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Questions of All India PG Entrance Exam 2006

2009-12-27T06:57:00.002+05:30

Questions of All India PG Entrance Exam 2006

1.    All of the following are features of prematurity in a neonate, except:



    1.    No creases on sole.

    2.    Abundant lanugo.

    3.    Thick ear cartilage.

    4.    Empty scrotum.

2.    A normally developing 10 month old child should be able to do all of the following except :



    1.    Stand alone.

    2.    Play peek a boo.

    3.    Pick up a pellet with thumb and index finger.

    4.    Build a tower of 3-4 cubes.

3.    The following are characteristic of autism except :



    1.    Onset after 6 years of age.

    2.    Repetitive behaviour.

    3.    Delayed language development.

    4.    Severe deficit in social interaction.

4.    The earliest indicator of response after starting iron in a 6- year-old girl with iron deficiency is:



    1.    Increased reticulocyte count.

    2.    Increased hemoglobin.

    3.    Increased ferritin.

    4.    Increased serum iron.

5.    A 1 month old boy is referred for failure to thrive. On examination, he shows features of congestive failure. The femoral pulses are feeble as compared to branchial pulses. The most likely clinical diagnosis is :



    1.    Congenital aortic stenosis.

    2.    Coarctation of aorta.

    3.    Patent ductus arteriosus.

    4.    Congenital aortoiliac disease.

6.    All of the following statements regarding subendocardinal infarction are true, except :



    1.    These are multifocal in nature.

    2.    These often result from hypotension or shock.

    3.    Epicarditis is not seen.

    4.    These may result in aneurysm.

7.    All of the following are true for mitral valve prolapse, except :



    1.    Transmission may be as an Autosomal dominant trait.

    2.    Majority of the case present with features of mitral regurgitation.

    3.    The value leaflets characteristically show myxomatous degeneration.

    4.    The disease is one of the common cardiovascular manifestations of Marfan Syndrome.

8.    The following diseases are associated with Epstein â€“ Barr virus infection, except :



    1.    Infectious mononucleosis.

    2.    Epidermodysplasia verruciformis.

    3.    Nasopharyngeal carcinoma.

    4.    Oral Hairy leukoplakia

9.    Megaloblastic anaemia due to folic acid deficiency is commonly due to :



    1.    Inadequate dietary intake.

    2.    Defective intestinal absorption.

    3.    Absence of folic acid binding protein in serum.

    4.    Absence of glutamic acid in the intestine.

10.    The most important prognostic factor in breast carcinoma is :



    1.    Histological grade of the tumour.

    2.    Stage of the tumour at the time of diagnosis.

    3.    Status of estrogen and progesterone receptors.

    4.    Over expression of p-53 tumour suppressor gene.

11.    Smoking is generally not associated as a risk factor with :



    1.    Small cell carcinoma.

    2.    Respiratory bronchiolitis.

    3.    Emphysema.

    4.    Bronchiolitis obliterans organizing pneumonia.

12.    The tumour, which may occur in the residual breast or overlying skin following wide local excision and radiotherapy for mammary carcinoma, is :



    1.    Leiomyosarcoma.

    2.    Squamous cell carcinoma.

    3.    Basal cell carcinoma.

    4.    Angiosarcoma.

13.    The type of mammary ductal carcinoma in situ (DCIS) most likely to result in a palpable abnormality in the breast is :



    1.    Apocrine DCIS.

    2.    Neuroendocrine DCIS.

    3.    Well differentiated DCIS.

    4.    Comedo DCIS.

14.    Acinic cell carcinomas of the salivary gland arise most often in the :



    1.    Parotid salivary gland.

    2.    Minor salivary glands.

    3.    Submandibular salivary gland.

    4.    Sublingual salivary gland.

15.    All of the following statements regarding primary effusion lymphoma are true except :



    1.    It generally presents in elderly patients.

    2.    There is often an association with HHV-8.

    3.    The proliferating cells are NK cells.

    4.    Patients are commonly HIV positive.

16.    Mantle cell lymphomas are positive for all of the following, except :



    1.    CD 23.

    2.    CD 20.

    3.    CD 5.

    4.    CD 43.

17.    Fine needle aspiration cytology is not suitable for diagnosing :



    1.    Tubercular lymphadenitis.

    2.    Papillary carcinoma thyroid.

    3.    Plasmacytoma.

    4.    Aneurymal bone cyst.

18.    All of the following immunohistochemical markers are positive in the neoplastic cells of granulocytic sarcoma, except :



    1.    CD 45 RO.

    2.    CD 43.

    3.    Myeloperoxidase.

    4.    Lysozyme.

19.    B cell prolymphocytic leukemia patients differ from those with B cell chronic lymphocytic leukemia in :



    1.    Presenting at a younger age.

    2.    Having a lower total leucocyte count.

    3.    Having prominent lymphadenopathy.

    4.    Having a shorter survival.

20.    Which of the following statements is incorrect about pthisis bulbi?



    1.    The intraocular pressure is increased.

    2.    Calcification of the lens is common.

    3.    Sclera is thickened.

    4.    Size of the globe is reduced.

21.    Which one of the following statements is incorrect about Optic glioma?



    1.    Has a peak incidence in first decade.

    2.    Arises from oligodendrocytes.

    3.    Causes meningeal hyperplasia.

    4.    Is associated with type I neurofirbromatosis.

22.    Which one of the following stromal dystrophy is a recessive condition ?



    1.    Lattice dystrophy.

    2.    Granular dystrophy.

    3.    Macular dystrophy.

    4.    Fleck dystrophy.

23.    In which of the following conditions Parakeratosis most frequently occurs?



    1.    Actinic Keratoses.

    2.    Seborrheic keratoses.

    3.    Molluscum contagiosum.

    4.    Basal cell carcinoma.

24.    Which one of the following is the most significant risk factor for development of gastric carcinoma?



    1.    Paneth cell metaplasia.

    2.    Pyloric metaplasia.

    3.    Intestinal metaplasia.

    4.    Ciliated metaplasia.

25.    Which of the following is the most common presenting symptom of non-cirrhotic portal hypertension?



    1.    Chronic liver failure.

    2.    Ascites.

    3.    Upper gastrointestinal bleeding.

    4.    Encephalopathy.

26.    Ethosuximide is used in the treatment of :



    1.    Tonic-clonic seizure.

    2.    Absence seizure.

    3.    Myoclonic seizure.

    4.    Simple partial seizure.

27.    Which of the following statements is not true about etomidate?



    1.    It is an intravenous anesthetic.

    2.    It precipitates coronary insufficiency.

    3.    It inhibits cortisol synthesis.

    4.    It causes pain at site of injection.

28.    Which one of the following antibacterials should not be used with d-tubocurarine?



    1.    Norfloxacin.

    2.    Streptomycin.

    3.    Doxycycline.

    4.    Cefotaxime.

29.    Which one of the following drugs is an antipseudomonal penicillin?



    1.    Cephalexin.

    2.    Cloxacillin.

    3.    Piperacillin.

    4.    Dicloxacillin.

30.    The following statements regarding benzodiazephines are true except:



    1.    Binds to both GABAA and GABAB receptors.

    2.    They have active metabolites.

    3.    Decreases nocturnal gastric secretion in human being.

    4.    Extensively metabolized by CYP enzymes.

31.    One of the following statements regarding mycophenolate mofetil is incorrect:



    1.    It is a prodrug.

    2.    It is a selective uncompetitive and reversible inhibitor of inosine monophosphate dehydrogenase.

    3.    It also inhibits calcineurin.

    4.    Selectivity inhibits lymphocyte proliferation.

32.    All of the following mechanisms of action of oral contraceptive pill are true, except :



    1.    Inhibition of ovulation.

    2.    Prevention of fertilization.

    3.    Interference with implantation of fertilized ovum.

    4.    Interference with placental functioning.

33.    Which one of the following drugs does not interfere with folic acid metabolism?



    1.    Phenytoin.

    2.    Gabapentin.

    3.    Phenobarbitone.

    4.    Primidone.

34.    Which one of the following drugs causes constipation?



    1.    Propranolol.

    2.    Verapamil.

    3.    Nitroglycerin.

    4.    Captopril.

35.    Which of the following drugs is not used topically for treatment of open angle glaucoma:



    1.    Latanoprost.

    2.    Brimonidine.

    3.    Acetazolamide.

    4.    Dorzolamide.

36.    Concomitant administration of clonazepam with which of the following antiepileptic drug can precipitate absence status?



    1.    Sodium valproate.

    2.    Phenobarbitone.

    3.    Carbamazepine.

    4.    Phenytoin.

37.    Which one of the following agents has been associated with hemorrhagic stroke?



    1.    Phenylpropanolamine.

    2.    Terfenadine.

    3.    Quinidine.

    4.    Fenfluramine.

38.    All of the following are therapeutic uses of Penicillin G, except :



    1.    Bacterial meningitis.

    2.    Rickettsial Infection.

    3.    Syphilis.

    4.    Anthrax.

39.    All of the following are major complications of massive transfusion, except:



    1.    Hypokalemia.

    2.    Hypothermia.

    3.    Hypomagnesemia.

    4.    Hypocalcemia.

40.    Which one of the following muscle relaxant has the maximum duration of action ?



    1.    Atracurium.

    2.    Vecuronium.

    3.    Rocuronium.

    4.    Doxacurium.

41.    Which enzyme is inhibited by Aminophylline?



    1.    Monoamine Oxidase.

    2.    Alcohol dehydrogenase.

    3.    Phjosphodiesterase.

    4.    Cytochrome P-450.

42.    Which one of the following local anaesthetics belongs to the ester group?



    1.    Procaine.

    2.    Bupivacaine.

    3.    Lignocaine.

    4.    Mepivacaine.

43.    The following are the benozodiazepines of choice in elderly and those with liver disease, except:



    1.    Lorazepam.

    2.    Oxazepam,

    3.    Temazepam.

    4.    Diazepam.

44.    Which one of the following agents sensitises the myocardium to catecholamines?



    1.    Isoflurane

    2.    Ether.

    3.    Halothane.

    4.    Propofol.

45.    Which of the following is the muscle relaxant of choice in renal failure?



    1.    Rapacurium

    2.    Pancuronium

    3.    Atracurium

    4.    Rocuronium

46.    Ovulation is primarily caused by preovulatory surge of :



    1.    Estradiol.

    2.    Luteinizing hormone.

    3.    Progesterone.

    4.    Follicle stimulating hormone.

47.    Most afferent fibers from the lateral geniculate nucleus terminate in the primary visual cortex in :



    1.    Layer 1.

    2.    Layer 2 & 3.

    3.    Layer 4.

    4.    Layer 5 & 6.

48.    The blobs of the visual cortex are associated with :



    1.    Ocular dominance.

    2.    Orientation.

    3.    Color processing.

    4.    Saccadic eye movements.

49.    The parvocellular pathway, from the lateral geniculate nucleus to the visual cortex, carries signals for the detection of :



    1.    Movement, depth and flicker.

    2.    Color vision, shape and fine details.

    3.    Temporal frequency.

    4.    Luminance contrast.

50.    A pilot in Sukhoi aircraft is experiencing negative G. Which of the following physiological events will manifest in such situation?



    1.    The hydrostatic pressure in veins of lower limb increases.

    2.    The cardiac output decreases.

    3.    Black out occurs.

    4.    The cerebral arterial pressure rises.

51.    In human being, the least useful physiological response to low environmental temperature is :



    1.    Shivering.

    2.    Vasoconstriction.

    3.    Release of thyroxine.

    4.    Piloerection.

52.    The cell bodies of orexinergic neurons are present in:



    1.    Locus coeruleus.

    2.    Dorsal raphe.

    3.    Lateral hypothalamic area.

    4.    Hippocampus.

53.    The tubuloglomerular feedback is mediated by:



    1.    Sensing of Na+ concentration in the macula densa.

    2.    Sensing of Cl+ concentration in macula densa.

    3.    Sensing NaCl concentration in the macula densa.

    4.    Opening up of voltage gated Na+ channels in afferent arteriole.

54.    The prime driving force for counter current multiplier system is :



    1.    Medullary hperosmolarity.

    2.    Reabsorption of Na+ in thick ascending limb.

    3.    Action of ADH via aquaporin channels.

    4.    Urea recycling.

55.    Which of the following organs is not involved in calcium homeostasis?



    1.    Kidneys.

    2.    Skin.

    3.    Intestines.

    4.    Lungs.

56.    Testosterone production is mainly contributed by:



    1.    Leydig cells.

    2.    Sertolie cells.

    3.    Seminiferous tubules.

    4.    Epididymis.

57.    Which of the following secretions has a very high pH?



    1.    Gastric juice.

    2.    Pancreatic juice.

    3.    Bile in gall bladder.

    4.    Saliva.

58.    The maintenance of posture in a normal adult human being depends upon:



    1.    Integrity of reflex are.

    2.    Muscle power.

    3.    Type of muscle fibres.

    4.    Joint movements in physiological range.

59.    The first reflex response to appear as spinal shock wears off in humans is :



    1.    Tympanic reflex.

    2.    Withdrawal reflex.

    3.    Neck righting reflex.

    4.    Labyrinthine reflex..

60.    The hyperkinetic features of the Huntingtonâ€™s disease are due to the loss of :



    1.    Nigrostriatal dopaminergic system.

    2.    Intrastriatal cholinergic system.

    3.    GABA-ergic and choloinergic system.

    4.    Intrastriatal GABA-ergic and cholinergic system.

61.    All of the following are part of the treatment of Lithium toxicity, except:



    1.    Treating dehydration.

    2.    Ingestion of polystyrene sulfonate.

    3.    Hemodialysis.

    4.    Using an antagonist.

62.    All are side effects of Clozapine except:



    1.    Granulocytopenia.

    2.    Seizures.

    3.    Sedation.

    4.    Extrapyramidal side effects

63.    Pavlovâ€™s experiment is an example of:



    1.    Operant conditioning.

    2.    Classical conditioning.

    3.    Learned helplessness.

    4.    Modelling.

64.    Bright light treatment has been found to be most effective in treatment of :



    1.    Anorexia Nervosa.

    2.    Seasonal Affective Disorder.

    3.    Schizophrenia.

    4.    Obsessive Compulsive Disorder.

65.    The most common side effect reported with treatment with haloperidol is :



    1.    Hypotension.

    2.    Akathisia.

    3.    Dryness of mouth.

    4.    Tic disorder.

66.    Mutism and akinesis in a person, who appears awake and even alert, is best described as :



    1.    Twilight State.

    2.    Oneroid state.

    3.    Stupor.

    4.    Delirium.

67.    Loosening of association is an example of :



    1.    Formal thought disorder.

    2.    Schneiderian first rank symptoms.

    3.    Perseveration.

    4.    Concrete thinking.

68.    Intense nihilism, somatization and agitation in old age are the hallmark symptoms of:



    1.    Involutional melancholia.

    2.    Aty[pical depression.

    3.    Somatized depression

    4.    Depressive stupor.

69.    Rivastigmine and Donepezil are drugs used predominantly in the management of:



    1.    Depression.

    2.    Dissociation.

    3.    Delusions.

    4.    Dementia.

70.    All of the following are associated with better prognosis in schizophrenia, except :



    1.    Late onset.

    2.    Married.

    3.    Negative symptoms.

    4.    Acute onset.

71.    The following features are true for Tetralogy of Fallot, except:



    1.    Ventricular septal defect.

    2.    Right ventricular hypertrophy.

    3.    Atrial septal defect.

    4.    Pulmonary stenosis.

72.    Which of the following statements is true regarding testicular tumours?



    1.    Are embryonal cell carcinomas in 95% of cases.

    2.    Bilateral in upto 10% cases.

    3.    Teratomas are more common than seminomas.

    4.    Usually present after 50 years of age.

73.    The most common retrobulbar orbital mass in adults is:



    1.    Neurofibroma.

    2.    Meningioma.

    3.    Cavernous haemangioma.

    4.    Schwannoma.

74.    In which of the following conditions left atrium is not enlarged:



    1.    Ventricular septal defect.

    2.    Atrial septal defect.

    3.    Aorto-pulmonary window.

    4.    Patent ductus arteriosus.

75.    Expansile lytic osseous metastases are characteristic of primary malignancy of :



    1.    Kidney.

    2.    Bronchus.

    3.    Breast.

    4.    Prostate.

76.    Which is the objective sign of identifying pulmonary plethora in a chest radiograph?



    1.    Diameter of the main pulmonary artery > 16mm.

    2.    Diameter of the left pulmonary artery > 16mm.

    3.    Diameter of the descending right pulmonary artery > 16mm.

    4.    Diameter of the descending left pulmonary artery > 16mm.

77.    The most accurate investigation for assessing ventricular function is :



    1.    Multislice CT.

    2.    Echocardiography.

    3.    Nuclear scan.

    4.    MRI.

78.    The most important sign of significance of renal artery stenosis on an angiogram is:



    1.    A percentage diameter stenosis > 70%.

    2.    Presence of collaterals.

    3.    A systolic pressure gradient > 20mm Hg across the lesion.

    4.    Post stenotic dilatation of the renal artery.

79.    The MR imaging in multiple sclerosis will show lesions in:



    1.    White matter.

    2.    Grey matter.

    3.    Thalamus.

    4.    Basal ganglia.

80.    The most common location of hypertensive intracranial haemorrhage is :



    1.    Subarachnoid space.

    2.    Basal ganglia.

    3.    Cerebellum.

    4.    Brainstem.

81.    Which of the following causes rib-notching on the chest radiograph?



    1.    Bidirectional Glem shunt.

    2.    Modified Blalock-Taussing shunt.

    3.    IVC occusion.

    4.    Coarctation of aorta.

82.    The most sensitive imaging modality to detect early renal tuberculosis is:



    1.    Intravenous urography.

    2.    Computed tomography.

    3.    Ultrasound.

    4.    Magnetic Resonance Imaging.

83.    All of them use non-ionizing radiation, except:



    1.    Ultrasonography.

    2.    Thermography.

    3.    MRI.

    4.    Radiography.

84.    Mixed tumours of the salivary glands are:



    1.    Most common in submandibular gland.

    2.    Usually malignant.

    3.    Most common in parotid gland.

    4.    Associated with calculi.

85.    In which of the following types of breast carcinoma, would you consider biopsy of opposite breast?



    1.    Adenocarcinoma-poorly differentiated.

    2.    Medullary carcinoma.

    3.    Lobular carcinoma.

    4.    Comedo carcinoma.

86.    A malignant tumour of childhood, that metastasizes to bones most often, is:



    1.    Wilmâ€™s tumour.

    2.    Neuroblastoma.

    3.    Adrenal gland tumours.

    4.    Granulosa cell tumour of ovary.

87.    When carcinoma of stomach develops secondarily to pernicious anemia, it is usually situated in the :



    1.    Pre Pyloric region.

    2.    Pylorus.

    3.    Body.

    4.    Fundus.

88.    With regard to the malignant behaviour of leiomysarcoma, the most important criterion is :



    1.    Blood vessel penetration by tumour cells.

    2.    Tumour cells in lymphatic channels.

    3.    Lymphocyte infiltration.

    4.    The number of mitoses per high power field.

89.    The most radiosensitive tumour among the following is:



    1.    Bronchogenic carcinoma.

    2.    Carcinoma parotid.

    3.    Dysgerminoma.

    4.    OSteogenic sarcoma.

90.    Ina suspected of ovarian cancer, imaging work-up is required for all of the following information, except:



    1.    Detection of adenexal lesion.

    2.    Characterization of the lesion.

    3.    Staging.

    4.    Assess resectability.

91.    In which of the following age group Myelodysplastic Syndromes (MDS) are most common?



    1.    2-10.

    2.    15-20.

    3.    25-40.

    4.    >50.

92.    A patient with leukemia on chemotheraphy develops acute right lower abdominal pain associated with anemia, thrombocytopenia and leukopenia. Which of following is the clinical diagnosis?



    1.    Appendictis.

    2.    Leukemic colitis.

    3.    Perforation peritonitis.

    4.    Neutropenic colitis.

93.    All of the following modalities can be used for in-situ ablation of liver secondaries, except:



    1.    Ultrasonic waves.

    2.    Cryotherapy.

    3.    Alcohol.

    4.    Radiofrequency.

94.    All of the following radioisotopes are used as systemic radionucleide, except:



    1.    Phosphorus-32.

    2.    Strontium-89.

    3.    Iridium-192.

    4.    Samarium-153.

95.    Phosphorous-32 emits:



    1.    Beta particles.

    2.    Alfa particles.

    3.    Neutrons.

    4.    X-rays.

96.    The ideal timing of radiotherapy for Wilms Tumour after surgery is:



    1.    Within 10 days.

    2.    Within 2 weeks.

    3.    Within 3 weeks.

    4.    Any time after surgery.

97.    The percentage of pulmonary emboli, that proceed to infraction, is approximately:



    1.    0-5%.

    2.    5-15%.

    3.    20-30%.

    4.    30-40%.

98.    Which of the following is used in the treatment of differentiated thyroid cancer:



    1.    131I.

    2.    99mTc.

    3.    32p.

    4.    131I-MIBG.

99.    Which one of the following imaging techniques gives maximum radiation exposure to the patient?



    1.    Chest X-ray.

    2.    MRI.

    3.    CT scan.

    4.    Bone scan.

100.    Which one of the following has the maximum ionization potential?



    1.    Electron.

    2.    Proton.

    3.    Helim ion.

    4.    Gamma(ï§) â€“ Photon.

101.    Which of the following is not a major criteria for dignosis of multiple myeloma?



    1.    Lytic bone lesions.

    2.    Plasmacytoma on tissue biopsy.

    3.    Bone marrow plasmacytosis > 30%

    4.    â€˜Mâ€™Spike > 3g% for 1g G, >2g% for 1g A.

102.    The treatment of choice for squamous cell anal cancer is:



    1.    Abdomino perennial resection.

    2.    Laser fulgaration.

    3.    Chemoradiotherapy.

    4.    Platinum based chemotheraphy.

103.    The magnification obtained with a direct ophthalmoscope is:



    1.    5 times.

    2.    10 times.

    3.    15 times.

    4.    20 times.

104.    The average distance of the fovea from the temporal margin of the optic disc is:



    1.    1 disc diameter.

    2.    2 disc diameter.

    3.    3 disc diameter.

    4.    4 disc diameter.

105.    The most common cause of vitreous haemorrhage in adults is :



    1.    Retinal hole.

    2.    Trauma.

    3.    Hypertension.

    4.    Diabetes.

106.    The retina receives its blood supply from all except:



    1.    Posterior ciliary artery,

    2.    Central retinal artery.

    3.    Retinal arteries.

    4.    Plexus of zinn & Haller arteries.

107.    Which drug can cause macular toxicity when given intravitreally?



    1.    Gentamycin.

    2.    Vancomycin.

    3.    Dexamethasone.

    4.    Ceftazidime.

108.    Typically bilateral inferior lens subluxation of the lens is seen in :



    1.    Marfanâ€™s syndrome.

    2.    Homocystinuria.

    3.    Hyperlusinaemia

    4.    Ocular trauma.

109.    Which of the following antiglaucoma medications can cause drowsiness?



    1.    Latanoprost.

    2.    Timolol.

    3.    Brimonidine,

    4.    Dorzolamide.

110.    Which of the following is the drug of choice for treatment of corneal ulcers caused by filamentous fungi?



    1.    Itraconazole.

    2.    Natamycin.

    3.    Nystatin.

    4.    Fluconazole.

111.    Which of the following medications is contraindicated in patients with allergy to sulphonamides?



    1.    Levobunolol.

    2.    Bimatoprost.

    3.    Brinzolamide.

    4.    Brimonidine.

112.    In which of the following uveitic conditions is it contraindicated to put in an intraocular lens after cataract surgery?



    1.    Fuchâ€™s heterochromic cyclitis.

    2.    Juvenile rheumatopid arthritis.

    3.    Psoriatic arthritis.

    4.    Reiterâ€™s syndrome.

113.    A case of Non-Insulin dependent diabetes mellitus (NIDDM) with a history of diabetes for one year should have an ophthalmic examination:



    1.    As early as feasible.

    2.    After 5 years.

    3.    After 10 years.

    4.    Only after visual symptoms develop.

114.    SAFE Strategy is recommended for the control of ?



    1.    Trachoma.

    2.    Glaucoma.

    3.    Diabetic retinopathy.

    4.    Cataract.

115.    As per the 1986-89 NPCB survey, what was the prevalence of blindness in India (at visual acuity <6/60 in better eye)?



    1.    1.38%

    2.    1.49%

    3.    1.72%

    4.    1.8%

116.    Under the National Programme for Control of Blindness, who is supposed to conduct the vision screening of school students?



    1.    School teachers.

    2.    Medical officers of health centres.

    3.    Ophthalmologists.

    4.    Health assistants.

117.    According to the World Health Organization, the definition of blindness is:



    1.    Visual acuity <6/60 in the better eye with available correction.

    2.    Visual acuity <3/60 in the better eye with available correction.

    3.    Visual acuity <6/60 in the better eye with best correction.

    4.    Visual acuity <3/60 in the better eye with best correction.

118.    The most common cause of ocular morbidity in India is :



    1.    Cataract.

    2.    Conjunctivitis.

    3.    Refractive error.

    4.    Trachoma.

119.    A vitreous aspirate from a case of metastatic endophthalmitis on culture yields Gram positive round to oval cells, 12-14ï in size. The aspirate on Gram staining shows the presence of pseudohyphae. Which of the following is the most likely aetiological agent?



    1.    Aspergillus.

    2.    Rhizopus.

    3.    Candida.

    4.    Fusarium.

120.    The most common malignancy found in Marjolinâ€™s ulcer is:



    1.    Basal cell carcinoma.

    2.    Squamous cell carcinoma.

    3.    Malignant fibrous histiocytoma.

    4.    Neurotrophic malignant melanoma.

121.    Mycotic aneurysm is an aneurysm infected because of :



    1.    Fungal infection.

    2.    Blood borne infection (intravascular)

    3.    Infection introduced from outside (extravascular)

    4.    Both intravascular & extravascular infection.

122.    The procedure of choice for the evaluation of an aneurysm is :



    1.    Ultrasonography.

    2.    Computed tomography.

    3.    Magnetic resonance imaging.

    4.    Arteriography.

123.    The most common cause of acquired arteriovenous fistuala is:



    1.    Bacterial infection.

    2.    Fungal infection.

    3.    Blunt trauma.

    4.    Penetrating trauma.

124.    Laryngocele arises as a herniation of laryngeal mucosa through the following membrance:



    1.    Thyrochyoid.

    2.    Criciothyroid.

    3.    Crico-tracheal.

    4.    Crisosternal.

125.    Which one of the following statements is incorrect regarding stones in the common bile duct?



    1.    Can present with Charcotâ€™s Triad.

    2.    Are suggested by a bile duct diameter >6mm of ultrasound.

    3.    ERCP, sphincterotomy and balloon clearance is now the standard treatment.

    4.    When removed by exploration of the common bile duct the T-tube can be removed after 3 days.

126.    Which of the following colonic polyps is not pre-maligant?



    1.    Juvenile polyps.

    2.    Hamartomatous polyps associated with Peutz-Jeghers syndrome.

    3.    Villous adenomas.

    4.    Tubular adenomas.

127.    A patient of post-cholecystectomy biliary stricture has undergone an ERCP three days ago. Following this she has developed acute cholangitis. Th most likely organism is:



    1.    Escherichia coli.

    2.    Bacillus fragilis.

    3.    Streptococcus viridans.

    4.    Pseudomonas aerogenosa.

128.    Biliary stricture developing after Laparascopic cholecystectomy usually occurs at which part of the common bile duct?



    1.    Upper.

    2.    Middle.

    3.    Lower.

    4.    All sites with equal frequency.

129.    Apart from Escherichia Coli, the other most common organism implicated in acute suppurative bacterial peritonitis is:



    1.    Bacteroides.

    2.    Klebsiella

    3.    Peptostreptococcus.

    4.    Pseudomonas.

130.    The treatment of choice for the management of carcinoma of the anal canal is :



    1.    Abdomino perineal resection.

    2.    Primary radiotherapy.

    3.    Combined radio-and chemotheraphy.

    4.    Neoadjuvant chemotherapy and local excision.

131.    The following statements about thyroglossal cyst are true, except:



    1.    Frequent cause of anterior midline neck masses in the first decade of life.

    2.    The cyst is located within 2 cm of the midline.

    3.    Incision and Drainage is the treatment of choice.

    4.    The swelling moves upwards on protrusion of tongue.

132.    Which of the following is not a preferred site for planning vascular access for maintenance haemodialysis ?



    1.    Non-dominant extremity.

    2.    Upper limb.

    3.    Radio-cephalic AV fistula.

    4.    Sapheno-femoral fistula.

133.    Which of the following drugs is not a part of the â€˜Triple Therapyâ€™ immunosuppression for post renal transplant patients?



    1.    Cyclosporine.

    2.    Azathioprine.

    3.    FK 506.

    4.    Prednisolone.

134.    Which of the following is not a component of Glasgow Coma Scale?



    1.    Eye opening.

    2.    Motor response.

    3.    Pupil size.

    4.    Verbal response.

135.    Allenâ€™s test is useful in evaluating:



    1.    Thoracic outlet compression.

    2.    Presence of cervical rib.

    3.    Integrity of palmar arch.

    4.    Digital blood flow.

136.    Neointimal hyperplasia causes vascular graft failure as a result of hypertrophy of:



    1.    Endothelial cells.

    2.    Collagen fibers.

    3.    Smooth muscle cells.

    4.    Elastic fibers.

137.    Dacron vascular graft is :



    1.    Nontextile synthetic.

    2.    Textile synthetic

    3.    Nontextile biologic.

    4.    Textile biologic.

138.    Total score in Glasgow Coma Scale of a conscious person is :



    1.    8

    2.    3

    3.    15

    4.    10

139.    Mycotic abscesses are due to:



    1.    Bacterial infection

    2.    Fungal infection.

    3.    Viral infection.

    4.    Mixed infection.

140.    The most preferred approach for pituitary surgery at the present time is:



    1.    Transcranial.

    2.    Tranethmoidal

    3.    Transphenoidal.

    4.    Transcallosal.

141.    The normal range of serum osmolality (in mOsm/L) is:



    1.    270 to 285.

    2.    300 to 320.

    3.    350 to 375.

    4.    200 to 250.

142.    Which of the following is the most common type of Glial tumors?



    1.    Astrocytomas.

    2.    Medulloblastomas.

    3.    Neurofibromas.

    4.    Ependymomas.

143.    Which of the following tumors is not commonly known to increase in pregnancy?



    1.    Glioma.

    2.    Pituitary adenoma.

    3.    Meningioma.

    4.    Neurofibroma

144.    The requirement of potassium in a child is :



    1.    1-2 mEq/kg.

    2.    4-7 mEq/kg.

    3.    10-12 mEq/kg.

    4.    13-14 mEq/kg.

145.    The common cause of subarachnoid hemorrhage is :



    1.    Arterio-venous malformation.

    2.    Cavernous Angioma.

    3.    Aneurysm.

    4.    Hypertension.

146.    Brain abscess in cyanotic heart disease is commonly located in :



    1.    Cerebellar hemisphere

    2.    Thalamus.

    3.    Temporal lobe.

    4.    Parietal lobe.

147.    Afferent component of corneal reflex is mediated by :



    1.    Vagus nerve.

    2.    Facial nerve.

    3.    Trigeminal nerve.

    4.    Glossopharyngeal nerve.

148.    In adults, the spinal cord normally ends at:



    1.    Lower border of L1.

    2.    Lower border of L3.

    3.    Lower border of S1.

    4.    Lower border of L5.

149.    Middle meningeal artery is direct branch of :



    1.    External carotid artery.

    2.    Internal maxillary artery.

    3.    Superficial temporal artery.

    4.    Middle cerebral artery.

150.    Which of the following is not a common feature of Anorexia Nervosa?



    1.    Binge eating.

    2.    Amennorhea.

    3.    Self perception of being â€˜fatâ€™.

    4.    Under weight.

151.    An affected male infant born to normal parents could be an example of all of the following, except:



    1.    An Autosomal dominant disorder.

    2.    An Autosomal recessive disorder.

    3.    A polygenic disorder.

    4.    A vertically transmitted disorder.

152.    The following methods can be used to detect the point mutation in the beta (ï¢) â€“ globin gene that causes sickle cell anemia, except:



    1.    Polymerase chain reaction with allele-specific oligonucleotide hybridization.

    2.    Southem blot analysis.

    3.    DNA sequencing.

    4.    Northern blot analysis.

153.    A child with a small head, minor anomalies of the face including a thin upper lip, growth delay, and developmental disability can have all of the following, except:



    1.    A chromosomal syndrome.

    2.    A teratogenic syndrome.

    3.    A Mendelian syndrome.

    4.    A polygenic syndrome.

154.    In a family, the father has widely spaced eyes, increased facial hair and deafness. One of the three children has deafness with similar facial features. The mother is normal. Which one of the following is most likely pattern of inheritance in this case ?



    1.    Autosomal dominant.

    2.    Autosomal recessive.

    3.    X-linked dominant.

    4.    X-linked recessive.

155.    Mitochondrial DNA is :



    1.    Closed circular.

    2.    Nicked circular.

    3.    Linear.

    4.    Open circular.

156.    Polar bodies are formed during :



    1.    Spermatogenesis.

    2.    Organogenesis.

    3.    Oogenesis.

    4.    Morphogenesis.

157.    Prenatal diagnosis at 16 weeks of pregnancy can be performed using all of the following, except:



    1.    Amniotic fluid.

    2.    Maternal blood.

    3.    Chorionic villi.

    4.    Fetal blood.

158.    The long and short arms of chromosomes are designated respectively as :



    1.    p and q arms.

    2.    m and q arms.

    3.    q and p arms.

    4.    l and s arms.

159.    Euchromatin is the region of DNA that is relatively:



    1.    Uncondensed.

    2.    Condensed.

    3.    Overcondensed.

    4.    Partially condensed.

160.    Microsatellite sequence is:



    1.    Small satellite.

    2.    Extra chromosomal DNA.

    3.    Short sequence (2-5) repeat DNA.

    4.    Looped-DNA.

161.    All of the following cell types contain the enzyme telomerase which protects the length of telomeres at the end of chromosomes, except :



    1.    Germinal

    2.    Somatic.

    3.    Haemopoetic.

    4.    Tumour.

162.    All of the following are the components of the white pulp of spleen, except :



    1.    Periarteriolar lymphoid sheath.

    2.    B cells.

    3.    Antigen presenting cells.

    4.    Vascular sinus.

163.    All of the following development events are dependent on the production of maternal or fetal glucocorticoid, except



    1.    Induction of thymic involution

    2.    Production of surfactant by type II alveolar cells

    3.    Functional thyroid

    4.    Functional hypothalamopituitary axis

164.    Referred pain from all of the following conditions may be felt along the inner side of right thigh, except:



    1.    Inflamed pelvic appendix

    2.    Inflamed ovaries

    3.    Stone n pelvic Ureter

    4.    Pelvic abscess

165.    A 43 year old woman came with a large abscess in the middle of the right posterior triangle of the neck. The physician incised and drained the abscess. Five days later the patient noticed that she could not extend her right hand above her head to brush her hair. Which of the following are the signs and symptoms of additional harm?



    1.    Damage to scalenus medius

    2.    Injury to suprascapular nerve

    3.    Cut to spinal part of accessory nerve

    4.    Spread of infection to shoulder joint

166.    Which of the following inhalational agents is the induction agent of choice in children?



    1.    Methyoxyflurae

    2.    Sevoflurane

    3.    Desflurane

    4.    Isoflurane

167.    Which of the following anesthetic agents doesnâ€™t trigger malignant hyperthermia?



    1.    Halothane

    2.    Isoflurane

    3.    Suxamethonium

    4.    Thiopentone

168.    Which of the following is not an indication for endotracheal intubation?



    1.    Maintenance of a patent airway

    2.    To provide positive pressure ventilation

    3.    Pulmonary toilet

    4.    Pneumothorax

169.    Which of the following agents is not used to provide induced hypotension during surgery?



    1.    Sodium nitroprusside

    2.    Hydralazine

    3.    Mephenteramine

    4.    Esmolol

170.    Which of the following agents is used for the treatment of postoperative shivering?



    1.    Thiopentone

    2.    Suxamethonium

    3.    Atropine

    4.    Pethidine

171.    Which of the following is not a sign of stellate ganglion block?



    1.    Meiosis

    2.    exopthalmus

    3.    Nasal congestion

    4.    Conjuctival redness

172.    Which of the following intravenous induction agents is the most suitable for day care surgery?



    1.    Morphine

    2.    Ketamine

    3.    Propofol

    4.    Diazepam

173.    Blalock and Taussig shunt is done between:



    1.    Aorta to Pulmonary artery

    2.    Aorta to Pulmonary vein

    3.    Subclavian artery to Pulmonary vein

    4.    Subclavian vein to artery

174.    A two month old infant has undergone a major surgical procedure. Regarding post operative pain relief which one of the following is recommended:



    1.    No medication is needed as infant does not feel pain after surgery due to immaturity of nervous system

    2.    Only paracetamol suppository is adequate

    3.    Spinal narcotics via intrathecal route

    4.    Intravenous narcotic infusion in lower dosage

175.    A 5 year old patient is scheduled for tonsiilectomy. On the day of surgery he had running nose, temperature 37.5ÂºC and dry cough. Which of the following should be the most appropriate decision for surgery?



    1.    Surgery should be cancelled.

    2.    Can proceed for surgery if chest is clear and there is no history of asthma

    3.    Should get x-ray chest before proceeding for surgery

    4.    Cancel surgery for 3 week and patient to be on antibiotic

176.    A common feature of all serine proteases is:



    1.    Autocatalytic activation of zymogen precursor

    2.    Tight binding of pancreatic trypsin inhibitor

    3.    Cleavage of protein on the carboxyl site of serine residues

    4.    Presence of Ser-His-Asp catalytic triad at the active site

177.    During replication of DNA, which one of the following enzymes polymerizes the Okazaki fragments?



    1.    DNA Polymerase I

    2.    DNA Polymerase II

    3.    DNA Polymerase III

    4.    RNA Polymerase I

178.    During phagocytosis, the metabolic process called respiratory burst involves the activation of:



    1.    Oxidase

    2.    Hydrolase

    3.    Peroxidase

    4.    Dehydrogenase

179.    Which one of the following is the complementary sequence of 5' TTAAGCTAC 3â€™?



    1.    5â€™ GTACGCTTAA 3â€™

    2.    5â€™ AATTCGCATG 3â€™

    3.    5â€™ CATGCGAATT 3â€™

    4.    5â€™ TTAAGCGTAC 3â€™

180.    Base substitution mutatins can have be following molecular consequences except:



    1.    Changes one codon for an amino acid into another codon for that same amino acid

    2.    Codon for one amino acid is changed into a codon of another amino acid

    3.    Reading frame changes downstream to the mutant site

    4.    Codon for one amino acid is changed into a translation termination codon

181.    Vitamin B12 acts as coenzyme to which one of the following enzymes?



    1.    Isocitrate dehydrogenase

    2.    Homocysteine methyl transferase

    3.    Glycogen synthase

    4.    G-6-P dehydrogenase

182.    The normal cellular counterparts of oncogenes are important for the following functions except:



    1.    Promotion of cell cycle progression

    2.    Inhibition of apoptosis

    3.    Promotion of DNA repair

    4.    Promotion of nuclear transcription

183.    The ligand-receptor complex dissociates in the endosome because:



    1.    Of its large size

    2.    The vesicle looses its clathrin coat

    3.    Of the acidic pH of the vesicle

    4.    Of the basic pH of the vesicle

184.    The amino acid which serves as a carrier of ammonia from skeletal muscle to liver is:



    1.    Alanine

    2.    Methionine

    3.    Arginine

    4.    Glutamine

185.    All of the following amino acids are converted to succinyl â€“ CoA, except:



    1.    Methionine

    2.    Isoleucine

    3.    Valine

    4.    Histidine

186.    The specialized mammalian tissue/organ in which fuel oxidation serves not to produce ATP but to generate heat is:



    1.    Adrenal gland

    2.    Skeletal muscle

    3.    Brown adipose tissue

    4.    Heart

187.    The human plasma lipoprotein containing the highest percentage of triacylglycerol by weight is:



    1.    VLDL

    2.    Chylomicrons

    3.    HDL

    4.    LDL

188.    All of the following enzymes are regulated by calcium or calmodulin, except:



    1.    Adenylate cyclase

    2.    Glycogen synthase

    3.    Guanylyl cyclase

    4.    Hexokinase

189.    The sigma (ï³) subunit of prokaryotic RNA Polymerase:



    1.    Binds the antibiotic Rifampicin

    2.    Is inhibited by ï¡-amanitin

    3.    Specifically recognizes the promoter site

    4.    Is part of the core enzyme

190.    Which type of RNA has the highest percentage of modified base:



    1.    mRNA

    2.    tRNA

    3.    rRNA

    4.    snRNA

191.    There are more than 300 variants of human hemoglobin gene. Among these only a few are fatal. Hence, the most important factor to be conserved in a protein for its function is the:



    1.    Amino acid sequence

    2.    Ligand binding residues

    3.    Structure

    4.    Environment

192.    Proteins are linear polymers of amino acids. They fold into compact structures. Sometimes, these folded structures associate to form homo â€“ or hetero-dimers. Which one of the following refers to this associated form?



    1.    Denatured state

    2.    Molecular aggregation

    3.    Precipitation

    4.    Quaternary structure

193.    Which one of the following can be a homologous substitution for isoleucine in a protein sequence?



    1.    Methionine

    2.    Aspartic acid

    3.    Valine

    4.    Arginine

194.    The comparison of the amino acid sequence of Cytochrome C from different species shows many variations. Most of these variations are found:



    1.    Randomly

    2.    Only in helical regions

    3.    Only in strand regions

    4.    Mainly in loop regions

195.    The structural proteins are involved in maintaining the shape of a cell or in the formation of matrices in the body. The shape of these proteins is:



    1.    Globular

    2.    Fibrous

    3.    Stretch of beads

    4.    Planar

196.    The major purpose of randomization in a clinical trails is to:



    1.    Facilitate double blinding

    2.    Help ensure the study subjects are representative of general population

    3.    Ensure the groups are comparable on base line characteristics

    4.    Reduce selection bias in allocation to treatment

197.    The purpose of double blinding in clinical trials is to:



    1.    Achieve comparability between study and control groups

    2.    Avoid observer bias

    3.    Avoid subject bias

    4.    Avoid observer and subject bias

198.    When a drug is evaluated for its usefulness in controlled conditions, it is termed as a trial signifying:



    1.    Efficacy

    2.    Effectiveness

    3.    Efficiency

    4.    Effect modification

199.    Which of the following is most strongly associated with coronary heart disease?



    1.    Apolipoproteins

    2.    VLDL

    3.    HDL

    4.    Total liproproteins

200.    The extra energy allowances needed per day during pregnancy is:



    1.    150 KCals

    2.    200 KCals

    3.    300 KCals

    4.    550 KCals

201.    In a village having population of 1000, we found patients with certain disease and the results of a new diagnostic test on that disease are given below.



        Disease

    Test result    Present    Absent

    +    180    400

    ï€    20    400



    Which of the following is the positive predictive value of diagnostic test in that population

    1.    45

    2.    31

    3.    95

    4.    50

202.    Physical quality of life index is measured by all except:



    1.    Infant mortality

    2.    Life expectancy at age one

    3.    Literacy

    4.    Per capita income

203.    All the statements are true about standardization except:



    1.    Standardization allows comparison to be made between two different populations

    2.    The national population is always taken as the standard population

    3.    For Direct Standardization, age specific rates of the study population are applied to that of the standard population

    4.    For Indirect Standardization, age specific rates of the standard population are applied to that of the study population

204.    All the following are true in a randomized control trial (RCT) except:



    1.    Baseline characteristics of intervention and control groups should be similar

    2.    Investigatorâ€™s bias is minimized by double blinding

    3.    The sample size required depends on the hypothesis

    4.    The drop-outs from the trial should be excluded from he analysis.

205.    Study the following table carefully and answer the following question:

        Disease

    Test result    Present    Absent

    +    40    225

    ï€    10    225



    What is the sensitivity of diagnostic test?

    1.    45

    2.    20

    3.    80

    4.    50

206.    Pre-treatment evaluation for Lithium therapy should include:



    1.    Fasting blood sugar

    2.    Serum creatinine

    3.    Liver function tests

    4.    Platelet count

207.    According to the World Health Report 2000, Indiaâ€™s health expenditure is:



    1.    4.8% of G.D.P.

    2.    5.2% of G.D.P.

    3.    6.8% of G.D.P.

    4.    7% of G.D.P.

208.    The premium of the â€œCommunity based Universal Health Insurance Schemeâ€ launched during 2003-04 ranges from



    1.    Rs.1 per day poor and individual to

Rs.2 per day for a family of seven

    2.    Rs.1 per day poor and individual to

Rs.3 per day for a family of seven

    3.    Rs.2 per day poor and individual to

Rs.2 per day for a family of seven

    4.    Rs.1 per day poor and individual to

Rs.7 per day for a family of seven

209.    In which of the following year the Transplantation of Human Organs Act was passed by Government of India?



    1.    1994

    2.    1996

    3.    2000

    4.    2002

210.    Indian (economic) real GDP growth for the year 2003 is:



    1.    6.0

    2.    6.5

    3.    7.8

    4.    10.5



211.    A 6-month-old infant had itchy erythematous papules and exudative lesions on the scalp, face, groins and axillae for one month. She also had vesicular lesions on the palms. The most likely diagnosis is:



    1.    Congenital syphilis

    2.    Seborrhoeic dermatitis

    3.    Scabies

    4.    Psoriasis

212.    Pterygium of nail is characteristically seen in:



    1.    Lichen planus

    2.    Psoriasis

    3.    Tinea unguium

    4.    Alopecia areata

213.    A patient had seven irregular hyperpigmented macules on the trunk and multiple small hyperpigmented macules in the axillae and groins since early childhood. There were no other skin lesions. Which is the most likely investigation to support the diagnosis?



    1.    Slit lamp examination of eye

    2.    Measurement of intraocular tension

    3.    Examination of fundus

    4.    Retinal artery angiography

214.    A 24-year-old unmarried woman has multiple nodular, cystic, pustular and comadonic lesions on face, upper back and shoulders for 2 years. The drug of choice for her treatment would be:



    1.    Acitretin

    2.    Isotretinoin

    3.    Doxycycline

    4.    Azithromycin

215.    A 45-year-old farmer has itchy erythematous papular lesions on face, neck, â€˜Vâ€™ area of chest, dorsum of hands and forearms for 3 years. The lesions are more severe in summers and improve by 75% in winters. The most appropriate test to diagnose the condition would be:



    1.    Skin biopsy

    2.    Estimation of IgE levels in blood

    3.    Patch test

    4.    Intradermal prick test

216.    Finger Print Bureau was first established in:



    1.    England

    2.    China

    3.    India

    4.    Singapore

217.    Spaldingâ€™s sign occurs after:



    1.    Birth of live foetus

    2.    Death of foetus in uterus

    3.    Rigor mortis of infant

    4.    Cadaveric spasm

218.    Medical qualifications awarded by institutions out side India and recognized by MCI are registered in:



    1.    First schedule of Indian Medical Council Act 1956

    2.    Second schedule of Indian Medical Council Act 1956

    3.    Part I of third schedule of Indian Medical Council Act 1956

    4.    Part II of third schedule of Indian Medical Council Act 1956

219.    Scab or Crut of abrasion appears brown:



    1.    Between 12-24 hours

    2.    Between 2-3 days

    3.    Between 4-5 days

    4.    Between 5-7 days

220.    Which of following tests is used to detect semen?



    1.    Phenolphthalein test

    2.    Reineâ€™s test

    3.    Barberioâ€™s test

    4.    Paraffin test

221.    The presence of anti-Saccharomyces cerevisae antibody is a surrogate marker of one of the following



    1.    Coeliac disease

    2.    Crohnâ€™s disease

    3.    Ulcerative colitis

    4.    Tropical sprue

222.    The most common cause of gastric outlet obstruction in India is:



    1.    Tuberculosis

    2.    Cancer of stomach

    3.    Duodenal lymphoma

    4.    Peptic ulcer disease

223.    Which of the following parasitic infestation can led to malabsorption syndrome?



    1.    Amoebiasis

    2.    Adcariasis

    3.    Hookworm infestation

    4.    Giardiasis

224.    Which of the following is not a feature of hypercalcemia:



    1.    Diarrhoea

    2.    Polyuria

    3.    Depression

    4.    Vomiting

225.    Joint erosions are not a feature of:



    1.    Rheumatoid arthritis

    2.    Psoriasis

    3.    Multicentric reticulohistiocytosis

    4.    Systemic lpus erythematosus

226.    Nevirapine is a:



    1.    Protease inhibitor

    2.    Nucleoside reverse transcriptase inhibitor

    3.    Non-nucleoside reverse transcriptase inhibitor

    4.    Fusion inhibitor

227.    Anticentromere antibodies are most commonly associated with:



    1.    Diffuse cutaneous systemic sclerosis

    2.    Mixed connective tissue disease

    3.    CREST syndrome

    4.    Polymyositis

228.    A 58 years old woman, who had backache and recurrent chest infections for 6 months, develops sudden weakness of the legs and urinary retention. Her investigations show a hemoglobin of 7.3gm/dl, serum calcium 12.6mg/dl, phosphate-2.5mg/dl, alkaline phosphatase-100u/l, serum albumin-3 gm/dl, globulin-7.1gm/dl and urea-178 mg/d. What is the most likely diagnosis?



    1.    Lung cancer

    2.    Disseminated tuberculosis

    3.    Multiple myeloma

    4.    Osteoporosis

229.    All of the following drugs are protease inhibitors except:



    1.    Nelfinavir

    2.    Saquinavir

    3.    Abacavir

    4.    Ritonavir

230.    Which one of the following clinical findings excludes the diagnosis of polymyositis?



    1.    Neck muscle involvement

    2.    Extraocular muscle involvement

    3.    Dysphagia

    4.    Abdominal muscle involvement

231.    All of the following are the known causes of osteroporosis except:



    1.    Flurosis

    2.    Hypogonadism

    3.    Hyperthyroidism

    4.    Hyperparathyroidism

232.    A 28 years old woman having limited cutaneous scleroderma for the last 10 years complains of shortness of breath for last one month. Her pulmonary function tests (PFT) are as follows:



    PFT    Observed    Predicted

    FVC    2.63    2.82

    FEV1    88%    80%

    DLCO    5.26    16.3



    What is the most likely diagnosis in this case?

    1.    Interstitial lung disease

    2.    Pulmonary artery hypertension

    3.    Congestive heart failure

    4.    Bronchiectasis

233.    Which of the following is least likely to cause infective endocarditis:



    1.    Staphylococcus albust

    2.    Streptococcus faecalis

    3.    Salmonella typhi

    4.    Pseudomonas aeruginosa

234.    All of the following may occur due to hyperkalemia, except:



    1.    Prolonged PR interval

    2.    Prolonged QRS interval

    3.    Prolonged QT interval

    4.    Ventricular asystole

235.    Renal artery stenosis may occur in all of the following, except:



    1.    Atherosclerosis

    2.    Fibromuscular dysplasia

    3.    Takayasuâ€™s arteritis

    4.    Polyarteritis nodosa

236.    Sudden cardiac death may occur in all of the following, except:



    1.    Dilated cardiomyopathy

    2.    Hypertrophic cardiomyopathy

    3.    Eisenmengerâ€™s syndrome

    4.    Ventricular septal defect

237.    All of the following are risk factors for atherosclerosis except:



    1.    Increased waist-hip ratio

    2.    Hyperhomocysteinemia

    3.    Decreased fibrinogen levels

    4.    Decreased HDL levels

238.    All of the following may occur in Downâ€™s syndrome except:



    1.    Hypothyroidism

    2.    Undescended testis

    3.    Ventricular septal defect

    4.    Brushfieldâ€™s spots

239.    All of the following may be seen in patients of cardiac tamponade except:



    1.    Kussmaulâ€™s sign

    2.    Pulsus paradoxus

    3.    Electrical alternans

    4.    Right ventricular diastolic collapse on echocardiogram

240.    A 15 year old female presents with primary amenorrhoea. Her breasts are Tanner 4 but she has no axillary or pubic hair. The most likely diagnosis is:



    1.    Turnerâ€™s syndrome

    2.    Mullerian agenesis

    3.    Testicular feminization syndrome

    4.    Premature ovarian failure

241    The common side effect with Fluoxetine therapy is:



    1.    Seizure

    2.    Anxiety

    3.    Hypotension

    4.    Loose stools

242    A young girl has consumed barium carbonate with suicidal intent. She complains of generalized muscle weakness. The most likely electrolyte is:



    1.    Hyponatremia

    2.    Hypocalcemia

    3.    Hypokalemia

    4.    Hypomagnesemia

243    All of the following antibacterial agents acts by inhibting cell wall synthesis, except:



    1.    Carbapenems.

    2.    Monobactams

    3.    Cephamycins

    4.    Nitrofurantoin

244    A veterinary doctor had pyrexia of unknown origin. his blood culture in special laboratory media was positive for gram negative short bacilli which was oxidase positive. Which one of the following is the likely organism grown in culture?



    1.    Pasturella spp.

    2.    Francisella spp.

    3.    Bartonella spp.

    4.    Brucella spp.

245    Which one of the following statement is true regarding pathogenicity of Mycobacteria species?



    1.    M.tuberculosis is more pathogenic than M.bovis to the humans.

    2.    M. Kansasii can cause a disease indistinguishable from tuberculosis.

    3.    M.africanum infection is acquired from the environmental source.

    4.    M.marinum is responsible for tubercular lymphadenopathy.

246    A young boy had a flea bite while working in a wheat grain godown. After 5 days he developed fever and had axillary lymphadenopathy. A smear was sent to the laboratory to perform a specific staining. Which one of the following staining method would help in the identification of the suspected pathogen:



    1.    Albert staining.

    2.    Zeihl â€“ Neelson staining

    3.    Mc Fadyeanâ€™s staining

    4.    Wayson staining

247    A 40 years old women presented to the gynecologist with complaints of profuse vaginal discharge. There was no discharge from the cervical os on the speculum examination. The diagnosis of bacterial vaginosis was made based upon all of the following findings on microscopy except:



    1.    Abundance of gram variable coccobacilli.

    2.    Absence of Lactobacilli.

    3.    Abundance of polymorphs.

    4.    Presence of clue cells.

248    A patient complained of chills and fever following a louse bite 2 weeks before. He had rashes all over the body and was delirious at the time of presentation to the hospital and subsequently went into coma. A provisional diagnosis of vasculitis due to Rickettsial infection was made. Which one of the following can be cansative agent:



    1.    Rickettsia typhi.

    2.    Rickettsia rickettsiae

    3.    Rickettsia prowazekii.

    4.    Rickettsia akarai.

249    A diabetic patient developed cellutitis due to Staphylococcus aureus, which was found to be Methicillin resistant on the antibiotic sensitivity testing. All the following antiboditics will be appropriate except.



    1.    Vancomycin

    2.    Imipenem

    3.    Teichoplanin

    4.    Linezoiid

250    A VDRL reactive mother gave birth to an infant. All of the following would help in determining the risk of transmission to the infant except:



    1.    TPHA test on the serum sample of the mother.

    2.    TPHA test on the serum sample of the infant

    3.    VDRL on the paired serum sample of the infant and mother.

    4.    Time interval between the treatment of the mother and her delivery.

251    At what period does tuberculosis flare up most commonly in a pregnant patient?



    1.    First trimester

    2.    Second trimester

    3.    Third trimester

    4.    Puerperium.

252    which surgical procedure has the highest incidence of ureteric injury?



    1.    Vaginal hysterectomy

    2.    Abdomainal hysterectomy.

    3.    Wertheimâ€™s hysterectomy

    4.    Anterior colporraphy.

253    The following hormone is raised in polycystic ovarian syndrome:



    1.    17-OH Progesterone

    2.    Follicular stimulating hormone

    3.    Lutenising hormone

    4.    Thyroid stimulating hormone

254    which vitamin deficient is most commonly seen in a pregnant mother who is on phenytion therepy for Epilesy?



    1.    Vitamin B6

    2.    Vitamin B12

    3.    Vitamin A.

    4.    Folic Acid

255    Which of the following ovarian tumour is most prone to undergo torsion during pregnancy?



    1.    Serous Cystadenoma

    2.    Mucenous Cystadenoma

    3.    Dermois cyst

    4.    Theca Lutein Cyst

256    Which one ot the following congenital malformation of the fetus can be diagnosed in first trimester by ultrasound?



    1.    Anencephaly

    2.    Inencephaly

    3.    Microcephaly

    4.    Holoprosencephaly.

257    The most common cause of tubal block in India is:



    1.    Gonorrhoea infection

    2.    Chlamydia infection

    3.    Tuberculosis

    4.    Bacterial Vaginosis

258    The following complications dueing pregnancy increase the risk of Post Partum Haemorrhage (PPH) except:



    1.    Hypertension

    2.    Macrosomia

    3.    Twin pregnancy

    4.    Hydramnios.

259    Indicators of impending uterine rupture during labour include all of the following except:



    1.    Fetal distress.

    2.    Hematuria

    3.    Fresh bleeding per vaginum

    4.    Passage of meconium

260    which of the following statements is incorrect regarding polycystic ovarian disease?



    1.    Elevated LH hormone

    2.    Can cause infertility

    3.    May be associated with abnormal glucose tolerance test.

    4.    Results in postdated pregnancy.

261    Which of the following statements is incorrect regarding levonorgestral releasing intra-uterine system?



    1.    There is increased incidence of menorrhagia.

    2.    This system can be used as hormone replacement therapy.

    3.    this method is useful for the treatment of Endometerial hyperplasia

    4.    Irregular uterine bleeding can be problem initially.

262    All of the following mechanisms might account for a reduced risk of upper genital tract infection in users of progestin â€“ releasing IUDs, except:



    1.    Reduced retrograde menstruation

    2.    Decreased ovulation

    3.    Thickened cervical mucus

    4.    Decidual changes in the endometrium.

263    Emergency contraception prevents pregnancy by all of the following mechanisms, except.



    1.    Delaying / inhibiting ovulation

    2.    Inhibiting fertilization

    3.    Preventing implantation of the fertilized egg.

    4.    Interrupting an early pregnancy.

264    Misoprostol is a:



    1.    Prostaglandin E1 analogue

    2.    Prostaglandin E2 analogue

    3.    Prostaglandin antagonist

    4.    Antiprogestin.

265    Lymphatic drainage of the cervix occurs by all of the following lymph nodes, except:



    1.    Parameterial lymph nodes.

    2.    Deep inguinal lymph nodes.

    3.    Obtruator lymph nodes

    4.    Ext. iliac lymph nodes.

266.    The treatment for a case of virilising adrenal hyperplasia is:



    1.    Estrogens

    2.    Antiandrogens

    3.    ACTH.

    4.    Cortisone.

267    A primigravida presents to casually at 32wks.

gestation with acute pain abdomen for 2hours, vaginal bleeding and decreased fetal movements, She should be managed by:



    1.    Immediate caesarean section

    2.    Immediate induction of labour

    3.    Tocolytic therapy

    4.    Magnesium sulphate therapy

268    The investigation of choice in a 55 year old postmenopausal woman who has presented with postmenopausal bleeding is:



    1.    Pap smear

    2.    Fractional curettage

    3.    Transvaginal ultrasound

    4.    CA-125 estimation

269    In which of the following genital tract malignancy, the risk of metastasis to ovary is the least?



    1.    Carcinoma cervix

    2.    Carcinoma endometrium

    3.    Carcinoma fallopian tube

    4.    Uterine sarcoma

270    The best way of diagnosing Trisomy-21 during second trimester of pregnancy is:



    1.    Triple marker estimation

    2.    Nuchal skin fold thickness measurement

    3.    Chorionic villus sampling

    4.    Amniocentesis

271    Calcitonin is secreted by:



    1.    Thyroid gland

    2.    Parathyroid gland

    3.    Adrenal glands

    4.    Ovaries

272    Which of the following is an intraarticular tendon?



    1.    Sartorius

    2.    Semitendinosus

    3.    Anconeus

    4.    Popliteus

273    which of the following conditions is least likely to present as an eccentric osteolytic lesion:



    1.    Aneurysmal bone cyst.

    2.    Giant cell tumor

    3.    Fibrous cortical defect

    4.    Simple bone cyst

274    Bisphosphonates act by:



    1.    Increasing the osteoid formation.

    2.    Increasing the mineralisation of osteoid.

    3.    Decreasing the osteoclast mediated resorption of bone.

    4.    Decreasing the parathyroid hormone secretion.

275    All the statements are true about exotosis, except:



    1.    It occurs at the growing end of bone.

    2.    Growth continues after skeletal maturity.

    3.    It is covered by cartilaginous cap.

    4.    Maligant transformation may occur.

276    â€œRugger Jersey Spineâ€ is seen in:



    1.    Fluorosis

    2.    Achondroplasia

    3.    Renal Osteodystrophy.

    4.    Marfanâ€™s Syndrome.

277    Brown tumours are seen in:



    1.    Hyperparathyroidism.

    2.    Pigmented villonodular synovitis

    3.    Osteomalacia

    4.    Neurofibromatosis

278    All of the following statements are true about development dysplasia (DDH) of the hip, except:



    1.    It is more common in females.

    2.    Oligohydramnios is associated with a higher risk of DDH.

    3.    The hourglass appearance of the capsule may prevent a successful closed reduction.

    4.    Twin pregnancy is a known risk factor.

279    All are true regarding brachial plexus injury, except:



    1.    Preganglinoic lesions have a better prognosis than postganglionic lesions.

    2.    Erbâ€™s palsy causes paralysis of the abductors and external rotators of the shoulder.

    3.    In Klumpkeâ€™s palsy, Hornerâ€™s syndrome may be present on the ipsilateal side.

    4.    Histamine test is useful to differentiate between the preganglinoic and postganglinoic lesions.

280    The ideal treatment of bilateral idiopathic clubfoot in a newborn is:



    1.    Manipulation by mother.

    2.    Manipulation and Dennis Brown splint.

    3.    Manipulation and Casts.

    4.    Surgical release.

281    The postero superior retraction pocket, if allowed to progress, will lead to:



    1.    Sensori-neural hearing loss.

    2.    Secondary Cholesteatoma.

    3.    Tympanoscelerosis.

    4.    Tertiary cholesteatoma.

282    A 30 year old male is having Attic cholesteatoma of left ear with lateral sinus thrombophelebitis. Which of the following will be the operation of choice?



    1.    Intact canal wall mastiodectomy.

    2.    Simple mastoidectomy with Tympanoplasty.

    3.    Canal wall down mastoidectomy.

    4.    Mastoidectomy with cavity obliteration.

283    Which of the following conditions causes the maximum hearing loss?



    1.    Ossicular disruption with intact tympanic membrane

    2.    Disruption of malleus and incus as well tympanic membrane.

    3.    Partial fixation of the stapes foorplate.

    4.    Ottitis media with effusion.

284    During inspiration the main current of airflow in a normal nasal cavity is through:



    1.    Middle part of the cavity in middle meatus in a parabolic curve.

    2.    Lower part of the cavity in the inferior meatus in a parabolic curve.

    3.    Superior part of the cavity in the superior meatus.

    4.    Through olfactory area.

285    Which is the investigation of choice in assessing hearing loss in neonates ?



    1.    Impedance audiometry.

    2.    Brainstem Evoked Response Audiometry (BERA).

    3.    Free field audiometry.

    4.    Behavioral audiometry.

286    The most common etiological agent for acute bronchiolitis in infancy is :



    1.    Influenza virus.

    2.    Para influenza virus.

    3.    Rhinovirus.

    4.    Respiratory syncytial virus.

287    Which of the following is the principal mode of heat exchange in an infant incubator?



    1.    Radiation.

    2.    Evaporation.

    3.    Convection.

    4.    Conduction.

288    Late onset hemorrhagic disease of newborn is characterized by all of the following features except:



    1.    Usually occurs in cow-milk fed babies.

    2.    Onset occurs at 4-12wk of age.

    3.    Intracranial hemorrhage can occur.

    4.    Intramuscular vitamin K prophylaxis at birth has a protective role.

289    Which of the following malformation in a newborn is specific for maternal insulin dependent diabetes mellitus?



    1.    Transposition of great arteries

    2.    Caudal regression

    3.    Holoprosencephaly.

    4.    Meningmyelocele.

290    the prognosis of rhabdomysarcoma is likely to be poor if the site of the tumour is:



    1.    Orbit

    2.    Para testicular

    3.    Extremity

    4.    Urinary bladder.

291    Which of the following malignant tumors is radioresistant?



    1.    Ewingâ€™s sarcoma.

    2.    Retinoblastoma.

    3.    Osteosarcoma

    4.    Neuroblastoma.

292    The most common second malignancy in survivors of retinoblastoma is:



    1.    Thyroid cancer.

    2.    Nasopharyngeal carcinoma

    3.    Optic glioma.

    4.    Osteosarcoma.

293    The most important determinant of prognosis in Wilms tumor



    1.    Stage of disease.

    2.    Loss of heterozygosity of chromosome 1p.

    3.    Histology.

    4.    Age less than one year at presentation.

294    The finnish type of cogential nephrotic syndrome occurs due to gene mutations affecting the following protein.



    1.    Podocin

    2.    Alpha-actinin

    3.    Nephrin

    4.    CD2 activated protein.

295    Sensorineural deafness may be feature of all, except:



    1.    Nail patella syndrome

    2.    Distal renal tubular acidosis.

    3.    Bartter syndrome.

    4.    Alport syndrome.

296    With reference to mumps which of the following is true?



    1.    Meningoencephalitis can precede parotitis.

    2.    Salivary gland involvement is limited to the parotids.

    3.    The patient is not infectious prior to clinical parotid enlargement.

    4.    Mumps orchitis frequently leads to infertility.

297    A child is below the third percentile for height. His growth velocity is normal, but chronologic age is more than skeletal age. The most likely diagnosis is:



    1.    Constitutional delay in growth.

    2.    Genetic short stature.

    3.    Primordial dwarfism.

    4.    Hypopituitarism.

298    Drug induced lupus can be identified by



    1.    Anti-histone antibodies.

    2.    Double stranded DNA antibodies.

    3.    Antinuclear antibodies.

    4.    Anti-SM antibodies.

299    The process underlying differences in expression of a gene, according to which parent has transmitted, is called:



    1.    Anticipation

    2.    Mosaicism

    3.    Non-penetrance

    4.    Genomic imprinting.

300    the sodium content of ReSoMal (rehydration solution for malnourished children) is:



    1.    90mmol/L.

    2.    60mmol/L

    3.    45mmol/L

    4.    30mmol/L

Brainstem Anatomy Mnemonics

2009-05-15T06:08:00.000+05:30

In 2005, Peter Gates published a superb paper titled:

‘The rule of 4 of the brainstem: a simplified method for understanding brainstem anatomy and brainstem vascular syndromes for the non-neurologist’.

Gates described a simplified method for answering the question ‘Where is the lesion?’ using only the parts of the brainstem that we actually examine during a clinical examination to understand brainstem vascular syndromes.
Firstly, a quick review of the blood supply of the brainstem. Simply put the blood supply comes from:

paramedian branches
long circumferential branches (SAP)

superior cerebellar artery (SCA)

anterior inferior cerebellar artery (AICA)

posterior inferior cerebellar artery (PICA)

And occlusion of these two groups of vessels results in two distinct types of brainstem syndrome:

medial (or paramedian) brainstem syndromes
( due to para-median branch occlusion)
lateral brainstem syndromes
( due to occlusion of the circumferential branches, also occasionally seen in unilateral vertebral occlusion)

And now the rules. If you can remember these rules the diagnosis of brainstem vascular syndromes becomes a pitifully simple exercise (?!) - here’s how it works:

In the rule of 4 there are 4 rules

There are 4 structures in the ‘midline‘ beginning with M

There are 4 structures to the ‘side‘ (lateral) beginning with S

There are 4 cranial nerves in the medulla, 4 in the pons and 4 above the pons (2 in the midbrain)

The 4 motor nuclei that are in the midline are those that divide equally into 12 except for 1 and 2, that is 3, 4, 6 and 12
(5, 7, 9 and 11 are in the lateral brainstem)

The 4 medial structures and the associated deficits are:

Motor pathway (or corticospinal tract):
contralateral weakness of the arm and leg
Medial Lemniscus:
contralateral loss of vibration and proprioception in the arm and leg
Medial longitudinal fasciculus:
ipsilateral inter-nuclear ophthalmoplegia
(failure of adduction of the ipsilateral eye towards the nose and nystagmus in the opposite eye as it looks laterally)
Motor nucleus and nerve:
ipsilateral loss of the cranial nerve that is affected (3, 4, 6 or 12)

The 4 ’side’ (lateral) structures and the associated deficits are:

Spinocerebellar pathway:
ipsilateral ataxia of the arm and leg
Spinothalamic pathway:
contralateral alteration of pain and temperature affecting the arm, leg and rarely the trunk
Sensory nucleus of the 5th cranial nerve:
ipsilateral alteration of pain and temperature on the face in the distribution
of the 5th cranial nerve
(this nucleus is a long vertical structure that extends in the lateral aspect of the pons down into the medulla)
Sympathetic pathway:
ipsilateral Homer’s syndrome, that is partial ptosis and a small pupil (miosis)

According to Gates:

These pathways pass through the entire length of the brainstem and can be likened to ‘meridians of longitude‘ whereas the various cranial nerves can be regarded as ‘parallels of latitude‘. If you establish where the meridians of longitude and parallels of latitude intersect then you have established the site of the lesion.

The 4 cranial nerves in the medulla are CN9-12:

Glossopharyngeal (CN9):
ipsilateral loss of pharyngeal sensation
Vagus (CN10):
ipsilateral palatal weakness
Spinal accessory (CN11):
ipsilateral weakness of the trapezius and stemocleidomastoid muscles
Hypoglossal (CN12):
ipsilateral weakness of the tongue The 12th cranial nerve is the motor nerve in the midline of the medulla. Although the 9th, 10th and 11th cranial nerves have motor components, they do not divide evenly into 12 (using our rule) and are thus not the medial motor nerves.

The 4 cranial nerves in the pons are CN5-8:

Trigeminal (CN5):
ipsilateral alteration of pain, temperature and light touch on the face back as far as the anterior two-thirds of the scalp and sparing the angle of the jaw.
Abducent (CN6):
ipsilateral weakness of abduction (lateral movement) of the eye (lateral rectus).
Facial (CN7):
ipsilateral facial weakness.
Auditory (CN8):
ipsilateral deafness. The 6th cranial nerve is the motor nerve in the medial pons.
The 7th is a motor nerve but it also carries pathways of taste, and using the rule of 4 it does not divide equally in to 12 and thus it is not a motor nerve that is in the midline.
The vestibular portion of the 8th nerve is not included in order to keep the concept simple and to avoid confusion. Nausea and vomiting and vertigo are often more common with involvement of the vestibular connections in the lateral medulla.

The 4 cranial nerves above the pons are CN1-4:

Olfactory (CN1):
not in midbrain.
Optic (CN2):
not in midbrain.
Oculomotor (CN3):
impaired adduction, supradduction and infradduction of the ipsilateral eye with or without a dilated pupil.
The eye is turned out and slightly down.
Trochlear (CN4):
eye unable to look down when the eye is looking in towards the nose (superior oblique). The 3rd and 4th cranial nerves are the motor nerves in the midbrain.

Thus a medial brainstem syndrome will consist of the 4 M’s and the relevant motor cranial nerves, and a lateral brainstem syndrome will consist of the 4 S’s and either
the 9-11th cranial nerve if the lesion is in the medulla, or the 5th, 7th and 8th cranial nerve if the lesion is in the pons.

Handy tip:
If there are signs of both a lateral and a medial (paramedian) brainstem syndrome, then one needs to consider a basilar artery problem, possibly an occlusion.

I’ll let you mull over these rules until the next ‘brainstem’ post, where you’ll be able to test drive ‘Gates’ Brainstem Rules of 4′ on some clinical scenarios.
References
Gates, P. The rule of 4 of the brainstem: a simplified method for understanding brainstem anatomy and brainstem vascular syndromes for the non-neurologist. Internal Medicine Journal 2005; 35: 263-266 [pubmed]
Goldberg, S. Clinical Neuroanatomy Made Ridiculously Simple. MedMaster Series, 2000 Edition. [betterworldbooks]

Difference between acute pyelonephritis and Uncomplicated UTI are all except

2009-01-07T02:26:00.003+05:30

Question 90

Difference between acute pyelonephritis and Uncomplicated UTI are all except

a. Loss of Concentrating ability

b. Presence of White blood casts

c. Presence of Antibody against Tamm-Horsfall proteins of tubules

d. Bacterial colony Count more than 10⁸

Answer

d. Bacterial colony Count more than 10⁸

Reference:

Harrison 16^th Edition Page 1717

Journal reference :

a. P. LARSSON, A. FASTH, U. JODAL, A. SOHL ÅKERLUND, C. SVANBORG EDÉN (1978) : URINARY TRACT INFECTIONS CAUSED BY PROTEUS MIRABILIS IN CHILDREN The Antibody Response to O and H Antigens and Tamm-Horsfall Protein and Bacterial Adherence to Uro-epithelium . Acta Paediatrica 67 (5), 591–596. doi:10.1111/j.1651-2227.1978.tb17807.x

b. Kidney International (1976) 9, 23–29; doi:10.1038/ki.1976.3. Experimental pyelonephritis: The effect of chronic active pyelonephritis on renal function. Thomas E Miller1, David Layzell1 and Elaine Stewart1

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Normal urine is sterile. UTI can therefore be diagnosed if a single viable gram negative bacterium inhabits the urinary tract (kidney, ureters, bladder). In reality, the bacteria causing UTI multiply in log phase growth in normal urine, and most people with urinary tract infection have 10⁴-10⁶ bacteria/ml. The acute number will depend on the urine flow rate, characteristics of the urine, the duration of infection, etc. The problem in diagnosis is that of contamination arising from voided specimens passing through the non-sterile distal urethra. For this reason, clinicians use the criteria of 10⁵ bacteria/ml of “clean catch” urine to diagnose UTI. At this level, < 1% of the represent contaminants. At counts of 1000-10,000/ml, there is a 50/50 chance the result represents contamination. Such a count may represent true infection, but to be sure a second culture showing the same organism might be more convincing. The second criteria for diagnosing UTI is the presence of pyuria (> 5 WBC/HPF) on the urinalysis.

Explanation

a. A severe loss of urine concentrating capacity was demonstrable when the maximum urinary osmolality of a group of cases with pyelonephritis was compared with controls. Concentrating capacity decreased sharply over the first month but further loss over an eight-month period was minimal.

b. Presence of White blood casts is Pathognomic for Pyelonephritis

c. Presence of Antibody against Tamm-Horsfall proteins of tubules . "An increase in antibody levels against O antigen and Tamm-Horsfall protein was noted only in patients with acute pyelonephritis indicating that antibody determinations can be useful in differentiating between upper and lower urinary tract infection caused by Proteus in similarity to those caused by E. coli"

d. Bacterial colony Count more than 10⁸

Comments : This is what the Journal Says : Sera from seven girls with acute symptomatic pyelonephritis and nine children with acute symptomatic cystitis caused by Proteus mirabilis were analysed for antibodies against the bacterial O and H1 antigens and the Tamm-Horsfall protein. An increase in antibody levels against O antigen and Tamm-Horsfall protein was noted only in patients with acute pyelonephritis indicating that antibody determinations can be useful in differentiating between upper and lower urinary tract infection caused by Proteus in similarity to those caused by E. coli. In contrast no difference in adhesive ability was noted comparing Proteus strains causing acute pyelonephritis or cystitis.

Remarks

If you have a better TEXTBOOK, reference, please send a mail to bruno@nellaimedicos.com

Thymoma commonly presents with Myasthenia Gravis

2009-01-07T02:26:00.002+05:30

Question 89

Thymoma commonly presents with

a. Myasthenia Gravis

b. ??

c. ??

d. ??

Answer

a. Myasthenia Gravis

Reference

Harrison 16^th Edition Page

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Myasthenia gravis (MG) is an acquired autoimmune disorder characterized clinically by weakness of skeletal muscles and fatigability on exertion. Thomas Willis reported the first clinical description in 1672.

The antibodies in MG are directed toward the acetylcholine receptor (AChR) at the neuromuscular junction (NMJ) of skeletal muscles.

Explanation

The exact mechanism of loss of immunologic tolerance to AChR, a self antigen, is not understood. MG can be considered a B cell–mediated disease, as antibodies (a B cell product) against AChR are responsible for the disease. However, the importance of T cells in pathogenesis of MG is becoming increasingly apparent. The thymus is the central organ in T cell–mediated immunity, and thymic abnormalities such as thymic hyperplasia or thymoma are well recognized in myasthenic patients.

Comments

Since this question is often repeated, every one attempted it in a jiffy that they could not even recollect the other choices afterwards

Tips

Ä MG is idiopathic in most patients.

Ä Penicillamine is known to induce various autoimmune disorders, including MG.

Most common islet cell tumour in MEN 1 is Gastrinoma

2009-01-07T02:26:00.001+05:30

Question 88

Most common islet cell tumour in MEN 1 is

a. Gastrinoma

b. Insulinoma

c. Glucagonoma

d. Somatostatinoma

Answer

a. Gastrinoma

Reference

Schwartz 7^th Edition Page 1686

Sabiston 15^th Edition Page 685

Harrison 16^th Edition Page 2231

Robbins 5^th Edition Page 1170

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Neoplasia of the pancreatic islets is the second most common manifestation of MEN 1 and tends to occur in parallel with hyperparathyroidism. Increased pancreatic islet cell hormones include pancreatic polypeptide (75 to 85%), gastrin [60%; Zollinger-Ellison syndrome (ZES)], insulin (25 to 35%), vasoactive intestinal peptide (VIP) (3 to 5%; Verner-Morrison or watery diarrhea syndrome), glucagon (5 to 10%), and somatostatin (1 to 5%). The tumors rarely produce adrenocorticotropin (ACTH), corticotropin-releasing hormone (CRH), growth hormone-releasing hormone (GHRH), calcitonin gene products, neurotensin, gastric inhibitory peptide, and others. Many of the tumors produce more than one peptide. The pancreatic neoplasms differ from the other components of MEN 1 in that approximately one-third of the tumors display malignant features, including hepatic metastases (Chap. 93).

Explanation

Of the choices given, the most Common Pancreatic Tumour in MEN I is Gastrinoma.

Comments

Multiple Endocrine Neoplasia (MEN) Syndromes
Type	MEN 1	MEN 2		Mixed Syndromes
Type	MEN 1	MEN 2A	MEN 2B	Mixed Syndromes
Name	Wermer’s Syndrome	Sipple’s Syndrome
Gene	11q 11-13	RET
Parathyroid	Parathyroid hyperplasia or adenoma	Parathyroid hyperplasia or adenoma		Familial pheochromocytoma and islet cell tumor von Hippel-Lindau syndrome, pheochromocytoma, and islet cell tumor Neurofibromatosis with features of MEN 1 or 2 Myxomas, spotty pigmentation, and generalized endocrine overactivity in a single family
Pancreas	Islet cell hyperplasia, adenoma, or carcinoma
Pituitary	Pituitary hyperplasia or adenoma
Thyroid	C Cell Hyperplasia	Medullary Thyroid Carcinoma	MTC
Adrenal	Rarely Cortical Involvement	Pheochromocytoma	Pheochromocytoma
Others	Other less common manifestations: foregut carcinoid, , subcutaneous or visceral lipomas, dermal angiofibromas or collagenomas	Cutaneous lichen amyloidosis Hirschsprung disease Familial Medullary Thyroid Carcinoma	Mucosal and gastrointestinal neuromas Marfanoid features

Tips

This is one of the most repeated topics for AIPG. There will be 2 to 3 questions every year

MEN

Ä Pancreatic islet cell tumors are diagnosed by identification of a characteristic clinical syndrome, hormonal assays with or without provocative stimuli, or radiographic techniques. One approach involves annual screening of people at risk with measurement of basal and meal-stimulated levels of pancreatic polypeptide to identify the tumors as early as possible; the rationale of this screening strategy is the concept that surgical removal of islet cell tumors at an early stage will be curative. Other approaches to screening include measurement of serum gastrin and pancreatic polypeptide levels every 2 to 3 years, with the rationale that pancreatic neoplasms will be detected at a later stage but can be managed medically, if possible, or by surgery. High-resolution, early-phase computed tomography (CT) scanning provides the best noninvasive technique for identification of these tumors, but intraoperative ultrasonography is the most sensitive method for detection of small tumors.

Ä ZES is caused by excessive gastrin production and occurs in more than half of MEN 1 patients with pancreatic islet cell tumors. Clinical features include increased gastric acid production, recurrent peptic ulcers, diarrhea, and esophagitis. The ulcer diathesis is refractory to conservative therapy such as antacids. The diagnosis is made by finding increased gastric acid secretion, elevated basal gastrin levels in serum [generally >115 pmol/L (200 pg/mL)], and an exaggerated response of serum gastrin to either secretin or calcium. Other causes of elevated serum gastrin levels, such as achlorhydria, treatment with H2 receptor antagonists or omeprazole, retained gastric antrum, small-bowel resection, gastric outlet obstruction, and hypercalcemia, should be excluded. Gastrin-producing carcinoid-like tumors are frequently present in the duodenal wall.

Ä Insulinoma causes hypoglycemia in about one-third of MEN 1 patients with pancreatic islet cell tumors. The tumors may be benign or malignant (25%). The diagnosis can be established by documenting hypoglycemia during a short fast with simultaneous inappropriate elevation of serum insulin and C-peptide levels. More commonly, it is necessary to subject the patient to a supervised 72-h fast to provoke hypoglycemia. Large insulinomas may be identified by CT scanning; small tumors not detected by radiographic techniques may be localized by selective arteriographic injection of calcium into each of the arteries that supply the pancreas and sampling the hepatic vein for insulin to determine the anatomic region containing the tumor. Intraoperative ultrasonography can also be used to localize these tumors, but preoperative calcium injection data are helpful in guiding the subtotal pancreatectomy if multiple or no abnormalities are detected by intraoperative ultrasonography.

Ä Glucagonoma in occasional MEN 1 patients causes a syndrome of hyperglycemia, skin rash (necrolytic migratory erythema), anorexia, glossitis, anemia, depression, diarrhea, and venous thrombosis. In about half of these patients the plasma glucagon level is high, leading to its designation as the glucagonoma syndrome, although elevation of plasma glucagon level in MEN 1 patients is not necessarily associated with these symptoms. The glucagonoma syndrome may represent a complex interaction between glucagon overproduction and the nutritional status of the patient.

Ä The Verner-Morrison or watery diarrhea syndrome consists of watery diarrhea, hypokalemia, hypochlorhydria, and metabolic acidosis. The diarrhea can be voluminous and is almost always found in association with an islet cell tumor, prompting use of the term pancreatic cholera. However, the syndrome is not restricted to pancreatic islet tumors and has been observed with carcinoids or other tumors. This syndrome is believed to be due to overproduction of VIP, although plasma VIP levels may not be elevated. Hypercalcemia may be induced by the effects of VIP on bone as well as by hyperparathyroidism.

Conn’s Syndrome is Adrenal Adenoma

2009-01-07T02:26:00.000+05:30

Question 87

Conn’s Syndrome is

a. Adrenal hyperplasia

b. Adrenal carcinoma

c. Adrenal adenoma

d. None of the above

Answer

c. Adrenal Adenoma.

Reference:

Harrison 16^th Edition Page 2138

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In the original case of excessive and inappropriate aldosterone production, the disease was the result of an aldosterone-producing adrenal adenoma (Conn's syndrome). Most cases involve a unilateral adenoma, which is usually small and may occur on either side.

Explanation

Self Explanatory. Though Hyperaldosteronism can be due to many causes, an aldosterone producing adrenal adenoma is called as Conn’s Disease

Comments

Rarely, primary aldosteronism is due to an adrenal carcinoma. Aldosteronism is twice as common in women as in men, usually occurs between the ages of 30 and 50, and is present in approximately 1% of unselected hypertensive patients. However, the prevalence may be as high as 10%, depending on the criteria and study population. Most of this difference is not secondary to the prevalence of patients with an aldosteronoma but rather because of the inclusion of those with bilateral hyperplasia.

In many patients with clinical and biochemical features of primary aldosteronism, a solitary adenoma is not found at surgery. Instead, these patients have bilateral cortical nodular hyperplasia. In the literature, this disease is also termed idiopathic hyperaldosteronism, and/or nodular hyperplasia. The cause is unknown

Tips

High blood pressure (hypertension) is the main, and often the only, symptom.

Other symptoms may occur because high aldosterone levels in the blood act on the kidney to increase the loss of the mineral potassium in the urine. This in turn may lead to a fall in blood potassium, resulting in tiredness, muscle weakness and passing of large volumes of urine (polyuria), especially at night (nocturia). However, these symptoms are also found in many other conditions (for example, diabetes mellitus or hypercalcaemia) and do not, by themselves, establish a diagnosis of Conn's syndrome. Also, many patients with proven Conn's syndrome do not have a low blood potassium level.

Cushing’s disease presents with

2009-01-07T02:25:00.013+05:30

Question 86

Cushing’s disease presents with

a. Increased ACTH, Increased Cortisol

b. Decreased ACTH and Decreased Cortisol

c. Increased ACTH and Decreased Cortisol

d. Increased Catecholamines

Answer

a. Increased ACTH and Increased Cortisol

Reference

Harrison 16^th Edition Page 2135

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Cushing's syndrome (also called hypercortisolism or hyperadrenocorticism) is an endocrine disorder caused by high levels of cortisol in the blood from a variety of causes, including primary pituitary adenoma (known as Cushing's disease), primary adrenal hyperplasia or neoplasia, ectopic ACTH production (e.g., from a small cell lung cancer), and iatrogenic (steroid use).

Explanation
Self Explanatory

Comments

Cushing's disease was described by American physician, surgeon and endocrinologist Harvey Cushing (1869-1939) and reported by him in 1932.

Tips

Question about the earliest manifestation of Cushings was asked in 2004

A 24 year old female presents with palpable Purpura and with rashes all over trunk limbs buttocks and paid abdomen

2009-01-07T02:25:00.012+05:30

Question 85

A 24 year old female presents with palpable Purpura and with rashes all over trunk limbs buttocks and paid abdomen. The most probable diagnosis is

a. Meningococceimia

b. HSP

c. ??

d. ??

Answer

b. HSP

Reference

Harrison 16^th Edition Page 2010

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Henoch-Schonlein purpura, also referred to as anaphylactoid purpura, is a distinct systemic vasculitis syndrome that is characterized by palpable purpura (most commonly distributed over the buttocks and lower extremities), arthralgias, gastrointestinal signs and symptoms, and glomerulonephritis. It is a small vessel vasculitis.

Henoch-Schonlein purpura is usually seen in children; most patients range in age from 4 to 7 years; however, the disease may also be seen in infants and adults. It is not a rare disease; in one series it accounted for between 5 and 24 admissions per year at a pediatric hospital. The male-to-female ratio is 1.5:1. A seasonal variation with a peak incidence in spring has been noted

Explanation

Self Explanatory

Comments TREATMENT

The prognosis of Henoch-Schonlein purpura is excellent. Most patients recover completely, and some do not require therapy. Treatment is similar for adults and children. When glucocorticoid therapy is required, prednisone in doses of 1 mg/kg per day and tapered according to clinical response has been shown to be useful in decreasing tissue edema, arthralgias, and abdominal discomfort; however, it has not proven beneficial in the treatment of skin or renal disease and does not appear to shorten the duration of active disease or lessen the chance of recurrence. Patients with rapidly progressive glomerulonephritis have been anecdotally reported to benefit from intensive plasma exchange combined with immunosuppressive drugs.

Tips :

Ä Renal failure is the most common cause of death in the rare patient who dies of Henoch-Schonlein purpura.

Ä Myocardial involvement can occur in adults but is rare in children.

Ä Routine laboratory studies generally show a mild leukocytosis, a normal platelet count, and occasionally eosinophilia. Serum complement components are normal, and IgA levels are elevated in about one-half of patients.

What will be the appropriate investigation for a 40 female with jaundice and spherocytosis

2009-01-07T02:25:00.011+05:30

Question 84

What will be the appropriate investigation for a 40 female with jaundice and spherocytosis

a. Osmotic fragility

b. Coomb's test

c. Electrophoresis

d. ??

Answer

b. Coomb’s Test

Reference

Harrison 16^th Edition Page 609

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Hereditary spherocytosis must be distinguished primarily from the spherocytic hemolytic anemias associated with RBC antibodies. The family history of anemia and/or splenectomy is helpful, when present.

Explanation

The diagnosis of immune spherocytosis is usually readily established by a positive direct Coombs test

Comments

Spherocytes are also seen in association with hemolysis induced by splenomegaly in patients with cirrhosis, in clostridial infections, and in certain snake envenomations (due to the action of phospholipases on the membrane). A few spherocytes are seen in the course of a wide variety of hemolytic disorders, particularly glucose-6-phosphate dehydrogenase (G6PD) deficiency

Tips

Many Questions in AIIMS Papers have something called as NESTROF Test. It is nothing but “Naked Eye Single Tube Redcell Osmotic Fragility Test”

A drug used in the treatment of CML is Imatinib Mesylate Gleevec ST1571

2009-01-07T02:25:00.010+05:30

Question 83

A drug used in the treatment of CML is – imatinb CML

a. Imatinib Mesylate

b. Gleevee

c. ST1571

d. All of the above

Answer

d. All of the above

Reference

Harrison 16^th Edition Page 639

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Allogeneic Stem Cell Transplant (SCT) is the only curative therapy for CML and, when feasible, is the treatment of choice. However, it is complicated by a high early mortality rate owing to the transplant procedure.

Outcome of SCT depends on multiple factors including:

(1) the patient (i.e., age and phase of disease);

(2) the type of donor [i.e., syngeneic (monozygotic twins) or HLA-compatible allogeneic, related or unrelated];

(3) the preparative regimen;

(4) GVHD; and

(5) posttransplantation treatment

Explanation

Ä Imatinib is a drug used to treat certain types of cancer. It is currently marketed by Novartis as Gleevec (USA) or Glivec (Europe/Australia) as its mesylate salt, imatinib mesilate (INN). It was originally coded during development as CGP57148B or STI-571 (these terms are used in early preclinical publications). It is used in treating chronic myelogenous leukemia (CML), gastrointestinal stromal tumors (GISTs) and a number of other malignancies.

Ä It is the first member of a new class of agents that act by inhibiting particular tyrosine kinase enzymes, instead of non-specifically inhibiting rapidly dividing cells.

Comments

Some students felt that Infliximab was one of the choices

Tips

Ä Infliximab is a “chimeric monoclonal antibody” (“chimeric” refers to the use of both mouse (murine) and human components of the drug i.e. murine binding VK and VH domains and human constant Fc domains)

Ä The drug blocks the action of TNFα (tumour necrosis factor alpha) by binding to it and preventing it from signaling the receptors for TNFα on the surface of cells. (TNFα is one of the key cytokines that triggers and sustains the inflammation response.)

Ä Infliximab is used in the treatment of

o psoriasis,

o pediatric Crohn's disease,

o ankylosing spondylitis,

o psoriatic arthritis,

o rheumatoid arthritis,

o ulcerative colitis.

Ä Infliximab is administered by intravenous infusion, typically at 6-8 week intervals.

One of the Causative organisms for Crohn's disease is Mycobacterium paratuberculosis

2009-01-07T02:25:00.009+05:30

Question 82

One of the Causative organisms for Crohn's disease is

a. Mycobacterium paratuberculosis

b. Chlyamidia

c. ??

d. ??

Answer

a. Mycobacterium paratuberculosis

Reference

Harrison 16^th Edition Page 1777

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Crohn disease is an idiopathic, chronic inflammatory disorder of the bowel that involves any region of the alimentary tract from the mouth to the anus.

Explanation

IBD may have an as yet undefined infectious etiology. Three specific agents have received the greatest attention, Mycobacterium paratuberculosis, Paramyxovirus, and Helicobacter species. The immune response to a specific organism could be expressed differently, depending upon the individual's genetic background. Although M. paratuberculosis had initially been identified in CD patients, further studies have not confirmed a disease association. In addition, antimycobacterial agents have not been effective in treating CD. A role for the measles virus or paramyxoviruses in the development of CD has been suggested based on an increase in the incidence of CD in

England

that paralleled use of the measles vaccine. However, studies in the

United States

have not substantiated this finding. In an animal model of IBD, Helicobacter hepaticus has been implicated as a trigger for the inflammatory response; evidence in people is lacking

Comments

Although there are many similarities between ulcerative colitis and Crohn disease, there are also major differences in the clinical course and distribution of the disease in the gastrointestinal tract. The inflammatory process tends to be eccentric and segmental, often with skip areas (i.e., normal regions of bowel between inflamed areas). Whereas inflammation in ulcerative colitis is limited to the mucosa (except in toxic megacolon), gastrointestinal involvement in Crohn disease is transmural. Among children with Crohn disease, the initial presentation most commonly involves ileum and colon (i.e., ileocolitis) but may involve the small bowel alone in about 40% (50% of children have terminal ileitis alone) or colon alone in about 10% (granulomatous colitis). Crohn disease may rarely present in the first years of life. As with ulcerative colitis, Crohn disease tends to have a bimodal age distribution with the first peak beginning in the late teens.

Tips

Several factors have been suggested in causation of crohns disease:

Ä Genetic - in up to 20% of patients with Crohn's disease there is another family member affected by Crohn's or ulcerative colitis.

Ä Low intake of fibre from fruit and vegetables has been associated with the development of Crohn's

Ä Immune mechanisms - may be a down-regulating of the normal mucosal immune response in Crohn's

Which of the following is not true for Hereditary Hemochromatosis – Desferroxamine not treatment of choice

2009-01-07T02:25:00.008+05:30

Question 81

Which of the following is not true for Hereditary Hemochromatosis

a. Gonadal failure is seen

b. Desferroxamine is the treatment of choice

c. Arthropathy is seen

d. Skin pigmentation is seen

Answer

b. Desferroxamine is the treatment of choice

Reference

Harrison 16^th Edition Page 2302

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Hemochromatosis is a common disorder of iron storage in which an appropriate increase in intestinal iron absorption results in deposition of excessive amounts of iron in parenchymal cells with eventual tissue damage and impaired function of organs, especially the liver, pancreas, heart, joints, and pituitary. The disease was termed hemochromatosis and the iron-storage pigment was called hemosiderin because it was believed that the pigment was derived from the blood. The terms hemosiderosis and siderosis are often used to describe the presence of stainable iron in tissues, but tissue iron must be quantified to assess body iron status Hemochromatosis implies potentially severe progressive iron overload leading to fibrosis and organ failure.

Explanation

Ä Cirrhosis of the liver, diabetes mellitus, arthritis, cardiomyopathy, and hypogonadotrophic hypogonadism are common manifestations.

Ä The therapy of hemochromatosis involves removal of the excess body iron and supportive treatment of damaged organs. Iron removal is best begun by weekly or twice-weekly phlebotomy of 500 mL. Although there is an initial modest decline in the volume of packed red blood cells to about 35 mL/dL, the level stabilizes after several weeks. The plasma transferrin saturation remains increased until the available iron stores are depleted. In contrast, the plasma ferritin concentration falls progressively, reflecting the gradual decrease in body iron stores. Since one 500-mL unit of blood contains 200 to 250 mg iron and about 25 g iron should be removed, weekly phlebotomy may be required for 1 or 2 years. When the transferrin saturation and ferritin level become normal, phlebotomies are performed at appropriate intervals to maintain levels within the normal range. The measurements promptly become abnormal with iron reaccumulation. Usually one phlebotomy every 3 months will suffice.

Ä Chelating agents such as deferoxamine, when given parenterally, remove 10 to 20 mg iron per day, which is much less than that mobilized by once-weekly phlebotomy. Phlebotomy is also less expensive, more convenient, and safer for most patients. However, chelating agents are indicated when anemia or hypoproteinemia is severe enough to preclude phlebotomy. Subcutaneous infusion of deferoxamine using a portable pump is the most effective means of administration.

Comments

The management of hepatic failure, cardiac failure, and diabetes mellitus is similar to conventional therapy for these conditions. Loss of libido and change in secondary sex characteristics are partially relieved by parenteral testosterone or gonadotropin therapy

Tips

Ä Hereditary or genetic hemochromatosis: This disorder is most often caused by inheritance of a mutant HFE gene, which is tightly linked to the HLA-A locus on chromosome 6p. The genetic disease can be recognized during its early stages when iron overload and organ damage are minimal. At this stage the disease is best referred to as early or precirrhotic hemochromatosis.

Ä Secondary iron overload: Tissue injury usually occurs secondary to an iron-loading anemia such as thalassemia or sideroblastic anemia, in which increased erythropoiesis is ineffective. In the acquired iron-loading disorders, massive iron deposits in parenchymal tissues can lead to the same clinical and pathologic features as in hemochromatosis

A young man presents with HBsAg positive, HBeAg negative and normal levels of AST and ALT

2009-01-07T02:25:00.007+05:30

Question 80

A young man presents with HBsAg positive, HBeAg negative and normal levels of AST and ALT normal. He is asymptomatic. What is the next line of management

a. Wait and Watch

b. Antivirals

c. Immunoglobulin

d. Liver Transplant

Answer

a. Wait and Watch

Reference

Nelson 15th Edition Chapter 221

Harrison 16^th Edition Pg 1825, 15^th Edition page 1729

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· Routine screening for hepatitis B requires assay of at least two serologic markers.

· HBsAg is the first serologic marker of infection to appear and is found in almost all infected persons; its rise coincides closely with the onset of symptoms.

· HBeAg is often present during the acute phase and indicates a highly infectious state.

· Because HBsAg levels fall before the end of symptoms, IgM antibody to hepatitis B core antigen (IgM anti-HBcAg) also is required because it rises early after infection and persists for many months before being replaced by IgG anti-HBcAg, which persists for years. IgM anti-HBcAg usually is not present in perinatal HBV infections.

· Anti-HBcAg is the most valuable single serologic marker of acute HBV infection because it is present almost as early as HBsAg and continues to be present later in the course of the disease when HBsAg has disappeared.

· Only anti-HBsAg is present in persons immunized with hepatitis B vaccine, whereas anti-HBsAg and anti-HBcAg are detected in persons with resolved infection.

Explanation

Considering all the points, the best option would be to wait and watch

Comments

HBV infections in neonates are much more common, but most infections are not associated with clinically evident disease. Most HBV infections occur at the time of delivery or in the early postpartum period; transplacental transmission occurs but is uncommon. The infection usually is caused by one of three mechanisms.

Tips

Ä The virus is divided into four major serotypes (adr, adw, ayr, ayw) based on antigenic epitopes present on its envelope proteins.

Ä The virus is divided into eight genotypes (A-H) according to overall nucleotide sequence variation of the genome. The genotypes have a distinct geographical distribution and are used in tracing the evolution and transmission of the virus. Differences between genotypes affect the disease severity, course and likelihood of complications, and response to treatment and possibly vaccination.[

Which of the following is not a feature of Conus Syndrome

2009-01-07T02:25:00.006+05:30

Question 79

Which of the following is not a feature of Conus Syndrome

a. Late Bladder involvement

b. Saddle Anaesthesia

c. Bilateral signs

d. Affects sacral segments

Answer

a. Late Bladder involvement

Reference

Textbook of Medicine : Vasan and Seshadhri 1^st Edition Pages 463-465

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Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are complex neurological disorders that can be manifested through a variety of symptoms. Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal and/or urinary incontinence or dysfunction. Although patients typically present with acute disc herniations, traumatic injuries at the thoracolumbar junction at the terminal portion of the spinal cord and cauda equina are also common.

Explanation

Self Explanatory

Comments

Since this is a memory recollected paper, there was as considerable discussion regarding the choices. Few students were of the opinion that “Muscle Spasticity” “Involvement of Knee and Ankle Jerks” were also in the choices

Tips

Conus Medullaris Syndrome	Cauda Equina Syndrome
More likely to present with bilateral signs since the conus is compact	More likely to be unilateral at onset
Isolated conus lesions cause no lower limb weakness; if concomitant nerver root involvement occurs, L3 which lies close to the tip of the conus is most often affected – weak quadriceps L3 hyperalgesia	Typically, there is unilateral lower limb weakness involving feet and toes
Saddle anaesthesia seen early without weakness or anaesthesia elsewhere	Saddle anaesthesia seen late with bilateral lower limb weakness, sensory findings
Absent Anal reflex, bladder involvement Early	Rare, Late
Aching low back pain	Root pain radiating into legs

Which is not a feature of Extramedullary Tumour Sacral Sparing

2009-01-07T02:25:00.005+05:30

Question 78

Which is not a feature of Extramedullary Tumour

a. Early Corticospinal Signs and Descending paralysis

b. Root pain or Midline Back Pain

c. CSF Abnormal

d. Sacral sparing

Answer

d. Sacral Sparing

Reference

Textbook of Medicine : Vasan and Seshadhri 1^st Edition Pages 463-465

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Extramedullary Lesion	Intramedullary Lesion
Root pain or Midline Back Pain	Funicular Pain
Brown Sequard Syndrome	Dissociated anaesthesia
Early Corticospinal Signs	Corticospinal signs late and less prominent
Early loss of sacral sensation	Sacral sparing
CSF Abnormal	CSF more likely to be normal

Explanation

Self Explanatory

Comments

Classically in a extramedullary lesion, the ipsilateral lower limb is involved first followed by the ipsilateral upper limb and then contralateral upper limb and contralateral lower limb. Be careful when you see the words Ascending paralysis or Descending Paralysis in future exams

Tips

The Author of the book (I have given for reference) is from AIIMS J

Dying Back Neuropathy is due to all except Gullain Barre Syndrome

2009-01-07T02:25:00.004+05:30

Question 77

Dying Back Neuropathy is due to all except

a. Gullain Barre Syndrome

b. Arsenic

c. DM

d. Porphyria

Answer

a. Gullain Barre Syndrome

Reference

Nelson 15^th Edition Chapter 565, Table 76–2

http://www.aafp.org/afp/980215ap/poncelet.html

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Although peripheral neuropathy has multiple etiologies, the nerve has a limited number of ways to respond to injury. The damage can occur at the level of the axon (i.e., axonopathy). A disruption of the axons (e.g., trauma) results in degeneration of the axon and the myelin sheath distal to the site of the injury (i.e., Wallerian degeneration). In most toxic and metabolic injuries, the most distal portion of the axons degenerates, with concomitant breakdown of the myelin sheath (known as "dying-back," or length-dependent, neuropathy).

Explanation

a. Gullain Barre Syndrome is a postinfectious polyneuropathy that causes demyelination in mainly motor but sometimes also sensory nerves. It is not a predominant distal neuropathy

b. Many chemicals (organophosphates), toxins, and drugs are capable of causing peripheral neuropathy. Heavy metals are well-known neurotoxins. Lead poisoning, especially if chronic, causes mainly a motor neuropathy involving selective large nerves, such as the common peroneal, radial, or median nerves, a condition known as mononeuritis multiplex. Arsenic produces painful burning paresthesias as well as motor polyneuropathy.

c. Polyneuropathy is the commonest type of diabetic neuropathy. The feet get involved first. When the neuropathy progresses then symptoms ascend from the toes to foot and gradually further to the knees. Later the hands may get involved. The symptoms of neuropathy are always worse at night. The commonest symptom is numbness.

d. Porphyria (AIP) presents with Neurologic manifestations like nausea, vomiting, abdominal pain, diarrhea, constipation, ileus, dysuria muscle hypotonia, respiratory failure, sensory neuropathy, seizures

Comments

Ä Antimetabolic drugs, especially vincristine, produce polyneuropathies as complications of chemotherapy for neoplasms.

Tips

Ä Chronic uremia is associated with toxic neuropathy and myopathy. The neuropathy is due to excessive levels of circulating parathormone. Reduction in serum parathyroid hormone is accompanied by clinical improvement and a return to normal of nerve conduction velocity.

Meningitis in elderly all except HSV 2

2009-01-07T02:25:00.003+05:30

Question 76

Meningitis in elderly all except

a. Listeria

b. Streptococcus Pneumonia

c. Gram Negative

d. HSV 2

Answer

d. HSV 2

Reference

Harrison 16^th Edition Page 2471

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· S. pneumoniae is the most common cause of meningitis in adults >20 years. There are a number of predisposing conditions that increase the risk of pneumococcal meningitis, the most important of which is pneumococcal pneumonia. Additional risk factors include coexisting acute or chronic otitis media, alcoholism, diabetes, splenectomy, hypogammaglobulinemia, complement deficiency, and head trauma with basilar skull fracture and cerebrospinal fluid (CSF) rhinorrhea.

· Enteric gram-negative bacilli are the causative organisms of meningitis that is associated with chronic and debilitating diseases such as diabetes, cirrhosis or alcoholism, and chronic urinary tract infections and following neurosurgical procedures, particularly craniotomy or craniectomy.

· Resistance to infection with L. monocytogenes requires effective cell-mediated immunity. As a result, elderly individuals and those with impaired cell-mediated immunity due to organ transplantation, pregnancy, malignancy, chronic illness, or immunosuppressive therapy are all at increased risk for listerial meningitis. Infection is acquired by ingesting foods contaminated by this organism. Foodborne human listerial infection has been reported from contaminated coleslaw, milk, deli meat, and soft cheeses.

Explanatory

Self Explanatory

Comments

· The frequency of H. influenzae type b meningitis in children has declined dramatically since the introduction of the Hib conjugate vaccine, although rare cases of Hib meningitis in vaccinated children have been reported. More frequently, H. influenzae causes meningitis in unvaccinated children and adults

· Staphylococcus aureus and coagulase-negative staphylococci are predominant organisms causing meningitis that follows invasive neurosurgical procedures, particularly shunting procedures for hydrocephalus, or occurs as a complication of the use of subcutaneous Ommaya reservoirs for the administration of intrathecal chemotherapy

· Etiology Enteroviruses account for 75 to 90% of aseptic meningitis cases in most series. Viruses belonging to the Enterovirus genus are members of the family Picornaviridae and include the coxsackieviruses, echoviruses, polioviruses, and human enteroviruses 68 to 71. Using a variety of diagnostic techniques including CSF polymerase chain reaction (PCR) tests, culture, and serology, a specific viral cause can be found in 75 to 90% of cases of viral meningitis. CSF cultures are positive in 30 to 70% of patients, the frequency of isolation depending on the specific viral agent. Approximately two-thirds of culture-negative cases of aseptic meningitis have a specific viral etiology identified by CSF PCR testing (see below)

Tips

· N. meningitidis accounts for nearly 60% of bacterial meningitis cases in children and young adults between the ages of 2 and 20. The nasopharynx is initially colonized by this organism, resulting in either an asymptomatic carrier state or invasive meningococcal disease. The risk of invasive disease following nasopharyngeal colonization depends on both bacterial virulence factors and host immune defense mechanisms, including the host's capacity to produce antimeningococcal antibodies and to lyse meningococci by both the classic and alternative complement pathways. Individuals with deficiencies of any of the complement components, including properdin, are highly susceptible to meningococcal infections.

Diffuse Axonal Injury is characterized by all except Increased Intracranial tension is seen in all cases

2009-01-07T02:25:00.002+05:30

Question 75

Diffuse Axonal Injury is characterized by all except

a. Due to Shearing Force

b. Predominant white matter haemorrhages, in basal ganglia and corpus collosum

c. Increased Intracranial tension is seen in all cases

d. Most common at junction of grey & white matter

Answer

c. Increased Intracranial tension is seen in all cases

Reference

Harrison 16^th Edition Page 2448

Nelson 15^th Edition Chap 551

Sabiston: Chapter 41

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Rotation of the brain within the skull may lead to tearing of axons within the white matter of the brain, causing diffuse axonal injury. According to the theory of Ommaya and Gennarelli, mild injuries damage only subcortical axons, but increases in the rotational force involve progressively deeper areas of brain. There is little cerebral swelling and no increased intracranial pressure associated with this form of brain injury. A computed tomographic (CT) scan made immediately following such an injury may demonstrate hemorrhage in the corpus callosum and the superolateral aspect of the brain stem, but the remainder of the brain appears relatively normal, even though the patient may manifest severe neurologic damage. Months after the injury, the CT scan demonstrates that the bulk of the white matter is reduced. Magnetic resonance imaging (MRI) demonstrates diffuse, small, focal abnormalities limited to white matter tracts.

Explanation

Self Explanatory

Comments

The presence of widespread axonal damage of both hemispheres, a state called diffuse axonal injury, has been proposed as the explanation of persistent coma or vegetative state, but small ischemic-hemorrhagic lesions in the midbrain and low diencephalon are as often the cause.

Tips

Only severe shearing lesions that contain blood are visualized by CT, usually in the corpus callosum and centrum semiovale (; however, within days of the injury, MRI scan demonstrates such lesions throughout the white matter, especially with the use of gradient echo MRI sequences.

A young 25 year old male basket ball player suddenly collapsed while undergoing an athletic event and died.

2009-01-07T02:25:00.001+05:30

Question 74

A young 25 year old male basket ball player suddenly collapsed while undergoing an athletic event and died. At Autopsy the septum was hypertrophied. The most probable diagnosis is

a. HOCM

b. Right Ventricular Conduction Abnormality

c. Epilepsy

d. Snake bite

Answer

a. HOCM

Reference

Harrison 17^th Edition page 1410

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Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy, typically of a nondilated chamber, without obvious cause such as hypertension or aortic stenosis. It is found in about 1 in 500 of the general population.

Explanation

Two features of HCM have attracted the greatest attention: (1) heterogeneous left ventricular hypertrophy, often with preferential hypertrophy of the interventricular septum resulting in asymmetric septal hypertrophy; and (2) a dynamic left ventricular outflow tract pressure gradient, related to a narrowing of the subaortic area as a consequence of the midsystolic apposition of the anterior mitral valve leaflet against the hypertrophied septum, i.e., systolic anterior motion (SAM) of the mitral valve. Initial studies of this disease emphasized the dynamic "obstructive" features, and it has been termed idiopathic hypertrophic subaortic stenosis and hypertrophic obstructive cardiomyopathy. It has become clear, however, that only about one-quarter of patients with HCM demonstrate an outflow tract pressure gradient. The ubiquitous pathophysiologic abnormality is not systolic but rather diastolic dysfunction, characterized by increased stiffness of the hypertrophied muscle. This results in elevated diastolic filling pressures and is present despite a hyperdynamic left ventricle

The clinical course of HCM is highly variable. Many patients are asymptomatic or mildly symptomatic and may be relatives of patients with known disease. Unfortunately, the first clinical manifestation of the disease may be sudden death, frequently occurring in children and young adults, often during or after physical exertion.

Comments

In symptomatic patients, the most common complaint is dyspnea, largely due to increased stiffness of the left ventricular walls, which impairs ventricular filling and leads to elevated left ventricular diastolic and left atrial pressures. Other symptoms include angina pectoris, fatigue, syncope, and near-syncope ("graying-out spells"). Symptoms are not closely related to the presence or severity of an outflow pressure gradient.

Tips

Most patients with gradients demonstrate a double or triple apical precordial impulse, a rapidly rising carotid arterial pulse, and a fourth heart sound. The hallmark of obstructive HCM is a systolic murmur, which is typically harsh, diamond-shaped, and usually begins well after the first heart sound, since ejection is unimpeded early in systole. The murmur is best heard at the lower left sternal border as well as at the apex, where it is often more holosystolic and blowing in quality, no doubt due to the mitral regurgitation that usually accompanies obstructive HCM.

The most common anomaly associated with co arctation of aorta is Bicuspid aortic valve

2009-01-07T02:25:00.000+05:30

MEDICINE

Question 73

The most common anomaly associated with co arctation of aorta is

a. Bicuspid AV

b. PDA

c. ASD

d. VSD

Answer

a. Bicuspid aortic valve

Reference

Nelson 15^th Edition Chapter 386.17

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Constrictions of the aorta of varying degrees may occur at any point from the transverse arch to the iliac bifurcation, but 98% occur just below the origin of the left subclavian artery at the origin of the ductus arteriosus (juxtaductal coarctation).

Explanation

Coarctation of the aorta may be a feature of Turner (XO) syndrome and is associated with bicuspid aortic valve in over 70% of patients. Mitral valve abnormalities, for example, a supravalvar mitral ring or parachute mitral valve, and subaortic stenosis are not uncommon associated lesions.

Comments

The anomaly occurs twice as often in males as in females.

Tips

When this group of left-sided obstructive lesions occurs together, they are referred to as Shone complex.

A middle aged man from West Bengal presents with paraesthesia of hands and feet, hyperkeratosis, lines in the nails and rain drop pigmentation in the hands.

2009-01-06T01:12:00.007+05:30

Question 72

59. A middle aged man from West Bengal presents with paraesthesia of hands and feet, hyperkeratosis, lines in the nails and rain drop pigmentation in the hands. The most likely causative toxin for the above mentioned symptoms is:

1. Lead.

2. Arsenic

3. Thallium.

4. Mercury.

Answer

2. Arsenic

Reference

The Essentials of Forensic Medicine and Toxicology 21^st Edition : K.S.Narayana Reddy Page 462

P.C.Dikshit 1^st Edition Page 477

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Ä Arsenic is termed a metalloid as it has properties of both metals and non-metals.

Ä Forms

o Trivalent (e.g. arsenic trioxide, arsenious acid, and arsenites) and

o Pentavalent (e.g. arsenic pentoxide, arsenic acid, and arsenates) derivatives.

o Inorganic arsenical compounds may generate arsine gas when in contact with acids and reducing metals (e.g. iron and zinc) or with sodium hydroxide and aluminium.

Ä Use

o Electronics industry,

o Production of special types of crystal and optical glass,

o Hardening lead and copper alloys,

o Manufacture of fireworks,

o Wood preservative and

o Pesticide. It is a byproduct of copper smelting.

Ä In exposed individuals high concentrations of arsenic are present in

o Bone,

o Hair, and

o Nails. The half-life is in the range of 1 to 3 days.

Ä Excretion is predominantly in the

o urine as mono- and dimethyl-derivatives.

CLINICAL FEATURES

Ä Acute poisoning

o This can follow accidental, suicidal, or deliberate ingestion,

o Toxicity being largely dependent on the water solubility of the ingested compound.

§ Within 2 h of substantial ingestion of a soluble arsenical compound, severe haemorrhagic gastritis or gastroenteritis may ensue with collapse and death usually within 4 days.

§ A metallic taste, salivation, muscular cramps, facial oedema, difficulty in swallowing, hepatorenal dysfunction, convulsions, and encephalopthy are reported.

§ A peripheral neuropathy (predominantly sensory), striate leukonychia (Mees' lines) and hyperkeratotic, hyperpigmentated skin lesions are common in those surviving a near fatal ingestion.

§ In moderate or severe arsenic poisoning investigations may show anaemia, leucopenia, thrombocytopenia, and disseminated intravascular coagulation. ECG abnormalities have been reported and include QT prolongation and ventricular arrhythmias.

o Exposure to arsenic trioxide and trichloride dust causes irritation of the eyes, nose, throat, and lower respiratory tract. Corrosive skin damage may follow skin contact with arsenical compounds such as arsenious acid and arsenic trichloride.

Ä Chronic poisoning

o Source

§ Contaminated drinking water or

§ “Tonics” containing inorganic trivalent arsenical compounds

o Features

§ Progressive weakness,

§ Anorexia, Nausea, Vomiting, Stomatitis, Colitis,

§ Increased salivation, Epistaxis, Bleeding gums, Conjunctivitis,

§ Weight loss, and Low grade fever.

§ Hyperkeratosis (palms and soles of the feet)

§ “Raindrop” (skin),

§ “Mees” (nails).

§ Skin cancer (usually squamous cell epithelioma)

§ A symmetrical peripheral neuropathy is typical.

§ Sensory symptoms predominate but motor involvement is also

§ Central nervous system effects

· hearing loss,

· psychological impairment and

· EEG changes.

§ disturbances of liver function

§ Ulceration and perforation of the nasal septum.

Ä Chronic exposure to trivalent and pentavalent forms of arsenic has been linked to excess lung cancer and lung cancer occurring in lead, tin, and copper smelter workers has been attributed to arsenic.

Explanation

1. Lead poisoning presents with a whole lot of features like Aneamia, Colic, Neuropathy, facial pallor, lead line or Burtonian line, lead encephalopathy , optic atrophy etc.

2. Acute Arsenic Resembles Diarrhoea where as Chronic Arsenic resembles “fading Measles”

3. Thallium poisoning resembles Guillain Barre Syndrome.

4. Minamita disease, hatter’s shakes and mercurial erethesm are a few of the prominent features of Mercury Poisoning.

Comments

TREATMENT :

Ä Dimercaprol (British Anti-Lewisite, BAL) given by deep intramuscular injection (2.5-5 mg/kg four hourly for 2 days followed by 2.5 mg/kg intramuscularly twice daily for 1 to 2 weeks).

Ä DMSA (succimer) and DMPS (unithiol) are more effective in reducing the arsenic content of tissues and, unlike dimercaprol they do not cause accumulation of arsenic in the brain DMSA and DMPS may be given orally (in a dose of 30 mg/kg body weight daily).

Tips

The fact that Arsenic is tasteless and odorless was known even eras ago. It is alleged that the governor of St.Helena “slow poisoned” the “petit corporal” while he was in the jail as a prisoner of Britain. But they didn’t perhaps know that Arsenic is a BAD homicidal poison as it can be detected even centuries after in Bone and Hair (as was detected from Napolean’s mortal remains).

An example of Polychlorinated hydrocarbon is Endrin

2009-01-06T01:12:00.006+05:30

Question 71

An example of Polychlorinated hydrocarbon is

a. Parathion

b. Malathion

c. Diazinon

d. Endrin

Answer

d. Endrin

Reference:

P.C.Dikshit 1^st Edition Page 573

Park 18^th Edition Page 589

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Endrin is a cyclodiene insecticide used on cotton, maize, and rice. It also acts as an avicide. As a rodenticide, it is used to control mice and voles. It is a solid, cream to light tan to white, almost odorless substance. It melts and decomposes at 200 °C. It is moderately soluble in benzene and acetone, slightly soluble in alcohols, alkanes, and xylene, and almost insoluble in water.

Explanation

Parathion, Malathion and Diazinon are Organophosphorus Insecticides

Comments

Endrin is a stereoisomer of dieldrin and is structurally similar to aldrin, and heptachlor epoxide.

Tips

It is also known as Mendrin, and Compound 269.

Mechanism of labour in abortion stick is due to . Necrosis of uterine endometrium and stimulation of uterine contraction

2009-01-06T01:12:00.005+05:30

Question 70

Mechanism of labour in abortion stick is due to

a. Necrosis of uterine endometrium and stimulation of uterine contraction

b. Oxytocin present in the stick

c. Prostaglandins present in the stick

d. All of the above

Answer

a. Necrosis of uterine endometrium and stimulation of uterine contraction

Reference

P.C.Dikshit 1^st Edition Page 355

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An abortion stick is a thin wood or bamboo stick, from 12 to 18 cms long. This stick is wrapped around at one end or for the greater portion of its length with cotton wool or a piece of cloth, and soaked with juice of marking nuts , calotropis, jequirity, asafetida, or a paste made of arsenic oxide, arsenic sulphate and red lead.

Explanation

It is introduced into the vagina or the uterine os by professional abortionists (dhais) and retained there till uterine contractions begin. In some cases the irritant fluid is directly applied to the os or a piece of cloth saturated with irritating juice or paste is introduced into the vagina.

Comments

Instead of stick, a twig or irritant plant such as calotrophis, Nerium Odorum or Plumago rosea can be used.

Tips

To avoid the misuse of induced abortions, most countries have enacted laws whereby only qualified Gynecologists under conditions laid down and done in clinics/hospitals that have been approved can do abortions. The Medical Termination of Pregnancy Act was enacted by the Indian Parliament in 1971 and came into force from 01 April, 1972. The MTP act was again revised in 1975.

The reagent used to detect presence of Vaginal Cells in on the penis of an accused in a rape case is Lugol’s Iodine

2009-01-06T01:12:00.004+05:30

Question 69

The reagent used to detect presence of Vaginal Cells in on the penis of an accused in a rape case is

a. Lugol's iodine

b. Phenophthalein test.

c. Orthotoluidine test.

d. Benzidine.

Answer

a. Lugol’s Iodine

Reference

P.C.Dikshit 1^st Edition Page 395

Discussion

If the accused has had a sexual intercourse with the victim, there could be vaginal cells over his penis. These vaginal cells can not be seen with the naked eye, but can be detected by chemical. These cells turn brown when exposed to the vapors of Lugol's iodine.

The skin of the penis is wiped with a filter paper moistened with salt solution and then it is exposed vapors of Lugol's iodine. It the filter paper turns brown, the accused as had sexual intercourse.

Explanation

1. Benzedine test: Stain Extract in Test Tube + few drops of 10 % Benzidine in Glacial Acetic Acid + few drops of H₂O₂à Blue Colour indicates Positive test (Similarly the stain is moistened with Normal Saline and a blotter is pressed over the area + Benzidine Solution + H₂O₂à Blue Colour indicates Positive test.

2. Phenophthalein test (Kastle mayer test): Diluted Stain Extract + Reduces Alkaline Phenopthaline + few drops of H₂O₂à Pink Colour indicates Positive test

3. Orthotoluidine test (Kohn and O’Kelly test): Equal volume of Working Solution (4% Orthotoludine in Ethyl Alcohol + Glacial Acetic Acid + Distilled Water in equal amounts ) and H₂O₂are mixed . Then few drops of this mixture is added to the stain extract in a test tube à Blue or Green Colour indicates Positive test

Comments

The paper turns brown in colour due to the high glycogen content of vaginal cells, when present.

Tips

While we find Glycogen with Iodine in this test, there is another test where the plant equivalent of Glycogen (ie Starch) is used to find Iodine. It is done to find out whether the common salt is iodised or not

Expanded Lungs may sink due to Atelectasis

2009-01-06T01:12:00.003+05:30

Question 68

Expanded Lungs may sink due to

a. Atelectasis

b. Putrefaction

c. Mouth to mouth respiration

d. Alcoholic fixationMeconium aspiration

Answer

a. Atelectatis

Reference

P.C.Dikshit 1^st Edition Page 321

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Hydrostatic Test is also called as Raygat’s Test

· First noted by Scheyer in 1683

· Done to determine whether the child was live born or still born

· Specific gravity of lung decreases from 1040 - 1050 (more than water) to 940 (less than water) after respiration

· If lung sinks à Unexpanded Lung àNo Respiration

· If lungs Float à Expanded Lung à Child has taken the first breadth

Explanation

· Expanded Lungs may sink due to

o Diseases

§ Acute pulmonary Edema

§ Pneumonia

§ Congenital syphilis

o Atelectasis (non expansion)

§ Air not reaching the alveoli due to feeble respiration

§ Complete absorption of air from lungs by blood if circulation continue after respiration has been stopped or a state of asphyxia

§ More air being expelled from the lungs during expiration due to recoil of lung tissue

§ Obstruction by alveolar duct membrane

o Drowning

§ When birth occurs in toilet bowl or bucket containing water

Comments

· Unexpanded Lungs may float due to

o Putrefaction

o Artificial inflation – eg : mouth to mouth respiration

o Alcoholic fixation

Tips

· This test is not needed when

o Fetus < 180 days

o Fetus is a monster

o Fetus is macerated or mummified

o Umbilical cord is separated or cicatrized

o Stomach contains milk

o Whole of thorax contents float

MCQsOnline - Online Collection of MCQs of Medical PG Entrance Exams

Questions of All India PG Entrance Exam 2006

Brainstem Anatomy Mnemonics

Difference between acute pyelonephritis and Uncomplicated UTI are all except

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Thymoma commonly presents with Myasthenia Gravis

Most common islet cell tumour in MEN 1 is Gastrinoma

Multiple Endocrine Neoplasia (MEN) Syndromes

Type

MEN 1

MEN 2

Mixed Syndromes

Conn’s Syndrome is Adrenal Adenoma

Cushing’s disease presents with

A 24 year old female presents with palpable Purpura and with rashes all over trunk limbs buttocks and paid abdomen

What will be the appropriate investigation for a 40 female with jaundice and spherocytosis

A drug used in the treatment of CML is Imatinib Mesylate Gleevec ST1571

One of the Causative organisms for Crohn's disease is Mycobacterium paratuberculosis

Which of the following is not true for Hereditary Hemochromatosis – Desferroxamine not treatment of choice

A young man presents with HBsAg positive, HBeAg negative and normal levels of AST and ALT

Which of the following is not a feature of Conus Syndrome

Which is not a feature of Extramedullary Tumour Sacral Sparing

Dying Back Neuropathy is due to all except Gullain Barre Syndrome

Meningitis in elderly all except HSV 2

Diffuse Axonal Injury is characterized by all except Increased Intracranial tension is seen in all cases

Question 75

A young 25 year old male basket ball player suddenly collapsed while undergoing an athletic event and died.

Answer

Reference

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The most common anomaly associated with co arctation of aorta is Bicuspid aortic valve

Question 73

Answer

Reference

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A middle aged man from West Bengal presents with paraesthesia of hands and feet, hyperkeratosis, lines in the nails and rain drop pigmentation in the hands.

An example of Polychlorinated hydrocarbon is Endrin

Mechanism of labour in abortion stick is due to . Necrosis of uterine endometrium and stimulation of uterine contraction

The reagent used to detect presence of Vaginal Cells in on the penis of an accused in a rape case is Lugol’s Iodine

Expanded Lungs may sink due to Atelectasis