AIIMS Nov 2014 MCQs Key discussion


AIIMS November 2014 MCQ Key discussion by Dr Murali Bharadwaz at 5 pm 11 th November 2014 Tuesday

Venue : Nampally Centre Hyderabad . Also you can access online Live discussion from your laptop at home at the link

Before discussion we keep posting AIIMS Nov 2014 MCQs as and when as the explanation get ready here .

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# Biochemistry

@ Study of molecular structure is done by

a) X ray crystallography

Ans A

Xray crystallography -The study of molecular structure by examining diffraction patterns made by x-rays beamed through a crystalline form of the molecules

@ Child with pellagra like symptoms, amino acids in urine, family history of 4 siblings affected 4 normal , parents not affected ,D iagnosis is-

a)  Phenylketonuria

b)  Mayple syrup

c)   Hartnups disease

Ans C

@ A 10 month old child vomits after fresh fruit intake. He has been exclusively breast fed upto now. The doctor suggests fructose intolerance. which of the following enzymes would be deficient in this person?

A. Fructokinase

b. Aldolase B

c. Fructose 1, 6 biphosphatase

Ans B

Hereditary fructose intolerance (HFI) is an inborn error of fructose metabolism caused by a deficiency of the enzyme aldolase B. Individuals affected with HFI are asymptomatic until they ingest fructose, sucrose, or sorbitol. If fructose is ingested, the enzymatic block at aldolase B causes an accumulation of fructose-1-phosphate. This accumulation has downstream effects on gluconeogenesis and regeneration of adenosine triphosphate (ATP). Symptoms of HFI include vomiting, hypoglycemia, jaundice, hemorrhage, hepatomegaly, hyperuricemia and potentially kidney failure. While HFI is not clinically a devastating condition, there are reported deaths in infants and children as a result of the metabolic consequences of HFI. Death in HFI is always associated with problems in diagnosis

@ Which amino acid is absent in collagen

a)   glycine

b)    proline

c)     hydroxyproline

d)    Desmosine

Ans D

The triple-helical structure of collagen arises from an unusual abundance of three amino acids: glycine, proline, and hydroxyproline



@Which of the following is not used as 1st line management in anovulatory bleeding in 13 year old girl

a)  Mefenemic acid

b)  Tranexamic acid

c)  Estrofen+progesterone

d)  Progesterone


As anovulatory cycles have no pain ,mefanamate is of no use


@ 40 Yr old man wid Primary infertility..testis palpable .Vas not palpable …on semen analysis shows azoospemia ,low volume, low pH , high viscosity and high liquefaction time..diagnosis is ??

a)    CFTR mutation

b)   hyperprolactinemia

c)     estrogen alpha mutation

d)    varicocele

Ans A

  • high viscosity caused by a mutation of the gene that causes cystic fibrosis
  • Most men with cystic fibrosis have congenital bilateral absence of the vas deferens (CBAVD)


# Pediatrics

@Child with k/c/o bronchial asthma comes with respiratory distress rate 48/min cant speak 2 words,occasionsl wheeze.Saturation 95% .you have given 3 doses of salbutamol nebulisation then he started to speak a sentence but saturation falls to 85%  AIIMS Nov 2014 MCQs


B.R to left shunt

C.Due to salbutamol

D.Faulty pulse oxymeter

Ans D



@Treatment of meniere’s disease

a) surgery is mainstay


For many years, surgery was the mainstay of therapy for medically refractory patients, but recently, transtympanic gentamicin perfusion has attracted increasing interest and is a method frequently used for treating Meniere’s disease

Surgery to decompress the endolymphatic sac has shown to be effective for temporary relief from symptoms. Most patients see a decrease in vertigo occurrence, while their hearing may be unaffected. This treatment, however, does not address the long-term course of vertigo in Ménière’s disease[47] and may require repeated surgery.

@ Most common cause of vocal cord palsy

a)  Trauma

b)  Malignancy

c)  Neurological

d)    Surgical

Ans B

@ Correction of cleft palate done at

a)  24 months

b)  8-10 months

c)  15-18 months

d)    9-12 months

Ans D

Most times, cleft lip repair is done when the child is 6 to 12 weeks old

Cleft palate can also be corrected by surgery, usually performed between 6 and 12 months

Most times, cleft palate repair is done when the child is older, between 9 months and 1 year old. This allows the palate to change as the baby grows. Doing the repair when the child is this age will help prevent further speech problems as the child develops.


@ Head injury, patient conscious, CT is not showing fracture, CSF leakage thru right nostril-management?

(a) Clear fluid from nose

(b) wait for 5 to 6 days for spontaneous stoppage of leakage

(c) immediate cisternography and transcranial operation to close the defect

(d) Endoscopically stop leakage

Ans B


@ False regarding Malignant otitis externa

a)  Seen in otitis media

b)  Caused by pseudomonas

c)  Basal skull infection

d)    Cause Severe hearing loss

Ans D


@ False about Cavernous Sinus thrombosis

a)   Occur most commonly due to ethmoid sinusitis

b)   Loss of sensation around orbit

c)   Loss of Jaw jerk reflex


Ans C


Cavernous Sinus thrombosis

  • CST most commonly results from contiguous spread of infection from a nasal furuncle (50%), sphenoidal or ethmoidal sinuses (30%) and dental infections (10%)
  • The most common signs of CST are related to anatomical structures affected within the cavernous sinus, notably cranial nerves III-VI, as well as symptoms resulting from impaired venous drainage from the orbit and eye.
  • Classic presentations are abrupt onset of unilateral periorbital edema, headache, photophobia, and bulging of the eye (proptosis).
  • Other common signs and symptoms include:
  • Ptosis, chemosis, cranial nerve palsies (III, IV, V, VI).
  • Sixth nerve palsy is the most common.
  • Sensory deficits of the ophthalmic and maxillary branch of the fifth nerve are common.
  • Periorbital sensory loss and impaired corneal reflex may be noted. Papilledema, retinal hemorrhages, and decreased visual acuity and blindness may occur from venous congestion within the retina.
  • Fever, tachycardia and sepsis may be present. Headache with nuchal rigidity may occur.
  • Pupil may be dilated and sluggishly reactive. Infection can spread to contralateral cavernous sinus within 24–48 hours of initial presentation.

ü  Jaw jerk reflex

  • The jaw jerk reflex or the masseter reflex is a stretch reflex used to test the status of a patient’s trigeminal nerve (CN V
  • The mandible—or lower jaw—is tapped at a downward angle just below the lips at the chin while the mouth is held slightly open. In response, the masseter muscles will jerk the mandible upwards. Normally this reflex is absent or very slight. However in individuals with upper motor neuron lesions the jaw jerk reflex can be quite pronounced.
  • The jaw jerk reflex can be classified as a dynamic stretch reflex. As with most other reflexes, the response to the stimulus is monosynaptic, with sensory neurons of the trigeminal mesencephalic nucleus sending axons to the trigeminal motor nucleus, which in turn innervates the masseter. This reflex is used to judge the integrity of the upper motor neurons projecting to the trigeminal motor nucleus. Both the sensory and motor aspects of this reflex are through CN V.


@ complications of adenoidectomy are all except

a)    hyponasality of speech

b)    velopharyngeal insufficiency

c)    Infection of skull bone

d)    Retropharyngeal abscess

Ans a

velopharyngeal insufficiency causing hypernasal speech occur after adenoidectomy

  • Some causes of hyponasal speech are adenoid hypertrophy, allergic rhinitis, deviated septum, sinusitis, and turbinate hypertrophy.
  • Hypernasal speech or hyperrhinolalia or rhinolalia aperta is inappropriate increased airflow through the nose during speech, especially with syllables that beginning with plosive and fricative consonants.
  • Hyponasal speech, denasalization or rhinolalia clausa is a lack of appropriate nasal airflow during speech, such as when a person has nasal congestion.



Examples of hypernasal speech include cleft palate and velopharyngeal insufficiency.


@ Postoperative steroids are not used for

a) post antrochoanal surgery

b) post Surgery for chronic rhinosinusitis

c) post fungal sinusitis Surgery

d) multiple ethmoidal polyp

Ans b

(A repeat from AIIMS Nov 2013)

Chronic rinisinusitis

Corticosteroid nasal sprays have been shown to delay the recurrence of polyps after surgery however, the benefit for nonpolypoid CRS has been harder to demonstrate

Antihistaminics, low dose steroids, local steroid sprays, help to regress the ethmoidal polyps to a certain extent. However, the above treatment rarely eliminates well formed polyps and is often combined with surgery.

Most patients with antrochoanal polyps have a history of chronic sinusitis and/or allergy. The dominating symptoms in patients with ACPs are nasal obstruction and chronic rhinorrhea. Other common symptoms of ACPs in children are snoring, nocturnal sleep apnea and recurrent upper respiratory tract infections. Computed tomography is an important radiological examination of choice for evaluation of antrochoanal polyps. The treatment of choice is always surgical. Functional endoscopic sinus surgery (FESS) with polypectomy has been the dominating surgical approach. Nasal steroids are used in the initial treatment and after the surgical management in order to prevent recurrence.

Allergic fungal sinusitis

The treatment of choice is generally surgery. Systemic steroids may be indicated once surgery is performed and the diagnosis is confirmed. Some authors suggest a low dose of prednisone (0.5 mg/kg) in a tapering dose with alternate-day dosage over a 3-month period. Topical nasal steroids are helpful postoperatively. Aggressive nasal salt-water washes are recommended. Immune therapy for specific allergens is controversial, even though some reports suggest benefit from this treatment. Systemic antifungals are not indicated in the absence of invasion.

# Orthopedics

@Boy with small lytic lesion surrounding a sclerosing lesion in mid shaft tibia?

(a) osteoid osteoma

(b) fibrous cortical defect

(c) Fibrous dysplasia


Ans A

In osteoid osteoma, the patient age is typically less than 20 years. The male-to-female ratio is usually 2:1. The location is diaphyseal or metaphyseal; epiphyseal lesions are very rare. The epicenter is eccentric. The appearance consists of a lucent nidus that is sometimes calcified, associated with surrounding sclerosis.


@When Pronation of the foot occurs ,axes of which joints move in parallel direction?

(a) Talo navicular – calcaneo cuboid

(b) Calcaneo navicular – Talo cuboid



Ans A

ronation is the opposite of supination and involves the calcaneus everting, abducting and dorsiflexion

When the STJ is pronated the axis of the Calcaneo-cuboid joint is parallel to the axis of the talo-navicular joint and free motion occurs. When the foot is supinated the axes are divergent and the motion is more restricted.


@ Sun ray appearance in osteosarcoma is due to

a)  Periosteal reaction

b)  Calcification around vessel

c)     Calcification around spindles

Ans A


@ A 2yr old child is unable to move elbow and crying after her mother lifted the baby holding at the wrist…Cause for pain

a)  Elbow dislocation

b)  Pulled elbow

c)     Referred pain

Ans B

@After 1year,,osteoporosis in a hemiparesis patient is first seen in


a)    distal radius

b)   upper end femur

c)     lower end humerus

d)    lumbar vertebra

Ans B

@ . Which of the following is not seen in colle’s fracture

a)  radial displacement

b)  volar tilt

c)  dorsal displacement

d)  supination

Ans B

  • Die-punch fracture

o   A depressed fracture of the lunate fossa of the articular surface of the distal radius

  • Barton’s fx

o   Fx dislocation of radiocarpal joint with intra-articular fx involving the volar or dorsal lip (volar Barton or dorsal Barton fx)

  • Chauffer’s fx

o   Radial styloid fx

  • Colles’ fx

o   Low energy, dorsally displaced, extra-articular fx

  • Smith’s fx

o   Low energy, volar displaced, extra-articular fx


# Anesthesia

@ Brechner and Bethune discovered

a)    Precordial doppler

b)    Plethysmography

c)    Trans esophageal echo cardiography

d)   End tidal co2 (etco2) monitor

Ans D


@Patient had eye Surgery. Was given propofol & SCh. 8 hrs after surg had pain in legs on walking. It is due to :-

A propofol

B Succinyl choline

C due to surgery

D. Early mobilization


Ans B

@Which of the following Iv drug used in daycare surgery?

a)  Ketamine

b)  Propofol

c)  Diazepam

Ans B


# Surgery

@Le veen shunt is between peritoneum and

  1. Renal cortex
  2. SVC
  3. Umbilicus
  4. Gall Bladder

Ans B

A peritoneovenous shunt (also called LeVeen Shunt) is a shunt which drains peritoneal fluid from the peritoneum into veins, usually the internal jugular vein or the superior vena cava. It is sometimes used in patients with refractory ascites.

@Weeping umbilicus is seen with

a)  patent urachus


Ans A
@ 50 yr old male became dizzy while passing stools and noticed fresh blood in the stools. Previous stool examination for routine screening of Ca colon was normal. What is the most likely cause of bleed?

a)  Early ca colon

b)  Sigmoid diverticulosis

c)  Microscopic colitis

d)  Dilation of veins of colon

Ans B

Diverticulosis can present with painless rectal bleeding as bright red blood per rectum.


@ 10 Yr old girl with alopecia , mental retardation presented wiith lump in epigastrium..on palpation crepitus was present in epigastrium and resp rate was increased..diag??

a)    trichobezar

b)   worm

c)     gastric ulcer

d)    barrets esophagus

Ans A


Small trichobezoars are usually asymptomatic. Large trichobezoars are often palpable and may cause malaise, weight loss, vague abdominal pain associated with meals, anorexia, halitosis, vomiting, wasting, and cachexia. Complications include gastritis (which can cause occult blood loss and secondary anemia), ulceration, intestinal obstruction, necrosis, peritonitis, and perforation.


@ Which of the following is least pre malignant


a)  Chrons disease

b)  Ulcerative colitis

c)     Peutz jegher’s syndrome

d)    Barrets esophagus

Ans C

@ FNAC of thyroid cannot diagnose


a)  Thyroiditis

b)  anaplastic Carcinoma

c)  follicular Carcinoma

d)  papillary Carcinoma

Ans C

@ First investigation to be done in a case of Billous vomiting neonate


a)  Chest X Ray

b)  babygram,

c)  CT

d)  Ultrasound

Ans B


– Bilious vomiting

–      Retained meconium –

–      Abdominal distension

• Pathologic types – Intraluminal

– Extraluminal

– Functional

• Aids in early dx

– Mother history,miscarriage,siblings

–      Polyhydramnious

• Investigation

– PlainX-ray( KUB or babygram)

– Contrast studies(enema or UGIS)

Bilious vomiting, with or without abdominal distention, is an initial sign of intestinal obstruction in newborns. A naso- or orogastric tube should be placed immediately to decompress the stomach. Physical examination should be followed by plain abdominal films. Dilated bowel loops and air-fluid levels suggest surgical obstruction. Contrast radiography may be required. Duodenal atresia, midgut malrotation and volvulus, jejunoileal atresia, meconium ileus and necrotizing enterocolitis are the most common causes of neonatal intestinal obstruction.

When the patient is hemodynamically stabilized, appropriate imaging studies of the abdomen should be performed. These would include plain abdominal films and/or contrast studies. When dilated bowel loops and air-fluid levels are demonstrated, the diagnosis of a surgical abdomen is suggested, and urgent consultation with a pediatric surgeon is indicated, preferably in a pediatric surgical center. Gastric decompression, hydration and secured airway must be completed before initiating transport of the patient. Intestinal obstruction with bilious vomiting in neonates can be caused by duodenal atresia, malrotation and volvulus, jejunoileal atresia, meconium ileus, and necrotizing enterocolitis



@10 month old infant crying .Passed red coloured stool and then stopped crying after sometime .Diagnosis is

a)  Meckels diverticulum

b)  Intussusception

c)    Intraluminal worms


Ans B


@Most common site of MALToma ?

a)  stomach

b)  ileum

c)    duodenum

Ans A

MALT lymphomas can develop almost anywhere in the body but the most common place for MALT lymphoma to develop is in the stomach


@ Picture based MCQ on resected specimen of thyroid. With HPE slide showing Orphan annie eyed cells

25 yr female with longstanding module in right lobe 2 X 2 cm in size . She underwent hemithyroidectomy . The finding is suggestive of –

a)  Graves

b)  Follicular adenoma

c)  Papillary carcinoma

d)  Adenomatous goitre.

Ans C


@ Baby not passed stool in 48 hours , abdominal distension is present . What is investigation of choice

a)    CFTR mutations

b)   Chloride level in secretions

c)    trypsinogen levels

Ans B


Since no option mentioned about Hirschsprung disease , it is meconium ileus

Infants born, or presenting in the first few days of life, with meconium ileus due to CF may have normal trypsinogen levels and would therefore not test positive on newborn screening. Infants with meconium ileus are tested directly with DNA and sweat chloride testing


@30000 Molecular weight similar to Albumin is

a)  Dextran

b)   Pergelin

Ans A

  • Dextrans are polysaccharides that have a similar colloidal activity to that of albumin when given IV.
  • Dextrans are available in multiple molecular weights ranging from 3,000 Da to 2,000,000 Da. The larger dextrans (>60,000 Da) are excreted poorly from the kidney and therefore remain in the blood for as long as weeks until they are metabolized. Consequently, they have prolonged antithrombotic and colloidal effects.
  • In this family, dextran-40 (MW: 40,000 Da), has been the most popular member for anticoagulation therapy. Close to 70% of dextran-40 is excreted in urine within the first 24 hours after intravenous infusion while the remaining 30% will be retained for several more days.

@A girl with swelling on posterior aspect of thigh, gradual in onset, soft on palpation, color doppler showed multiple venous channels but no major arterial contribution .All of the following are used as sclerosing agents except?

a)  Cyanoarcylate

b)  absolute alcohol

c)  polyvinyl alcohol

d)  sodium tetradocyl sulfate

Ans C

Vascular malformations are categorized according to channel type and flow characteristics.

  • High-flow vascular anomalies include arteriovenous fistula (AVF) and arteriovenous malformations (AVM).
  • Low-flow malformations include capillary malformations (CM), venous malformations (VM) and lymphatic (LM) malformations.
  • Some patients have combined channel anomalies (e.g. Klippel–Trenaunay syndrome (CLVM)).
  • PVA is utilised predominantly for tumor embolisation as well as pre-operative devascularisation of other lesions. PVA is the preferred embolic agent for bronchial artery embolisation and the 500-700 micron diameter particles are utilised extensively for fibroid embolisation
  • This category includes sodium tetradecyl, the most commonly used sclerosant, ethanolamine and polydocanol. Like alcohol, these sclerosants damage the endothelial cells and cause coagulation of the intraluminal blood product
  • Cyanoacrylate materials have been used as adhesive embolic agents for more than 20 years. Their role in the embolisation of high-flow vascular lesions has been well established. Indications of NBCA are numerous, including the embolisation of various types of cerebral and spinal vascular malformations, as well as a growing number of peripheral vascular lesions, such as systemic AVMs.



To diminish the volume of the malformation, percutaneous sclerotherapy is the gold standard treatment. The goal is to obliterate the channels by causing damage to the endothelium with subsequent inflammation and fibrosis. Among all the sclerosing agents, absolute ethanol is the most effective one with the lowest recurrence rate, but also with the most serious local and systemic side effects.

  • Liquid embolic agents –
  • Used for AVM, these agents can flow through complex vascular structures so the surgeon does not need to target his catheter to every single vesse
  • nbca – n-butyle-2-cyanoacrylate – This agent is a permanent rapidly acting liquid, similar to glues sold under trade names such as “SuperGlue,” that will polymerize immediately upon contact with ions. It also undergoes an exothermic reaction which destroys the vessel wall. Since the polymerization is so rapid, it requires a skilled surgeon. During the procedure, the surgeon must flush the catheter before and after injecting the NBCA, or the agent will polymerize within the catheter.
  • ethiodol
  • It is usually used for chemoembolizations, especially for hepatomas, since these tumors absorb iodine.
  • Sclerosing agents – These will harden the endothelial lining of vessels. They require more time to react than the liquid embolic agents. Therefore, they cannot be used for large or high-flow vessels.
  • ethanol – This permanent agent is very good for treating AVM. The alcohol does need some time to denature proteins of the endothelium and activate the coagulation system to cause a blood clot. Therefore, some surgeons will use a balloon occlusion catheter to stop the blood flow and allow time for ethanol to work. Ethanol is toxic to the system in large quantities and may cause compartment syndrome. In addition, the injections are painful.
  • ethanolamine oleate – This permanent agent is used for sclerosing esophageal varices. It contains 2% benzyl alcohol, so it is less painful than ethanol. However it does cause hemolysis and renal failure in large doses.
  • sotradecol – This agent is used for superficial lower extremity varicose veins. It has been around for a very long time and is a proven remedy. However, it does cause hyperpigmentation of the region in 30% of patients. It is less painful than ethanol.
  • Particulate embolic agents –
  • These are only used for precapillary arterioles or small arteries.
  • These are also very good for AVM deep within the body. The disadvantage is that they are not easily targeted in the vessel. None of these are radioopaque, so they are difficult to view with radiologic imaging unless they are soaked in contrast prior to injection.
  • Gelfoam hemostasis
  • polyvinyl alcohol (PVA) – These are permanent agents. They are tiny balls 50-1200 um in size. The particles are not meant to mechanically occlude a vessel. Instead they cause an inflammatory reaction. Unfortunately, they have a tendency to clump together since the balls are not perfectly round. The clump can separate a few days later, failing as an embolic agent.
  • acrylic gelatin microspheres


# Dermatology


@ Picture based MCQ :

A female with rash in butterfly area , has psychological mabifestations . What si diagnosis

a)  Acne rosacea

b)  SLE

Ans B

Some students recalled it as acne picture based question on sun light excerbation

Dx- rosacea




@ Picture based MCQ

65 year male with tense blister which are itchy . Diagnosis is

a)  urticarial plaque

b)  Bullous Pemphigoid

c)  dermatitis herpatiformis

d)   Pemphigus vulgaris

Ans B

  • Bullous pemphigoid is a blistering skin condition that most often affects the elderly. This is a close-up picture of the typical blisters. Large blisters, like these, are called bullae.
  • The onset of bullous pemphigoid may be either subacute or acute, with widespread, tense blisters. Significant pruritus is frequently present and may be the only manifestation of the disease, especially in older patients.[35] In some patients, the blisters arise after persistent urticarial lesions.
  • Bullous pemphigoid has been reported following several nonbullous, chronic, inflammatory skin diseases, such as lichen planus and psoriasis.
  • Bullous pemphigoid has been reported to be precipitated by ultraviolet irradiation, x-ray therapy, and exposure to some drugs.
  • Drugs associated with bullous pemphigoid include furosemide, ibuprofen and other nonsteroidal anti-inflammatory agents, captopril, penicillamine, and antibiotics.



@ Which is not abdominal method of sterilisation??


a)  essure

b)  parkland

c)  pomeroy

d)  irving

Ans A


@ Even though it is fatal ,Avian influenza H5N1 does not cause pandemic because of

a)  presence of avian gene

b)  it does not spread between people

c)  it affects only wild birds

d)  less transmission between birds

Ans B

Most human cases of “highly pathogenic“ H5N1 virus infection have occurred in people who had recent contact with sick or dead poultry that were infected with H5N1 viruses. About 60% of people infected with the virus died from their illness.

Unlike other types of flu, H5N1 usually does not spread between people.


@Epigenetic studies include all except?

(a) HPLC

(b) methylation

(c) Bisulphite sequencing

(d) ChIP-on-chip

Ans d

The term epigenetics refers to heritable changes in gene expression (active versus inactive genes) that does not involve changes to the underlying DNA sequence; a change in phenotype without a change in genotype.

Epigenetic change is a regular and natural occurrence but can also be influenced by several factors including age, the environment/lifestyle, and disease state. Epigenetic modifications can manifest as commonly as the manner in which cells terminally differentiate to end up as skin cells, liver cells, brain cells, etc. Or, epigenetic change can have more damaging effects that can result in diseases like cancer.

At least three systems including DNA methylation, histone modification and non-coding RNA (ncRNA)-associated gene silencing are currently considered to initiate and sustain epigenetic change.

Bisulphite sequencing (also known as bisulfite sequencing) is the use of bisulphite treatment of DNA to determine its pattern of methylation. DNA methylation was the first discovered epigenetic mark, and remains the most studied

HPLC methods of determining DNA methylation may require relatively large amounts of DNA (50 μg); as many tissues have low DNA yields,

ChIP-on-chip (also known as ChIP-chip) is a technology that combines chromatin immunoprecipitation (“ChIP”) with DNA microarray (“chip”). Like regular ChIP, ChIP-on-chip is used to investigate interactions between proteins and DNA in vivo. Specifically, it allows the identification of the cistrome, sum of binding sites, for DNA-binding proteins on a genome-wide basis



@ In ICDS,diet given to pregnant women has

——- kal energy and ——— gms protein supplementation

a)  330 kcal+15 gm protein

b)  380 kcal+15 gm protein

c)  200 kcal+10 gm protein

d)  250 kcal+10 gm protein

May be option is 600 calories + 18 gm protein

Nutrition and feeding norms shall be altered to ensure the following: children between 6 months and 3 years of age have to avail through SNP 500 calories and 12-15 grams of protein; severely malnourished children, 800 calories and 20-25 grams of protein; and pregnant women and lactating mothers, 600 calories and 18-20 grams of protein


@Not associated with vaccine derived polio

a)  iVDPV

b)  aVDPV

c)  cVDPV

d)  mVDPV

Ans D

Properties of VDPVs


  • Three poliovirus serotypes (PV1, PV2, and PV3) have been identified. Poliovirus isolates are grouped into three categories: 1) WPVs (current WPVs are genetically unrelated to any vaccine strain), 2) vaccine-related polioviruses (VRPVs; <1% divergent [PV1 and PV3] or <0.6% divergent [PV2] from the corresponding OPV strain), and 3) VDPVs (VRPVs >1% divergent [PV1 and PV3] or >0.6% divergent [PV2] from the corresponding OPV strain) VDPVs are further categorized as
  • cVDPVs when evidence of person-to-person transmission in the community exists;
  • iVDPVs, which are isolated from persons with primary, B-cell immunodeficiencies (defects in antibody production
  • ambiguous VDPVs (aVDPVs), which are either clinical isolates from persons with no known immunodeficiency and no evidence of transmission or sewage isolates whose source is unknown


# Medicine


Heart failure marker all except


b) Sirtuin


d) CRP

Ans B

Diagnostic and prognostic markers of cardiac dysfunction

  • B-type natriuretic peptide (BNP)
  • NT-proBNP
  • Troponins

Sirtuin or Sir2 proteins are a class of proteins that possess either mono-ADP-ribosyltransferase, or deacylase activity, including deacetylase, desuccinylase, demalonylase, demyristoylase and depalmitoylase activity.[2][3][4][5] Sirtuins regulate important biological pathways in bacteria, archaea and eukaryotes

Sirtuin activity is inhibited by nicotinamide, which binds to a specific receptor site, so it is thought that drugs that interfere with this binding should increase sirtuin activity. Development of new agents that would specifically block the nicotinamide-binding site could provide an avenue for development of newer agents to treat degenerative diseases such as cancer, Alzheimer’s, diabetes, atherosclerosis, and gout.

@Most effective treatment in severe falciparum.malaria

a)  Chloroquine

b)  Artesunate

Ans B

@Heart sound not heard in Mitral Stenosis

a)  3rd heart sound

b)  opening snap

c)  MDM

d)  4 th heart sound

Ans A

@ angina, syncope and dyspnea are cardinal clinical features of

a)  AS

b)  AR

c)  MS

d)    MR

Ans C

@Tension pnemothorax, first step in management is

a)  Chest X Ray

b)  emergency thorctomy

c)  insert needle at 2nd intercostal space at mid clavicular line

Ans C

@Drug of choice for acute bacterial meningitis.

a)  Erythromycin

b)  Sulfamethoxazole

c)     cefotaxime

d)    Cefadozone

Ans C

fter admission to the hospital, the widely accepted empiric treatment is the administration of a third-generation cephalosporin, such as cefotaxime sodium or ceftriaxone sodium, with ampicillin if listerial meningitis cannot be ruled out. In patients with obvious meningococcal disease, penicillin is the drug of choice.

@Vasculitis not seen in elderly-

a)  Kawasaki disease

b)  Henoch schonlein purpura

c)     giant cell arteritis

Ans A

@ HLAB27 associated > 90% with

a. Enteropathic

b. Reactive

c. Rheumatoid arthritis

d. ankylosing spondylitis

Ans D

HLA-B27 is present in 90–95% of patients with ankylosing spondylitis, 60–90% of patients with reactive arthritis, 50–60% of patients with psoriatic arthritis or inflammatory bowel disease and spondylitis, and 80–90% of children with juvenile ankylosing spondylitis.


@ Not associated with Tuberous sclerosis

a) Giant cell astrocytoma

b) Ependymoma

c) subependymal tumor

d) White matter lesion

Ans B

Tuberous sclerosis was classically described as presenting in childhood with a triad of:


  • seizures: absent in one-quarter of individuals
  • mental retardation: up to half have normal intelligence
  • adenoma sebaceum: only present in about three-quarters of patient

white matter abnormalities:

  • variable appearance, with nodular, ill-defined, cystic and band like lesions seen
  • radial bands are thought to be relatively specific for T

subependymal giant cell astrocytomas (SGCA) are also associated


@First neurological disorder due to single neurotransmitter deficiency?

a)  Alzheimer’s disease

b)  Parkinson’s disease

c)  Huntington’s disease

d)  Schizophrenia

Ans A

Acetylcholine is a neurotransmitter that is deficient in people with Alzheimer’s


@ Big toe swollen , bony erosion , soft tissue swelling

a)  Gout

b)  Reiters disease

c)     Psoriasis

d)    Rhuematoid arthritis

Ans A


@Which of the following is true regarding Idiopathic Non specific Interstitial pneumonia?

A) Early appearance with Honey combing on CT

B) Male predominant

C) Elderly age

D) Good prognosis

Answer : D

Non-specific interstitial pneumonia (NSIP) is a form of idiopathic interstitial pneumonia

Patients with an NSIP histologic pattern on biopsy have a better prognosis than those with usual interstitial pneumonia (UIP). There are two variants of NSIP: cellular and fibrosing. The cellular variant features chronic inflammatory cells with minimal collagen deposition while the fibrosing pattern consists of diffuse interstitial fibrosis with fewer inflammatory cells. In contrast to UIP, NSIP has little or no honeycomb change, and fibroblast foci are scant or absen


@All the following pulmonary symptoms and non pulmonary causes are correctly matched except

(a) cyanosis-anxiety

(b) wheezing –Congestive heart failure

(c) tachypnea-acidosis

(d) chest pain-pericarditis

Ans A


@ H-Reflex is useful in diagnosing which radiculopathy

a. L1 radiculopathy

b.L2 radiculopathy

c. L 4 radiculopathy

D.S1 radiculopathy

Ans D

The Hreflex on stimulation of the tibial nerve in the popliteal fossa is routinely used in the diagnosis of first sacral (S1) nerve-root radiculopathy

H-Reflex in Lumbosacral Radiculopathy

Lumbosacral radiculopathy (LSR) is a common clinical problem that involves L5and S1 nerve roots

The H-reflex (or Hoffmann’s reflex) is a reflectory reaction of muscles after electrical stimulation of sensory fibers (Ia afferents stemming from muscle spindles) in their innervating nerves (for example, those located behind the knee). The H-reflex test is performed using an electric stimulator, which gives usually a square-wave current of short duration and small amplitude (higher stimulations might involve alpha fibers, causing an F-wave, compromising the results), and an EMG set, to record the muscle response. That response is usually a clear wave, called H-wave, 28-35 ms after the stimulus, not to be confused with an F-wave. An M-wave, an early response, occurs 3-6 ms after the onset of stimulation

H-reflex is analogous to the mechanically induced spinal stretch reflex (for example, knee jerk reflex). “The primary difference between the H-reflex and the spinal stretch reflex is that the H-reflex bypasses the muscle spindle, and, therefore, is a valuable tool in assessing modulation of monosynaptic reflex activity in the spinal cord.


@ Least commonly invoved in Rheumatic Heart Disease ?

a)  MS

b)  AS

c)  PS

d)    TS

Ans D

Tricuspid stenosis of rheumatic etiology occurred in only 3% of the 1010 cases

@Attention and concentration is mediated by ?

a)  Frontal lobe

b)  Basal ganglia

c)  Hypothalamus

d)    Parietal lobe

Ans D

The parietal lobe has many functions and duties in the brain and its main functioning can be divided down into two main areas: (1) sensation and perception (2) constructing a spatial coordinate system to represent the world around us.[19] The parietal lobe helps us to mediate attention when necessary and provides spatial awareness and navigational skills. Also, it integrates all of our sensory information (touch, sight, pain etc.) to form a single perception.[19] Parietal lobe gives the ability to focus our attention on different stimuli at the same time, PET scans show high activity in the parietal lobe when participates being studied were asked to focus their attention at two separate areas of attention.[19] Parietal lobe also assists with verbal short term memory and damage to the supramarginal gyrus cause short term memory loss.[20]

Damage to the parietal lobe results in the syndrome ‘neglect’ which is when patients treat part of their body or objects in their visual field as though it never existed. Damage to the left side of the parietal lobe can result in what is called Gerstmann syndrome.[21] It includes right-left confusion, difficulty with writing (agraphia) and difficulty with mathematics (acalculia). It can also produce disorders of language (aphasia) and the inability to perceive objects.[21] Damage to the right parietal lobe can result in neglecting part of the body or space (contralateral neglect), which can impair many self-care skills such as dressing and washing. Right side damage can also cause difficulty in making things (constructional apraxia), denial of deficits (anosognosia) and drawing ability.[21] Neglect syndrome tends to be more prevalent on the right side of the parietal lobe, because the right mediates attention to both the left and right fields.[21] Damage in the somatic sensory cortex results in loss of perception of bodily sensations, namely sense of touch.

  • Attention is the behavioral and cognitive process of selectively concentrating on a discrete aspect of information, whether subjective or objective, while ignoring other preceivable information. Attention has also been referred to as the allocation of limited processing resources.
  • The first aspect is called bottom-up processing, also known as stimulus-driven attention or exogenous attention. These describe attentional processing which is driven by the properties of the objects themselves. Some processes, such as motion or a sudden loud noise, can attract our attention in a pre-conscious, or non-volitional way. We attend to them whether we want to or not.[23] These aspects of attention are thought to involve parietal and temporal cortices, as well as the brainstem.
  • The second aspect is called top-down processing, also known as goal-driven, endogenous attention, attentional control or executive attention. This aspect of our attentional orienting is under the control of the person who is attending. It is mediated primarily by the frontal cortex and basal ganglia as one of the executive functions. Research has shown that it is related to other aspects of the executive functions, such as working memory,and conflict resolution and inhibition


# Pathology

@ identify Immunohisto markers wrongly matched.

A. Melanoma – S 100

B. Lymphoma – common leucocyte antigen

C . Carcinoma – desmin

d sarcoma – vimentin

Ans c

S-100 protein, commonly used in the immunohistochemical diagnosis of malignant melanoma and melanoma metastases

Desmin is one of the earliest protein markers for muscle tissue in embryogenesis as it is detected in the somites.[7] Although it is present early in the development of muscle cells, it is only expressed at low levels, and increases as the cell nears terminal differentiation. A similar protein, vimentin, is present in higher amounts during embryogenesis while desmin is present in higher amounts after differentiation. This suggests that there may be some interaction between the two in determining muscle cell differentiation

CD45 antigen (leukocyte common antigen), a unique and ubiquitous membrane glycoprotein with a molecular mass of about 200 kDa, is expressed on almost all hematopoietic cells except for mature erythrocytes.

In nearly all non-Hodgkin’s lymphomas of the B- and T-cell types (74 of 80; 93 per cent), the lymphoid infiltrate was immunoreactive for LCA

@ Apoptosis is caused by  AIIMS Nov 2014 MCQs

a)  Oliec acid

b)  Glucocorticoid

c)  Myristic acid

d)  Isoprenoid.

Ans b

Induction of apoptosis in lymphocytes, which may account for the therapeutic effects of glucocorticoids in various diseases including leukemia,

  • Saturated free fatty acids, palmitic acid and stearic acid, induce apoptosis
  • Oleic acid causes apoptosis and dephosphorylates Bad gene

AIIMS Nov 2014 MCQs Key discussion

@ Karyotype picture based MCQ of cri du chat with chromosome 5 deletion

a)   Angelman Syndrome

b)   Fragile X

c)   Bloom Syndrome

d)   Cri Du Chat Syndrome

Criduchat (cat’s cry) syndrome, also known as 5p- (5p minus) syndrome

AIIMS Nov 2014 MCQs Key discussion

@ False regarding GIST-  AIIMS Nov 2014 MCQs

a)  Originate from Cajal cells

b)  Most common mesenchymal tumour of gastrointestinal tract

c)  Prognosis depends on size

d)    ALK mutation is associated.

Ans D

  • Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract
  • GISTs are thought to arise from interstitial cells of Cajal (ICC) that are normally part of the autonomic nervous system of the intestine. They serve a pacemaker function in controlling motility.
  • The purpose of radiologic imaging is to locate the lesion, evaluate for signs of invasion and detect metastasis. Features of GIST vary depending on tumor size and organ of origin. The diameter can range from a few millimeters to more than 30 cm. Larger tumors usually cause symptoms in contrast to those found incidentally which tend to be smaller and have better prognosis. Large tumors tend to exhibit malignant behavior but small GISTs may also demonstrate clinically aggressive behavior
  • Anaplastic lymphoma kinase (ALK) also known as ALK tyrosine kinase receptor or CD246 (cluster of differentiation 246) is an enzyme that in humans is encoded by the ALK gene.
  • The 2;5 chromosomal translocation is associated with approximately 60% anaplastic large-cell lymphomas (ALCLs). The translocation creates a fusion gene consisting of the ALK (anaplastic lymphoma kinase) gene and the nucleophosmin (NPM) gene: the 3′ half of ALK, derived from chromosome 2 and coding for the catalytic domain, is fused to the 5′ portion of NPM from chromosome 5.
  • The EML4-ALK fusion gene is responsible for approximately 3-5% of non-small-cell lung cancer(NSCLC).
  • Xalkori (crizotinib), produced by Pfizer, was approved by the FDA for treatment of late stage lung cancer




@ cancers are usually associated with all except : (AIIMS NOV 2014))

a)   hypomethylation of Oncogenes

b)   methylation of tumour suppressor gene

c)   Loss of heteozygosity

d)   Mutation in introns

Ans D

Global hypomethylation has also been implicated in the development and progression of cancer through different mechanisms.[18] Typically, there is hypermethylation of tumor suppressor genes and hypomethylation of oncogenes

The loss of heterozygosity is a common occurrence in cancer, where it indicates the absence of a functional tumor suppressor gene in the lost region. However, many people remain healthy with such a loss, because there still is one functional gene left on the other chromosome of the chromosome pair. However, the remaining copy of the tumor suppressor gene can be inactivated by a point mutation, leaving no tumor suppressor gene to protect the body. Loss of heterozygosity does not imply a reversal to the homozygous state.


@ 65 year old with gray white mass in central bronchus, diagnosis?

(a) contain all 3 germ layers

(b) increased calcium

(c) small cell carcinoma

(d) elongated spindle arrangement

Ans D

It is squamous cell carcinoma of bronchus gross appearance .



@ Schwannoma on microscopy shows

a)  Antony A and Antony B area

b)  Storiform pattern

Ans A

Classic microscopic appearances of a schwannoma, which is benign. Note the more cellular “Antoni A” pattern on the left with palisading nuclei surrounding pink areas (Verocay bodies). On the right is the “Antoni B” pattern with a looser stroma, fewer cells, and myxoid change

A storiform pattern is an important structural feature of fibrous histiocytoma (FH)


@Asbestos exposure patient, solid lesion in upper part of lung . histopathology of mass shows

a)  Microvilli in cells

b)  Desmosomes

Ans A

The detection of long microvilli, is an ultrastructural feature unique for malignant epithelial mesothelioma


@Patient has been given penicillin 48 hrs ago, with no history of drug allergy. Now he develops wheeze and hemolysis. Antibody for penicillin is positive.

Type of hypersensitivity ?

a) Type 1 hypersensitivity

b) Type 2 hypersensitivity

c) Type3 hypersensitivity

d) Type 4 hypersensitivity

Ans B

  • An example of type II hypersensitivity is the reaction to penicillin wherein the drug can bind to red blood cells, causing them to be recognized as different; B cell proliferation will take place and antibodies to the drug are produced. IgG and IgM antibodies bind to these antigens to form complexes that activate the classical pathway of complement activation to eliminate cells presenting foreign antigens (which are usually, but not in this case, pathogens). That is, mediators of acute inflammation are generated at the site and membrane attack complexes cause cell lysis and death. The reaction takes hours to a day.
  • Type II reactions can affect healthy cells. Examples include Red blood cells in Haemolytic Anaemia, Acetylcholine receptors in Myasthenia Gravis, and TSH receptors in Grave’s Disease.
  • Another example of type II hypersensitivity reaction is Goodpasture’s syndrome where the basement membrane(containing collagen type IV) in the lung and kidney is attacked by one’s own antibodies.[2]
  • Another form of type II hypersensitivity is called antibody-dependent cell-mediated cytotoxicity (ADCC). Here, cells exhibiting the foreign antigen are tagged with antibodies (IgG or IgM). These tagged cells are then recognised by natural killer cells (NK) and macrophages (recognised via IgG bound (via the Fc region) to the effector cell surface receptor, CD16 (FcγRIII)), which in turn kill these tagged cells.


# Ophthalmology

@ congenital cataract gene?



C. PAX 6


Ans A

The PITX3 gene is seen in posterior polar congenital cataract i


@ method to assess vision in Intravitreal iron foreign body in eye (Siderosis bulbi)

a)  visually evoked potentials

b)  electrooculogram

c)  electroretinogram

Ans C

Siderosis bulbi: ERG can detect and prognosticate siderotic changes in eyes with retained iron intraocular foreign body (IOFB). ERG may be normal or show a negative ERG . pattern in early phase of siderosis bulbi. Removal of IOFB may lead to improvement in ERG changes and a stable outcome in such cases. In advanced siderosis, media is hazy and ‘rust coloured’ with undetectable ERG .Removal of IOFB will not stop progressive visual loss and sometimes phthisis bulbi. The upper waveform shows a blink artefact.


@Laser trabeculoplasty is indicated in?

a)  Chronic angle closure glaucoma

b)  uveitic glaucoma

c)  pseudoexfoliation glaucoma

d)  neovascular glaucoma

Ans C

  • Pseudoexfoliation syndrome is a systemic disorder in which a fibrillar, proteinaceous substance is produced in abnormally high concentrations within ocular tissues. It is the most common cause of secondary glaucoma worldwide, and the most frequent cause of unilateral glaucoma
  • Pseudoexfoliation glaucoma responds poorly to medical therapy compared with other types of glaucoma and can lead to rapid progression of optic nerve damage.
  • Traditional IOP-lowering medications are less effective in pseudoexfoliation glaucoma than in POAG, but they are used frequently as first-line therapy. These medications include beta blockers, selective alpha2-receptor agonists, topical and systemic carbonic anhydrase inhibitors, prostaglandin agonists and sympathomimetics. The next line of therapy is argon or selective laser trabeculoplasty (ALT or SLT). Most studies have shown good responses to ALT and SLT. Of note, once laser trabeculoplasty starts to wear off, patients with pseudoexfoliation glaucoma tend to demonstrate a more rapid IOP increase than POAG patients. If medications and laser treatment do not control IOP adequately, a guarded filtration procedure may be performed.


@What is the value of Light peak to dark trough ratio in EOG in Normal eye?

(a) More than 185%

(b) Less than 185%

(c) Less than 1.5

(d) Less than 1

Ans A

The EOG was described and named by Elwin Marg in 1951. Clinical applications were described first by Geoffrey Arden in 1962, who realized that the most valuable information was the comparison of the amplitudes under light and dark-adapted states (the Arden ratio).

The Arden ratio, the ratio of the Light peak (Lp) to dark trough (Dt) is used to determine the normalcy of the results.

An Arden ratio of 1.80 or greater is normal, 1.65 to 1.80 is subnormal, and < 1.65 is significantly subnormal.


# Pharmacology

@ which of the following is used for clostridium difficile associated pseudo membranous colitis

a)  linezolid

b)  macrolide

c)  oral vancomycin

d)  diloxate

Ans C

@ Cephalosporin with anti MRSA action

a)  ceftriaxone

b)  Ceftobiprole

Ans B

ü  The mnemonic “LAME” is used to note organisms against which cephalosporins do not have activity: Listeria, Atypicals (including Mycoplasma and Chlamydia), MRSA, and enterococci.


ü  Fifth-generation cephalosporins are effective against MRSA

ü  Ceftobiprole has been described as “fifth-generation” cephalosporin, though acceptance for this terminology is not universal. Ceftobiprole has powerful antipseudomonal characteristics and appears to be less susceptible to development of resistance. Ceftaroline has also been described as “fifth-generation” cephalosporin, but does not have the antipseudomonal or VRE coverage of ceftobiprole

üCeftobiprole medocaril is the first member of a new series of advanced cephalosporins with activity against methicillin-resistant Staphylococcus aureus (MRSA)


@Time dependent with prolonged post antibiotic effect-

a)  clindamycin

b)  erythromycin

c)  beta lactam

Ans A

It has been suggested that an alteration of DNA function is possibly responsible for post antibiotic effect following the observation that most inhibitors of protein and nucleic acid synthesis (aminoglycosides, fluoroquinolones, tetracyclines, clindamycin, certain newer macrolides/ketolides, and rifampicin and rifabutin) induce long-term PAE against susceptible bacteria.

The post antibiotic effect (PAE) is defined as persistent suppression of bacterial growth after a brief exposure (1 or 2 hours) of bacteria to an antibiotic even in the absence of host defense mechanisms.[3] Factors that affect the duration of the post antibiotic effect include duration of antibiotic exposure, bacterial species, culture medium and class of antibiotic. [4][3] Theoretically, the ability of an antibiotic to induce a PAE is an attractive property of an antibiotic since antibiotic concentrations could fall below the MIC for the bacterium yet retain their effectiveness in their ability to suppress the growth. Therefore, An antibiotic with PAE ,require less frequent administration and it can improve patient adherence through pharmacotherapy[

@Oral dxoc for Vancomycin-resistant Staphylococcus aureus

a)  Linezolid

b)  Clindamycin

Ans A

Trimethoprim/sulfamethoxazole[citation needed] was shown to have efficacy in treating the first known US case of VRSA. Linezolid, quinupristin/dalfopristin and daptomycin are treatments of consideration

@ Which of the following is incorrect about PACLITAXEL

a)  derived from e.coli

b)  Bone marrow sparing

c)  alopecia

d)   Used in breast and lung cancers

Ans B

  • E coli was used to produce 1g of taxadiene, a precursor of Taxol
  • Taxol (paclitaxel) is used to treat breast cancer, lung cancer, and ovarian cancer.
  • Irreversible and severe alopecia occur following docetaxel or paclitaxel cytotoxic therapy for breast cancer
  • Paclitaxel causes myelosuppesion,

@ Not associated with long term use of Proton pump inhibitors (ppi) ?


b)community acquired pneumonia


d)clostridium difficle enterocolitis

Ans A

  • Gastric acid suppression, using H2-receptor antagonists and PPIs, is associated with an increased risk of community-acquired pneumonia.[34] Acid suppression may result in insufficient elimination of pathogenic organisms. Therefore, patients at higher risk of pneumonia are suggested to be prescribed proton pump inhibitors only at lower doses and only when necessary.
  • On 8 February 2012, the US-FDA issued a safety announcement on PPIs, based on the review report from the Adverse Event Reporting System. This review report suggested an increased risk of Clostridium difficile-associated diarrhea with PPI use.[37] The safety announcement reported that PPIs have been shown to raise risk of Clostridium difficile infection by 1.7 times with once-daily use and 2.4 times with more-than-once-daily use
  • here is recent epidemiological evidence of an increased risk of fracture with longterm use of PPIs


@ All the following are used for treatment of chronic Hepatitis B except

A) Entecavir

B) Telbivudine

C) Zidovudine

D) Lamivudine

Ans c


@ Fatal dose of lithium  AIIMS Nov 2014 MCQs

a)  8 g

b)  6 g

c)  4 g

d)    2 g

Ans B

about 20 tablets of a lithium salt, or about 6 g should be the fatal dose.

@ false about NSAIDs  AIIMS Nov 2014 MCQs

a)  used in neuropathic pain

b)  decreases efficacy of hypertensives

c)  cause renal failure

d)    can be used topically

Ans A

  • NSAIDs reduce renal blood flow and thereby decrease the efficacy of diuretics, and inhibit the elimination of lithium and methotrexate.[45]
  • NSAIDs cause hypocoagulability, which may be serious when combined with other drugs that also decrease blood clotting, such as warfarin.[45]
  • NSAIDs may aggravate hypertension (high blood pressure) and thereby antagonize the effect of antihypertensives, such as ACE Inhibitors.[46]
  • NSAIDs may interfere and reduce efficiency of SSRI antidepressants

Globally, topical preparations are available for diclofenac, eltenac, felbinac, ibuprofen, ketoprofen, and piroxicam.

Nociceptive and neuropathic pain are caused by different neuro-physiological processes, and therefore tend to respond to different treatment modalities. Nociceptive pain is mediated by receptors on A-delta and C-fibers which are located in skin, bone, connective tissue, muscle and viscera. These receptors serve a biologically useful role at localizing noxious chemical, thermal and mechanical stimuli. Nociceptive pain can be somatic or visceral in nature. Somatic pain tends to be well localized, constant pain that is described as sharp, aching, throbbing, or gnawing. Visceral pain, on the other hand, tends to be vague in distribution, paroxysmal in nature and is usually described as deep, aching, squeezing and colicky in nature. Examples of nociceptive pain include: post-operative pain, pain associated with trauma, and the chronic pain of arthritis. Nociceptive pain usually responds to opioids and non-steroidal anti-inflammatories (NSAIDS).

Neuropathic pain, in contrast to nociceptive pain, is described as “burning”, “electric”, “tingling”, and “shooting” in nature. It can be continuous or paroxysmal in presentation. Whereas nociceptive pain is caused by the stimulation of peripheral of A-delta and C-polymodal pain receptors, by algogenic substances (eg. histamine bradykinin, substance P, etc.) neuropathic pain is produced by damage to, or pathological changes in the peripheral or central nervous systems. Examples of pathological changes include prolonged peripheral or central neuronal sensitization, central sensitization related damage to nervous system inhibitory functions, and abnormal interactions between the somatic and sympathetic nervous systems.

AIIMS Nov 2014 MCQs Key discussion

@ False regarding Rituximab

a) chimeric anti CD-20

b)used for indolent lymphomas

c)most common adverse effects are infusion related

d)half life is dose related

Ans C

Some studetns recalled the following options

  • myelosuppression and alopecia (True)
  • dose independent pharmacokinetics (False

Halif life – 30 to 400 hours (varies by dose and length of treatment)

  • Rituximab is a chimeric monoclonal antibody against the protein CD20, which is primarily found on the surface of immune system B cells.
  • Rituximab destroys B cells and is therefore used to treat diseases which are characterized by excessive numbers of B cells, overactive B cells, or dysfunctional B cells. This includes many lymphomas, leukemias, transplant rejection, and autoimmune disorders.
  • b. Rituximab results in a 40% to 50% response rate in patients who relapse with indolent B-cell lymphomas
  • A serious but rare side effect of rituximab is potential for a severe infusion reaction, typically with the first infusion (during infusion or within 30-120 minutes of infusion).
  • Fever and chills (see flu like symptoms) are side effects seen more coomonly

@ Advanced prostatic Carcinoma..drug approved is




Ans A

@ Dexmedetomedine is

a)    Centrally acting alpha 2 agonist

b)   centrally acting alpha 2 antagonist

c)     peripherally acting alpha 2 agonist

d)  peripherally acting alpha 2 antagonist

Ans a

Dexmedetomidine is a sedative medication used by intensive care units and anesthesiologists. It is relatively unusual in its ability to provide sedation without causing respiratory depression. Like clonidine, it is an agonist of α2-adrenergic receptors in certain parts of the brain


@ Abatacept is used in?

(a) systemic sclerosis

(b) osteoarthritis

(c) rheumatoid arthritis

Ans c

Abatacept (marketed as Orencia) is a fusion protein composed of the Fc region of the immunoglobulin IgG1 fused to the extracellular domain of CTLA-4. In order for a T cell to be activated and produce an immune response, an antigen presenting cell must present two signals to the T cell. One of those signals is the major histocompatibility complex (MHC), combined with the antigen, and the other signal is the CD80 or CD86 molecule (also known as B7-1 and B7-2). Abatacept binds to the CD80 and CD86 molecule, and prevents the second signal. Without the second signal, the T cell can’t be activated. Abatacept was developed by Bristol-Myers Squibb and is licensed in the United States for the treatment of rheumatoid arthritisin the case of inadequate response to anti-TNFα therapy.


@ Treatment of choice for Pseudomonas

a)  Ceftriaxone

b)  Piperacillin + tazobactam

c)   Second generation cephalosporin

Ans B


@ All of the following are tertiary amines except?

(a) atropine

(b) Glycopyrrolate

(c) scopolamine

(d) Hyoscine

Ans b

Antimuscarinic drugs

Quaternary amines

  • Anisotropine
    • Clidinium
    • Glycopyrrolate
    • Isopropamide
    • Mepenzolate
    • Methantheline
    • Methscopolamine • Oxyphenonium
    • Propantheline
    • Tridihexethyl
    • Trospium

Tertiary amines

  • Atropine
    • Darifenacin
    • Dicyclomine
    • Oxybutynin
    • Oxyphencyclimine • Propiverine
    • Scopolamine
    • Solifenacin
    • Tolterodine


@Drug not causing edema

a. digoxin

b. amlodipine

c. estrogens

d. cyclosporine

Ans A

  • Drug induced edema

o  Nonsteroidal anti-inflammatory drugs

o  Antihypertensive agents

  • Direct arterial/arteriolar vasodilators
  • Calcium channel antagonists
  • a-Adrenergic antagonists

o  Steroid hormones

  • Glucocorticoids
  • Anabolic steroids
  • Estrogens
  • Progestines

o  Cyclosporine

o  Growth hormone

o  Immunotherapies

  • Interleukin 2
  • OKT3 monoclonal antibody


# Anatomy

@Facial colliculus lies deep to

a)  Abducens nerve

b)  Facial nerve

c)  Trigeminal

Ans a

The facial colliculus is an elevated area located on the dorsal pons in the floor of the 4th ventricle. It is formed by fibers from the motor nucleus of the facial nerve as they loop over the abducens nucleus. Thus a lesion to the facial colliculus would result in ipsilateral facial paralysis and ipsilateral unopposed eye medial deviation.


@ All of the following are true about external sphincter urethrae, except ?

(a) voluntary

(b) Supplied by pudendal nerve

(c).originates at ischiopubic ramus


Ans d


The external urethral sphincter originates at the ischiopubic ramus and inserts into the intermeshing muscle fibers from the other side. It is controlled by the deep perineal branch of the pudendal nerve. Activity in the nerve fibers constricts the urethra.

The internal sphincter muscle of urethra: located at the bladder’s inferior end and the urethra’s proximal end at the junction of the urethra with the urinary bladder. The internal sphincter is a continuation of the detrusor muscle and is made of smooth muscle, therefore it is under involuntary or autonomic control. This is the primary muscle for prohibiting the release of urine.

The external sphincter muscle of urethra (sphincter urethrae): located at the bladder’s distal inferior end in females and inferior to the prostate (at the level of the membranous urethra) in males is a secondary sphincter to control the flow of urine through the urethra. Unlike the internal sphincter muscle, the external sphincter is made of skeletal muscle, therefore it is under voluntary control of the somatic nervous system.



@ Dense regular connective tissues are all except

a)   Tendon

b)   Ligament

c)   Aponeurosis

d)   Periosteum

Ans d


Dense regular connective tissue provides connection between different tissues in the human body. The collagen fibers in dense regular connective tissue are bundled in a parallel fashion. In this kind of tissue, elastic and reticular fibers are completely absent


  • An example of their use is in tendons, which connect muscle to bone and derive their strength from the regular, longitudinal arrangement of bundles of collagen fibers.
  • Ligaments bind bone to bone and are similar in structure to tendons.
  • Aponeurosis is also formed from DRC


@ Membrana tectoria is part of

a)  posterior longitudinal ligament

b)   anterior longitudinal ligament

Ans B

The Membrana Tectoria (occipitoaxial ligaments) is situated within the vertebral canal.

  • It is a broad, strong band which covers the dens and its ligaments, and appears to be a prolongation upward of the posterior longitudinal ligament of the vertebral column.


  • It is fixed, below, to the posterior surface of the body of the axis, and, expanding as it ascends, is attached to the basilar groove of the occipital bone, in front of the foramen magnum, where it blends with the cranial dura mater.


  • Its anterior surface is in relation with the transverse ligament of the atlas, and its posterior surface with the dura mater.



@ a picture depicting foramen ovale . which of the following does not pass through foramen ovale ? AIIMS Nov 2014 MCQs

a.lesser petrosal nerve

b.maxillary nerve

c.sensory root of mandibular nerve

d.motor root of trigeminal nerve

Ans B

Several nerves, arteries and veins pass through the foramen ovale. They are as follows:

  • Mandibular nerve, the third branch of the trigeminal nerve
  • Lesser petrosal nerve, a branch of the glossopharyngeal nerve.
  • Accessory meningeal artery (small meningeal or parvidural branch, sometimes derived from the middle meningeal artery)
  • Emissary veins (from the cavernous sinus to the pterygoid plexus)

The otic ganglion is situated directly under the foramen, but is also transmitted through the foramen ovale.

The ophthalmic nerve and maxillary nerve travel lateral to the cavernous sinus exiting the cranium via the superior orbital fissure and foramen rotundum

AIIMS Nov 2014 MCQs Key discussion


@Turkish saddle is associated with

a)  Hippocampus

b)  Pituitary gland

c)  Thalamus

Ans B

The sella turcica (Turkish Chair) is a saddle-shaped depression in the body of the sphenoid bone of the human skull and of the skulls of other Hominidae including chimpanzees, orangutans, and gorillas. It serves as a cephalometric landmark.


@ Panniculus adiposus is seen in





Ans A

Reference Last Anatomy

The panniculus adiposus is the fatty layer of the subcutaneous tissues, superficial to a deeper vestigial layer of muscle, the panniculus carnosus.[1]


It includes structures that are considered fascia by some sources but not by others.


An example is the Fascia of Camper.


Another example is the superficial cervical fascia





# Forensic

@ hara kiri wound is self inflicted injury to?

a)    neck and chest

b)    neck and wrist

c)    abdomen

Ans C

Seppuku (切腹?, “stomach-cutting”, “abdomen-cutting“) is a form of Japanese ritual suicide by disembowelment. Seppuku was originally reserved only for samurai.[1] Part of the samurai bushido honour code, seppuku was either used voluntarily by samurai to die with honour rather than fall into the hands of their enemies (and likely suffer torture), or as a form of capital punishment for samurai who had committed serious offenses, or performed because they had brought shame to themselves

Seppuku is also known as harakiri

@ Most common form of parasuicide


b)wrist cutting

c)drug consumption


Ans B

Parasuicide (, para-, “near” or “resembling” and suicide) is a suicide attempt or gesture and self-harm where there is no result in death. It is a non-fatal act in which a person deliberately causes injury to him or herself or ingests any prescribed or generally recognised therapeutic dose in excess.

Wrist cutting is mostly practiced as a method of self harm rather than suicide


@ iliac crest fuses in female at what age

a)  17-18 years

b)  18-19 years

c)  19-21 years

d)  21-23 years

Ans B


@ If a patient consumes homicidal poison. , doctor must mandatorily inform police about the medico legal case under which section

a)   Section CrPc 39

b)   Section CrPc 37

c)   Section CrPc 174

d)   Section CrPc 176

Ans A

  • Under Section 39 CrPC, some specific sections of IPC have been mentioned where the public is bound to give information to the police.
  • the doctor is duty bound to provide information about these enlisted offences (in Sec 39 CrPC) to the police

@ Fatal dose of arsenic  AIIMS Nov 2014 MCQs

a.20-30 mg

b.50-60 mg

c.70-200 mg

d. 10 -20 mg

Ans C

The acute minimal lethal dose of arsenic in adults is estimated to be 70 to 200 mg

AIIMS Nov 2014 MCQs Key discussion


# Radiology

@Young lady presented with with bone pain, clavicle fracture, subperiosteal resorption on radial aspect of 2nd 3rd phalnges, diagnosis is

A. Hyperparathyroidism

B. Renal osteodystrophy

C. Hyperthyroidism

Ans A

@Which of the following is the Investigation of choice for evaluation of acute head injury?

A) NCCT Head

B) CECT Head

C) MRI Brain

D) CT angiography

Ans A

Computed tomography (CT) remains the imaging study of choice in the investigation of the head injured patients



# Microbiology

@70yr old women refused to take influenza vaccine,developed flu.Death happened 1 week after pneumonia.cause of post influenza pneumonia

a)  staphylococcus

b)  streptococcus pnuemoniae

c)  Legionella

d)  cmv

Ans b

the most publicized study of bacterial coinfection in H1N1 found that, by a combination of PCR and immunohistochemistry, a coinfecting organism could be identified in 22/74 fatal cases24. The distribution of organisms was comparable to that ob- served in prior influenza superinfections: S. pneumoniae (45%), S. pyogenes (27%), S. aureus (32%), Streptococcus mitis (9%), H. influenza (5%), and multiple organ- isms (18%).


@ MHC1 and MHC 2 the major function is

a) Production of interleukins .

b) Present the Antigen to T cells

c) Present the processed Antigen to T cells for humoral immunity.

Ans B

Repeat from AIIMS Nov 2013

Class I MHC molecules bind peptides generated mainly from degradation of cytosolic proteins by the proteasome. The MHC I:peptide complex is then inserted into the plasma membrane of the cell. The peptide is bound to the extracellular part of the class I MHC molecule. Thus, the function of the class I MHC is to display intracellular proteins to cytotoxic T cells (CTLs). However, class I MHC can also present peptides generated from exogenous proteins, in a process known as cross-presentation.

A normal cell will display peptides from normal cellular protein turnover on its class I MHC, and CTLs will not be activated in response to them due to central and peripheral tolerance mechanisms. When a cell expresses foreign proteins, such as after viral infection, a fraction of the class I MHC will display these peptides on the cell surface. Consequently, CTLs specific for the MHC:peptide complex will recognize and kill the presenting cell.

Alternatively, class I MHC itself can serve as an inhibitory ligand for natural killer cells (NKs). Reduction in the normal levels of surface class I MHC, a mechanism employed by some viruses during immune evasion or in certain tumors, will activate NK cell killing.

@ Which is the following is not caused by Untypeable Hemophilus Influenzae?

A) Otitis media

B) Meningitis

C) Sinusits

D) Puerperal sepsis

Ans b

Unntypeable Haemophilus influenzae is a common cause of community-acquired respiratory tract infections in adults and may cause acute sinusitis and/or acute otitis media.

The possibility of infection with H. influenzae and the emergence of beta-lactamase producing strains warrant adequate culture procedures in women with obstetrical and gynecological infections in order to ensure proper treatment


# Physiology

@ Raised ICT, hypertension bradycardia, respiratory changes is called


A. Cushing’s reflex

b. Bainbridge’s reflex

c. Bezold zarisch refleX

d. Herring bruer reflex

Ans A

@ Sleep spindles and K complexes are seen in which stage of sleep

a)  NREM stage 1

b)  NREM stage 2

c)  NREM stage 3

d)  REM

Ans B

sleep is divided into two broad types: rapid eye movement (REM sleep) and non-rapid eye movement (NREM or non-REM sleep).

A sleep spindle is a burst of oscillatory brain activity visible on an EEG that occurs during stage 2 sleep. It consists of 12–14 Hz waves that occur for at least 0.5 seconds.Sleep spindles are generated in the reticular nucleus of the thalamus.

NREM stage 1: This is a stage between sleep and wakefulness. The muscles are active, and the eyes roll slowly, opening and closing moderately.

NREM stage 2: In this stage, theta activity is observed and sleepers become gradually harder to awaken; the alpha waves of the previous stage are interrupted by abrupt activity called sleep spindles and K-complexes.[10]

NREM stage 3: Formerly divided into stages 3 and 4, this stage is called slow-wave sleep (SWS). SWS is initiated in the preoptic area and consists of delta activity, high amplitude waves at less than 3.5 Hz. The sleeper is less responsive to the environment; many environmental stimuli no longer produce any reactions.

REM: The sleeper now enters rapid eye movement (REM) where most muscles are paralyzed. REM sleep is turned on by acetylcholine secretion and is inhibited by neurons that secrete serotonin. This level is also referred to as paradoxical sleep because the sleeper, although exhibiting EEG waves similar to a waking state, is harder to arouse than at any other sleep stage. Vital signs indicate arousal and oxygen consumption by the brain is higher than when the sleeper is awake.[11] An adult reaches REM approximately every 90 minutes, with the latter half of sleep being more dominated by this stage. REM sleep occurs as a person returns to stage 1 from a deep sleep.[8] The function of REM sleep is uncertain but a lack of it impairs the ability to learn complex tasks. One approach to understanding the role of sleep is to study the deprivation of it.[12] During this period, the EEG pattern returns to high-frequency waves that look similar to the waves produced while the person is awake

@Single ion channel current measurement is done with?

(a) inotophoresis

(b) Patch clamp

Ans B


@ all the following contribute to counter

current mechanism except

a. vasarecta

b.thick limb of loop of henle

c. thin limb of loop of henle

d.collecting duct

Ans D

As the thin descending limb makes its way into the medulla the surrounding tissue becomes ever increasingly hypertonic and therefore the osmotic gradient increases the deeper the limb goes. As the limb is permeable to water it leaves the tubule via osmosis. The tube then bends back on itself and heads back up the cortex. The thin ascending limb is entered. Here salt enters the tubule passively due to the hypertonicity of the medulla creating a gradient. This results in a very high salt concentration at the bottom of the loop. The fluid moves on and enters the thick ascending limb. This has salt transporters and so salt is pumped into the medulla via active transport causing more water to leave the thin descending limb. The vasa recta has a similar countercurrent uptake system and only removes what is absorbed maintaining the medulla in a hypertonic state.

This is a challenging concept which is hard to explain. It is explained below in a different way:

  • “Descending limb is permeable to water but not solutes”
  • “The thick ascending loop is not permeable to water but solutes are pumped out”
  • “Therefore, osmolarity of peritubular space is elevated, which draws water out of the descending limb”
  • “Therefore, solute concentration of the fluid in the ascending limb is higher… causing more pumping”

“Therefore, osmolarity of peritubular space is elevated, which draws more water out of descending limb


@ Deep patellar tendon reflex is due to

a)   involves golgi tendon organ

b)   both muscle spindle and golgi tendon organ

c)  dynamic intrafusal fibre

d)   static globe chain intrafusal fibres and golgi tendon organ

Ans C

o   There are two kinds of muscle fibers: intrafusal muscle fibers and extrafusal muscle fibers.

o   Extrafusil fibers are the ones that contain myofibrils and are what is usually meant when we talk about muscle fibers.

o   Intrafusal fibers are also called muscle spindles and lie parallel to the extrafusal fibers.

o   Muscle spindles, or stretch receptors, are the primary proprioceptors in the muscle.

o   Another proprioceptor that comes into play during stretching is located in the tendon near the end of the muscle fiber and is called the golgi tendon organ.

o   A third type of proprioceptor, called a pacinian corpuscle, is located close to the golgi tendon organ and is responsible for detecting changes in movement and pressure within the body.

o  When the extrafusal fibers of a muscle lengthen, so do the intrafusal fibers (muscle spindles).

o  The muscle spindle contains two different types of fibers (or stretch receptors) which are sensitive to the change in muscle length and the rate of change in muscle length. When muscles contract it places tension on the tendons where the golgi tendon organ is located. The golgi tendon organ is sensitive to the change in tension and the rate of change of the tension

  • The stretch reflex has both a dynamic component and a static component.
  • The static component of the stretch reflex persists as long as the muscle is being stretched. The dynamic component of the stretch reflex (which can be very powerful) lasts for only a moment and is in response to the initial sudden increase in muscle length.
  • The reason that the stretch reflex has two components is because there are actually two kinds of intrafusal muscle fibers: nuclear chain fibers, which are responsible for the static component; and nuclear bag fibers, which are responsible for the dynamic component.
  • Nuclear chain fibers are long and thin, and lengthen steadily when stretched. When these fibers are stretched, the stretch reflex nerves increase their firing rates (signaling) as their length steadily increases. This is the static component of the stretch reflex.

o   Nuclear bag fibers bulge out at the middle, where they are the most elastic. The stretch-sensing nerve ending for these fibers is wrapped around this middle area, which lengthens rapidly when the fiber is stretched. The outer-middle areas, in contrast, act like they are filled with viscous fluid; they resist fast stretching, then gradually extend under prolonged tension. So, when a fast stretch is demanded of these fibers, the middle takes most of the stretch at first; then, as the outer-middle parts extend, the middle can shorten somewhat. So the nerve that senses stretching in these fibers fires rapidly with the onset of a fast stretch, then slows as the middle section of the fiber is allowed to shorten again. This is the dynamic component of the stretch reflex: a strong signal to contract at the onset of a rapid increase in muscle length, followed by slightly “higher than normal” signaling which gradually decreases as the rate of change of the muscle length decreases.


@Nerve endings sensitive to noxious substance are present in??

a)  Intestine

b)  Spleen

c)  Liver

d)   Mesentry


Ans D



@Posterior column carries all the following except

a)  Pain

b)  Touch

c)  Proprioception

d)   Vibration

Ans A


@ Stimulation of hippocampal formation causes

a)  long term depression

b)  long term potentiation

c)  post tetanic potentiation

d)   long term synaptic plasticity

Ans B

Long-term potentiation (LTP) in the hippocampal formation is an example model for neural plasticity.[7] Schaffer collateral synapses have been used as a sample synapse, a typical excitatory glutamatergic synapse in the cortex that has very well been studied in order to try to identify the rules of both the patterns of stimulation in electrical rules and the chemical mechanisms by which synapses get persistently stronger and which synapses get persistently weaker as well. LTPs are involved in how people store information and how they retrieve information and involve networks of memories that are involved in facts and in emotions as well because the hippocampus is the part of the limbic system connected to the amygdala.



# spm

@Infant Mortality rate does not include

a)  Still birth

b)  Early neonatal birth

c)  Post neonatal birth

d)  Late neonatal birth

Ans A

Infant mortality rate (IMR) is the number of deaths of children less than one year of age per 1000 live births. The rate for a given region is the number of children dying under one year of age, divided by the number of live births during the year, multiplied by 1,000.[2]


Forms of infant mortality:

  • Neonatal mortality is newborn death occurring within 28 days postpartum. Neonatal death is often attributed to inadequate access to basic medical care, during pregnancy and after delivery. This accounts for 40–60% of infant mortality in developing countries.[3]
  • Postneonatal mortality is the death of children aged 29 days to one year. The major contributors to postneonatal death are malnutrition, infectious disease, and problems with the home environment.
  • Perinatal mortality is late fetal death (22 weeks gestation to birth), or death of a newborn up to one week postpartum

A stillbirth occurs when a fetus dies in the uterus. A wide variety of definitions exist.[1] Once the fetus has died, the mother may or may not have contractions and undergo childbirth. The term is often used in distinction to live birth or miscarriage and the word miscarriage is often used incorrectly to describe stillbirths. Most stillbirths occur in full-term pregnancies

@ If each 10th one is picked , such a sampling is

a)    Simple random sampling

b)   systematic random sampling

c)  stratified sampling

Ans B

Systematic sampling is a modification of random sampling. To arrive at a systematic sample we simply calculate the desired sampling fraction, e.g. if there are 100 distributors of a particular product in which we are interested and our budget allows us to sample say 20 of them then we divide 100 by 20 and get the sampling fraction 5. Thereafter we go through our sampling frame selecting every 5th distributor. In the purest sense this does not give rise to a true random sample since some systematic arrangement is used in listing and not every distributor has a chance of being selected once the sampling fraction is calculated.


@ true statement regarding ESI act is

a)State government share 1/8 and esi corporation 7/8

b)Funeral charges put up to 30000 are given

c) a employ with 70 rs daily wage should contribute 3000 per month

d)Employee contributes 8.5 percent and govt 4.75 percent


(Repeated stock AIIMS MCQ)

At present the 7/8th share of the prescribed ceiling (i.e. Rs. 1500/- per IP per annum) is being borne by the ESI Corporation and 1/8 th share borne by the State Govt. as per the prescribed ratio fixed by the ESIC HQ New Delhi.


@ measure of variablity between 2 different scales

a)  standard deviation

b)  co-efficient of variation

c)  Standard error

d)  Variance

Ans B

The coefficient of variation

In some cases, it may be most relevant to describe the relative variation within a sample or population. Put another way, knowing the sample SD is really not very informative unless we also know the sample mean. Thus, a sample with a SD = 50 and mean = 100 shows considerably more relative variation than a sample with SD = 100 but mean = 10,000.

Coefficient of variance = Standard deviation /mean

Thus, low CVs indicate relatively little variation within the sample, and higher CVs indicate more variation. In addition, because units will cancel out in this equation, CV is a unitless expression. This is actually advantageous when comparing relative variation between parameters that are described using different scales or distinct types of measurements. Note, however, that in situations where the mean value is zero (or very close to zero), the CV could approach infinity and will not provide useful information. A similar warning applies in cases when data can be negative. The CV is most useful and meaningful only for positively valued data. A variation on the CV is its use as applied to a statistic (rather than to individual variation)


@ Smoking causes Coronary Heart disease .Then low exercise and high exercise are

(a)  Bias

(b)  Confounding

(c)   effect modifier

(d)  collinear factor

Ans C

Bias: A systematic error in the design, recruitment, data collection or analysis that results in a mistaken estimation of the true effect of the exposure and the outcome.

Confounding: A situation in which the effect or association between an exposure and outcome is distorted by the presence of another variable. Positive confounding (when the observed association is biased away from the null) and negative confounding (when the observed association is biased toward the null) both occur.

Effect modification : a variable that differentially (positively and negatively) modifies the observed effect of a risk factor on disease status. Different groups have different risk estimates when effect modification is present

If  the method used to select subjects or collect data results in an incorrect association – think BIAS

If an observed association is not correct because a different (lurking) variable is associated with both the potential risk factor and the outcome, but it is not a causal factor itself – THINK >> Confounding!

  • If an effect is real  but the magnitude of the effect is different for different groups of individuals (e.g., males vs females or blacks vs whites).

THINK >> Effect modification!


@regarding dengue all are true except

a. causative agent belongs to flaviviridae group

b. lamivudine is drug of choice

c.malnutrition is protective

d.aedes aegypti acts as vector

Ans B

Four dengue viruses (types 1-4) within the genus flavivirus and family flaviviridae, are the causative agents. All four subtypes are found in India.

Reservoir of infection is both man and mosquito. The transmission cycle is “Man-Mosquito-Man”. Aedes aegypti is the principal vector, the other less important vectors being Aedes albopictus, Aedes polynesiensis, and several species of Aedes scutellaris complex

Factors affecting prognosis of dengue fever5.

1. Presence of enhancing and non-neutralising antibodies increases the severity.

2. Age: Susceptibility of DHF/DSS drops considerably after 12 years of age.

3. Sex: Females are more often affected than males.

4. Race : Caucasians are more often affected then blacks.

5. Nutritional status : Malnutrition is protective.

6. Sequence of infection: Serotype 1 followed by serotype

2 seems to be more dangerous than serotype 4

followed by serotype 2.

7. Infecting serotype: Type 2 is apparently more

dangerous than the other serotypes

@urban area larvicidal measure …clean sewage/cover ditch/



# Microbiology

@ True about viral antibodies

a)    Formed before interferons

b)   Formed against nuclear sequences

Ans B




# Medicine

@ All are true about elevated lactate in traumatic brain injury , except

a)    uptake of lactate from circulation

b)   increased lactate is associated with bad prognosis

Ans A


Lactate is proposed to be generated by astrocytes during glutamatergic neurotransmission and shuttled to neurons as ‘preferred’ oxidative fuel.

Elevated lactate as an early marker of brain injury in inflicted traumatic brain injury

Patients with elevated cerebral lactate are more likely to die or have serious long-term disability

Results show that lactate release from human brain to blood predominates over its uptake after TBI


@ A nephrotic syndrome patient after diarrhea presented with acute kidney injury with creatinine 4.5. All are possible reasons except

a)    Renal vein thrombosis

b)   Water depletion due to diarrhea

c)    Water depletion due to frusemide

d)   Steroid induced diabetes

Ans D

acute kidney injury (AKI) due to diarrhea-induced acute tubular necrosis (ATN) in a patient with nephrotic syndrome secondary to biopsy-proven collapsing focal and segmental glomerulosclerosis (FSGS). The clinical picture mimicked rapidly progressive glomerulonephritis (RPGN) and motivated pulse therapy with methylprednisolone and cyclophosphamide


# Pharmacology

@ Cholinomimetics are not used in

a)  bradycardia

b)  glaucoma

c)   Myasthenia gravis

Ans A


# Psychiatry

@ alcohol withdrawal patient can be given all except-

a)    disulfiram

b)    acamprosate

c)    naltrexone,

d)    phenytoin

Ans d

Some students recalled it as , patient dependent on alcohol

Several studies have demonstrated that phenytoin is ineffective in the treatment of alcohol withdrawal seizures and the drug should not be used for this purpose

# Dermatology

@ Which of the following not a type of lichen planus?

a)    Lichen scrofulosorum

Ans A

Lichen scrofulosorum (also known as “Tuberculosis cutis lichenoides”) is a rare tuberculid that presents as a lichenoid eruption of minute papules in children and adolescents with tuberculosis. The lesions are usually asymptomatic, closely grouped, skin-colored to reddish-brown papules, often perifollicular and are mainly found on the abdomen, chest, back, and proximal parts of the limbs. The eruption is usually associated with a strongly positive tuberculin reaction

@ recurrent penile ulcers with hyper pigmentation in a young male are due to

b)  Fixed drug eruption

# Radiology

@ Investigation of choice for acute appencitis in a child

a)  Ultrasound

Ultrasound with its lack of ionizing radiation should be the investigation of choice in young patients,


@Investigation of choice for bronchiectasis

a)    HRCT

@ investigation of choice for glass foreign body in finger –

a)  X ray

b)  MRI

c)  Ultrasound

d)  CT Scan

Ans C

  • Foreign bodies (FBs) re- tained in the soft tissues are a common reason for medical consultation, and usually consist of wooden or metal splinters or glass shards
  • As traditional radiograms are widely available, simple to perform and inexpensive, X-ray is the reference examina- tion [2] and will identify radiopaque FBs (glass, metal, stone) in around 80% of cases, but only displays 15% of non-radiopaque FBs (wood, plastic) [4, 14]. Radioscopy offers a more accurate topographic assessment and allows reference points to be marked on the skin to aid subsequent FB removal. However, radioscopy exposes patient and operator alike to relatively high doses of ionizing radiation. Computed tomography (CT) and magnetic resonance (MR) scans are very expensive and have very limited indications for FB detection as they have poor sensitivity and specificity
  • Ultrasound is the first choice investigation in the diagnosis of an FB retained in the soft tissues, as it has a sensitivity and specificity of 90% and 96%, respectively

# Opthalmology

@Corneal edema in hypoxic condition due to

a)  CO 2

b)  lactic acid

c)  glycogen

d)   pyruvate

Ans B

Two explanations have been proposed for contact lens-induced stromal thinning. It is thought that contact lens-induced edema may inhibit stroma tissue synthesis.[2] Alternatively, contact lens-induced hypoxia may trigger a lactic acid buildup that leads to the erosion of stromal tissue.[2] The mechanism behind contact lens-induced polymegethism is unknown, though it is also thought to be a byproduct of corneal edema and epithelial hypoxia

@Patient with spectacles complains of distortion of image equal in both meridian . true about this condition include all except

a)  Occur due to spherical lenses

b)  Also known as Anisokenia

c)  Also known as pin cushion defect

d)  Occur due to cyclindrical lenses


If astigmatism is the only defect then a cylindrical lens can be used. If other defects are present as well, then the lens may be given one spherical and one cylindrical surface.

Pincushion distortion

In pincushion distortion, image magnification increases with the distance from the optical axis. The visible effect is that lines that do not go through the centre of the image are bowed inwards, towards the centre of the image, like a pincushion.

@ Category B drug in pregnancy

a)  pilocarpine

b)  brimonidine

c)  latanoprost

d)    dorzolamide

Ans B

Brimonidine ophthalmic has been assigned to pregnancy category B by the FDA. The manufacturer recommends that brimonidine ophthalmic should only be given during pregnancy when the benefit outweighs the risk.

@patient with intraocular pressure of 60 presenting with painless diminution of vision. Diagnosis is

a)  chronic papilledema

b)  glaucomatocyclitic crisis

c)  acute angle closure glaucoma

d)  Neovascular glaucoma

Ans D



Glaucomatocyclitic crises or Posner-Schlossman’s syndrome usually presents with recurrent attacks of visual blur, halos, cells in the aqueous, and an elevated intraocular pressure. This can often be distinguished by the presence of a few keratic precipitates, which never occur in primary angle-closure glaucoma itself, and by an open angle

  • Most commonly, a crisis presents with slight discomfort. The patient may be pain-free even though the IOP is quite elevated.
  • The patient may report blurred vision or halo vision if the IOP is high and induces corneal edema.

A history of past attacks of blurred vision lasting several days, which recurs monthly or yearly, is usual.


Neovascular (hemorrhagic) glaucoma

Neovascular (hemorrhagic) glaucoma often presents as a painful congested eye with high intraocular pressure, corneal edema and cells, and flare in the anterior chamber. There may be an associated history of diabetes mellitus or retinal vascular occlusion with sudden painless loss of vision months before inflammation of the eye occurred. On examination, this entity is distinguished by rubeosis, a fine network of abnormal arborizing vessels on the iris surface, which extends over the angle structures. One need see only a few arborizing vessels on the meshwork to make this diagnosis. Broad peripheral anterior synechiae are often associated with a mat-like membrane with blood vessels, which gradually progresses and contracts to close the entire angle, sometimes obscuring the extensive network of new vessels that initiated angle closure.

@ a new generation intraocular pressure (IOP) measuring instrument is nowadays used for self-tonometry

a)  applanation tonometre

b)  perkin’s tonometre

c)  goldman’s tonometre

d)  Diaton transpalpebral tonometer

transpalpebral tonometer, a new generation intraocular pressure (IOP) measuring instrument is nowadays used for self-tonometry. It is convenient and noninvasive and seems suitable for IOP measurement at home, as recommended by several authors. Apart from its use for self-tonometry, it has been reported that transpalpebral tonometer is more accurate in determining the IOP in thinned cornea after photorefractive procedures when compared with Goldmann applanation tonometer (GAT)

Goldmann applanation tonometry (GAT) is the golden standard. IOP may show marked variations over the course of the day and from day to day. While GAT is available only in hospitals and doctors’ offices, with occasional measurements these relevant variations may be missed.

Rebound tonometry

Rebound tonometers determine intraocular pressure by bouncing a small plastic tipped metal probe against the cornea. The device uses an induction coil to magnetise the probe and fire it against the cornea. As the probe bounces against the cornea and back into the device, it creates an induction current from which the intraocular pressure is calculated. The device is simple and easy to use and self-use versions are available. It is portable, does not require the use of eye drops and is particularly suitable for children and non-cooperative patients


@ fungal keratomycosis alternative Rx:

a)  linezolid

b)  tetracycline

c)  silver sulfadiazine

d)  vancomycin

Ans C

A presumptive diagnosis of fungal keratitis requires immediate empirical therapy. Natamycin ophthalmic suspension is the drug of choice for filamentous fungal infection. Fluconazole ophthalmic solution is recommended for Candida infection of the cornea. Amphotericin B eye drops may be required for non-responding cases, but can be quite toxic and requires expert pharmacist for preparatio




@Which of the following is not true about Expected date of delivery

a)  Less than 5% deliveries on EDD

b)  50% within a week

c)  90%.within 2 weeks

d)  Standard deviation is 3 weeks

Ans C

Only 4% of babies are actually born on their “due dates”.  6-10% of babies are born early – prior to 37 weeks; 4-14% of pregnancies last more then 42 weeks.

Large studies have shown that there is a standard deviation of 13 days from the due date, meaning that 90% of women will give birth within 3 weeks of the due date in either direction, not only earlier than but later as well.


@ Universal cesarean section is recommended at GEATATIONAL AGE of ——– weeks

a)  37

b)  38

c)  39

d)  40

Ans b

Cesarean delivery either scheduled at 38-39 weeks gestation or in labor if they presented sooner.


@Which of the following life style modification is not associated with improving fertility

A. Weight gain

B. Less exercise

C. Vegetarian diet

D Weight loss

Ans c


Overweight patients who undergo significant weight loss may ovulate without the need for fertility medication

if is suggested which of the following is least useful in increasing fertility


# Pyschiatry

@ treatment of choice in Posttraumatic stress disorder

a)  cognitive behaviour therapy

b)  Eye movement desensitization and processing

c)  ECT

d)  Hypnosis

Ans B

Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy developed by Francine Shapiro that emphasizes disturbing memories as the cause of psychopathology[1][2] and alleviates the symptoms of post-traumatic stress disorder (PTSD). EMDR is used for individuals who have experienced severe trauma that remains unresolved.[3] According to Shapiro, when a traumatic or distressing experience occurs, it may overwhelm normal cognitive and neurological coping mechanisms. The memory and associated stimuli are inadequately processed and stored in an isolated memory network.[1] The goal of EMDR therapy is to process these distressing memories, reducing their lingering effects and allowing clients to develop more adaptive coping mechanisms. This is done in an eight-phase approach that includes having clients recall distressing images while receiving one of several types of bilateral sensory input, including side to side eye movements

@a person with schizophrenia taking haloperidol on 3rd day unable to look down and rolling up his eyes . cause is

a)  acute dystonia

b)  hysterical

c)  malingering,

d)  seizure

Ans a

# Anesthesia

@ Spontaneous breathing anaesthesia circuit of choice in adult

a)  Mapleson A

b)  Mapleson B

c)  Mapleson D

d)  Mapleson E

Ans A

  • For adults, Mapleson A is the circuit of choice for spontaneous respiration where as Mapleson D and its Bains modifications are best available circuits for controlled ventilation.
  • For neonates and paediatric patients Mapleson E and F (Jackson Rees modification) are the best circuits

In Mapleson A system, fresh gas enters the circuit near the reservoir bag away from the patient end A corrugated tubing connects the reservoir bag near the machine end to the adjustable pressure limiting valve at the patient end of the system. Length of tubing is 110 cm. APL valve is near the patient end for the exhaust of gases during expiration. Reservoir bag is used for monitoring respiration as well as ventilating the patient. It also acts as reservoir of gas and protects the patient from excessive pressure within the breathing system.




  1. Comment: sir the salbutamol question option was VQ mismatch and not bronchomalacia.. that should be the ans na? as ventilation improved but not perforation. pls provide explanation.

    also the cause of apoptosis, is a direct repeat from last exam and ans was given glucocort. by all guides/coachings earlier.. pls confirm

  2. Induction of apoptosis in lymphocytes, which may account for the therapeutic effects of glucocorticoids in various diseases including leukaemia,
    Hence answer is Glucocorticoids for apoptosis MCQ

  3. Thank you so much sir. That will be very very helpful. I will definitely attend the PGI discussion sir. The AIIMS discussion was very helpful and definitely help me prepare for the MAY 2015 AIIMS. Thank you so much!

  4. Thank you sir for uploading the HIGH YIELD TOPICS. There is a problem in the physiology topics sir. Surgery topics have come under the physiology topic. Kindly note sir.

    • We will correct . Thanks for the feed back doctor. Also we are uploading free download of 5000 pages High yield topic notes pdf of all 19 Subjects. Please check the download section.

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