APPG 2015 Key explanations discussion

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Q.1 A mother in a village has brought her 1 month baby with a complaint of fever to the PHC. You find that the baby’s respiratory rate is 69 /minute. The baby is irritable but able to feed; the baby does not have chest indrawing or stridor. There is no history of convulsions. According to the RCH program, the baby’s illness is classified as

   1)  Very severe disease

  2)  Pneumonia

  3)  No pneumonia: Cough or cold

  4)  Severe Pneumonia

Ans D

No convulsions and able to feed – Hence it is not Very severe pneumonia does not have chest indrawing – Hence it is not Severe Pnuemonia There is fast breathing – Hence it is notNo pneumonia: Cough or cold Hence Answer should be B

Very fast breathing (60 to 70 breaths or more in 1 minute)

Q.2 A 70 year old diabetic and hypertensive patient was being investigated for angina and a coronary angiogram was performed. Two days later, he developed fever and abdominal discomfort and dyspnea and a mottled skin rash. His great toe appeared black. His BP increased to 180/100. His creatinine was found to have risen from a preangio level of 1.2 to 3.6mg/dl. He has eosinophilia. Which one of the following statements is TRUE regarding this condition.

   1)  N-acetylcysteine would have prevented this condition

  2)  Heparin is the treatment of choice

  3)  This is contrast induced nephropathy

  4)  Kidney biopsy will show microvessel occlusion with a cleft in the vessel

Ans D

 Atherosclerotic renovascular disease (ARVD) is increasingly recognised as an important cause of both chronic and end stage renal failure. These patients tend to do badly on dialysis, which reflects their systemic atherosclerotic burden. In an effort to delay and perhaps prevent their need for renal replacement therapy, some patients are subjected to a variety of medical, radiological and surgical interventions, although evidence for each is sparse. Postgrad Med J 2001;77:68-74 doi:10.1136/pmj.77.904.68

  •               PLAQUE INSTABILITY

Recent data reports increased cardiovascular morbidity and mortality in patients with irregular as opposed to smooth carotid plaques.50 The increased risk, which must reflect a systemic predisposition to unstable atherosclerotic plaques, did not correlate with conventional risk factors and this suggests additional as yet unrecognised factor(s) for plaque progression. Similarly, the very high incidence of recurrent disease after coronary angioplasty in haemodialysis patients suggests that plaques behave differently in uraemia.51Unstable atherosclerotic plaques may embolise cholesterol crystals and other debris that lodge in the dependent circulation, even down to the capillary level. In the kidney, cholesterol embolisation can lead to progressive microvascular obliteration, chronic inflammation and worsening renal failure, with the diagnosis clinched by the characteristic appearance of intravascular cholesterol clefts on renal biopsy

(A) Characteristic histological appearance on light microscopy of a cholesterol cleft in a small artery with evidence of intimal thickening, concentric hypertrophy, and interstitial inflammation. Embolised cholesterol crystals dissolve during the fixation process. (B) Electron micrograph demonstrating a cholesterol cleft in an afferent glomerular arteriole. The destination vessel depends on crystal size and this variability may determine the clinical presentation.

 Q.3. Schwartzman reaction is an example of

   1)  Type III hypersensitivity reaction

  2)  Type I hypersensitivity reaction

  3)  Type II hypersensitivity reaction

  4)  None of the options

 Ans D

 Shwartzman reaction is not a hypersensitivity reaction.

Shwartzman phenomenon, also known as Shwartzman reaction, is a rare reaction of a body to particular types of toxins, called endotoxins, which cause thrombosis in the affected tissue. A clearing of the thrombosis results in a reticuloendothelial blockade, which prevents re-clearing of the thrombosis caused by a repeat introduction of the toxin. That will cause tissue necrosis. Shwartzman phenomenon is usually observed during delivery or abortion, when foreign bodies are introduced into the tissues of the female reproductive system.

The Shwartzman phenomenon is named for Gregory Shwartzman, the doctor at Mount Sinai Hospital in New York City who was the first to develop the concept of immune system hypersensitivity in the 1920s. This reaction was experimented using Neisseria meningitidis endotoxin.

 This is notably seen with Neisseria meningitidis

 Q.4 The following are True regarding Pompholyx EXCEPT

   1)  They are painful but not pruritic

   2)  Topical corticosteroids are usually helpful

   3)  50% of patients have a history of atopy

   4)  Pruritic “tapioca” vesicles on palms and sides of fingers

Ans A

 What is pompholyx?

 Pompholyx is a common type of eczema affecting the hands (cheiropompholyx), and sometimes the feet (pedopompholyx).

 Pompholyx is also known as dyshidrotic eczema or dyshidrosis.

 What causes pompholyx and who gets it?

 Pompholyx may be related to sweating. It most often affects young adults.

 There is a personal or family history of atopic eczema in 50%

  • Flares often occur during hot weather or following emotional upset
  • An association with nickel contact allergy has been reported
  • It can follow tinea fungal infection (when it is known as a dermatophytid)

What are the clinical features of pompholyx?

 Pompholyx presents as recurrent crops of deep-seated blisters on the palms and soles. They cause intense itch and/or a burning sensation. The blisters peel off and the skin then appears red, dry and has painful fissures (cracks).

  • Severe pompholyx around the nail folds may cause nail dystrophy, resulting in irregular ridges and chronic paronychia (nail fold swelling)

Potent topical steroids should be applied to the affected areas nightly under occlusion (eg covered with food wrap). They help reduce inflammation and itching. The more potent products should not be used for more than two weeks. Steroid creams are used when the skin is blistered or weeping. Steroid ointments are used for the chronic dry stage.

 Q.5 Currently most used endometrial ablation method is

   1)  Thermal ballon ablation

   2)  Laser ablation

   3)  Trans cervical resection

   4)  Roller ball coagulation

 Ans A

Endometrial ablation may be considered in premenopausal women for the treatment of menorrhagia. Significant uterine pathology and medical conditions that can cause menorrha- gia should be excluded before performing the ablative proce- dures. Ablative therapy may also be considered when medical treatments fail, are contraindicated, or are poorly tolerated.

Overall, the techniques for global destruction of the endome- trium can be divided into two groups: hysteroscopic proce- dures and nonhysteroscopic procedures. Hysteroscopic techniques include endometrial ablation with either laser , radiofrequency or electrical energy , and endome- trial resection using an electrosurgical wire-loop electrode . The newer nonhysteroscopic procedures employ devices that deliver energy in a global and uniform manner to ablate the endometrium.

The first effective hysteroscopic endometrial ablation was performed using photovaporization with a neodymium-yit- trium, aluminum, garnet laser (5). Less expensive techniques using an electrosurgical rollerball instrument or an un- modified resectoscopewere described subsequently. The latter technique, often referred to as transcervical resec- tion of the endometrium, typically is followed by ablation using the rollerball electrode.

 

Radiofrequency thermal balloon The radiofrequency thermal balloon device consists of an expandable silastic balloon with 12 electrodes mounted on the surface . The device is inserted inside its protective sheath and 10 mL to 15 mL of air are instilled to expand the balloon and bring the electrodes into contact with the endometrial surface. Using radiofre- quency energy, the electrodes achieve and maintain a surface temperature of 700C–750C during a 4-minute treatment ses- sion. The slightly lower temperatures achieved in the cornual regions avoid extrauterine injury. As of January, 2006, the radiofrequency balloon device was not approved by the FDA for use in the United States.

Hydrothermal ablation Hydrothermal ablation (HydroTher- mAblatorâ; Boston Scientific, Natick, MA) is a technique that involves the insertion of a single-use, polycarbonate- sheathed 3-mm hysteroscope into the endometrial cavity and the instillation and circulation of heated physiologic saline. Temperature, inflow, and outflow are regulated by a microprocessor. The saline is heated to and maintained at 900C for 10 minutes resulting in endomyometrial necro- sis to a depth of 2 mm to 4 mm Saline is infused at a pres- sure <45 mm Hg, resulting in an intrauterine net pressure between 50 mm and 55 mm Hg that prevents flow through the fallopian tubes. The Hydro Thermal Ablation device has been approved by the FDA for use in the United States

 

Q.6 Buprenorphine belongs to

   1)  Full agonist at ‘mu’ receptors

   2)  Full agonist at ‘k’ receptors

   3)  Partial agonist at ‘k’ receptors

   4)  Partial agonist at ‘mu’ receptors

 Ans D

 Buprenorphine can essentially be thought of as a non-selective, mixed agonist–antagonist opioid receptor modulator, acting as a partial agonist of the MOR, an antagonist/very weak partial agonist of the KOR, an antagonist of the DOR, and a relatively low-affinity, weak partial agonist of the ORL-1

Q.7. This picture depicts photos of 4 patients being asked to open the mouth as much as possible and stick the tongue out without phonating. Which of the following statements is TRUE regarding these pictures?

   1)  They depict varying degrees of hypoglossal nerve paralysis

   2)  They depict Mallampati Classification

   3)  They depict different stages of tonsillitis and quinsy

   4)  They are used in Forensic Medicine for identification purpose

Ans B

Q.8 The following are True regarding Rotator cuff tendinitis EXCEPT

   1)  Acromial beak of bone appears with age

   2)  Injection of local anesthetic helps in diagnosis

   3)  Steroid injections are contraindicated

   4)  Painful arc of movement causes secondary weakness

Ans C

 Presence of a bony spur on the inferior surface of the acromion.

 Rotator cuff tendinitis

  • Subacromial corticosteroid and local anesthetic agent injection also appears to be more effective than an injection of a local anesthetic alone, although some authors disagree. Corticosteroid injection also appears to be significantly more effective than NSAIDs. Therefore, subacromial corticosteroid injection appears indicated when pain persists after simple analgesic and NSAIDs have been used.
  • As the disease progresses, shoulder pain becomes more constant. Overhead and arm-length activities typically increase the pain. Discomfort and night pain also can be present. With time, the individual can notice some weakness during shoulder elevation. Crepitus also can be noted. With the evolution of the disease, shoulder pain can be accompanied by cervical and mid back pain.

Q.9. The following statements are True regarding the picture depicted above EXCEPT –

   1)  Baby has an umbilical hernia

   2)  This is a case of right psoas abscess

   3)  Baby has a large right inguinal hernia

   4)  Surgery is indicated for the groin swelling

Ans b

Q.10. A 40 year old multiparous lady presented with menorrhagia of 6 months duration. On examination, she is found to have a bulky uterus and an 8x8cm. adnexal mass on the right side. She underwent total abdominal hysterectomy with bilateral salpingo- oopherectomy. Histopathological examination of the adnexal mass showed Call Exner bodies. What is the type of ovarian tumor?

  1)  Endodermal sinus tumor

   2)  Clear cell tumor

   3)  Dysgerminoma

   4)  Granulosa cell tumor

Ans D

 Call–Exner bodies are small eosinophilic fluid-filled spaces between granulosa cells.  The granulosa cells are usually arranged haphazardly around the space.

  • They are usually associated with Granulosa cell tumors.
  • They are composed of membrane-packaged secretion of granulosa cells and have relations to the formation of liquor folliculi which are seen among closely arranged granulosa cells. . Ref onlinembbs

 Call–Exner bodies marked with black circles in an intermediate-high magnification micrograph of a granulosa cell tumour , a type of sex cord stromal tumour. H&E stain.

Q.11 Whipple’s Triad is diagnostic of

   1)  Glucagonoma

   2)  Somatostatinoma

   3) Gastrinoma

   4)  Insulinoma

Ans D

Whipple’s triad is a collection of three criteria (called Whipple’s criteria) that suggest a patient’s symptoms result from hypoglycemia which may indicate insulinoma. The triad is stated in various versions, but the essential conditions are:

  • Symptoms known or likely to be caused by hypoglycemia especially after fasting or heavy exercise
  • A low plasma glucose measured at the time of the symptoms
  • Relief of symptoms when the glucose is raised to normal

Q.12. Which one of the following statements is True regarding the diagrams depicted above?

  1)  the left picture (red) is a compound bar diagram

   2)  the right picture (green) is best used for continuous quantitative data

   3)  a frequency polygon can be drawn from the picture on the left (red)

   4)  the left picture (red) is best used for qualitative data

 Ans C

 The left picture (red) is a HISTOGRAM

A histogram is a graphical representation of the distribution of data. It is an estimate of the probability distribution of a continuous variable (quantitative variable) and was first introduced by Karl Pearson.

 The right picture (green) is BAR DIAGRAM

A bar chart or bar graph is a chart with rectangular bars with lengths proportional to the values that they represent. The bars can be plotted vertically or horizontally. A vertical bar chart is sometimes called a column bar chart.

 A bar graph is a chart that uses either horizontal or vertical bars to show comparisons among categories. One axis of the chart shows the specific categories being compared, and the other axis represents a discrete value. Some bar graphs present bars clustered in groups of more than one (grouped bar graphs), and others show the bars divided into subparts to show cumulative effect (stacked bar graphs).

  • Bar graphs charts provide a visual presentation of categorical data.[1] Categorical data is a grouping of data into discrete groups, such as months of the year, age group, shoe sizes, and animals. These categories are usually qualitative. In a column bar chart, the categories appear along the horizontal axis; the height of the bar corresponds to the value of each category.
  • A bar graph contains a bar for each category of a set of qualitative data.

Q.13. Ottawa ankle rules are used to

   1)  Decide on immediate vs. delayed treatment of ankle disclocation

   2)  To diagnose rupture of Achilles tendon

   3)  To decide on treatment option for CTEV

   4)  Decide on need of x-rays for possible fracture

Ans D

 Ottawa ankle rules are a set of guidelines for clinicians to help decide if a patient with foot or ankle pain should be offered X-rays to diagnose a possible bone fracture. Before the introduction of the rules most patients with ankle injuries would have been imaged. However the vast majority of patients with unclear ankle injuries do not have bony fractures.As a result many unnecessary X-rays were taken, which was costly, time consuming and a slight health risk due to radiation exposure.

The Ottawa ankle rules

Ankle X-ray is only required if there is any pain in the malleolar zone and any one of the following:

  • Bone tenderness along the distal 6 cm of the posterior edge of the tibia or tip of the medial malleolus, OR
  • Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus, OR
  • An inability to bear weight both immediately and in the emergency department for four steps.

Additionally, the Ottawa foot rules indicate whether a foot X-ray series is required. It states that it is indicated if there is any pain in the midfoot zone and any one of the following:

  • Bone tenderness at the base of the fifth metatarsal (for foot injuries), OR
  • Bone tenderness at the navicular bone (for foot injuries), OR
  • An inability to bear weight both immediately and in the emergency department for four steps.

Certain groups are excluded, in particular pregnant women, and those with diminished ability to follow the test (for example due to head injury or intoxication). Several studies strongly support the use of the Ottawa Ankle Rules in children over 6 (98.5% sensitivity);[2] however, their usefulness in younger children has not yet been thoroughly examine

Q.14. Which one of the following is the likely diagnosis based on the smear given above?

   1)  Acute lymphoblastic leukemia

   2)  Chronic lymphocytic leukemia

   3)  Acute myelogenous leukemia

   4)  Hairy cell leukemia

  Ans C

 [ACUTE MYELOGENOUS LEUKEMIA, M2]. Myeloblasts may contain long needle-like structures called “Auer rods” that represent abnormal condensation of azurophilic

Q.15 What is the category and color of the drug box for sputum smear positive cases who are ‘treated after default’ under the RNTCP?

   1)  Category 1, Red

   2)  Category 2, Blue

   3)  Category 2, Yellow

   4)  Category 1, Green

 Ans B

Q.16 A 6 month infant presented with recurrent episodes of polyuria and dehydration. Lab. tests revealed serum Na of 130 meq/li., K of 3 meq/li Cl of 92 meq/li., bicarbonate of 30 meq/li. pH was 7.48. Ser creat was 0.4 mg/dl. The patient had hypercalciuria and ultrasound showed medullary nephrocalcinosis. Which one of the following is the most likely diagnosis?

   1)  Bartter syndrome

   2)  Distal renal tubular acidosis

   3)  Liddle syndrome

   4)  Gitelman syndrome

 Ans A

  In 90% of cases, neonatal Bartter syndrome is seen between 24 and 30 weeks of gestation with excess amniotic fluid (polyhydramnios). After birth, the infant is seen to urinate and drink excessively (polyuria, and polydipsia, respectively). Life-threatening dehydration may result if the infant does not receive adequate fluids. About 85% of infants dispose of excess amounts of calcium in the urine (hypercalciuria) and kidneys (nephrocalcinosis), which may lead to kidney stones. In rare occasions, the infant may progress to renal failure.

People suffering from Bartter syndrome present symptoms that are identical to those of patients who are on loop diuretics like furosemide.

  • The clinical findings characteristic of Bartter syndrome are hypokalemia, metabolic alkalosis, and normal to low blood pressure. These findings may also be caused by:

 Chronic vomiting: These patients will have low urine chloride levels (Bartter’s will have relatively higher urine chloride levels).

  • Abuse of diuretic medications (water pills): The physician must screen urine for multiple diuretics before diagnosis is made.
  • Magnesium deficiency and Calcium deficiency: These patients will also have low serum and urine magnesium and calcium
  • Patients with Bartter syndrome may also have elevated renin and aldosterone levels.

Prenatal Bartter syndrome can be associated with polyhydramnios

Q.17. Identify this mosquito?

   1)  Aedes

   2)  Culex

   3)  Mansonoides

   4)  Anopheles

 Ans D

 Comparison between different types of mosquito: Anopheles (on the left) and Aedes and Culex (on the right)

 Q.18. IgG immunoflorescence deposits at dermo-epidermal junction as band like floresence is seen in both involved and uninvolved skin of patients with one of the following diseases

   1)  Discoid lupus erythematosis

   2)  Mixed connective tissue disease

   3)  SLE

   4)  Scleroderma

 Ans C

 Here is another immunofluorescence staining pattern with antibody to IgG showing evidence for immune complexes at the dermal-epidermal junction. If such a pattern is seen only in skin involved by a rash, then the pattern is more characteristic for DLE, but if this pattern appears even in skin uninvolved by a rash,then SLE may underlie this phenomenon

Q.19. Which one of the following is the most likely diagnosis from the picture depicted above?

   1)  Syphilitic gumma

   2)  Dentigenous ulcer

   3)  Aphthous ulcer

   4)  Leukoplakia

 Ans A

 Syphilitic Gumma

A 45-year-old woman presented to an outreach clinic in rural Uganda with a 1-year history of a progressively enlarging ulcerated mass on the hard palate (Panel A). The mass had initially been painless but more recently had become painful and was causing difficulty in speaking and swallowing. She had received a diagnosis of cancer and was attempting to sell her home to pay for surgical resection. She had no history of syphilitic symptoms or treatment. The results on Treponema pallidum hemagglutination assay were positive for syphilis; nontreponemal testing was not locally available. Serologic analysis for human immunodeficiency virus was negative. Tertiary syphilis with an oral gumma was diagnosed. The patient was treated with three intramuscular injections of 2.4 million units of penicillin G benzathine at 1-week intervals. At follow-up 2 months after the end of treatment, there was resolution of the mass and symptoms (Panel B). In the oral cavity, gummas may occur as masses on the hard palate or tongue that frequently ulcerate.

Q.20 Owl’s eye appearance inclusions are seen in

   1)  Herpes simplex virus infections

   2)  Epstein-Barr virus infection

   3)  Adenovirus infection

   4)  ytomegalovirus infections

Ans D

 Cytomegalovirus (CMV) is a member of the herpes virus family. Complete CMV particles contain double-stranded DNA enclosed in an icosahedral capsid and surrounded by an envelope. CMV infects epithelial cells and lymphocytes. It moves into the nucleus where it can produce intranuclear inclusion.

CMV infections in humans are frequently asymptomatic and many people carry it (up to 80% of adults have antibodies against it). However, a wide spectrum of diseases can occur in the fetus, newborn and immunocompromised individuals; the most serious of which is congential CMV disease.

One method of detecting CMV is direct examination of biopsy specimens using a Hematoxylin-Eosin stain. Infected specimens may contain characteristic large cells with basophilic intranuclear inclusions. The typical nuclear inclusion has the appearance of an “owl’s eye” because it can be surrounded by a clear halo that extends to the nuclear membrane. Even when this characteristic appearance is seen, virologic or serologic confirmation is recommended for diagnosis. CMV infection can occur without the typical cytomegalic cells.

 Q.21 Following regimens are used in endometriosis to suppress ovulation & relieve pain, EXCEPT

   1)  Subcutaneous DMPA (depot medroxyprogesterone acetate)

   2)  Cyclical low dose oral contraceptive pills

   3)  Anastrozole / letrozole is recomended for routine use

   4)  Nafarelin nasal spray

Ans C

 Recently, a few gynaecologists have begun prescribing aromatase inhibitors for women with endometriosis, who have not had success with other treatments or who cannot use other treatments because of their side effects.

Q.22 Causes of Diffues Hyperpigmentation include the following EXCEPT

   1)  Nelson’s syndrome

   2)  Addison’s disease

   3)  Busulfan adminstration

   4)  Hermansky-Pudlak syndrome

 Ans D

 Hermansky–Pudlak syndrome (HPS) is a rare autosomal recessive[1] disorder which results in oculocutaneous albinism (decreased pigmentation), bleeding problems due to a platelet abnormality (platelet storage pool defect), and storage of an abnormal fat-protein compound (lysosomal accumulation of ceroid lipofuscin).

Q.23

  1)  pqr = yxw

   2)  pqr = xwy

   3)  pqr = wyx

   4)  pqr = wxy

Ans B

  • Bartholin duct cyst – Marsupialisation
  • Conisation = CIN
  • Cerclage  – Cervical incompetence

Q.24. Which one of the following vaccines is contraindicated in children with egg allergy?

  1)  BCG

   2)  DPT

   3)  MMR

   4)  Yellow Fever

 Ans d

For which vaccines is an egg allergy a contraindication?

1) Yellow fever is contraindicated for people who have a history of a severe (anaphylactic) allergy to eggs.

2) People who have experienced a serious systemic or anaphylactic reaction (e.g., hives, swelling of the lips or tongue, acute respiratory distress, or collapse) after eating eggs should consult a specialist for appropriate evaluation to help determine if influenza vaccine should be administered. A previous severe allergic reaction to influenza vaccine, regardless of the component suspected to be responsible for the reaction, is a contraindication to future receipt of the vaccine.

Q.25 The following are main diagnostic criteria for Allergic Bronchopulmonary Aspergillosis EXCEPT –

   1)  Bronchial asthma

   2)  Pulmonary infiltrates

   3)  Distal bronchiectasis

   4)  Peripheral eosinophilia

Ans C

 Allergic bronchopulmonary aspergillosis

ABPA is defined by abnormalities including the following:

  • Asthma
  • Eosinophilia
  • A positive skin test result for Aspergillus fumigatus
  • Serum IgE level > 1000 IU/dL
  • Positive test results for Aspergillus precipitins (primarily IgG but also IgA and IgM)
  • Minor criteria for diagnosis include positive Aspergillus radioallergosorbent assay test results and sputum culture

Chest radiography results in ABPA may vary from fleeting pulmonary infiltrates to mucoid impaction to central bronchiectasis. Computed tomography (CT) is helpful for better defining bronchiectasis, and images may demonstrate that apparent lobulated masses are mucus-filled dilated bronchi. Areas of atelectasis related to bronchial obstruction from mucoid impaction may be present

Q.26 A 40 year old lady came with menorrhagia since 1 year. Ultrasound showed a single intramural fibroid of 8×6 cms. in the anterior wall. She is very certain she does not want to undergo hysterectomy. The following are treatment options for her EXCEPT

   1)  High intensity focussed ultrasound

   2)  Uterine artery embolisation

   3)  Non hormonal intrauterine device

   4)  Myometcomy

Ans C

  it is important to remember that not all women with fibroids who have heavy bleeding are bleeding because of the fibroids. A small intramural fibroid or large pedunculated fibroid (one that is hanging off the uterus) are not likely causing heavy bleeding. One option for managing heavy bleeding in women with or without fibroids is the Mirena intrauterine system. This progesterone releasing IUD is a highly effective method of birth control and is the most commonly used reversible method worldwide. It is placed in the uterus during an office visit and immediately begins releasing a low and steady dose of progesterone into the lining of the uterus. The IUD acts in a number of ways to prevent pregnancy. It also thins the lining of the uterus, an effect that eventually leads to lighter periods. In fact, after a few months, many women with stop menstruating.

Q.27 Regarding prostatectomy which one of the statements is FALSE

   1)  Retrograde ejaculation occurs in about 65% of men

   2)  Intraurethral stents are helpful in the management of men who are grossly unfit (ASA grade 4)

   3)  Perineal prostatectomy (Young) is a commonly done surgical procedure

   4)  Water intoxication and hyponatremia can give rise to CHF

Ans C

 Radical perineal prostatectomy (RPP) was described in 1905 by Young . It was the first method used to remove the prostate as part of cancer therapy.

In 1947, Millin first described radical retropubic prostatectomy (RRP).[2] He suggested the procedure as an alternative to RPP, on the grounds that patients often had pelvic lymph node metastases at diagnosis. As expertise in performing RRP improved, the importance of pelvic lymph node dissection (PLND) for staging became evident. Over time, RRP became the most common method of radical prostatectomy.

Today, many men diagnosed with prostate cancer have early-stage disease for which PLND is not mandatory. Consequently, interest in RPP has seen a resurgence. Compared with RRP, RPP can offer reductions in blood loss, operating time, duration of hospitalization, and duration of convalescence

Advantages of RPP over RRP include the following:

  • A small, hidden incision for better cosmesis
  • Avoidance of major muscle groups
  • Less pain and patient convalescence
  • Faster return to work and strenuous activities
  • Fewer adverse cardiovascular effects because fluid shifts are reduced
  • Less blood loss
  • Shorter operating time and duration of hospitalization
  • Excellent posterior exposure to limit positive margins posteriorly, laterally, and apically
  • Precise watertight anastomosis performed under direct vision
  • Easier for patients who are obese
  • Avoidance of scar tissue from previous abdominal surgery
  • Better visualization of the prostatic apex – The improved visualization of the apex facilitates avoidance of positive apical margins, sparing of neurovascular bundles, and visualization of the membranous urethra

Q.28. Which one of the following techniques of tubectomy is depicted in the diagramm above?

   1)  Kroener technique

   2)  Pomeroy technique

   3)  Uchida technique

   4)  Irving technique

Ans B

 Pomeroy technique. A. A loop of the proximal portion of the tubal ampulla is elevated to reveal the vascular supply of the mesosalpinx. B. A strand of absorbable suture material is used to bilaterally ligate the tube and simultaneously provide hemostasis. C. A hemostat is placed on the suture strands immediately distal to the knot to prevent the tube from retracting into the abdomen. The open blade of the Metzenbaum scissors is used to pierce the mesosalpinx and approximately 1 cm of the tube is excised. D. The end result following dissolution of the absorbable suture material is return of the proximal and distal portions of the tube to their normal anatomic position.

Q.29. Which of the following is True regarding Carcinoma Endometrium?

1) most common in the 3rd & 4th decade of life

2) Papanicolaou smear is a very sensitive test for diagnosis

3) transvaginal sonography showing endometrial thickening of 6-8 mm. excludes Ca endometrium

4) 90% present as abnormal bleeding

Ans D

Q.30. Which of the following is nephrotoxic?

1) Cyclophosphamide

2) Azathioprine

3) Tacrolimus

4) Mycophenolate mofetil

Ans C

Cyclosporine and tacrolimus nephrotoxicity

Calcineurin inhibitors, while representing advances for solid organ transplantation, have nephrotoxic potential that reduces their net benefit.

Mycophenolate mofetil (MMF) has no known nephrotoxicity

Q.31

1) pqrs = zxyw

2) pqrs = wyxz

3) pqrs = xzwy

4) pqrs = yzwx

Ans A

• Optokinetic nystagmus – assess visual acuity in malingering patients

• Photostress test to diagnose macular disease

• Teller’s cards –to assess visual acuity in toddlers

• Anomaloscope – to test colour vision

Photostress test

Retinal diseases such as Age-Related Macular Degeneration (ARMD) affect nearly one in three elderly patients. ARMD damages the central vision photoreceptors in the fovea. The Photostress Test is a simple technique for testing for the early effects of ARMD. Here, the illumination sources in a novel self-administered Photostress Testing device were modeled for safety and distribution in illumination software.

The Photostress Test is a simple means for screening for ARMD In the test, a bright spot of light is shone on the fovea to bleach the photoreceptors, effectively creating the spots people “see” following flash photography. In healthy retinas, the after image spots resolve fairly quickly, while in patients with early stage ARMD, the spots take much longer to disappear.

Light stress test. A. The retina is bleached with bright light as the patient occludes the other eye. B. The recovery phase is timed.

Teller acuity cards

Teller acuity cards in use. The child is making a looking response to the left

Anomaloscope Oculus
Q.32. The following statements are True about normal pregnancy EXCEPT

1) Cardiac output increases by 40-50% towards term

2) RBC mass increases by 20-30%

3) Mean arterial pressure increases by 15-20%

4) Blood volume increases by 40-50%

Ans C

In uncomplicated pregnancy, mean arterial pressure drops, reaching its nadir between the 16th and 20th weeks of gestation

Q.33. Wolfe Graft is

1) Full thickness skin graft

2) Medium thickness split thickness skin graft

3) Thin split thickness graft

4) Thick split thickness skin graft

Ans A

Wolfe graft – a full-thickness skin graft without any subcutaneous fat.

• Split-thickness

o A split-thickness skin graft (STSG) is a skin graft including the epidermis and part of the dermis. Its thickness depends on the donor site and the needs of the patient. It can be processed through a skin mesher which makes apertures onto the graft, allowing it to expand up to nine times its size. Split-thickness grafts are frequently used as they can cover large areas and the rate of autorejection is low. The same site can be harvested again after six weeks.[5] The donor site heals by re-epithelialisation from the dermis and surrounding skin and requires dressings.

• Full-thickness

o A full-thickness skin graft consists of the epidermis and the entire thickness of the dermis. The donor site is either sutured closed directly or covered by a split-thickness skin graft.

• Composite graft

o A composite graft is a small graft containing skin and underlying cartilage or other tissue. Donor sites include, for example, ear skin and cartilage to reconstruct nasal alar rim defects.

Q.34. Foldable IOLs are made of

1) Acrylic

2) Polypropylene

3) Sodium hyaluronate

4) Polymethyl methacrylate

Ans A

The latest advance in foldable IOLs is the AcrySof Acrylic Foldable Intraocular Lens

Q.35. Physical Quality of Life Index is a composite based on the following EXCEPT

1) Infant mortality rate

2) Life expectancy at age one

3) Maternal mortality ratio

4) Literacy rate

Ans C

 

Q.36. NICE guidelines for computed tomography in head injury include the following EXCEPT

1) GCS < 13 at any Point

2) More than one episode of vomiting

3) Focal neurological deficit

4) Mild head injury in a patient less than 40 years

Ans d

 

Q.37. Which one of the following is the most likely diagnosis from this x-ray?

1) Right hydropneumothorax

2) Hydatid cyst right lung

3) Perforated abdominal viscus

4) Right pleural effusion

Ans A

Q.38. Which of the following is TRUE about GyneFix?

1) It is a T shaped device

2) It is especially suited for nulliparous women

3) It contains levonorgestrel

4) Risk of expulsion is more

Ans B
GyneFix IUCD

GyneFix® is different from conventional IUDs (coil), it is an innovative contraceptive for women. 

GyneFix® is implanted in the wall of the uterus (womb). GyneFix® consists of 4 (GyneFix® 200) or 6 (GyneFix® 330) copper tubes which are threaded on a length of nylon. A tiny knot at the upper end of the thread keeps the IUD in place. This special characteristic of the device reduces expulsion.

GyneFix® mini should be the preferred option in nulliparous women

Q.39. Which of the following is NOT TRUE about Ethambutol

1) Peripheral sensory neuropathy is a rare complication

2) Optic neuritis is the most serious adverse effect

3) First line bacteriocidal antituberculosis drug

4) Not recommended in younger children

Ans C

Ethambutol (commonly abbreviated EMB or simply E) is a bacteriostatic antimycobacterial drug prescribed to treat tuberculosis

Q.40. Angle of Hisí refers to

1) Meeting of Anus and Rectum

2) Ileo-cecal junction

3) Duodeno-jejunal junction

4) Meeting of Fundus and GE junction

Ans D

Q.41. Match the above HLA associations and choose the best match.

1) pqrs = ywzx

2) pqrs = wxzy

3) pqrs = zxwy

4) pqrs = xwyz

Ans A

• HLA-A3 Hemochromatosis

• HLA-B27 Seronegative Spondylarthropathies (Psoriasis, Ankylosing spondylitis, Inflammatory bowel disease, Reiter’s syndrome)

• HLA-B8 Graves’ disease

• Multiple sclerosis HLA-DR2

• Hay fever HLA-DR2

• SLE HLA-DR2

• Goodpasture’s HLA-DR2

• DMI HLA-DR3, HLA-DR4

• Rheumatoid arthritis HLA-DR4

• Pernicious Anemia HLA-DR5

• Hashimoto’s thyroiditis HLA-DR5

• Steroid-responsive nephrotic syndrome HLA-DR7

• HLA-DR7 Steroid-responsive nephrotic syndrome

• HLA-DR2 Multiple sclerosis Hay fever SLE Goodpasture’s

• HLA-DR3 DMI

• HLA-DR4 Rheumatoid arthritis DMI

• HLA-DR5 Pernicious Anemia Hashimoto’s thyroiditis

Q.42 Which of the following is NOT a feature of Severe Preeclampsia?

1) Urine output < 400 ml /24 hours

2) Platelet count < 1 lakh /cu.mm.

3) HELLP syndrome

4) Urinary protein excretion > 2 G / day

Ans D

Same MCQ in Maharashtra PGMAT 2015

Q.43. Which one of the following is most likely diagnosis of the picture of cervix depicted above in this woman with leukorrhea?

1) Trichomonas vaginalis infection

2) Gardnerella infection

3) Candidal infection

4) Carcinoma cervix

Ans A

Mechanism of infection

• Trichomonas vaginalis, a parasitic protozoan, is the etiologic agent of trichomoniasis, and is a sexually transmitted infection

• Symptoms

o Trichomoniasis, a sexually transmitted infection of the urogenital tract, is a common cause of vaginitis in women, while men with this infection can display symptoms of urethritis. ‘Frothy’, greenish vaginal discharge with a ‘musty’ malodorous smell is characteristic.

• Signs

• Only 2% of women with the infection will have a “strawberry” cervix (colpitis macularis, an erythematous cervix with pinpoint areas of exudation) or vagina on examination

• This is due to capillary dilation as a result of the inflammatory response

Q.44. Scleroma is caused by

1) Klebsiella rhinoscleromatis

2) Aspergillus fumigatus

3) Rhinosporidium seeberi

4) Candida guilliermondii

Ans A

Q.45. Identify the anatomical structures – X,Y,Z of the neck depicted above in that order.

1) omohyoid, muscular triangle, submentalis

2) posterior belly of digastric, digastric triangle, platysma

3) posterior belly of digastric, carotid triangle, omohyoid

4) anterior belly of digastric, digastric triangle, stylohyoid

Ans C

Carotid triangle

1. Its bounded by the superior belly of the omohyoid, the posterior belly of the digastric, and the anterior border of the sternocleidomastoid.

2. This triangle is important because the common carotid artery ascends into it, making it a vascular triangle

Q.46 .The above picture shows the pressure curves and volume curve and ECG. The following statements are True from the picture EXCEPT –

1) There is no significant gradient between LA & LV in diastole

2) B represents ejection

3) C is isovolumic relaxation

4) A represents isovolumic contraction

Ans C

Q.47 .Henoch Schonlein purpura is characterized by the following EXCEPT

1) Glomerulonephritis

2) Palpable purpura

3) Hematocchezia

4) Thrombocytopenia

Ans D

Q.48. Characteristic antibodies of autoimmune hepatitis include all of the following EXCEPT

1) Anti -CCP antibodies

2) ANAs

3) Smooth muscle antibodies

4) Anti LKM antibodies

Ans A

Clinicians must consider the diagnosis of autoimmune hepatitis in any patient who has acute hepatitis or acute liver failure (defined by the new onset of coagulopathy). In addition to aminotransferase levels and other liver function studies, the workup of such patients should include the following assays:

• Serum antinuclear antibody (ANA)

• Anti–smooth muscle antibody (ASMA)

• Liver-kidney microsomal type 1 (LKM-1) antibody

• Serum protein electrophoresis (SPEP)

• Quantitative immunoglobulins

Urgent liver biopsy, transjugular if appropriate, may help to confirm the clinical suspicion of acute autoimmune hepatitis.

Laboratory findings in autoimmune hepatitis include the following:

• Elevated serum aminotransferase levels (1.5-50 times reference values)

• Elevated serum immunoglobulin levels, primarily immunoglobulin G (IgG)

• Seropositive results for ANAs, SMAs, or LKM-1 or anti–liver cytosol 1 (anti-LC1) antibodies

Anti–citrullinated protein antibodies (ACPAs)

Anti–citrullinated protein antibodies (ACPAs) are autoantibodies (antibodies directed against an individual’s own proteins) that are directed against peptides and proteins that are citrullinated. They are present in the majority of patients with rheumatoid arthritis. Clinically, cyclic citrullinated peptides (CCP) are frequently used to detect these antibodies with high sensitivity in patient serum or plasma (then referred to as anti–citrullinated peptide antibodies). One of the first identified antigens for these antibodies is citrullinated filaggrin.[1] Historically, the same antibody specificity has been described as anti-keratin antibodies (AKA) and anti-perinuclear factor (APF).

During inflammation, arginine amino acid residues can be enzymatically converted into citrulline ones in proteins such as vimentin, a process called citrullination. If their shapes are significantly altered, the proteins may be seen as antigens by the immune system, thereby generating an immune response.[3] ACPAs have proved to be powerful biomarkers that allow the diagnosis of rheumatoid arthritis (RA) to be made at a very early stage.

Q.49. Which of the following is True regarding Hypospadias?

1) It is seen in 1 in 1500 boys

2) It is attributed to failure of complete urethral tubularisation in the fetus

3) Urethral opening is most commonly in the perineum

4) Urethra opens proximally and dorsally

Ans B

Hypospadias affects about one in 150 boys and is usually detected at birth.

This anomaly is caused by failure of tubularization and fusion of the urethral groove

Q.50. Scorpion Sting may present with the following EXCEPT

1) Salivation and Lacrymation

2) Hypothermia

3) Hypertension and pulmonary edema

4) Arrhythmias

Ans b

hyperthermia is induced by scorpion venom

Q.51. In Mitochondria, urea cycle is integrated to

1) Electron Transport chain

2) Oxidation of fatty acids

3) TCA cycle

4) Oxidative phosphorylation

Ans C

The urea cycle and the tricarboxylic acid cycle are coupled together through fumarate and aspartate. Thus unless the fumarate released when arginosuccinate is cleaved can be cycled through the TCA cycle to oxaloacetate, the urea cycle will be slowed or inhibited. Fumarate is the precursor to oxaloacetate 
Oxaloacetate can:
be transaminated to aspartate and feed back into urea cycle 
condense with AcCoA and feed into citric acid cycle 
proceed into gluconeogenesis 
be converted to pyruvate

Q.52. Loss of taste sensation from the anterior part of the tongue is associated with lesion of which one of the following nerves?

1) IX

2) VII

3) V

4) XII

Ans b

Innervation of taste and sensation is different for the anterior and posterior part of the tongue because they are derived from different embryological structures (pharyngeal arch 1 and pharyngeal arch 3 and 4, respectively)

Anterior two thirds of tongue (anterior to the vallate papillae):

• Taste: chorda tympani branch of the facial nerve (CN VII) via special visceral afferent fibers

• Sensation: lingual branch of the mandibular division (V3) of the trigeminal nerve (CN V) via general visceral afferent fibers

Posterior one third of tongue:

• Taste and sensation: glossopharyngeal nerve (CN IX) via a mixture of special and general visceral afferent fibers

Q.53. Which of the following is NOT True regarding Anakinra?

1) Not combined with anti TNF drugs due to the risk of serious infections

2) Useful in Familial Cold Urticaria

3) soluble IL-2 receptor antagonist

4) Used in Muckle Wells Syndrome & adult Still’s disease

Ans C

Anakinra is a drug used to treat rheumatoid arthritis. It is an interleukin-1 (IL-1) receptor antagonist.

Q.54. Which one of the following is the contraceptive of choice for a woman with sickle cell disease

1) Depot medroxy progesterone acetate Injection

2) IUCD

3) Low dose combined contraceptive pills

4) High dose combined contraceptive pills

Ans A

Depo-Provera has several advantages:

• Highly effective at preventing pregnancy.

• Injected every 12 weeks. The only continuing action is to book subsequent follow-up injections every twelve weeks, and to monitor side effects to ensure that they do not require medical attention.

• No estrogen. No increased risk of deep vein thrombosis (DVT), pulmonary embolism (PE), stroke, or myocardial infarction.

• Minimal drug interactions (compared to other hormonal contraceptives).

• Decreased risk of endometrial cancer. Depo-Provera reduces the risk of endometrial cancer by 80%.[

• The reduced risk of endometrial cancer in Depo-Provera users is thought to be due to both the direct anti-proliferative effect of progestogen on the endometrium and the indirect reduction of estrogen levels by suppression of ovarian follicular development.

• Decreased risk of iron deficiency anemia, pelvic inflammatory disease (PID), ectopic pregnancy,and uterine fibroids.

• Decreased symptoms of endometriosis.

• Decreased incidence of primary dysmenorrhea, ovulation pain, and functional ovarian cysts.

• Decreased incidence of seizures in women with epilepsy. Additionally, unlike most other hormonal contraceptives, Depo-Provera’s contraceptive effectiveness is not affected by enzyme-inducing antiepileptic drugs.

• Decreased incidence and severity of sickle cell crises in women with sickle-cell disease

Q.55. The following are true regarding antipsychotic drugs EXCEPT

1) Olanzapine & clozapine have been linked to risk of new onset type 2 diabetes mellitus

2) Lurasidone is effective in acute decompensation of schizophrenia & has a low incidence of weight gain / hyperlipidemia

3) Quetiapine use can lead to cataract formation

4) Clozapine should not be given in patients with a past history of neuroleptic / antipsychotic malignant syndrome

Ans D

Quetiapine may increase cholesterol levels and contribute to the formation of cataracts

New Atypical Antipsychotic Lurasidone Appears To Improve Schizophrenia Without Weight-Gain Side Effects

Q.56. Among the following, the least common cause of acute upper GI bleeding is

1) Varices

2) Ulcer

3) Mallory Weiss tear

4) Vascular ectasia

Ans D

Q.57.Identify these two surgical instruments.

1) Thumb forceps & Sponge Holder

2) Artery Forceps & Needle Holder

3) Needle Holder & Ovum Forceps

4) Sponge Holder & Allis Forceps

Ans B

Thumb forceps

Rampley Sponge Holder 7″

Ovum Forceps

——————————————————————————–

Allis Tissue Forceps
Mosquito artery forceps – curved

Needle holder

Q.58. Which one of the following is not used as chemical warfare agent?

1) Sarin

2) Tabun

3) Cyclosarin

4) Taurine

Ans D

The organophosphate nerve agents tabun (GA), sarin (GB), soman (GD), and cyclosarin (GF) are among the most toxic chemical warfare agents known.[1] Together they comprise the G-series nerve agents, thus named because German scientists first synthesized them, beginning with GA in 1936.

Q.59. MAC for inhalational drugs in anesthesia stands for

1) Minimum Alveolar Concentration

2) Minimum Arterial Concentration

3) Mean Alveolar Concentration

4) Maximum Alveolar Concentration

Ans A

Q.60. Abraded collar in gunshot injuries indicates

1) Type of projectile

2) Direction of firing

3) Velocity of firing

4) Distance of firing

Ans B

the area of abraided tissue surrounding this gunshot wound of entrance is the ‘abrasion collar’.

• ‘abrasion collar’ (where the bullet has abraded the skin surface as it passes through it)

• abrasion collar is of an irregular width and widest border indicates the direction of the bullet.

• The elliptical abrasion collars associated with these gunshot wounds of entrance indicate that the projectile passed from right to left

• The abraded and dirt collar is usually present irrespective of the firing distance

Q.61. Optional timing of administration of prophylactic antibiotic for surgical patients is

1) Any time during the surgical procedure

2) One hour prior to induction of anesthesia

3) At the induction of anesthesia

4) One hour after induction

Ans b
Clinical application. For surgical antibiotic prophylaxis to be

successful, the antibiotic must be given so that good tissue levels are present at the time of the procedure and for the first 3-4 hours afterthesurgicalincision .There is neither need nor reason to start prophylactic antibiotics days in advance.

Recommendedtiming.Recentreviews suggest administering the parenteral antibiotic 30-60 minutes before the surgical incision is made (i.e., with the induction of anesthesia). For cesarean section, antimicrobial prophylaxis should be delayed until the umbilical cord is clamped and then should be initiatedimmediatel

 

Q.62. What does this picture show?

1) Lovset’s maneuvre

2) Pinod’s maneuvre

3) Burns Marshall method

4) Mauriceau Smellie Veit technique

Ans C
Once the shoulders are delivered, the head rotates typically to the fetal chin posteriorly. Controlled, slow delivery of the after-coming head is essential. The fetal head should be maintained in a flexed position to allow delivery of its smallest diameter. This can be accomplished by:

• Mauriceau-Smellie-Veit manoeuvre (with fetus resting on hand and forearm, the operator’s index and middle fingers lift up the fetal maxillary prominences and an assistant applies suprapubic pressure).

• The Burns-Marshall method (feet are grasped and with gentle traction swept in a slow arc over the maternal abdomen).

• Forceps delivery

Q.63. Hill Sach’s lesion is related to

1) Subscapularis muscle

2) Glenoid labrum

3) Head of humerus

4) Anterior capsule of shoulder

Ans C
A Hill–Sachs lesion, or Hill–Sachs fracture, is a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.

Anterior shoulder dislocation on X-ray with a large Hill–Sachs lesion

Q.64. The following are True regarding kidney development EXCEPT

1) Collecting parts of kidney develop from the ureteric bud

2) Kidney starts developing in the sacral region and ascends to the lumbar position

3) Human kidney develops mainly from metanephros

4) Mesonephric duct disappears

Ans D
• The mesonephric duct (also known as Wolffian duct, archinephric duct, Leydig’s duct and nephric duct) is a paired organ found in mammals including humans during embryogenesis. Wolffian structures are male urogenital structures that include the epididymis, vas deferens, and seminal vesicles that differentiate from this structure.

• The mesonephric duct connects the primitive kidney, the mesonephros, to the cloaca and serves as the anlage for certain male reproductive organs.

• In both the male and the female the Wolffian duct develops into the trigone of urinary bladder, a part of the bladder wall. However, further development differentiates between the sexes in the development of the urinary and reproductive organs.

Q.65 The risk of rupture of lower segment Cesarean section scar during labor is

1) 2%

2) 4%

3) less than 0.4%

4) 1%

Ans C

A Caesarean section leaves a scar in the wall of the uterus which is considered weaker than the normal uterine wall. A VBAC carries a risk of uterine rupture of 22–74/10,000. There is virtually no risk of uterine rupture in women undergoing ERCS.If a uterine rupture does occur, the risk of perinatal death is approximately 6%. Mothers with a previous lower uterine segment cesarean are considered the best candidates, as that region of the uterus is under less physical stress during labor and delivery.

Q.66. Lower fungi which have nonseptate hyphae and which form sporangiospores are called

1) Basidiomycetes

2) Deuteromycetes

3) Ascomycetes

4) Phycomycetes

Ans D

Q.67. A family consists of 2 parents (already immune) and 4 children who are susceptible to measles. There occurs a primary case of measles in the family and 2 secondary cases occur within a short period of time. The secondary attack rate is about ñ

1) 25%

2) 67%

3) 33%

4) 50%

Ans C
Secondary attack rate = (2/3) X 100 = 67%

Q.68. Which of the following is TRUE regarding human hair?

1) Hair changes are identical in scalds and burns

2) Barr bodies present in the cortex layer of hair shaft help to determine XX genotype

3) ABO group can be determined from a single hair bulb from any part of the body

4) Roots of hair from adults, in contrast to children, will dissolve very rapidly in a solution of caustic potash

Ans C

ABO groups can be determined in a single hair if blub is present

Q.69. Which one of the following is FALSE regarding Chronic maxillary sinusitis?

1) Headache is absent except during exacerbation of acute sinusitis

2) FESS is indicated for failure of medical treatment or presence of sinonasal polys

3) Patient complains of postnasal discharge

4) Normal xray effectively excludes hypertrophic variant

Ans A
By definition chronic sinusitis lasts longer than three months and can be caused by many different diseases that share chronic inflammation of the sinuses as a common symptom. Symptoms of chronic sinusitis may include any combination of the following: nasal congestion, facial pain, headache, night-time coughing, an increase in previously minor or controlled asthma symptoms, general malaise, thick green or yellow discharge, feeling of facial ‘fullness’ or ‘tightness’ that may worsen when bending over, dizziness, aching teeth, and/or halitosis.

Each of these symptoms has multiple other possible causes, which should be considered and investigated as well. Often chronic sinusitis can lead to anosmia, a reduced sense of smell.[2] In a small number of cases, acute or chronic maxillary sinusitis is associated with a dental infection. Vertigo, lightheadedness, and blurred vision are not typical in chronic sinusitis and other causes should be investigate

Q.70. All are malignant tumors of nasal cavity EXCEPT

1) Ringertz tumor

2) Stewart’s granuloma

3) Malignant melanoma

4) Olfactory neuroblastoma

Ans A
Ringertz tumour is a benign warty neoplasm that arises from the lateral wall of nasal cavity

• Instead of growing outwards, it grows into the stroma

• Epidemiology:

o Seen in 40-70 yrs age group

o More in males

• Clinical features:

o Red / grey oedematous mass

o Always unilateral

o May be confused with nasal polyp

• Treatment:

o Wide surgical excision

o Lateral rhinotomy

o Medial maxillectomy with en bloc ethmoidectomy

o Chance of recurrence

o May be associated with squamous cell carcinoma in 10-15% individuals

Q.71.These pictures depict

1) Exfoliative dermatitis

2) Toxic epidermal necrolysis

3) Extensive Tinea corporis

4) Psoriasis

Ans D

Pitting nails – Psoriasis

Eczema Psoriasis

Cause Eczema is generally a response to environmental factors like exposure to products containing harsh chemicals Psoriasis usually has a genetic link and is the response to factors inside of the body

Age distribution Usually in childhood Generally a disease of adults

Appearance of skin lesion Eczema is described as dry skin that may appear to be small blisters or raised spots. psoriasis is rough, red and raise skin, which can be itchy too.

Silvery scales over the skin lesion Absent Present

Dennie Morgan fold i.e. extra fold of skin beneath the eye Present Absent

Allergy to food May be present Usually not present

Emotional distress Usually not seen May be seen with it.

Arthritis It is not associated with arthritis It is associated with Psoriatic arthritis.

Treatment Topical steroids, emollients, antihistamines (loratadine, fexofenadine, cetirazine), tacrolimus, sirolimus, pimecrolimus Topical treatment, cognitive behavior therapy, UV photo therapy, photo chemotherapy, systemic treatment, biological agents (Adalimumab, Efalizumab), topical vitamin A/D derivatives, coal tars, methotrexate

Symptoms pruritus, erythema, xeroderma, ichthyosis Skin plaques, “silver” scales, nail pitting, arthritis

Location face, flexor surfaces extensor surfaces, trunk, lower back, hairline

Causes dry skin, genetic component Immune mediated injury to skin, genetic factors.

Diagnosis clinical Appearance of skin and sometimes a biopsy of skin is carried out.

Q.72. This patient came with this complaint one month after an extramarital sexual contact. He has no pain. Which one of the following statements is TRUE?

1) A single dose of 2.4 million units of benzathine penicillin IM is the treatment

2) Examination of the groin will reveal a characteristic Groove Sign

3) It is caused by Hemophilus ducreyi

4) He is likely to develop arthritis of the knee

Ans A
Leision is syphilitic chancre

Groove Sign – lgv

Hemophilus ducreyi – chancroid

develop arthritis of the knee – Reiters disease

Q.73. Kleihauer Betke Test is used for

  1)  Detecting the karyotype in structurally normal fetus

  2)  Evaluating the volume of feto maternal hemorrhage

  3)  Diagnosing fetal infections

  4)  Testing cephalopelvic disproportion

Ans B

The Apt test can also be used to detect the presence of fetal blood in the maternal circulation in cases of suspected fetal-maternal hemorrhage. Since the test is only a qualitative determination of the presence of fetal hemoglobin in maternal blood, the quantitative Kleihauer-Betke test is more commonly used.

Q.74. This is the fundus picture of a lady patient, who was on estrogen containing pills, and came now with acute deterioration of vision. What is the likely diagnosis?

  1)  central retinal artery occlusion

  2)  central retinal vein occlusion

  3)  diabetic background retinopathy

  4)  hypertensive retinopathy

Ans B

 

Central retinal vein occlusion showing dilation and tortuosity as well as intraretinal hemorrhages in all four quadrants

Q.75 Which of the following is TRUE regarding Radiotherapy for Cancer?

  1)  A rise in PSA after Brachytherapy for prostate cancer indicates recurrence

  2)  Radiation to the axillary lymph nodes prevents the incidence of arm edema after partial mastectomy

  3)  Thoracic radiation therapy is given concurrently with chemotherapy in patients with Limited Small Cell Lung Carcinoma

  4)  Radiation therapy is indicated in breast cancer in women > 70years, tumor size < 2cms. and lymph nodes negative

Ans C

PSA bounce

  • Some men who have undergone external beam radiation therapy or implantation of radioactive seeds (brachytherapy) experience a phenomenon known as PSA bounce, a temporary spike in PSA that does not necessarily indicate recurrence. Studies offer varying conclusions about how common this phenomenon is, probably because they use different definitions of what constitutes a “bounce.”

Breast cancer

  • 70% of women with early stage breast cancer (tumors between 1 and 2 cms with negative axillary lymph nodes) are cured by standard surgical techniques.

Q.76. Pneumatoceles in chest xray are characteristically seen in pneumonia due to

  1)  Staphylococcus aureus

  2)  Streptococcus pneumoniae

  3)  Hemophilus influenza

  4)  Streptococcus pyogenes

Ans a

 

Pulmonary pneumatoceles are thin-walled, air-filled cysts that develop within the lung parenchyma. They can be single emphysematous lesions but are more often multiple, thin-walled, air-filled, cystlike cavities. Most often, they occur as a sequela to acute pneumonia, commonly caused by Staphylococcus aureus. However, pneumatocele formation also occurs with other agents, including Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, group A streptococci, Serratia marcescens, Klebsiella pneumoniae, adenovirus, and tuberculosis. Pneumatoceles are generally observed soon after the development of pneumonia but can be observed on the initial chest radiograph.

Q.77. Based on the picture depcited above, the following are True statements EXCEPT

  1)  Commonest and most troublesome complication is neuralgia

  2)  The patient would have a past history of varicella

  3)  Early treatment with valaciclovir 1 gram tid is helpful

  4)  Ramsay Hunt syndrome includes similar lesions on the ophthalmic division of V nerve & cornea

Ans D

Ramsay Hunt syndrome (herpes zoster oticus) occurs when a shingles infection affects the facial nerve near one of your ears

Q.78. Which of the following is TRUE regarding tuberculosis

  1)  Primary tuberculosis usually involves the mid and lower zones

  2)  90% of inhaled bacilli from droplet nuclei reach the alveoli

  3)  Primary tuberculosis carries a high level of transmissibility

  4)  Hilar / paratracheal lymphadenopathy is characteristically absent in primary tuberculosis

Ans D

Primary infection occurs on first exposure to M. tuberculosis. Since inhaled droplet nuclei (containing M. tuberculosis) are so small, they avoid the mucociliary defenses of the bronchi and lodge in the terminal alveoli of the lungs. Infection begins when the bacilli start replicating in the lungs, forming the pneumonic focus. M. tuberculosis replicates slowly but con- tinuously and spreads via the lymphatic system to the hilar lymph nodes. The immune response (delayed hypersensitivity and cellular immunity) develops about 4–6 weeks after the primary infection.

The pneumonic focus and related hilar lymphadenopathy form a pri- mary complex. Bacilli may spread through the blood from the primary com- plex to other organs in the body of the infected person. The next phase is determined by the strength of the immune response of the infected person. In most people with competent immune systems, the immune response would stop the replication of M. tuberculosis, leaving some bacilli dormant. In a few cases, the immune response may not be adequate enough to pre- vent replication of M. tuberculosis and primary TB disease develops within a few months. Although primary TB may be severe and disseminated, it is not generally associated with high-level transmissibility. Reinfection or repeat infection in a person who has already had a primary infection is still considered primary TB.

Q.79. Fifth Vital Sign  commonly elicited by anesthesiologists on surgical patients is

  1)  Pain

  2)  Blood pressure

  3)  FiO2

  4)  Core temperature

Ans A

one of the most important changes in the process of improving the efficacy of pain treatment is to introduce pain assessment as the fifth vital sign in addition to the traditional four vital signs (temperature, pulse, blood pressure and respiratory rate).

Q.80. Choose the FALSE statement from the following

  1)  Aspirin is less potent as well as less efficacious analgesic than morphine

  2)  Diazepam is more potent as well as more efficacious CNS depressant than pentobarbitone

  3)  Frusemide is a less potent but more efficacious diuretic than metalozone

  4)  Pethidine is a less potent but equally efficacious analgesic as morphine

Ans B

Q.81. A normal anion gap metabolic acidosis is seen in

  1)  Methanol poisoning

  2)  Diarrhea

  3)  Diabetic ketoacidosis

  4)  Salicylate poisoning

Ans B

non-anion gap metabolic acidoses (NAGMA), which I learned as a resident. It’s “HARDUP“, which stands for the following:

 

H = hyperalimentation (e.g., starting TPN).

A = acetazolamide use.

R = renal tubular acidosis (Type I = distal; Type II = proximal; Type IV = hyporeninemic hypoaldosteronism.

D = diarrhea

U = uretosigmoid fistula (because the colon will waste bicarbonate).

P = pancreatic fistula (because of alkali loss–the pancreas secretes a bicarbonate-rich fluid).

Q.82. Allen’s test is useful in evaluation of

  1)  Digital blood flow

  2)  Thoracic outlet compression

  3)  Presence of cervical rib

  4)  Integrity of palmar arch

Ans D

Also same MCQ in AIPGMEE 2006

How to perform allen’s test: (To check for patency of radial and ulnar arteries and to confirm integrity of the palmar arterial arch between them)

  • The patient makes a tight fist
  • The examiner compresses the radial and ulnar arteries distally
  • The fist is released and compression of the ulnar artery is released
  • The speed of return of colour to the palm is looked for
  • Steps 1 and 2 are repeated, but release the radial artery compression instead of the ulnar artery
  • Again look for speed of return of colour to the palm

Normally, the colour should return in 5-7seconds. This indicates that the arteries and the palmar arch is patent and functioning well.

Q.83. Which of the following statements is fully TRUE?

  1)  Raloxifene is a SERM that prevents breast cancer but increases risk of endometrial cancer

  2)  Lobular carcinoma in situ arises from epithelial lining of the minor ducts and 10% occur in males

  3)  Paget’s disease of the nipple is a type of breast cancer with prominent Paget cells and presence of S-100 Ag immunostaining

  4)  BRCA 1&2 gene mutations cause breast cancer and are passed from mother to daughter by mitochondrial inheritance

Ans A

Controversial MCQ

Raloxifene is a second-generation SERM approved for prophylaxis against postmenopausal osteoporosis. Unlike tamoxifen, it does not have an estrogenic effect on the uterus. The Multiple Outcomes of Raloxifene randomized trial, after 40 months of follow-up, showed that raloxifene reduced the risk of estrogen receptor–positive breast cancer, without increasing endometrial cancer (RR, 0.8; 95% CI, 0.2–2.7)

Q.84. The term cellular pathology was coined by

  1)  Louis Pasteur

  2)  Gregor Mendel

  3)  Robert Koch

  4)  Rudolf Virchow

Ans d

Rudolf Virchow : Among his books, Cellular Pathology published in 1858 is regarded as the root of modern pathology.

Q.85. Choristoma is a

  1)  Benign tumor of trophoblastic cell

  2)  Example of hamartoma

  3)  Heterotopic (ectopic) rest of cells

  4)  Benign tumor of cartilaginous tissue

Ans C

Q.86. Parotitis and orchitis are common manifestations of

  1)  Measles

  2)  Mumps

  3)  Diphtheria

  4)  Rubella

Ans B

Q.87. Most common malignancy that metastasizes to the Spine is

  1)  Breast

  2)  Lung

  3)  Prostate

  4)  Thyroid

Ana A

Q.88. A 25 year old man has pigmented macules over the palms, soles and oral mucosa. He also has anemia and abdominal pain. Which one of the following is the most likely diagnosis?

  1)  Cushing’s syndrome

  2)  Peutz – Jegher’s Syndrome

  3)  Incontinentia pigmenti

  4)  Albright’s Syndrome

Ans B

Q.89. Which one of the following is implicated in the etiology of Fitz-Hugh-Curtis syndrome?

  1)  Chlamydial infection

  2)  Perforation of dermoid cyst

  3)  Gastric perforation

  4)  Liver metastases in ovarian cancer

Ans A

 Perihepatic adhesions

Fitz-Hugh–Curtis syndrome occurs almost exclusively in women. It is usually caused by gonorrhoea (acute gonococcal perihepatitis) or chlamydia bacteria, which cause a thinning of cervical mucus and allow bacteria from the vagina into the uterus and oviducts, causing infection and inflammation. Occasionally, this inflammation can cause scar tissue to form on Glisson’s capsule, a thin layer of connective tissue surrounding the liver.

 

Previously, Neisseria gonorrhoeae was thought to be the major organism responsible. Recent studies, however, have shown that cases of FHC due to infection with Chlamydia trachomatis outnumber those due to infection with Neisseria gonorrhoeae by a ratio of 5:1. Bacteroides spp., and facultative organisms such as Gardnerella, E. coli, and streptococcus may also play a role in some cases but are less commonly involved

Q.90. What is this procedure?

  1)  Pudendal block

  2)  D & C

  3)  Culdocentesis

  4)  Colposcopy

Ans C

Q.91. This young boy came with history of fever and severe right throat pain and odynophagia. His voice is muffled (hot potato voice). This is his picture. Which one of the following is the most likely cause of his complaints?

  1)  Quinsy

  2)  Chronic fibrotic tonsillitis

  3)  Candidial infection

  4)  Glossitis

Ans A

There will be signs and symptoms of a general malaise and sore throat. ‘Good’ symptoms for quinsy include:

  • ‘Thick’ or ‘hot potato’ voice (not hoarse, croaky voice)
  • Stertor
  • Trismus
  • Inability to swallow more than saliva or a sip or water
  • Pain much worse on one side than the other (+/- otalgia)

To differentiate it from tonsillitis, a quinsy will have many of the following signs:

  • There is usually a degree of trismus
  • On the affected side, the anterior arch will be pushed medially
  • On the affected side, the palate will bulge towards you ie the normally concave palate becomes convex
  • The uvula may or may not be pushed away from the affected side
  • On the affected side, the mucosa of the arch and palate may look angrily erythematous

Right peritonsillitis/peritonsillar cellulitis. Notice that a) there is no trismus; b) there is erythema of the right anterior arch and palate; c) the right anterior arch is pushed medially but there is still a reasonable view of the right tonsil; d) there is no swelling or convexity of the palate. Compare the photo below.

 

Right quinsy. Notice that a) there is moderate trismus; b) the right anterior arch is being pushed medially; c) the uvula is very obviously deviated to the left (the midline is in the middle of the tongue depressor – note where the upper incisors are); d) there is a convex swelling of the palate. 

Q.92. Which of the following is TRUE regarding Epistaxis

  1)  Patient is kept in sitting and slight leaning forward position while compressing the nares

  2)  Topical phenylephrine is contraindicated as it increases blood pressure

  3)  Commonly from Kiesselbach venous plexus in the anterior septum

  4)  Pneumatic nasal tamponade is a treatment option

Ans B

arteries anastomose to form a vascular plexus called Kiesselbach’s plexus

The vast majority of nose bleeds occur in the anterior (front) part of the nose from the nasal septum. This area is richly endowed with blood vessels (Kiesselbach’s plexus). This region is also known as Little’s area. Bleeding farther back in the nose is known as a posterior bleed and is usually due to bleeding from Woodruff’s plexus, a venous plexus situated in the posterior part of inferior meatus.[7] Posterior bleeds are often prolonged and difficult to control. They can be associated with bleeding from both nostrils and with a greater flow of blood into the mouth.

Q.93. Which one of the following values is not a feature of Acute Severe Asthma.

  1)  PaO2 of less than 8 kPa

  2)  Heart rate of more than 110 / min.

  3)  Pulsus Paradoxus

  4)  PEF of 60 to 70% of expected

Ans D

1

Q.94. Pregnancy rate in copper bearing IUCD is

  1)  12 per 100 woman years

  2)  5 per 100 woman years

  3)  2 per 100 woman years

  4)  8 per 100 woman years

Ans C

Copper bearing IUCD

One of the most effective and long-lasting methods:

  • Less than 1 pregnancy per 100 women using an IUD over the first year (6 to 8 per 1,000 women). This means that 992 to 994 of every 1,000 women using IUDs will not become pregnant.
  • A small risk of pregnancy remains beyond the first year of use and continues as long as the woman is using the IUD.
  • Over 10 years of IUD use: About 2 pregnancies per 100 women

Q.95. All the following are True regarding Familial Adenomatous Polyposis EXCEPT

1) Congenital Hypertrophy of Retinal Pigment Epithelium is seen in upto 50% patients

2) It is an Autosomal Dominant disorder

3) It is due to a mutation of APC gene in chromosome 15

4) > 100 colorectal polyps are present

Ans C

he APC gene is located on the long (q) arm of chromosome 5 b

Q.96. This 25 year old lady came with anemia jaundice and joint pains. The following are True EXCEPT

1) She can present with pulmonary syndrome

2) Hydroxyurea would help her

3) She may have retinopathy

4) HbF and HbA2 will be undetectable

Ans D

• Hemoglobin A2 (HbA2) is a normal variant of hemoglobin A that consists of two alpha and two delta chains (α2δ2) and is found at low levels in normal human blood. Hemoglobin A2 may be increased in beta thalassemia or in people who are heterozygous for the beta thalassemia gene.

• HbA2 exists in small amounts in all adult humans (1.5-3.1% of all hemoglobin molecules) and is increased in people with Sickle-cell disease

Q.97. Which of the following is most likely in this patient?

1) Anisokoria

2) Unilateral exophthalmos

3) Bellís palsy right

4) Horner’s syndrome left

Ans D
Ans can be A also

Anisocoria is a condition characterized by an unequal size of the eyes’ pupils. Affecting 20% of the population, it can be an entirely harmless condition or a symptom of more serious medical problem

Anisocoria has various causes:

Physiological anisocoria: About 20% of normal people have a slight difference in pupil size which is known as physiologic anisocoria. In this condition, the difference between pupils is usually less than 1 mm.[3]

Horner’s syndrome

Mechanical anisocoria: Occasionally previous trauma, eye surgery, or inflammation (uveitis, angle closure glaucoma) can lead to adhesions between the iris and the lens.

Adie tonic pupil: Tonic pupil is usually an isolated benign entity, presenting in young women. It may be associated with loss of deep tendon reflex (Adie’s syndrome). Tonic pupil is characterized by delayed dilation of iris especially after near stimulus, segmental iris constriction, and sensitivity of pupil to a weak solution of pilocarpine.

Oculomotor nerve palsy: Ischemia, intracranial aneurysm, head trauma, and brain tumors are the most common causes of oculomotor nerve palsy in adults. In ischemic lesions of the oculomotor nerve, pupillary function is usually spared whereas in compressive lesions the pupil is involved.

Pharmacological agents will cause anisocoria if instilled in one eye. Some examples of pharmacological agents which may affect the pupils include pilocarpine, cocaine, tropicamide, MDMA, Dextromethorphan, and ergolines.[4] Alkaloids present in plants of the genera Brugmansia and Datura, such as scopolamine, may also induce anisocoria

Q.98. Alcohol dehydrogenase requires NAD+ for catalytic activity. The NAD+ is functioning as

1) Coenzyme-cosubstrate

2) Cofactor

3) Apo enzyme

4) Coenzyme-prosthetic group

Ans A
Straight pick from Lippincot biochemistry

Q.99. Treatment of choice for molar pregnancy is

1) Oxytocin infusion

2) Intramuscular carboprost

3) Sublingual misoprostol

4) Suction evacuation

Ans D

Q.100. Which of the following statements is FALSE regarding vocal cords

1) One muscle adjusts the length of the Vocal cords

2) One muscle abducts (opens) the vocal cords

3) Two muscles adduct (close) the Vocal cords

4) One muscle adjusts the tension of the Vocal cords

Ans D

Q.101. Pringle Maneuver may be required for treatment of

1) Injury to Tail of Pancreas

2) Liver Laceration

3) Bleeding Esophageal Varices

4) Mesenteric Ischemia

Ans B

Hilum of liver region. Hepatoduodenal ligament clamping procedure (Pringle manoeuvre)

The Pringle manoeuvre is a surgical manoeuvre used in some abdominal operations. A large atraumatic haemostat is used to clamp the hepatoduodenal ligament (free border of the lesser omentum) interrupting the flow of blood through the hepatic artery and the portal vein and thus helping to control bleeding from the liver. More commonly, in the absence of soft clamp, manual compression of the hepaticoduodenal ligament is performed.

Should bleeding though continue, it is likely that the inferior vena cava or the hepatic vein were also traumatised. Also, if bleeding did continue, a variation in arterial blood flow may be present.

It was developed by James Hogarth Pringle, a graduate of medicine at the University of Edinburgh Medical School.

The Pringle manoeuvre is very often used during liver surgery to minimize blood loss, however it can directly lead to reperfusion phenomenon in the liver and it has recently been suggested that it should be avoided in hepatectomy for cancer patients due to its side effects on tumor recurrence and worse prognosis.[2] The Pringle maneuver is applied during closure of a vena cava injury when an atriocaval shunt is placed

Q.102. The thoracic vertebrae are characterized by the presence of which one of the following?

1) Mamillary process

2) Costal facet

3) Accessory process

4) Bifid spine

Ans B

Q.103. Which of the following women would be an absolute contraindication for Combined Oral Contraceptive Pills as per WHO category 4

1) History of stroke

2) Cancer cervix

3) Epilepsy

4) Smoker < 35 years

Ans A

Q.104. Which of the following is TRUE regarding Fern tree appearance of cervical mucosa

1) It is due to high progesterone

2) It is seen by naked eye examination

3) It is due to low NaCl & high protein

4) It is due to high estrogen

Ans D

Fern test refers to detection of a characteristic ‘fern like’ pattern of cervical mucus when a specimen of cervical mucus is allowed to dry on a glass slide and is viewed under a low power microscope. The fern test is used to provide evidence of the presence of amniotic fluid and is used in obstetrics to detect rupture of membranes and onset of labor. It also may provide indirect evidence of ovulation and fertility, however this test does not predict the time of ovulation.

Ferning is due to the presence of sodium chloride in the mucus under estrogen effect. When high levels of estrogen are present, just before ovulation, the cervical mucus forms fern-like patterns due to crystallization of sodium chloride on mucus fibers. This pattern is known as arborization or ‘ferning’.

When progesterone is the dominant hormone, as is just after ovulation, fern pattern is no longer discernible. Fern pattern is completely absent by 22nd day of cycle. Disappearance of fern pattern after 22nd day suggests ovulation and its persistence throughout menstrual cycle suggests an-ovulation (infertility).

Q.105. Identify this organism.

1) Trichomonas vaginalis

2) Malassezia furfur

3) Trichinella spiralis

4) Sarcoptes scabei

Ans D

Q.106. The equilibrium potential for potassium ion in mammalian spinal motor neuron is

1) Plus 70mV

2) Minus 90 mV

3) Plus 60 mV R15

4) Minus 70 mV

Ans B

 

Q.107 . What type of suture is this?

1) Purse String suture

2) Pare’s suture

3) Halsted’s suture

4) Mattress interrupted suture

Ans A

Pare’s suture: The approximation of the edges of a wound by pasting strips of cloth to the surface and stitching them instead of the skin

 

Q.108. Scheuermann’s Disease occurs in

1) Adults

2) Adolescents

3) Elderly

4) Infants

Ans B.
Scheuermann’s disease is a self-limiting skeletal disorder of childhood. It is also known as Scheuermann’s kyphosis (since it results in kyphosis), Calvé disease, and idiopathic juvenile kyphosis of the spine. It is named after Holger Werfel Scheuermann.[1][2][3] Scheuermann’s disease describes a condition where the vertebrae grow unevenly with respect to the sagittal plane; that is, the posterior angle is often greater than the anterior. This uneven growth results in the signature “wedging” shape of the vertebrae, causing kyphosis

Scheuermann’s disease is considered to be a form of juvenile osteochondrosis of the spine. It is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. Patients suffering with Scheuermann’s kyphosis cannot consciously correct their posture. The apex of their curve, located in the thoracic vertebrae, is quite rigid.

 

Q.109. Which of the following is TRUE regarding occipital hemianopia

1) All the given options are true

2) Riddoch phenomenon is typical

3) Often incongruous hemianopia

4) Macula is involved

Ans B
Riddoch syndrome (also known as the Riddoch phenomenon) is an ocular affectation often caused by lesions in the occipital lobe which limit the sufferer’s ability to distinguish objects. Only moving objects in a blind field are visible, static ones being invisible to the patient.The moving objects are not perceived to have color or detail. The subject may only have awareness of the movement without visual perception of it (gnosanopsia),[2] or the general shape of a moving object may be perceivable as a shadow like outline.

Homonymous hemianopia is typically incongruous in optic tract lesions

Q.110. Major lipid component in chylomicrons is

1) Triacylglycerol

2) Free fatty acids

3) Phospholipid

4) Cholesterol

Ans A

Q.111. What is True regarding the picture depcited above?

1) Rodent ulcer appearance

2) Exposure to Solar UV radiation is a risk factor

3) This is basal cell carcinoma which arises from the basal layer of nonkeratinocytes

4) All these options are true

Ans D
Q.112. What is FALSE about Informed Consent

1) All information must be given, except expected complications, as the patient may get frightened

2) Information must be given, regarding any treatment options better than the treatment option being provided

3) All information must be given regarding treatment options

4) All disclosures must be in patient’s own language

Ans A

Q.113. The performance and analysis of routine measurements aimed at detecting changes in the environment or in the health status of the population is called

1) Monitoring

2) Surveillance

3) Situational analysis

4) Evaluation

Ans A

Monitoring is the periodic oversight of the implementation of an activity which seeks to establish the extent to which input deliveries, work schedules, other required actions and targeted outputs are proceeding according to plan, so that timely action can be taken to correct deficiencies detected. “Monitoring” is also useful for the systematic checking on a condition or set of conditions, such as following the situation of women and children.

Evaluation is a process which attempts to determine as systematically and objectively as possible the relevance, effectiveness, efficiency and impact of activities in the light of specified objectives. It is a learning and action-oriented management tool and organizational process for improving both current activities and future planning, programming and decision-making.

Q.114. In ultrasonography, fetal abdominal circumference is measured at the level of

1) Kidney and renal artery

2) Liver and cystic duct

3) Stomach and umbilical vein

4) Spleen and celiac plexus

Ans C

Abdominal Circumference

This should be determined at the skin line on a true transverse view at the level of the junction of the umbilical vein, portal sinus, and fetal stomach, when visible. The abdominal circumference measurement is used with other biometric parameters to estimate fetal weight and may allow detection of intrauterine growth restriction or macrosomia

Q.115. Which type of pelvis favors face to pubis delivery?

1) Platypelloid

2) Android

3) Gynaecoid

4) Anthropoid

Ans D

The fetal occiput presents posteriorly in about 25% of early labors and 10–15% of active labors. The anthropoid-type pelvis predisposes to this position. Clinical signs of occiput posterior position include accentuated maternal backache, persistent anterior cervical lip, ineffective contractions, and a prolonged second stage. Ultrasound is invaluable to confirm an occiput posterior position when the diagnosis by clinical examination is questionable. Spontaneous rotation to occiput anterior may be impeded by regional anesthesia and poor voluntary effort. If the posterior triangle of the pelvic outlet is roomy, the infant can deliver spontaneously from the occiput posterior position, but an episiotomy may be needed. Other options include manual or forceps rotation. Kielland forceps, which do not have a pelvic curve, are ideal. Classic forceps can be used to rotate the vertex by the Scanzoni maneuver. Forceps rotations are seldom performed in current clinical practice, and require training and expertise.

As occipito-posterior position pregnancies often result in a long labour, close maternal and fetal monitoring are required. An epidural is often recommended and it is essential that adequate fluids be given to the mother.

The mother may get the urge to push before full dilatation but this must be discouraged. If the head comes into a face to pubis position then vaginal delivery is possible as long as there is a reasonable pelvic size. Otherwise, forceps or caesarean section may be required.

Q.116. Ross procedure involves

1) Replacement of aortic valve with pulmonic homograft

2) Replacement of aortic valve with porcine valve and repair of pulmonary valve

3) Replacement of mitral valve with tissue prosthesis and repair of tricuspid valve

4) Replacement of aortic valve with autologous pulmonic valve and implantation of pulmonic valve homograft

Ans D

Ross procedure

The Ross Procedure is a type of specialized aortic valve surgery where the patient’s diseased aortic valve is replaced with his or her own pulmonary valve. The pulmonary valve is then replaced with cryopreserved cadaveric pulmonary valve. In children and young adults, or older particularly active patients, this procedure offers several advantages over traditional aortic valve replacement with manufactured prostheses.

he pulmonary valve and a segment of the pulmonary artery are excised. This pulmonary segment will later be placed in the aortic position replacing the diseased aortic valve.

he diseased aortic valve and proximal tissue is removed, leaving the right and left coronary arteries with only a button of tissue

The pulmonary autograft is placed in the aortic position and the buttons of tissue on both the right and left coronary arteries are then sewn into that pulmonary segment and closed. A cadaveric pulmonary valve and artery homograft is then replaced in the pulmonary position to replace the excised pulmonary segment

 

 

 

Q.117. This patient, previously healthy, came now with dyspnea and low grade fever since 4 months. His lungs are clear. JVP is normal. ECG showed low voltage complexes. What is the possible diagnosis?

1) Tuberculous pericardial effusion

2) Syphilitic Aortic aneurysm

3) Hypertrophic cariomyopathy

4) Rheumatic Mitral stenosis

Ans A

Q.118. This young patient came with wing beating tremor and liver cell failure. The above is picture of his eye. What is the diagnosis?

1) Galactosemia

2) Paralysis agitans

3) Primary biliary cirrhosis

4) Hepatolenticular degeneration

Ans D

Q.119. In hanging, the tension which is required on the ligature to block the trachea is

1) 20Kgs

2) 5Kgs

3) 2Kgs

4) 15Kgs

Ans D

Neck Structure Compression Pressure

Jugular veins 4.4 lb

Carotid arteries 5.5-22 lb

Trachea 33 lb

Vertebral arteries 18-66 lb

Table 1: Adult Neck Structures and the Compression

ASPHYXIA: The constricting force of the ligature, causes compressive narrowing of laryngeal and tracheal lumina, and forces up the root of the tongue against the posterior wall of the pharynx, and folds the epiglottis over the entrance of the larynx to block the airway. Atension of 15 kg on ligature blocks the trachea.

Q.120. These lesions are suggestive of ñ

1) Erythema nodosum

2) Erythema induratum

3) Erythema multiforme

4) Erythema infectiosum

Ans C

Q.121. All are 160 kDa family of co-activators EXCEPT

1) Steroid receptor coactivator I

2) CREB binding protein

3) Activator of the thyroid & retinoic acid receptor

4) Glucocorticoid receptor interacting protein I

Ans B

Nuclear hormone receptors (NRs) activate transcription by binding to specific enhancer elements associated with target genes. Transcriptional activation is accomplished with the help of complexes of co-activator proteins that bind to NRs. p160 co-activators, a family of three related 160 kDa proteins, serve as primary co-activators by binding directly to NRs and recruiting additional secondary co-activators. Some of these (CBP/p300 and p/CAF) can acetylate histones and other proteins in the transcription complex, thus helping to modify chromatin structure and form an active transcription initiation complex

Q.122. To reach the tunica vaginalis in the scrotum, all the following structures have to be pierced by a needle EXCEPT

1) Dartos muscle

2) Skin

3) Tunica albuginea

4) Cremasteric fascia

Ans C

Tunica albuginea may refer to:

Tunica albuginea (penis), the tough fibrous layer of connective tissue that surrounds the corpora cavernosa of the penis

Tunica albuginea (testicles), a layer of connective tissue covering the testicles

Tunica albuginea (ovaries), the connective tissue covering of the ovaries

Q.123. Plaster of Paris is hemihydrated

1) Calcium citrate

2) Calcium phosphate

3) Calcium sulfate

4) Calcium carbonate

Ans C

the hemihydrate (CaSO4•~0.5H2O) is better known as plaster of Paris, while the dihydrate (CaSO4•2H2O) occurs naturally as gypsum. The anhydrous form occurs naturally as β-anhydrite. Depending on the method of calcination of calcium sulfate dihydrate, specific hemihydrates are sometimes distinguished: alpha-hemihydrate and beta-hemihydrate.[7] They appear to differ only in crystal shape

Q.124.Identify the crystals depicted in urine microscopy.

1) Uric acid crystals

2) Struvite crystals

3) Oxalate crystals

4) Cystine crystals

Ans a
Struvite crystals (magnesium ammonium phosphate, triple phosphate) usually appear as colorless, 3-dimensional, prism-like crystals (“coffin lids”). Occasionally, they instead resemble (vaguely) an old-fashioned double-edged razor blade (lower frame).

Q.125. Which of the following is not a Mullerian anomaly?

1) Imperforate hymen

2) Septate uterus

3) DES related uterine anomaly

4) Arcuate uterus

Ans A

What types of müllerian anomalies exist?

There are several different forms of müllerian anomalies ranging from the absence of a uterus to the formation of a half uterus or a double uterus to a uterus divided by a septum. All types affect the reproductive tract in varying degrees. They include:

Agenesis & hypoplasia: Mayer-Rokitansky-Kuster-Hauser syndrome is most common. All or part of the müllerian tract fails to form, or is extremely underdeveloped.

Unicornuate uterus (UU): When one müllerian duct is underdeveloped or fails to develop, a banana-shaped half-uterus is formed. A missing kidney or other kidney problems accompany this asymmetric anomaly more than they do other müllerian anomalies. This is a rare condition.

Uterus didelphys (UD): Commonly referred to as a ‘double uterus’. There may be complete duplication of the vagina, cervix and uterus, and the two halves may be divided by a ligament of connective tissue. UD is has the best pregnancy outcomes of all the MAs.

Bicornuate uterus (BU): This is the most common form of müllerian nomaly. Described as a womb with two horns. The womb is not pear-shaped, instead it is shaped like a heart, with a deep indentation at the top. This means that the baby has less space to grow than in a normally shaped womb.

Septate uterus: Occurs when the inside of the uterus is divided by a wall or the septum. The septum may extend only part way into the uterus or it may reach as far as the cervix.

DES-related uterus: A T-shaped uterine cavity, dilated horns and malformed cervix and upper vagina may characterize this anomaly. A T-shaped uterus is sometimes caused by maternal ingestion of DES, although sometimes the cause is unknown.

Arcuate uterus (AU): The fundus of the uterus may be indented slightly both inside and outside. The shape is so slight that it is considered a variation of normal.

 

Q.126. Among the clinical signs of pregnancy in the first trimester, Goodell’s sign refers to

1) Dusky hue of the vaginal walls at 8th wk of gestation

2) Increased pulsations felt through the lateral fornices at 8th week of gestation

3) Regular & rhythmic uterine contractions during bimanual palpation as early s 4-8 wks

4) Softening of cervix as early as 6 wks

Ans D

Q.127. Which one of the following is considered as Reference Protein

1) Milk

2) Egg

3) Meat

4) Fish

Ans B

The nutritional value of eggs lies chiefly in their providing proteins of good biological value; an average-sized egg (60 g) provides approximately 7 g of proteins, these proteins are rich in essential amino acids, with a very good balance between those amino acids, so that egg protein can be regarded as a reference protein. To exemplify, 2 eggs provide as much protein as 100 g of meat or 100 g of fish. 

The energy value for an average egg (60 g) is approximately 376 kJ (90 kcal). The lipid content is 7 g, most of those lipids being contained in the yolk. 2/3 of the fatty acids are unsaturated. An egg also contains 180 mg of cholesterol. An egg is rich in vitamins (A, D, E) and trace elements (iron and zinc).

Q.128. Mid Systolic Click is classically heard in

1) Hamman – Rich syndrome

2) Congenital MS

3) Rheumatic aortic regurgitation

4) Mitral valve prolapse

Ans D

Q.129. Which mechanism in phototherapy is chiefly responsible for reduction in serum bilirubin?

1) Structural isomerisation

2) conjugation

3) Photooxidation

4) Geometric Photoisomerisation

Ans D was given by Board

This was AIIMS May 2005 MCQ

Phototherapy is effective because 3 reactions can occur when bilirubin is exposed to light, as follows:

Initially, photooxidation was believed to be responsible for the beneficial effect of phototherapy. However, although bilirubin is bleached through the action of light, the process is slow and is now believed to contribute only minimally to the therapeutic effect of phototherapy.

Configurational isomerization is a very rapid process that changes some of the predominant 4Z,15Z bilirubin isomers to water-soluble isomers in which one or both of the intramolecular bonds are opened (E,Z; Z,E; or E,E). In human infants, the 4Z,15E isomer predominates, and, at equilibrium conditions, the isomer constitutes about 20-25% of circulating bilirubin after a few hours of phototherapy.[27] This proportion is not significantly influenced by the intensity of light. Data have shown that formation of photoisomers is significant after as little as 15 minutes of phototherapy.[27] Recent studies suggest that the initial rate of isomerization is inversely related to the hemoglobin level (Mreihil K et al, unpublished data). ear in mind when initiating phototherapy that lowering of the total serum bilirubin concentration may be only part of the therapeutic benefit. Because photoisomers, by virtue of their water-soluble nature, should not be able to cross the blood-brain barrier, phototherapy may reduce the risk of bilirubin-induced neurotoxicity as soon as the lights are turned on. At any given total serum bilirubin concentration, the presence of 20-25% of photoisomers means that only 75-80% of the total bilirubin may be present in a form that can enter the brain.

Structural isomerization consists of intramolecular cyclization, resulting in the formation of lumirubin. This process is enhanced by increasing the intensity of light. During phototherapy, lumirubin may constitute 2-6% of the total serum bilirubin concentration.

Q.130. In renal biopsy of a 14 year old boy with nephritic syndrome, glomeruli are showing proliferation of mesangial cells with GBM thickening and mesangial cell interposition. What is the most likely diagnosis in this case?

1) Membranous Nephropathy

2) Focal segmental glomerulosclerosis

3) Diffuse proliferative glomerulonephritis

4) Mesangiocapillary glomerulonepthritis

Ans D

MPGN Type 1

● Large glomeruli with accentuation of lobules
● Irregular thickening of glomerular basement membrane by interposition of mesangial cells between endothelium and basement membrane
● Causes tram track / double contour appearance (PAS or silver stain), crescents in 20%
● Neutrophils often present
● May have hyaline aggregates of immune complexes in capillary lumina

Q.131. Infraorbital nerve is injured commonly in

1) Mandibular fracture

2) Blow out fracture of orbit

3) Le Fort III fracture

4) Le Fort I fracture

Ans B

Q.132. Third person auditory hallucinations and delusions of thought interference / broadcasting are characteristic of

1) Delirium tremens

2) Fragile X syndrome

3) Manic phase of MDP

4) Schizophrenia

Ans D
Third person hallucinations are auditory hallucinations in which patients hear voices talking about themselves, referring to them in the third person, for example “he is an evil person”.

This type of auditory hallucination is particularly associated with schizophrenia, but can occur in affective disorders. Such voices may be experienced as commenting on the patient’s intended actions – “he wants to kill her”, or describing his current actions – “he is trying to sleep now”. A running commentary by voices is most suggestive of schizophrenia

Q.133. What does the intraoperative photograph above depict?

1) Intussusception

2) Transverse colon

3) Meckel’s diverticulum

4) Fallopian tube

Ans C
Famous wrong answer b

Q.134. All the following are True regarding FAST — EXCEPT

1) It is a focused abdominal sonar for trauma

2) It detects free fluid in the abdomen or pericardium

3) It is accurate in detecting < 50ml. of free blood

4) It cannot reliably exclude injury in penetrating trauma

Ans C

Focused Abdominal Sonography for Trauma (FAST)

FAST is accurate at detecting>100 mL of free blood; however, it is very operator and experience~dependent

Q.135. Commonest congenital anomaly seen in Pre-gestational Diabetes is

1) Caudal regression syndrome

2) Duodenal atresia

3) Meningimyelocoele

4) Renal atresia

Ans A

Q.136. Select the FALSE statement regarding the disease depicted in the picture above?

1) There is muscle atrophy and resultant hypotonia

2) Loss of fat from sucking pads of the cheeks is the earliest sign

3) This is nonedematous severe childhood undernutrition

4) Besan panjiri is an energy dense food used in treatment

Ans B

A diet chart was provided using home-based energy dense foods like besan-panjiri, khichdi, parantha enriching them with jaggery and oil

anagement of mild to moderate degree of malnutrition :

Management of mild to moderate degree of malnutrition This is usually done with the help of protein and calorie rich diets.

Besan Panjiri :

o Besan Panjiri Contents – Bengal gram flour, Wheat flour, Jaggery, Ghee (1 part each). Calories: 500 calorie/100gm. Protein: 9gm/100gm.

Shakti aahar :

o Shakti aahar Constituents: Roasted wheat 40gm, Roasted gram 20gm, Roasted peanuts 10gm, Jaggery 30gm. Calories: 390 calories/100gm. Protein: 11.4gm/100gm.

Hyderabad Mix :

o Hyderabad Mix Constituents: Whole wheat 40gm, Bengal gram 16gm, Groundnuts 10gm, Jaggery 20gm. Calories: 330 calories/86gm. Protein: 11.3gm/86gm.

Q.137. The earliest radiological sign in Pott’s disease is

1) Collapse & destruction of vertebra

2) Paraspinal soft tissue shadow

3) Erosion of vertebral bodies

4) Narrowing of intervertebral disc space

Ans D

Q.138. The following organisms are indicative of fecal pollution of water EXCEPT

1) E.coli

2) Clostridium perfringens

3) Halophilic vibrio

4) Fecal Streptococi

Ans C

 

Q.139. Cystic spaces lined by double layer of neoplastic epithelial cells resting on dense lymphoid tissue is a feature of

1) Hashimotoís thyroiditis

2) Warthin tumor

3) Aneurysmal bone cyst

4) Dermoid cyst

Ans B

Warthin’s tumor – papillary fronts with lymphoid tissue surrounded by double layer of neoplastic epithelial cells (very pink ones = oncocytes)

Q.140. Balkan nephropathy is possibly caused by

1) Aristolochic Acid

2) Fungal toxin

3) Calcineurin inhibitors

4) Lead

Ans A
Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial disease associated with a high frequency of urothelial atypia, occasionally culminating in tumors of the renal pelvis and urethra.

Affected patients most commonly reside in southeastern Europe, including the areas traditionally considered to comprise the Balkans: Serbia, Bosnia and Herzegovina, Croatia, Romania, and Bulgaria. More specifically, BEN is most likely to occur among those living along the confluence of the Danube River, a region in which the plains and low hills generally have high humidity and rainfall. The most likely cause of BEN is exposure to aristolochic acid (AA). In contrast to the classic presentation of AA nephropathy, which is characterized by a rapid decline in renal function (six months to two years), BEN is slowly progressive (10 to 20 years), however, likely due to low-level exposure.

Q.141. Extension of metacarpophalangeal joint of the hand is lost in injury to

1) Posterior interosseous nerve

2) Anterior interosseous nerve

3) Ulnar nerve

4) Median nerve

Ans A

Muscles which produce MCP joint extension

. Thumb: Extensor Pollicis Brevis and Extensor Pollicis Longus

. Index: Extensor Indicis

. Index, middle, ring and small: Extensor Digitorum Communis

. Small: Extensor Digiti Minimi

Q.142 Select the TRUE statement among the following

1) Roentgen is a measure of effective dose (energy deposited per unit of mass in a referneced individual)

2) Gray is a measure of exposure (amount of ionisations in dry air per unit of mass)

3) Becquerel is a measure of activity (the rate of radioactive decay)

4) Sievert is a measure of absorbed dose (energy deposited per mass of tissue)

Ans C
Sievert

The Sievert is a derived unit of ionizing radiation dose in the International System of Units (SI). It is a measure of the health effect of low levels of ionizing radiation on the human body. Quantities that are measured in sieverts are intended to represent the stochastic health risk, which for radiation dose assessment is defined as the probability of cancer induction and genetic damage.

The sievert is used for radiation dose quantities such as equivalent dose, effective dose, and committed dose. It is used both to represent the risk of the effect of external radiation from sources outside the body, and the effect of internal irradiation due to inhaled or ingested radioactive substances.

Grey

A unit used to measure the energy absorbed from radiation. One gray is equal to one joule per kilogram, or 100 rads

The roentgen is a unit for measuring exposure. It is defined only for effect on air

Q.143 The following are True regarding treatment of HIVAIDS EXCEPT

1) Efavirenz is used in the first trimester to prevent HIV transmission to the fetus

2) Raltegravir is an inhibitor of viral enzyme integrase

3) Zidovudine & stavudine are associated with lipodystrophy syndrome

4) Commonest toxicity with didanosine is a painful peripheral sensory neuropathy

Ans a
Current US guidelines recommend that pregnant women not use efavirenz during the first trimester of pregnancy.

Q.144 A middle aged male patient came with history of progressive night blindness followed by decreased vision since childhood. Now he has tubular vision. Retinal examination revealed jet black , spidery spots like bone corpuscles. Which of the following statements is True?

1) The diagnosis is retinitis pigmentosa

2) The retinal changes typically start at the posterior pole and spread anteriorly

3) Most commonly inherited as x-linked recessive

4) Papilledema occurs in later stages

Ans A

Q.145.Which is the most striking and specific test to diagnose amyloid in tissue?

1) Congo red + polarized microscopy

2) Methyl violet stain

3) Congo red stain + light microscopy

4) Toluidine stain

Ans A

Congo red using this protocol; the image is captured in cross polarised light and shows the bright green colour of the birefringent amyloid deposits.

Q.146. Which one of the following is NOT associated with microcytic hypochromic anemia?

1) Iron deficiency

2) Chronic lead poisoning

3) Hereditary Spherocytosis

4) Thalassemia

Ans c

Q.147.What is the most likely diagnosis of the picture above?

1) Noonan’s syndrome

2) Williams syndrome

3) Down’s syndrome

4) Pierre-Robin syndrome

Ans D
Pierre Robin syndrome (abbreviated to PRS, and also known as Pierre Robin malformation, Pierre Robin sequence, Pierre Robin anomaly or Pierre Robin anomalad), is a congenital condition of facial abnormalities in humans. PRS is a sequence, i.e. a chain of certain developmental malformations, one entailing the next. The 3 main features are cleft palate, retrognathia (abnormal positioning of the jaw or maxilla) and glossoptosis (airway obstruction caused by backwards displacement of the tongue base). A genetic cause to PRS was recently identified. Pierre Robin sequence may be caused by genetic anomalies at chromosomes 2, 11, or 17

Q.148. A patient was admitted with a history of severe vomiting. The following is his arterial blood gas report ñ

arterial blood pH = 7.7

plasma bicarbonate = 45 meq/ li.

Urinary chloride = 5 meq / li.

Which of the following statements is True regarding this patient?

1) This is saline unresponsive alkalosis

2) Patient needs urgent ammonium chloride infusion

3) Possible diagnosis is primary hyperaldosteronism

4) Patient should be given IV normal saline

Ans D
The causes of metabolic alkalosis can be divided into two categories, depending upon urine chloride levels.

Chloride-responsive (Urine chloride < 20 mEq/L)

Loss of hydrogen ions – Most often occurs via two mechanisms, either vomiting or via the kidney.

Vomiting results in the loss of hydrochloric acid (hydrogen and chloride ions) with the stomach contents. In the hospital setting this can commonly occur from nasogastric suction tubes.

Severe vomiting also causes loss of potassium (hypokalaemia) and sodium (hyponatremia). The kidneys compensate for these losses by retaining sodium in the collecting ducts at the expense of hydrogen ions (sparing sodium/potassium pumps to prevent further loss of potassium), leading to metabolic alkalosis.[2]

Congenital chloride diarrhea – rare for being a diarrhea that causes alkalosis instead of acidosis.

Contraction alkalosis – This results from a loss of water in the extracellular space which is poor in bicarbonate, typically from diuretic use. Since water is lost while bicarbonate is retained, the increased concentration of bicarbonate “mops up” more of the hydrogen ions and raises the blood pH.

Diuretic therapy – loop diuretics and thiazides can both initially cause increase in chloride, but once stores are depleted, urine excretion will be below < 25 mEq/L. The loss of fluid from sodium excretion causes a contraction alkalosis.

Posthypercapnia – Hypoventilation (decreased respiratory rate) causes hypercapnia (increased levels of CO2), which results in respiratory acidosis. Renal compensation with excess bicarbonate occurs to lessen the effect of the acidosis. Once carbon dioxide levels return to base line, the higher bicarbonate levels reveal themselves putting the patient into metabolic alkalosis.

Cystic Fibrosis

Chloride-resistant (Urine chloride > 20 mEq/L)[edit]

Retention of bicarbonate – retention of bicarbonate would lead to alkalosis

Shift of hydrogen ions into intracellular space – Seen in hypokalemia. Due to a low extracellular potassium concentration, potassium shifts out of the cells. In order to maintain electrical neutrality, hydrogen shifts into the cells, raising blood pH.

Alkalotic agents – Alkalotic agents, such as bicarbonate (administrated in cases of peptic ulcer or hyperacidity) or antacids, administered in excess can lead to an alkalosis.

Hyperaldosteronism – Renal loss of hydrogen ions occurs when excess aldosterone (Conn’s syndrome) increases the activity of a sodium-hydrogen exchange protein in the kidney. This increases the retention of sodium ions whilst pumping hydrogen ions into the renal tubule. Excess sodium increases extracellular volume and the loss of hydrogen ions creates a metabolic alkalosis. Later, the kidney responds through the aldosterone escape to excrete sodium and chloride in urine.[3]

Excess Glycyrrhizin consumption

Bartter syndrome and Gitelman syndrome – syndromes with presentations analogous to taking diuretics characterized with normotensive patients

Liddle syndrome – a syndrome from defect sodium channel deletion characterized by hypertension and hypoaldosteronism.

11β-hydroxylase deficiency and 17α-hydroxylase deficiency – both characterized by hypertension

Aminoglycoside toxicity can induce a hypokalemic metabolic alkalosis via activating the calcium sensing receptor in the thick ascending limb of the nephron, inactivating the NKCC2 cotransporter, creating a Bartter’s syndrome like effect.

 

Q.149. In studying the association between disease and exposure factor, a study design which allows the study of multiple outcomes for a given exposure is

1) Ecological study

2) Cohort study

3) Case control study

4) Cross sectional study

Ans B

Q.150. Which of the following statements is True regarding Tibalone used in Hormone replacement therapy

1) It causes endometrial atrophy

2) Does not prevent hot flushes

3) Recommended dose is 25mg /day

4) It is a nonsteroidal drug

Ans A

Tibolone is a synthetic steroid hormone drug, which is fairly non-selective in its binding profile, acting as an agonist mainly at estrogen receptors, with a preference for ER alpha.

. It is used mainly for treatment of endometriosis, as well as hormone replacement therapy in post-menopausal women.

. Tibolone has similar or greater efficacy compared to older hormone replacement drugs, but shares a similar side effect profile

. It has also been investigated as a possible treatment for female sexual dysfunction

Q.151 Which one of the following Cerebral Blood Flow patterns is likely in a patient with Huntingtonís disease

1) Hyperemia to basal ganglia with reduced flow to other areas in brain

2) Bilateral reduction in blood flow to caudate nucleus

3) Decreased blood flow to temporal lobes

4) Bilateral reduction in blood flow starting from occipital cortex and spreading anteriorly

Ans B

baseline single photon emission computed tomography (SPECT) shows reduced perfusion in the left parietal and temporal cortice

Q.152. This patient came with chronic productive cough and clubbing and coarse rales. What is the diagnosis of the CT scan above?

1) Miliary tuberculosis

2) Interstitial fibrosis

3) Bilateral sacular bronchiectasis

4) Multiple cavitating secondaries

Ans C

 

Q.153. The following statements are True regarding keratoconjunctivitis sicca (dry eyes) EXCEPT

1) Topical 3% sodium chloride solution is an effective treatment

2) Seen in Sjogrenís syndrome

3) It can be a hereditary disorder

4) Can occur in vitamin A deficiency

Ans A

 

Q.154. A 60 year old male patient who is a known diabetic, has come with choreoathetosis. He also has skin hyperpigmentation and restrictive cardiomyopathy. All of the following investigations will help in establishing the diagnosis EXCEPT

1) Genetic testing for C282Y mutation

2) Ultrasounography (abdominal & cardiac)

3) Transferrin saturation

4) Liver biopsy and hepatic iron index

Ans B
Examination of HFE mutations is pivotal for diagnosis of hemochromatosis; the discovery of the HFE gene allows easy differentiation of hereditary hemochromatosis from other forms of hepatic iron overload, including dysmetabolic hepatosiderosis. Liver biopsy and histologic evaluation of tissue iron accumulation was believed to be the criterion standard for diagnosis of hereditary hemochromatosis until testing of the HFE gene was introduce

Transferrin saturation corresponds to the ratio of serum iron and total iron-binding capacity (TIBC). The screening threshold for hemochromatosis is a fasting transferrin saturation of 45-50%. If transferrin saturation is greater than 45%, the presence of the C282Y or H63D mutation may be evaluated to confirm the diagnosis of hemochromatosis.

Hemochromatosis is suggested by a persistently elevated transferrin saturation in the absence of other causes of iron overload. This is the initial test of choice. However, similar to iron studies, transferrin saturation is influenced by liver disease (other than hemochromatosis) and inflammation; therefore, it has limitations in the diagnostic workup.

High transferrin saturation is the earliest evidence of hemochromatosis; a value greater than 60% in men and 50% in women is highly specific. However, approximately 30% of women younger than 30 years who have hemochromatosis do not have elevated transferrin saturation

Genetic tests for the C282Y and H63D mutations are widely available. Detection of hemochromatosis-associated mutations is conducted to confirm the diagnosis or to discover asymptomatic patients.

Liver biopsy with biochemical determination of hepatic iron concentration and calculation of the hepatic iron index (HII) as well as histologic evaluation with iron staining (Perls Prussian blue) was previously considered the criterion standard for diagnosis. The HII is calculated by dividing body weight in pounds by the hepatic iron concentration (HIC) in micromoles per gram of dry weight. An HII of greater than 1.9 can accurately differentiate homozygous hemochromatosis from heterozygous hemochromatosis, alcoholism, and normal controls. When the HII is 1.5-1.9, the diagnosis of hemochromatosis is equivocal.

Q.155 Which one of the following is a Gram negative fusiform gliding bacillus?

1) Kingella

2) Moraxella

3) Eikinella

4) Capnocytophaga

Ans D
These organismsaregramnegative,fusiform,capno- philic,saccharolytic,catalaseandoxidasenega- tive, and surface translocating (gliding).

Q.156. Which one of the following is NOT correct regarding thick ascending limb of Loop of Henle

1) It has Na+ -K+-2Cl- co transporters

2) It has important role in development of medullary hyperosmolarity

3) It is responsible for reabsorbtion of nearly 30% of filtered sodium

4) Thiazide diuretics act on this segment

Ans D
Without MCQ on Nephron physiology – No APPG

The members of this class of diuretics are derived from benzothiadiazine. They control hypertension in part by inhibiting reabsorption of sodium (Na+) and chloride (Cl−) ions from the distal convoluted tubules in the kidneys by blocking the thiazide-sensitive Na+-Cl− symporter

Q.157. The following are True regarding Carcinoma Cervix EXCEPT

1) HIV infection & smoking are risk factors

2) commonest histological type is adenocarcinoma

3) untreated, more than 50% of patients die due to obstructive uropathy

4) Etiologically related to infection with HPV, primarily types 16 & 18

Ans B

Q.158.

1) pqr = xyz

2) pqr = xzy

3) pqr = zxy

4) pqr = yzx

Ans C

Q.159. Politzerization refers to

1) Eustachean catheterisation with a micro catheter for aspiration and inflation of middle ear

2) Autoinflation by Valsalva’s maneuvre

3) Inflation in the nostril with an olivary nozzle while the patient sips water

4) Puncture of tympanic membrane

Ans C

Politzerization, also called the Politzer maneuver or method, is a medical procedure that involves inflating the middle ear by blowing air up the nose during the act of swallowing. It is often performed to reopen the Eustachian tube and equalise pressure in the sinuses.

Q.160. A 3 week female infant is brought for ambiguous genitalia and hyperpigmentation of skin. She has hyponatremia and hypokalemia. Which one of the following is the most likely diagnosis?

1) 17,20 lyase deficiency

2) 17 alpha hydroxylase deficiency

3) 11 beta hydroxylase deficiency

4) 21 hydroxylase deficiency

Ans D
Hyperkalemia should be there not Hypokalemia

Clinical presentation in females

Females with severe CAH due to deficiencies of 21-hydroxylase, 11-beta-hydroxylase, or 3-beta-hydroxysteroid dehydrogenase have ambiguous genitalia at birth (classic virilizing adrenal hyperplasia); genital anomalies range from complete fusion of the labioscrotal folds and a phallic urethra to clitoromegaly, partial fusion of the labioscrotal folds, or both

Females with mild 21-hydroxylase deficiency are identified later in childhood because of precocious pubic hair, clitoromegaly, or both, often accompanied by accelerated growth and skeletal maturation (simple virilizing adrenal hyperplasia)

Females with still milder deficiencies of 21-hydroxylase or 3-beta-hydroxysteroid dehydrogenase activity may present in adolescence or adulthood with oligomenorrhea, hirsutism, and/or infertility (nonclassic adrenal hyperplasia)[2]

Females with 17-hydroxylase deficiency appear phenotypically female at birth but do not develop breasts or menstruate in adolescence; they may present with hypertension

Clinical presentation in males

Males with 21-hydroxylase deficiency have normal genitalia

If the defect is severe and results in salt wasting, these male neonates present at age 1-4 weeks with failure to thrive, recurrent vomiting, dehydration, hypotension, hyponatremia, hyperkalemia, and shock (classic salt-wasting adrenal hyperplasia)

Males with less severe deficiencies of 21-hydroxylase present later in childhood with early development of pubic hair, phallic enlargement, or both, accompanied by accelerated linear growth and advancement of skeletal maturation (simple virilizing adrenal hyperplasia)

Males with steroidogenic acute regulatory (StAR) deficiency, classic 3-beta-hydroxysteroid dehydrogenase deficiency, or 17-hydroxylase deficiency generally have ambiguous genitalia or female genitalia; they may be raised as girls and seek medical attention later in life because of hypertension or a lack of breast development