other tissues.

Myoglobinuria is seen in which type of burns:: (A) Contact burn, (B) Electric burn, (C) Scald, (D) Flame burn

Answer is B. Electrical burns may cause extensive muscle necrosis and consequent myoglobinuria and hemoglobinuria, both of which may lead to renal insufficiency.

Sign of the groove is seen in:: (A) Lymphogranuloma venereum, (B) Granuloma inguinale, (C) Syphilis, (D) Chancroid

Answer is A. LGV is caused by Chlamydia trachomatis serovars L1, L2 and L3 and occurs in three stages. In the secondary stage or inguinal stage, enlargement of the femoral and inguinal lymph nodes separated by the inguinal ligament produces the 'sign of the groove'/sign of Greenblatt. NOTE: Ramrod /saxophone penis in males and Esthiomene in females occurs in the third stage of LGV. Ref: Sexually Transmitted infections, Bhushan Kumar, 2nd edition, pg 510-511.

A patient with psoriasis was staed on systemic steroids. After stopping the treatment, the patient developed generalized pustules all over the body.The cause is most likely to be -: (A) Bacterial infection, (B) Erythrodermic Psoriasis, (C) Drug induced reaction, (D) Pustular psoriasis

Answer is D. Patient of psoriasis on withdrawal of systemic steroids leads to: 1)Pustular Psoriasis: - Multiple sterile pustules develop on whole body(including palms & soles) k/a sterile as there is no infection, only infiltration present. -If generalised k/a Von Zumbusch disease. - Other provocating factors include Infection, Pregnancy and Hypocalcaemia associated with hypoparathyroidism. 2) Erythrodermic psoriasis >90% body surface area shows redness/inflamed or/- scaling Systemic steroids are contraindicated in psoriasis as, on withdrawal it causes pustular psoriasis except inpregnancy where they are drug of choice

Cholesteatoma is seen in:: (A) ASOM, (B) CSOM, (C) Secretory Otitis media, (D) Otosclerosis

Answer is B. (b) CSOM(Ref. Cummings, 6th ed., 2141)Cholesteatoma formation is characteristic of unsafe CSOM.The other mentioned options are not associated with cholesteatoma.

Which of the following indicates anticipated difficult bag mask ventilation: (A) Age >30 yrs, (B) BMI >20, (C) Beard, (D) None of the above

Answer is C. Predicting difficulty in mask ventilation Mask ventilation is the most basic, and arguably most impoant, skill in airway management. Patients who have been identified as having DMV, or who are predicted to be difficult, are, or potentially are, at the highest risk in airway management. It is this facet of management that should influence our decision-making the most, potentially with consideration given to awake techniques. DMV can also be suggestive of difficulty in subsequent laryngoscopy. DMV occurs in up to 5% of patients, and there are several factors that are known to be predictive of this. An early study highlighted five independent factors Mnemonic OBESE to be used. Fuher study of DMV added modified Mallampati class of 3 or 4, limited jaw protrusion, and the male sex. Neck irradiation is the most significant predictor of impossible mask ventilation, defined as an inability to achieve gas exchange despite the use of adjuncts, multiple providers, and neuromuscular block, as it causes development of fibrotic non-compliant tissue affecting the airway. BMI itself is not a very useful predictor, although it can be a marker for potential oxygenation issues (due to reduced FRC) and increased aspiration risk. In predicting DA, the actual distribution of body fat should be considered, with fat deposition in the parapharyngeal tissues increasing airway collapsibility, predisposing to OSA. This is seen more in android pattern obesity with distribution of adipose tissue around the trunk, upper body, and neck. The increased fat deposits in neck tissue can fuher narrow the airway. OSA, snoring without apnoea, and increasing neck circumference, above 40 cm, are associated with DMV. The probability of DMV increases with increasing neck circumference. Age >55 BMI > 26 (obesity) Beard Lack of teeth(edentulous) History of snoring (OSA) Neck circumference (>17 inches in men and > 16cm in women) Thyromental distance Large tongue facial and neck deformity Cervical spine disease or previous cervical spine surgery

Which of the following is a nonculturalable fungus-: (A) Rhinosporidium, (B) Candida, (C) Sporothrix, (D) Penicillium

Answer is A. None

Enzyme replacement therapy is used for-: (A) Gaucher's disease, (B) Krabbe's disease, (C) Metachromatic leukodystrophy, (D) Tay Sach's disease

Answer is A. Ans. is 'a' i.e., Gaucher's disease * Alglucerase (ceredase) is used in the treatment of Gaucher's disease.* Enzyme replacement therapy (ERT) is also available for Fabry's disease, Type I, Type II and Type VI Mucoploysaccharidosis, Pompe's disease and ADA deficiency

Pseudopolyposis is seen in -: (A) Crohn's disease, (B) Ulcerative colitis, (C) Juvenile polyposis, (D) Enteric fever

Answer is B. None

Organism that causes emphysematous cholecystitis is:: (A) Salmonella typhi, (B) Cytomegalovirus, (C) Clostridium perfringens, (D) Bacteroides

Answer is C. Ref: Harrison's 18th editionExplanation:Emphysematous CholecystitisIt is thought to begin with acute cholecystitis (calculous or acalculous) followed by ischemia or gangrene of the gallbladder wall and infection by gas-producing organisms.Bacteria most frequently cultured in this setting includeAnaerobes, such as C. welchii or C. perfringensAerobes, such as E. coli.This condition occurs most frequently in elderly men and in patients with diabetes mellitus.The clinical manifestations are essentially indistinguishable from those of nongaseous cholecystitis.The diagnosis is usually made on plain abdominal film by finding gas within the gallbladder lumen, dissecting within the gallbladder w all to form a gaseous ring, or in the pericholecvstic tissues.The morbidity and mortality rates with emphysematous cholecystitis are considerable.Prompt surgical intervention coupled with appropriate antibiotics is mandatory.

Which of the following conditions may necessitate emergency tracheostomy to prevent suffocation: (A) Cellulitis, (B) Ludwig's angina, (C) Cavernous sinus thrombosis, (D) Maxillary sinusitis

Answer is B. None

Most common site for extra mammary Paget&;s disease is: (A) Vulva, (B) Vagina, (C) Penis, (D) Anus

Answer is A. .It is superficial manifestation of an intraductal carcinoma. The malignancy spreads within the duct up to the skin of the nipple and down into the substance of the breast. It mimics eczema of nipple and areola.most commonly extra mammary manifestations of paget&;s disease is seen in the vulva. * Paget's disease of penis (Erythroplasia of Querat is persistent rawness of glans penis). ref:SRB&;s manual of surgery,ed 3,pg no 1009,473

Inferior Rib notching is seen in all except?: (A) Coarctation of aoa, (B) Classical blalock tausing operation, (C) SVC obstruction, (D) Neurofibromatosis

Answer is D. Answer is D (Neurofibromatosis) Neurofibromatosis is associated with superior rib notching Inferior rib notching is characteristically seen in coarctation of Aoa and may also be seen in Superior vena cava obstruction and a Blalock-Taussig shunt operation Rib-Signs in Coarctation of aoa: Inferior rib notching is characteristic, and is believed to be due to pressure erosion by intercostal aeries. Inferior rib notching takes several years to develop and is rarely seen before the age of 8 years.e '3' signemay be seen due to enlargement of left subclan aery above the coarctation Usually spares fist two ribse where intercostal aeries arise from costocervical trunk which is proximal to the usual site of CA. Mostly commonly affected ribs are the 4th to 8th ribs. Usually bilateral but asymmetrical.

Which is false regarding cryptococcus neoformans?: (A) Grows at 5degC and 37degC, (B) It has 4 serotypes, (C) Urease negative, (D) Causes superficial skin infection

Answer is C. Ans. is 'c' i e., Urease negative Cryptococcus neoformans is distinguished from other non-pathogenic crvptococci by ? - Ability to grow at 37degC Lack of fermentative ability - Ability to hydrolyze urease (urease positive) - Formation of brown pigment on niger seed agar - Ability to assimilate inositol Ability to produce phenole oxidase.

Histopathological finding of gluten hypersensitivity is?: (A) Crypt hyperplasia, (B) Increase in thickness of the mucosa, (C) Distal intestine involvement, (D) Villous hypertrophy

Answer is A. Ans. is 'a' i.e., Crypt hyperplasia Histopathological findings of gluten sensitivity enteropathy* Villous atrophy and Crypt hyperplasia with decrease in villus: crypt ratio.* Loss of microvilli brush border.* Inflammatory cells are present in lamina propria : plasma cells, macrophages, lymphocytes, eosinophils and mast cells.* One of the characteristic feature is that overall mucosal thickness remains same (as villous atrophy is compensated by crypt hyperplasia).* Mainly proximal intestine is involved.

All except one are centrally acting muscle blockers:: (A) Meprobamate, (B) Baclofen, (C) Diazepam, (D) Dantrolene sodium

Answer is D. None