Paper of FCPS Part 1 Surgery and Allied 1st January 2016


1. Regarding fat stores in adipose tissue A.insulin cause lipolysis in size by dividing adipocytes C.Growth hormone cause deposition of fat

2.Insulin causes A. decketogenesis B. inc lipolysis C .incglycogenolysis

3.Thorn prick…abscess formation..most likely organism A.Strept Pyogenes B.Staph aureus C.Pseudomonasaeruginosa

4.In Pregnant lady blood, there will b increase of A. ferritin B. TIBC C. iron

5.Pregnant lady normocytic normochromic anemia appropriate A.plasma volume expansion B.iron defanemia

6.after total gastrectomy what occurs A.iron def anemia B.Pernicious anemia host defence system in alveoli A.lymphatics B.alveolar macrophages C.nasal cilia D. IgA secretions

8.Most common cause of DVT ? A.prolonged bed rest B.After surgery C.inherited thrombophilia

9.14 yr old child with 8%creatinuria BP 180/110.. what is damaged A.glomeruli B.JG cells C.Macula densa

10.Mechanism involved in RMP is mainly A.k efflux pump

11.epidemic virus hep.e

12.dec arterial PO2 A.CO poisoning B.anemic hypoxia C.hypoxic hypoxia

13.4th Heart sound [S 4] due to A.Atrial contraction causes ventricular wallvibration B.aortic rebound C.verntricular filling

14.. Decreased resistance in afferent arteriole decreases A. GFR B.Filtration fraction C. Renin release beginning of 2nd week A.epiblast B.epiblastand mesoderm C.Epiblast and hypoblast

16.regarding Transitional epithelium A.pseudostratified B.Stratified columnar C.Stratified with outer cells bigger n rounder

17.regarding Cerebellum A.receive preprioceptive info from spinal cord B.afferent input from motor cortex

18.Regarding free water diuresis A.positive water clearance B.negative water clearance C. palsma osmolarit

19.Floor of 4th ventricle supralateral relation A.superior cerbellar peduncle B.middle cerebellar peduncle C.inferiorcerbellar peduncle D. Lower Ponsand pyramidal tracts

20.regarding atrial fibrillation A.p waves prominent B.regular rhythm C.pulsus deficit

21.Most sensative marker in MI A.creatine kinase B.Troponin T C.Myoglobin D.LDH

22.Uterine leiomyoma ,endometrium around the mass has few glands and lots of stroma,what has happend to endometrium around fibroid A.metaplasia B.hyperplasia C.atrophy D.dysplasia E. Neoplasm

23.alpha sympathetic stimulation A.pupils constrict B.pupils dilate

24.parasympathetic stimulation A.pupils dilate B.sphincteric muscle of irisconstrict heart rate D.dec GI motility

25.Free radicals formed by radiation they will damage A.DNA B.cell membrane C.mitochondria

26.virus cause disease A.directaction B.altering protein synthesis C.membrane damage ejection fraction causes A.dec EDV B.Dec ESV

28.SA node location A.superioraspect of sulcus terminalis B.lower part ofcrista terminalis

29.tumor suppressor gene A.p53

30.Diabetic nephropathy diagnosed by blood urea nitrogen levels creatinine urinary albumin

31.Question regarding……lowest resistance Gap junction

32.Host defence against neoplasm A.apoptosis B.good health family history

33.most common cause of neoplasm A.overexpression of proto-oncogenes B.non-lethal injuryof genes

34.abdominal aorta A. divide at L5 vertebra b.give renalartery at L2 C. Give lateral branches to parites

35.Regarding Down syndrome incidence with inc maternalage

36.Dorsal rami supply A.Flexors of trunk B.extensors of trunk

37.localized edema cause A.allergy

38.Regarding Red cells A.larger than all WBCs B.Mean MCV is 85 fl C.contain remnants of mitochondria and endoplasmic reticulum

39.myeloperoxidase is present in A.lymphocytes B.RBCs C.Neutrophils

40.Succinylcholine toxicity in individuals having deficiency of A.Acetylcholinesterase B.pseudocholinesteae C.MAO

41.Lady has breast implant 2 years ago since then she is having firmness and shape distortion .now the implants removed and fluid is leaking from implant inside .which cell wil most likely be present A. Neutro B. Mast C.Eosinophil D.Giant cell E.Plasma cell

42.vessel having 80% saturation in fetus A.umbilical vein B .Aorta C.IVC

43.which hormone causes extrahepatic protein catabolism and hepatic protein anabolism A.Thyroid hormone B.Epinephrine C.Cortisol D.growth hormone E.insulin

44.GFR is increased by A.afferent artiolar constriction B.dec plasma proteins C increase pressure of bowman capsule

45.Patent lumen of allantois A.Urachal sinus B.urachalcyst {not sure} C.umbilical vein D.urachal fistula

46.left adrenal vein is drained into A.IVC B.left renal vein C.Inf mesenteric vein

47.Tissue not regenerated A.kidney B.adrenal medulla C.lens lymphoid nodules seen in A.thymus B.Lymph node C.spleen

49.pseudomembranous colitis caused by which A.clostridium perfringens B.clostridium dificile

50 a.most common cause of gas gangrene lower limb A.clostridium birefrengens B.clostridium welchii C.clostridium septicum

51.joint b/w pubic bones allowing slight movement during birth of baby A.Synchondrosis B.syndesmosis C.Symphysis

52.Heart contractility depend on ions

53.Regarding thyroid gland A.change in epithelium occurs with function

54.rapidly adapting receptors A.pacinian B.Baroreceptors nerve endings

55.which of the following inhibits the muscle to stretch beyond limits A.golgi tendon organ B.muscle spindle

56.Dead space does not change in A.standing B.old age C.shallow breathing D.Deep inspiration E.Tracheostomy

57.Max. TAG found in A.VLDL B.chylomicrons remnants C.LDL D.HDL E.IDL

58.most common source of SYSTEMIC arterial emboli A.femoral vein thrombosis B.pulmonary vein thrombosis C.right atrial thrombus D.portal vein thrombus E.left ventricular mural thrombus

59. pyruvate is intermediate between A.glucose and acetylcoA B.acetoacetic acid and actylcoa C.Fat metabolism and acetylcoA D.carbohydrates and proteins

60.Pulmonary artery supply A.Bronchi B.Bronchioles C.Alveoli

61.Regarding bronchopulmonary segment A.airated by primary bronchus B.airated by secondary bronchus C.airated by tertiary bronchus D.not in touch with all other segments

62.A 45 yr old female presents with two years history of pruritis, months history of jaundice. On clinical examination she has bruises xanthomas and hepatosplenomegaly. The investigation which will confirm the diagnosis would be: A. ALT B. Alkaline phosphatase C. Anti-mitochondrialantibodies D. CT abdomen E. ultrasound abdomen.

63.ADH formed in A.posterior pituitary B.supraoptic nucleus C.ventromedial nucleus

64..metaplasia is caused by A.chronic irritation

65.Most common cause of Primary HCC A.hep C B.alpha 1 antitrypsin deficiency C.Aflatoxins

66.Two liters Normal saline infusion A.dec urinary sodium blood volume C.dec intracellular volume

67.tachyphylaxis A.Rapid dec in drug action B.Gradual dec in drug action C.Is like Anaphylaxis

68.Fastest speed of impulse in heart conduction system A.ventricular fibers B.AV node C.AV bundle D.purkinje fibers cant open mouth which muscle injured A.Masseter B.medial pteryogoid C.lateral pterygoid D.Buccinator E.Platysma

70.There is no blood agglutinins in following blood group A. AB- B. AB+ C O+ D. O-

71.Insulin increased by A.Glucagon B.Growth hormone has Gonococcus infection what is quicked way to check it A.ZN stain B.Gram stain C.Culture

73.Metaplasia A.functionalchange in cells B.change in size and shape of cells

74.Which artery has branches that are end arteries A.Coronary artery B.Centralartery of Retina

75.which are bipolar neurons A.posterior root ganglion cells B.anterior horn cells C.posterior horn cells D.Olfactory cells

76.memory function of which lobe? A.parietal B.Temporal C.Frontal D.Occipital E.insula

77.Pellagra caused by def of A.Vit B1 B.Vit.B6 C.nicotinic acid

78.Area 3,1,2 A .All somatic sensation

79.Which hormone causes smooth muscle constriction In Arteriols A. Aldosterone B.ADH

80.Ethics principle A. Autonomy ,Beneficence, Non-maleficence , justice

81.Regarding mean is some of all individual value divided bytotal number of values B.its a good measure of central tendency

82.Brocas Area A.Sup temporal lobe B.afluent aphasia

83.infraorbital artery is a branch of A.maxillary B.facial C.ophthalmic

84.Ther is painful swelling at site of below knee amputation A.neuroma B.ganglioneuroma

85.Sulfur containing amino acid A.Arginine B.Cysteine

86.pyogenic meningitis shows A.dec glucose concentration in csf

87.Axillary sheath from A.pretracheal sheath B.prevertebral fascia C.carotid sheath

88.hormone responsible for oxidative phosphorylation and inc in body temperature A.Thyroid hormone B.Growth hormone C.Insulin

89.Pt had severe headache…CSF showed blood tinge A.sub-dural hemorrhage B.sub-arachnoid hemorrhage

90. Young pt has bleeding history from minor trauma and also had chronic diarrhea , with no family hstry of any bleeding disorder , PT deranged , platelets normal , hb normal A.Vit k deficiency. 91.Edema is caused by A.dec hydrostatic pressure osmotic pressure C.blocked lymphatics 92. Midle age man while playing in groud had trauma bleeding started what will b immediate hemostatsis respocr A.vasocontriction B. Activation of cascade C. Platelet adhesion D. Fibrinolysis 93.potent chemotactic factor A.C3a B.C5a 94.Left coronary artery divides into A.LCX and anterior interventricular artery 95. XX + pseudohermaphroditism… A. androgenital syndrome 96.Female in which 2 years history HPV infection and also shows prominent and enlarge nuclei A.Hyperplasia B.carcinoma C.metaplasia D.dysplasia 97. Regarding skeletal muscle A.Belly is fleshy throughout length B. aponeurosis fibrosis C.Origin is mobile D.Fixed at insertion 98.endometrial hyperplasia increase estrogen level COMPILED BY LUMBER PLEXIUS CHANKA MEDICAL COLLAGE REMEMBER MEIN UR PRAYERS BEST OFLUCK 1st JANUARAY 2016 online morningshiftSURGERY paper 2 compiled byLUMBER PLEXIUS 1- Eating undercooked and raw meet can cause infestation by… dracunculous medinesnsis echinococcus granulosis liver fluke schistosomiasis tape worm 2- Iodine which is not used in the thyroid hormone syntheseis is secreted from body via Feces saliva urine sweat 3- Gustatory sweating is caused by Superficial Parotidectomy Diabetes Mellitus Glossectom 4- Mass movement is affected in colon due to problem in Auerbach plexus Submucosal plexus 5- In an adult Ileactomy and jejunectomy has been done. He has diarhoea and 15-20 bowel sounds per minute. The most likely cause of this decreased transit time in the intestine is due to osmotic Secretory secreroy plus osmotic {not sure} High concentration of bile salts in the colon 6- treatment of vWD FFP Cryoprecipitate Vit K Aminocaproic acid 7- The head of femur in adult is supplied by Anterior circumflex artery Sciatic artery Femoral artery Medial and lateral circumflex artery posterior circumflex artery 8- Head of humerus is supplied by Anterior circumflex posterior circumflex axillary 9- In acute pancreatitis, fluid will most like accumulate in a) Gutters b) Subphrenic space c) Retroperitoneal space d) lesser sach {not sure} 10- Washed RBCs are indicated to a- avoid ABO conflict b- Avoid Rh conflict c- avoid fever after transfusion d- avoid hypersensitivity reactions 13. A man havingrecurrent bacterial infections with streptococci also having diarrhea which on examination showed giardiasis, urther exam revealed normal T cells but ↓B cells levels of igM,igG and igA were given A. Diabetes B. Altered immunodeficiency C.Bruton’s agammaglobulinemia 12- highest amount of TAGs in a- Chylomicrons b- vldl c- hdl d- IDL e- Chylomicron remnants 13- Function of Gulteus medius and minimus is a- Extention of hip joint b- Flexion of hip joint c- Adduction and medial rotation of hip joint d- Abduction and medial rotation of the hip joint 14- Thorn prick…abscess formation..most likely organism A.Strept Pyogenes B.Staph aureus C.Pseudomonas aeruginosa 15- A 5 or 6 years child who develops muscular weakness. Anti voltage gated calcium chanel antibodies are present A.Myasthenia Gravis B.Lambert Eaton syndrome C.Duchenne Muscular Dystrophy D.Beckers myotrophy 16- A patient presents with enlarged mass in front of the neck. Biopsy of thyroid gland is performed which reveals no metastatic change. Which type of epithelium is found in thyroid? a- Simple squamous b- Simple striated squamous c- Simple cuboidal epithelium 17- Infarction of posterior 1/3 of interventricular septum.artery involed A.LCA B.RCA C.Rt marginal branch D.LCX E.Rt interventricular 18- Right border of heart is formed by a- right atrium b- SVC c- SVC+Rt Atrium d- Rt ventrical 19. which is a small blue cell tumour asociated with large amount of catecholamines in child a- Neuroblastoma b- wilms tumour 20. Most common tumour of child in epiphysis is? A.Eving sarcoma B.Osteoblastoma c.Chondrosarcoma d.Osteochondroma 21- which of the following prevents muscle tear under high pressure a. Golgi tendon organ b- Spindle fibers 22- cervical metaplasia most likely cause a- high multiparity b- HPV infection c- IUCD d, HPV 23-Which of the following ulcer is caused bysynergistic infection by microaerophilic non hemolytic streptococci and aerobic hemolytic staphlococci: A. Bazon ulcer B. Marjolin ulcer C.Meleney’s ulcer D.Venous ulcer E.Arterial ulcer 24- a young male has azoospermia. Which initial investigation will help in Dx a- testosterone level b- FSH level c- FSH and LH level d- Sperm count e- Antibodies against sperms 25- A pt with sore throat, cervical lymphadenopathy Infectious mononucleosis. 26- INR is used to monitor a- Heparin therapy b- Anti-platelet therapy c- Oral anticoagulation 27- clavipectoral fascia covers a- clavicle bone b- pectoralis minor c- serratus anterior d- serratus posterior 28- Cholecystectomy is done, where to put the drain? a-Subhepatic space b-Subphrenic space c-Rt paracolic gutter 29-Esophagectomy done stomach is mobilized to upper portion of thorax ..To anastomosis with phayrnx, Which artery is responsible for stomach supply now a.left gastric b.Right gastric c.Left gastroepiploic d.Short gastric vessels e.right gastroepiploic artery {not sure} 30-Chronic Myeloid Leukemia a.chromosome 9&22 b.chromosome11&22 C.chromosome14&22 31-common Postop infection in hospital cause by which organism: a.Staph Aureus b.pseudomonas c.e.coli d.Kliebsella 32-clawhand produced by unopposed action of a.flexor digitorum longus and flexor digitorum profundus b.extensor digitorum longus and extensor digitorum Indices c.extensor digitorum and flexor digitorum profundus 33- Which drug cause tachycardia in therapeutic doses: a.morphine b.Fentanyl c.fentanyl d.pethidine 34-Recurrent renal stone associated with which amino acid abnormality: A.Tryptophan B.Lysine C. Glutamate D. Alanine 35- nerve supply of extensor digiti minimi a.deep radial nerve b.superfcial radial nerve 36- Rotator cuff is formed by a.supraspinatus, infraspinatus, teres minor and subscapularis 37- Biguanides side affects: b.Elevated ALT b.diarrhea and flatulence 38- A middle aged woman presents with writing movements of arm ,was daignosed to be suffering from athetosis which nucleus of basal ganglia is effected a.putamen b.globus pallidus {asim shoib anaesthesia book) c.cuadate 39-If FACTOR IX not available: a.Cryoprecepitate b.FFP c.platelets d.whole blood 40-which of the following drain into superior mesenteric lymph node? a.Jejunum b.4thpart of duodenum c.Desending colon d.cecum 41- The muscle that causes eversion of foot. a.Tibialis post b.peroneus longus 42- Parotid gland a.Lat pterygoid lies anterior to pterygoid b.ext carotid and the fascial nerve passes through superficial gland c.facial nerve supplies it separated from the mandibular gland through a fascia 43-Carpal Tunnel Syndrome A.Anesthesia of thenar muscles b.wasting of thenar muscle c.Injury to ulnar nerve d.Injury to radial nerve 44-A pt with history of bleeding gums n wounds prolonged bleeding time and PT 28SEC (control 12sec) wats the diagnosis? a.heamophelia b.christmis c.won wiliband disease d.factor 7 deficiency 45-Drug which is strong analgesic but not a good anesthetic a.desflurane b.isofurane c.nitrous oxide 46- A young male comes to Pakistan for the first time, after 2days he has fever, altered state of consciousness and goes into Coma. Hb is low, PLTs low and neutrophils(dnt remember). Most like diagnosis a- Dengue b- Malaria falciparum 47- axon arise from conical shape part of neuron cell body called. a.perikaryot b.axon hillocks c.Dandrites 48- peptic ulcer profusely bleeding from posterior wall of duodenum…which artery involed? a.gastroduodenal b.gastroepiploic 49- Epithelium ofkidney(glomerulus is mentioned in brakets specifically) derived from A.endoderm only b.ectoderm only c.mesoderm only d.endoderm+mesoderm e.ectoderm + mesoderm 50-Deep inguinal ring is present in a.transversis abdominis muscle b.transversalis fascia c.internal oblique muscle 51- parathyroid glands are developed from a.1st pharyngeal pouch, b.2nd pouch c.3rd pharyngeal pouch d.4th pouch {not sure} ( superior parathyroid and 3rd pouch gives thymus and inferior parathyroid) 52- In IV drugs abusers there is increased risk of: A.Libman Sacks endocarditis b.bacterial endocarditis c.Mitral valve carditis d.Rheumatic fever or heart disease 53- true abt vertebral column A. Cervical nerves originate above correspondingvertebra {not sure} B. Vertebralarteryarchesant part of postarch ofaxis (Xcept C8 cervical nerve which is below C7 vertebrae , and allSpinal nerves also originate below the coresspondingvertebrae A is not the answer as C8 is a cervical nerve and does not originate above the corresponding vertebrae. (Somebody correct me if I am wrong…) Can’t recall the Option which looked to suit the best! 54- papillary carcinoma of thyroid in children may occur due to a.radiation b.chemotherapy c.viruses d.Mulitnodular Goitre 55-Seminoma is a tumour in male, its equivalent when occurs in ovary then its called a.yolk sac tumor b.embrynal tumor c.dysgerminoma d.Hydatiform mole 56- Which of the following is mostly premalignant in the oral cavity? a. Chronic irritation b. smoking c. lichen planus {not sure} 57- A female pt was having generalized pain, and has been taking NSAIDs for a long time. Now developed swelling n big toe, wht will b present in fluid aspirate? a.mono sodium urate crystals b.Calcium pyruvate 58- Ductus deferens terminates into: a. bulbar urethra b. seminal vesicle c. ejaculatory duct 59- lidocaine mechanism of action a.blocks na channels b.block k channels 60- there was a question regarding CORPUS CALLOSUM lies betweet a.join 2 hippocampus b.posterioly forms a ridge c.join parts in same cerebral hemisphere 61- About small intestine true is a.valvae connivents most numerous in ileum b.mesentry start from the rite of L2 c.valvae connivents 5mm wide d.small intestine 6– 8meters long 62- 230.Lysosome has secretion against bacterial iron because theycontain: A.Hydrolases B. Oxidases 63. Compression effects on esophagus by which organ enlargement: A. Aorta B.Left Atrium C. Pulmonaryartery D. Rightatrium E. Leftventricle 64. Prostatic carcinoma spread to skull bones through: A. Internal carotid artery B.External carotid artery C. Vertebral plexus 65. A Person wid malignant melanoma. Risk factor: A. Xeroderma pigmentosum B. Prolonged sunlight 66. Urethra is narrowest at: A. Pelvic brim B. Prostatic part C. Membranous D.External meatus 67. A man goes to a high altitude 02 deliveryto tissues is maintained by: A.Hb conc is increased B. Po2 is normal C. Hypercapnia D. Pa02 is higher than normal 68. Regardingindication of furosemide: A.SIADH B. Acute pulmonary edema 69. A patient was brought to the hospital after a roadside accident. On examination he was pale with low blood pressure and fracture of left 10th rib. Which organ is most likelyto be injured: A. Kidneys B. Liver C. Pancreas D.Spleen E.Stomach 70. Cholangiocarcinoma caused by: A.Schistosoma Hematobium B.Schistosoma Mansoni C.Cholonorchis Sinensis 71.Farmer wid migratorylesion on foot: A. Leishsmania B.Strongyloides stercoralis C.Cutaneous Larva migra 72.Ligament that prevents anterior dislocation of femur on tibia: A. Collateral B. Anteriorcruciate C.Posterior cruciate 72.Scrotum drains to: A. External Iliac Nodes B. Internal Iliac Nodes C. Superficial Inguinal Nodes D. Deep Inguinal Nodes 73. True about Thoracic duct, drains into: A. Right brachiocephalic B. SVC C. At Confluence of leftSubclavian and left Jugular 74. About Posterior Triangle of Neck what is true: A. Apexis mid ofclavicle B. Formed byant border of sternocaleidomastoid and ant border of trapezius C.Contains subclavian , three trunks of brachial plexus 75. Nerve loss in urogenital triangle which nerve involved: A. Pudendal Nerve B. Obturator Nerve 76. About Quadrate lobe, true is: A.Functionally part of right lobe B.Drains byleft hepatic duct {not sure} C. Lies between IVC and Ligamentum venosum 77. Isoniazid causes side effects which can be prevented bytaking which vitamin: A. B12 B. Riboflavin C.Pyridoxine D.Folate 78. About Trichomonas vaginalis what is correct: A. Can b a commensal in vagina B. Is sexuallytransmitted C. Is treated wid Quinolones 79. Athetosis is due to defect in: A.Caudate B. Putamen C. Globus pallidus D.Subthalamic nucleus 80. Main class associated wid antigen presentingcells: A. MHC1 B.MHC2 C.Gamma interferon D.Alpha interferon 81. Diabetic ptcame to ER insulin given whatchange will happen in blood: K in blood B.increased ketogenesis C.increased pH 82. If circumflex branch of leftcoronary arteryis blocked which area will b effected: A. Anterior surface of leftventricle B. Posterior surface of leftventricle C. Interventricular septum 83. Potassium will be lost mostlyfrm which segment following dietaryirregularities: A.straight proximal tubule B.convoluted proximal tubule C.distal tubule D.thin descendinglimb of loop of henle E.thickascendinglimb of loop of henle 84. Main diagnostic feature of DIC: A.raised aptt B.raised pt C.presence of D dimers 85. CO poisoning,methemoglobulinemia,anemia dont result in hyperpnoea..this is because A.carotid bodiesare stimulated B.aotic bodiesare stimulated C.Po2 remains normal (Anemia- Pa02,Sa02 – Normal MethHB and CO Poisoning- Pa02 – N,Sa02 DECREASED- Ref Goljan 86.Burkitt lymphoma cause is EBV 87Bitemporal hemiopnea Pituitary Adenoma 88.Subdural hematoma due to: a) leakage of cerebralvein B) Diploic fructure {this mayalso right] 89.Penetratinginjuryin left intercostal space just lateral to sternum will demage which of followingstructure first intercostal membrane demage ASIM SHOIB 90.young patien with history of takingsome drug with anemia, HB is 8 ,WBC 9000 and platele is 240000 and PERIPHERAL blood shows IMMUTURE CELLS. A.All B.aplastic anemia C.Heamolytic anemia 91.NON LETHAL MI what haffen within Carridiac arrthemias completlyrecovery 92.pnemothorax A.lung collapse chest inward B.lung collapse chest owtward 93.difereence between primary wound healing and secondry wound healing Granulation tissue Wound contraction 94.1. Hx of chest infection 10 days back. otherwise she is fine .Presented with petechiae and echymosis. Investigation A. PT B. APTT C. PLATELET COUNT {not sure} D. BLEEDING TIME 95. posterior relation relation of leftkidneyis DIAPHARM 96 .duringinspiration greater decrease in intrapleral pressure than alvelor pressure 97.younggirl HB 5,MCV LOW ,MHCH LOW,and abnormal morphology of RBCS,investigitiom?????? HB electropheresis ferritin fe TIBC 98.if head is tilted to A.Perilymph/lymph in horizontal canal move in opposite direction B.Sterocillia move awayfrom kinocellium 99- Pt with Diabetic ketoacidosis pt managed Bt died. Most likely infection is a.mucur b.candida c.E.coli 100—Dead organisms in vaccine: A.Measles B.Mumps C.Tetanus d.WHOOPING COUGH BY LUMBER PLEXIUS CHANKA MEDICAL COLLAGE REMEMBER MEIN UR PRAYERS BEST OFLUCK


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