AIIMS NOV 2011 Ebook Nitro

REVISED AIIMS NOV 2011 eBOOK
November 13, 2011

BY. DR. PAWAN KUMAR MBBS(RIMS)
1
st
Ebook on RxPG for AIIMS NOV 2011
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1. In acute inflammation endothelial cells
retraction due to cytoskeleton re-organisation
causes
a. Immediate transient increase in permeability
b. Delayed transient increase in permeability ANS
c. Early permanent increase in permeability
d. Late permanent increase in permeability
2. Which of the following has LEAST chance of
progression to multiple sclerosis
a. Optic nerve involvement
b. Absence of oligoclonal antibodies in CSF(speed) dams
c. Truncal ataxia
d. Pyramidal involvement
ans---b
Although the prognosis in an individual is difficult to establish, certain clinical features suggest a more favorable prognosis. These include
ON or sensory symptoms at onset, fewer than two relapses in the first year of illness, and minimal impairment after 5 years. By contrast,
patients with truncal ataxia, action tremor, pyramidal symptoms, or a progressive disease course are more likely to become disabled.
Still to confirm regarding oligoclonal antibodies
3. Which of the following therapy does not
penetrate deep tissue?
a. Short wave diathermy
b.Microwave
c. Infrared ans
d.Ultrasound
4. A female patient was on hemodialysis
developed carpel tunnel. It was found to be due
to
amyloidosis. What is the type of amyloid form
synovial fluid?
a. AA
b. AL
c. Beta2 microglobulin ANS
d. AL and AA
5. Which is not a feature of SIADH ?
a. Increase urinary sodium excretion
b. Urinary osmolality > plasma osmolality
c. Hypokalemia
d. Dilutional hyponatremia
ref ans C , refer MUDIT KHANNA 4 ed ,page 678
6. All are true regarding SIADH except
a.Serum Na can be as low as 125
b. Serum sodium is normal or slightly low
c. Vaptans are new FDA approved drugs for its
treatment
d. Urine sodium is normal or slightly low
Correct answer : D. Urine sodium is normal or slightly low
In SIADH, serum Na is decreased, urine sodium is increased. Vaptans act by inhibiting the action of vasopressin on its receptors (V1A, V1B and V2).
Water loading test:
If SIADH is suspected in a patient with mild hyponatremeia, a water loading test can be performed to confirm the diagnosis.
Ref: Tietzs applied laboratory medicine, Volume 564 By Mitchell G. Scott, Norbert W. Tietz, Ann M. Gronowski, Charles S. Eby (via google books)
7. Flaying is seen in what type of lacerated wound ?
A. Tear and split
B. Shearing force
C. Avulsion
D. Stretch
Correct answer : Avulsion
The grinding compression by a weight such as a wheel of a heavy vehicle or some heavt part of machinery passing over the limb may produce avulsion of the skin and subcutaneous tissues form
the underlying structures (shearing lacerations). Commonly seen in traffic accidents where the rotating force of a wheel tears off the skin over the relatively large area. This is sometimes termed
as flaying and most frequently occurs in legs where a heavy vehicle passes over the body that has already been knocked to the ground.
Ref: Textbook of Forensic Medicine and Toxicology : Principles and Practice, 5/e By Krishan Vij, p221 (via Google books)
Flaying is the removal of skin from the body. An animal may be flayed in preparation for human consumption, or for its hide or fur; this is more commonly called skinning. Flaying of humans is used
as a method of torture or execution, depending on how much of the skin is removed. (Wikipedia article on flaying)
8. Most common cause of Addisons disease in
India is
a.Tuberculosis
b. Post partum
c. Autoimmune
d. HIV
Primary adrenal insufficiency or Addison disease is a rare endocrine disorder first described by Thomas Addison in 1855. It has a prevalence of 1 in 100,000
with no particular sex predilection [1]. In contrast to developed countries where it most commonly results from autoimmune adrenalitis, in our region
tuberculosis plays an important role in its etiology [2]. It is characterized by gradual onset of fatigue, anorexia, weight loss, muscle weakness, and
hypotension. Nausea, vomiting, and diffuse abdominal pain when present are signs of impending addisonian crisis
9. If air is inspired forcefully maintenance of
tidal volume is by?
a. Bronchial stretch receptors dams
b. J receptors
c. Carotid/aortic body
d. Hering breuer reflex
10. Regarding LDL receptor all are true except.
a. Clathrin coated receptor on cell membrane
b. Present only in extrahepatic tissues/ Only
present in peripheral organs
c. . LDL is taken by endocytosis
d. Increased cellular chloesterol downregulates
the receptors
11. Criteria for chloroquine retinopathy are all
Except
a.Mild stippling or mottling in the macular
pigmentation
b. Seen at a dose of >250mg/d or >3mg/kg (speed)
c. >480g total dose
d. duration of use >2years dams
if
1.>age 60yrs
2.duraration >5yrs
3.>6.5mg/kg/day hydroxychloroquine. >3mg/kg/day chloroquine
4.renal ds
12. Investigation of choice for meningial
carcinamatosis?
a. Non contrast CT
b. Contrast MRI
c. SPECT
d. PET
Correct answer : B. Contrast MRI
Ref: Harrison, 18th ed
Leptomeningeal metastases are particularly challenging to diagnose as identification of tumor cells in the subarachnoid compartment may be elusive. MR imaging can be definitive in patients when
there are clear tumor nodules adherent to the cauda equina or spinal cord, enhancing cranial nerves, or subarachnoid enhancement on brain imaging. Imaging is diagnostic in approximately
75% of patients and is more often positive in patients with solid tumors.
(An image given with the above paragraph in Harrison shows Postgadolinium MRI images of extensive leptomeningeal metastases from breast cancer.)
13. A patient presents with recurrent sinusitis,
situs inversus and dextrocardia. Most
probable diagnosis is
a. Kartgeners syndrome ans
b. Horners Syndrome
c. Beckwith-Wiedemann syndrome
d. Brown-Squard syndrome
14. Mean arterial pressure is
a. (3DBP + SBP)/2
b. (DBP +SBP)/2
c. (SBP + PP)/3
d. (2DBP + SBP)/3 ans
15. Investigation of choice for Zenkers
diverticulum
a. Barium swallow ans
b. Oesophageal manometry
c. 24hr ph monitoring.
d. Endoscopy /MRI
It is a pulsion diverticulum caused by herniation of the oesophageal mucosa posteriorly between the cricopharyngeus muscle and the inferior pharyngeal
constrictor muscles.
Barium swallow is the investigation of choice
Ref http://www.gastrotraining.com/educational/learning-modules/oesophagus/zenker-diverticulum
16. During starvation gluconeogenesis is
dependent on?
a. Alanine ans
b.Beta oxidation of fatty acid
c.ADP
d. ATP
17. Increased level of alanine in serum after
fasting suggests :
a. Increased muscle breakdown ans
b. Reduced amino acid utilization from
gluconeogenesis
c. Break in continuity of plasma membrane so
amino acids leaking out..
d. Not Recalled
ANS-A
Gluconeogenesis
* The major aim of protein catabolism during a state of starvation is to provide the glucogenic amino acids (especially alanine and
glutamine)
* In the hypometabolic/starved state, protein breakdown for gluconeogenesis is minimized, especially as ketones derived from fatty
acids become the substrate preferred by certain tissues.
* In the hypermetabolic/stress state, gluconeogenesis increases dramatically
18. What is the probable diagnosis in a patient
with a dilated pupil not responsive to 1%
pilocarpine?
a. Diabetic 3rd nerve palsy
b. Adies tonic pupil
c. Uncal herniation
d. Pharmacological block ans
All except D affect the 3rd nerve. But when pilocarpine is instilled, it acts directly on the muscarinic receptor (M3) found on the iris sphincter muscle, causing the muscle to contract and engage in
miosis. If miosis does not occur with pilocarpine, it indicates that the muscarinic receptor on the the iris sphincter muscle is blocked hence pharmacologic blockade is
19. Dilator pupillae is supplied by
a. Post ganglionic parasympathetic edinger
wesphal
b. Post ganglionic sympathetic around ICA ans
c. Occulomotor
d. Trigeminal
Ref
http://books.google.co.in/books?id=5KeMFEE1s0AC&pg=PA303&lpg=PA303&dq=Dilator+pupillae+is+supplied+by&source=bl&ots=I1ECWgicel&sig=za4rk_a
gC602cFXyunRPRW8I0E0&hl=en&ei=xsTfTrjjO6eRiQf449WfBQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEMQ6AEwBA#v=snippet&q=dilator%20
pupilae%20supply%20by&f=false
20. Calcification around Foramen of Monro,
with periventricular infiltrate, raised
intracranial tension mass and below 3rd
ventricle is seen in?
a. Ependymoma
b. Sub ependydomal- giantcell astrocytoma (speed) dams
c. Neuronal-cyst
d. Central neurocytoma
21. All of the following occur in Herpes zoster
keratitis except?
a. Pseudodendritic keratitis
b. Anterior stromal keratitis
c. Sclero keratitis dams
d. Endothelitis
Correct answer : B. Anterior endothelial keratitis
Frequency of various corneal changes in Herpes Zoster Ophthalmicus:
Punctate epithelial keratitis 50%
Pseudodendritic keratitis 50%
Anterior stromal keratitis 40%
Keeratouveitis / endothelitis 34%
Serpiginous ulceration 7%
Sclerokeratitis 1%
Corneal mucous plaques 13%
Disciform keratitis 10%
Neurotrophic keratopathy 25%
Exposure keratopathy 11%
Interstitial keratitis / lipid keratopathy 15%
Permanent corneal edema 5%
Ref: Cornea, Volume 1 By Edward J. Holland (via google books)
You can search google for Anterior endothelial keratitis herpes zoster and the only results you will get are those from AIIMS recall websites!
22. In India, syndromic management is
applicable for?
a. Chancroid and chancre
b. Chancroid and herpes genitalis
c. Chancroid, chancre, herpes genitalis ans
d. Chancre and herpes genitalis
Correct answer : C. Chancroid, herpes and primary chancre
Ref: Park, 20th p292
According to the various flowcharts provided, syndromic approach is used for:
Urethral discharge Gonorrhoea / chlamydia
Genital ulcer Herpes / syphilis / chancroid
Vaginal discharge Trichomoniasis / bacterial vaginosis / candidiasis / gonorrhoea / chlamydia
Enlarged painful inguinal lymph nodes lymphogranuloma venereum / genital ulcer algorithm
23. A man presents with a 6 month history of
recurrent oral ulceration. He has yellowish
ulcerations on his lip which are erythematous,
with a central halo and nodular lesions
on his shin. Diagnosis is :
a. Behcet's syndrome
b. Herpes labialis
c. Fixed drug eruption
d. Pemphigus
24. NESTROFT test is used in?
a. Thalassemia ans
b. Autoimmune hemolytic anemia
C. Spherocytosis
d. Sickle cell disease
Objective: To evaluate the efficacy of NESTROFT (Naked Eye Single Tube Red Cell Osmotic. Fragility Test) as a screening tool for detection
of beta thalassemia
NESTROFT as a screening test for the detection of thalassaemia & common haemoglobinopathies
25. Which of the following does not occur in a
child exposed to cold climate?
a. Shivering
b. Flexion of body like a fetus
c. Cutaneous vasoconstriction
d. Production of noradrenalilne to release
energy from brown adipose tissue
(Repeat question AIIMS Nov 06 AA q123)
Correct answer : a) Shivering
http://www.drpawan.webs.com
26. Socialization of medicine leads to all except :
a) Ensures complete utilization of services by all
b) Free medical care supported by state
c) Eliminates the competition among physicians in search of clients
d) Ensures social equity, universal coverage of health services
Correct answer : a) Ensures complete utilization of services by all
27. Panic disorder involves all the following except?
A. Serotonin
B. Glutamate ans
C. GABA
D. CCK-Pentagastrin
Correct answer : B. Glutamate
Intravenous administration of the cholecystokinin B receptor agonists, CCK-4 and pentagastrin, reliably and dose dependently provoke panic attacks in panic disorder patients.
Ref: Lexicon of psychiatry, neurology, and the neurosciences By Frank J. Ayd (via google books)
Neurotransmitters commonly implicated int he etiology of panic disorder include norepinephrine, serotonin and gamma aminobuyric acid.
Ref: The Corsini Encyclopedia of Psychology, Volume 3 By Irving B. Weiner, W. Edward Craighead (via google books)
28. A patient with radiologically confirmed
Reflux nephropathy develops 3+ proteinuria.
What is the most probable cause of proteinuria
in this patient?
a. Membranoproliferative glomerulonephritis
b. Focal segmental glomerulonephritis ANS
c. Membranous glomerulonephritis
d. Rapidly progressive glomerulonephritis
(Repeat question AIIMS Nov 06 q98)
Correct answer : b) Focal segmental glomerulosclerosis
29. Glomerular capillary flow all are true except
a.Glomerular oncotic pressure lower than
filtrate
b. Oncotic pressure of filtrate is same as the
systemic oncotic pressure
c. Constriction of efferent arteriole leads to
increase in blood pressure
d. Increase in filtration lead to increase in
hematocrit
30. Evidence-based medicine (EBM) all are true
EXCEPT
a.ebm depend on clinical model and decision analysis to base its recommendation dams
b. the research paper is investigated by the
tools qouted in research paper itself
to check validity
c. the opinion of medical professionals n
researchers have given a least importance
d. Evidence is formed from weak study and
poor studies
31. If a thiazide diuretic is administered, the
response in excretion seen within 24 hrs are
a.Decreased calcium, increased sodium and
potassium ans
b. Increase sodium and potassium, increase
calcium
c. Decrease potassiumand increase sodium and
calcium
d. Not Recalled
32. Which is true for octreotide
a. Stimulates growth hormone
b. Used in secretory diarrhea ans
c. Used orally
d. Contraindicated in acromegaly
Molecular structure of octreotide
(Modified repeat question AIPGME 07 MK q86 All are true regarding octreotide except? )
Correct answer : B. Used in secretory diarrhoea
Ref: KDT 5th, p217, SRB 3rd, p618
Explanation:
Octreotide is a synthetic analog of somatostatin
Inhibits secretion of : Growth hormone, Pancreatic polypeptide, VIP, 5-HT, Gastrin, Glucagon, Insulin and Cholecystokinin.
It was first synthesized in 1979
It is given parenterally subcutaneous / intravenous / intramuscular not given orally
Dose: 50 microgram as loading dose IV, 50 microgram 1 hour in 5% dextrose as maintenance dose
Uses:
In hormone secreting tumours acromegaly, carcinoid syndrome, glucoganoma, gastrinoma, WDHA (watery diarrhea, hypokalemia, and achlorhydria)
Secretory diarrhoea due to carcinoid, short bowel syndrome, AIDS, diabetes (reduces fluid secretion, slows intestinal motility)
GI fistula, pancreatic fistulas
Variceal bleeding
filtrate
hematocrit
EXCEPT
to check validity
poor studies
potassium ans
calcium
calcium
d. Not Recalled
c. Used orally
Explanation:
Uses:
Variceal bleeding
filtrate
hematocrit
EXCEPT
to check validity
poor studies
potassium ans
calcium
calcium
d. Not Recalled
c. Used orally
Explanation:
Uses:
Variceal bleeding
filtrate
hematocrit
EXCEPT
to check validity
poor studies
potassium ans
calcium
calcium
d. Not Recalled
c. Used orally
Explanation:
Uses:
Variceal bleeding
filtrate
hematocrit
EXCEPT
to check validity
poor studies
potassium ans
calcium
calcium
d. Not Recalled
c. Used orally
Explanation:
Uses:
Variceal bleeding
filtrate
hematocrit
EXCEPT
to check validity
poor studies
potassium ans
calcium
calcium
d. Not Recalled
c. Used orally
Explanation:
Uses:
Variceal bleeding
Dumping syndrome
Pancreatic surgeries
Acute pancreatitis
33. Prophylaxis with Azithromycin is given in
cases of trachoma when prevalence in a
community is:
a. 4%
b.6%
c. 8 %
d. 10% ANS
Correct answer : D. 10%
A single dose of azithromycin was offered to all residents in four communities, where trachoma prevalence was 10%. (http://www.ajtmh.org/content/85/4/691.abstract)
34. Chymotrypsinogen is a
a. Carboxypeptidase
b. Zymogen ans
c. Transaminase
d. Elastase
Hydrolase: proteases (EC 3.4)
3.4.11-19: Exopeptidase
3.4.11 Aminopeptidase (Alanine, Arginyl, Aspartyl, Cystinyl, Leucyl, Glutamyl, Methionyl (1, 2), O)
3.4.13 Dipeptidase (1, 2, 3)
3.4.14 Dipeptidyl peptidase (Cathepsin C, Dipeptidyl peptidase-4) Tripeptidyl peptidase (Tripeptidyl peptidase I, Tripeptidyl peptidase II)
3.4.15 Angiotensin-converting enzyme
3.4.16 Serine type carboxypeptidases: Cathepsin A DD-transpeptidase
3.4.17 Metallocarboxypeptidases: Carboxypeptidase (A, A2, B, C, E, Glutamate II)
Other/ungrouped Metalloexopeptidase
3.4.21-24: Endopeptidase
Serine proteases Cysteine protease Aspartic acid protease Metalloendopeptidases
Other/ungrouped: Amyloid precursor protein secretase (Alpha secretase, Beta-secretase 1, Beta-secretase 2, Gamma secretase)
3.4.99: Unknown Staphylokinase
A zymogen (or proenzyme) is an inactive enzyme precursor. A zymogen requires a biochemical change (such as a hydrolysis reaction revealing the active site, or changing the
configuration to reveal the active site) for it to become an active enzyme.
34. Marker of bone formation is all except
a. Osteocalcin
b. Alkaline phosphatase
c. Procollagen residue
d. Hydroxyproline
(Modified repeat question AIPGMEE 07 MK q260 Which is a marker of new bone formation)
Correct answer : D. Hydroxyproline
Markers of bone formation:
Serum bone specific alkaline phosphatase
Serum propeptide / type I procollagen
Serum osteocalcin
Markers of bone resorption:
Urine hydroxyproline
Serum tartarate resistant acid phosphatase
Urine and serum N-telopeptide and C-telopeptide
Urine total free deoxypyrindinoline
Serum bone sialoprotein
Urine hydroxylysine glycosides
35. A pt present with sudden b/l loss of vision
with loss of light perception. The loss is more
on right side. Pupillary reflex, optokinetic
nystagmus are normal. Pt can touch to his
finger
on closing his right eye but not on closing lt.
What is diagnosis?
a. Optic neuritis
b. Anterior ischaemic optic neuropathy
c. CMV retinitis
d. Functional visual loss ans
ef p no 307 ak khurana hysterical blindness
it is a form of psychoneurosis , commonly seen in attention seeking personalities , especially females .
it is charactersised by sudden bilateral loss of vision ( c.f . malingering ) . the patient otherwise shows little concern for the symptoms
and negotiates well with the surroundings ( c. f. malingering). there may be associated blepharospasm and lacrimation . visual fields are
concentrically conracted . one can commonly find spiral fields as the target moves closer to the fixation point . pupillary responses are
essentially normal . and so is the blibk response. optokinetic nystagmus is intact . its treatment inculdes psycological support and
reassurance.placebo tablets may be helpful. a psychiatrists help should be sought for ,if these fail.
36. Exclusively involve neurons
a. Multiple cortical / system atrophy
b. Spinocerebellar ataxia ans
c. Corticobasal degeneration
d. Supranuclear palsy
37. Which of the following is a marker for
granulosa cell tumour?
a. Alkaline phosphatase
b. Inhibin ans
c. CA 19-9
d. CA 5
38. Not true about Alzheimers disease
a.Neurofibrillary tangles correlate with the
degree of dementia
b. Tau proteins
c. Plaques increase with age
d. Extracellular lesion occur without intracellular lesion ans speed
39. Alzheimer's disease is associated with all of
these except:
a. Acalculia
b. Aphasia
c. Apraxia
d. Agnosia dams
EXPLANATION: (Read the below lines from Harrison 18th edition and 17
th
ed page 2540) :
The cognitive changes of Alzheimer's disease(AD) tend to follow a characteristic pattern, beginning with memory impairment and
spreading to language and visuospatial deficits. Yet, approximately 20% of patients with AD present with nonmemory complaints such as
word-finding, organizational, or navigational difficulty. In the early stages of the disease, the memory loss may go unrecognized or be
ascribed to benign forgetfulness. Once the memory loss becomes noticeable to the patient and spouse and falls 1.5 standard deviations
below normal on standardized memory tests, the term MCI is applied. This construct provides useful prognostic information, because
approximately 50% of patients with MCI (roughly 12% per year) will progress to AD over 4 years. Slowly the cognitive problems begin to
interfere with daily activities, such as keeping track of finances, following instructions on the job, driving, shopping, and housekeeping.
Some patients are unaware of these difficulties(anosognosia), while others remain acutely attuned to their deficits. Changes in
environment (such as vacations or hospital stays) may be disorienting, and the patient may become lost on walks or while driving. In the
middle stages of AD, the patient is unable to work, is easily lost and confused, and requires daily supervision. Social graces, routine
behavior, and superficial conversation may be surprisingly intact. Language becomes impairedfirst naming, then comprehension, and
finally fluency. In some patients, aphasiais an early and prominent feature. Word-finding difficulties and circumlocution may be a
problem even when formal testing demonstrates intact naming and fluency. Apraxiaemerges, and patients have trouble
performing learned sequential motor tasks. Visuospatial deficits begin to interfere with dressing, eating, or even walking, and patients fail
to solve simple puzzles or copy geometric figures. Simple calculations and clock reading become difficult in parallel.
40. What is the level of disc prolapse in a lady with reduced extension, intact sensation & pain in great toe
but with no sphincter disturbance ?
A. L3-L4
B. L4-L5
C. L5-S1
D. S1-S2
Correct answer : B. L4-L5
Extension of great toe is by extensor hallucis longus muscle. It is supplied by deep peroneal nerve (L5, S1). L5 nerve root is involved in disc
prolapse at L4-L5 level. The patient has pain without sensory loss due to irritation of the nerve. Complete damage results in sensory loss,
whereas irritation of nerve results in pain.
Ref: Hutchisons clinical
41. A person had a fall from tree and has been
unable to move both of his lower limbs and
had no control over micturition. The dose of
methylprednisolone in this condition is
a. 30mg/kg within 3hrs ans
b. 45mg/kg within 6hrs
c. 60mg/kg within 9hrs
d. 75mg/kg within 12hrs
http://www.nejm.org/doi/full/10.1056/NEJM199005173222001
Abstract
Studies in animals indicate that methylprednisolone and naloxone are both potentially beneficial in acute spinal-cord injury, but whether any treatment is
clinically effective remains uncertain.
We evaluated the efficacy and safety of methylprednisolone and naloxone in a multicenter randomized, double-blind, placebo-controlled trial in patients
with acute spinal-cord injury, 95 percent of whom were treated within 14 hours of injury. Methylprednisolone was given to 162 patients as a bolus of 30
mg per kilogram of body weight, followed by infusion at 5.4 mg per kilogram per hour for 23 hours. Naloxone was given to 154 patients as a bolus of 5.4
mg per kilogram, followed by infusion at 4.0 mg per kilogram per hour for 23 hours. Placebos were given to 171 patients by bolus and infusion. Motor
and sensory functions were assessed by systematic neurologic examination on admission and six weeks and six months after injury.
After six months the patients who were treated with methylprednisolone within eight hours of their injury had significant improvement as compared with
those given placebo in motor function (neurologic change scores of 16.0 and 11.2, respectively; P = 0.03) and sensation to pinprick (change scores of
11.4 and 6.6; P = 0.02) and touch (change scores, 8.9 and 4.3; P = 0.03). Benefit from methylprednisolone was seen in patients whose injuries were
initially evaluated as neurologically complete, as well as in those believed to have incomplete lesions. The patients treated with naloxone, or with
methylprednisolone more than eight hours after their injury, did not differ in their neurologic outcomes from those given placebo. Mortality and major
morbidity were similar in all three groups.
We conclude that in patients with acute spinal-cord injury, treatment with methylprednisolone in the dose used in this study improves neurologic
recovery when the medication is given in the first eight hours. We also conclude that treatment with naloxone in the dose used in this study does not
improve neurologic recovery after acute spinal-cord injury. (N Engl J Med 1990; 322:140511.)
42. All are seen in 3rd nerve palsy except
a. Ptosis
b. Diplopia
c. Miosis ANS
d. Eye moves laterally
43. A patient develops delirium tremens after 4
days of abstaining from alcohol. In this state,
he assaults his neighbor. Which of the following
is true according to Indian Penal Code?
a. He is not held responsible for the act ans
b. He is partially responsible for the act
c. He is fully responsible for the act
d. Not Recalled
44. In a study in UK, it was found that there was
more death due to asthma as compared to
sale of drugs for asthma. This is an example of
a. Ecological study ans
b. Cohort
c. Case reference
d. Experimental
(Modified repeat question AIIMS Nov 06 AA q46 Original question was about anti arrhythmia drug)
Correct answer: A. Ecological study
An ecological study is an epidemiological study in which the unit of analysis is a population rather than an individual. For instance, an ecological study may look at the association between smoking
and lung cancer
45. All are true regarding function of normal
flora except
a.Mucin fermentation
b. Epithelial proliferation dams
c. Potassium Secretion
d. Not Recalled
ref http://en.wikipedia.org/wiki/Gut_flora#Functions
Functions
Bacteria in the gut fulfill a host of useful functions for humans, including digestion of unutilized energy substrates,
[23]
stimulating cell growth, repressing the
growth of harmful microorganisms, training the immune system to respond only to pathogens, and defending against some diseases.
[2][3][24]
[edit]Carbohydrate fermentation and absorption
Without gut flora, the human body would be unable to utilize some of the undigested carbohydrates it consumes, because some types of gut flora
have enzymes that human cells lack for breaking down certain polysaccharides.
[3]
Rodents raised in a sterile environment and lacking in gut flora need to eat
30% more calories just to remain the same weight as their normal counterparts.
[3]
Carbohydrates that humans cannot digest without bacterial help include
certain starches, fiber, oligosaccharides and sugars that the body failed to digest and absorb
[2][8][9]
like lactose in the case of lactose intolerance and
sugar alcohols, mucus produced by the gut, and proteins.
[8]
A further result is flatulence, specifically due to the metabolism of oligosaccharides (notably
from beans) by many different species.
Bacteria turn carbohydrates they ferment into short chain fatty acids, or SCFAs,
[7][8][9]
by a form of fermentation called saccharolytic fermentation.
[8]
Products
include acetic acid,propionic acid and butyric acid.
[7][8][9]
These materials can be used by host cells, providing a major source of useful energy and nutrients for
humans,
[8]
as well as helping the body to absorb essential dietary minerals such as calcium, magnesium and iron.
[2]
Gases and organic acids, such as lactic
acid, are also produced by saccharolytic fermentation.
[9]
Acetic acid is used by muscle, propionic acid helps the liver produce ATP, and butyric acid provides
energy to gut cells and may prevent cancer.
[8]
Evidence also indicates that bacteria enhance the absorption and storage of lipids
[3]
and produce and then
facilitate the body to absorb needed vitamins like vitamin K.
Another, less favorable type of fermentation, proteolytic fermentation, breaks down proteins like enzymes, dead host and bacterial cells,
and collagen and elastin found in food, and can produce toxins and carcinogens in addition to SCFAs. Thus, a diet lower in protein reduces exposure to
toxins.
[2][7]
Beneficial flora increase the gut's absorption of water, reduce counts of damaging bacteria, increase growth of human gut cells,
[7]
and stimulate growth of
indigenous bacteria.
[2]
[edit]Trophic effects
Another benefit of SCFAs is that they increase growth of intestinal epithelial cells and control their proliferation and differentiation.
[2]
They may also
cause lymphoid tissue near the gut to grow. Bacterial cells also alter intestinal growth by changing the expression of cell surface proteins such
as sodium/glucose transporters.
[3]
In addition, changes they make to cells may prevent injury to the gut mucosa from occurring.
[24]
[edit]Repression of pathogenic microbial growth
C. difficile colonies on a blood agar plate. The overgrowth of C. difficile in the gut can be harmful to the host.
Another important role of helpful gut flora is that they prevent species that would harm the host from colonizing the gut through competitive exclusion, an
activity termed the "barrier effect". Harmful yeasts and bacterial species such as Clostridium difficile (the overgrowth of which can cause pseudomembranous
colitis) are unable to grow excessively due to competition from helpful gut flora species adhering to the mucosal lining of the intestine, thus animals without
gut flora are infected very easily. The barrier effect protects humans from both invading species and species normally present in the gut at low numbers,
whose growth is usually inhibited by the gut flora.
[2]
Helpful bacteria prevent the growth of pathogenic species by competing for nutrition and attachment sites to the epithelium of the colon. Symbiotic bacteria
are more at home in this ecological niche and are thus more successful in the competition. Indigenous gut floras also produce bacteriocins, which are
proteinaceous toxins that inhibit growth of similar bacterial strains, substances that kill harmful microbes and the levels of which can be regulated by enzymes
produced by the host.
[2]
The process of fermentation, since it produces lactic acid and different fatty acids, also serves to lower the pH in the colon, preventing the proliferation of
harmful species of bacteria and facilitating that of helpful species.
[citation needed]
The pH may also enhance the excretion of carcinogens.
[8]
[edit]Immunity
Gut flora have a continuous and dynamic effect on the host's gut and systemic immune systems. The bacteria are key in promoting the early development of
the gut's mucosal immune system both in terms of its physical components and function and continue to play a role later in life in its operation. The bacteria
stimulate the lymphoid tissue associated with the gut mucosa to produce antibodies to pathogens. The immune system recognizes and fights harmful
bacteria, but leaves the helpful species alone, a tolerance developed in infancy.
[2][4][7][11]
As soon as an infant is born, bacteria begin colonizing its digestive tract. The first bacteria to settle in are able to affect the immune response, making it more
favorable to their own survival and less so to competing species; thus the first bacteria to colonize the gut are important in determining the person's lifelong
gut flora makeup. However, there is a shift at the time of weaning from predominantly facultative anaerobic species, such as Streptococci and Escherichia
coli, to mostly obligate anaerobic species.
[2][3]
Recent findings have shown that gut bacteria play a role in the expression of toll-like receptors (TLRs) in the intestines, molecules that help the host repair
damage due to injury. TLRs cause parts of the immune system to repair injury caused, for example, by radiation.
[3][24]
TLRs are one of the two classes of
pattern-recognition receptors (PRR) that provide the intestine the ability to discriminate between the pathogenic and commensal bacteria. These PRRs
identify the pathogens that have crossed the mucosal barriers and trigger a set of responses that take action against the pathogen, which involve three main
immunosensory cells: surface enterocytes, M cells and dendritic cells.
[5]
The other class of PRRs are known as the nucleotide-binding oligomerization domain/caspase recruitment domain isoforms (NOD/CARD), which are
cytoplasmic proteins that recognize endogenous or microbial molecules or stress responses and forms oligomers that activate inflammatory caspases. This
would result in the cleavage and activation of important inflammatory cytokines and/or activate NF-B signaling pathway to induce the production of
inflammatory molecules.
[5]
Bacteria can influence the phenomenon known as oral tolerance, in which the immune system is less sensitive to an antigen (including those produced by gut
bacteria) once it has been ingested. This tolerance, mediated in part by the gastrointestinal immune system and in part by the liver, can reduce an
overreactive immune response like those found in allergies andauto-immune disease.
[25]
[3]
[2][8][9]
[8]
[7][8][9]
[8]
Products
[7][8][9]
humans,
[8]
[2]
[9]
[8]
[3]
toxins.
[2][7]
[7]
[2]
[2]
They may also
[3]
[24]
[2]
[2]
[citation needed]
[8]
[edit]Immunity
[2][4][7][11]
[2][3]
[3][24]
[5]
[5]
[25]
[3]
[2][8][9]
[8]
[7][8][9]
[8]
Products
[7][8][9]
humans,
[8]
[2]
[9]
[8]
[3]
toxins.
[2][7]
[7]
[2]
[2]
They may also
[3]
[24]
[2]
[2]
[citation needed]
[8]
[edit]Immunity
[2][4][7][11]
[2][3]
[3][24]
[5]
[5]
[25]
[3]
[2][8][9]
[8]
[7][8][9]
[8]
Products
[7][8][9]
humans,
[8]
[2]
[9]
[8]
[3]
toxins.
[2][7]
[7]
[2]
[2]
They may also
[3]
[24]
[2]
[2]
[citation needed]
[8]
[edit]Immunity
[2][4][7][11]
[2][3]
[3][24]
[5]
[5]
[25]
[3]
[2][8][9]
[8]
[7][8][9]
[8]
Products
[7][8][9]
humans,
[8]
[2]
[9]
[8]
[3]
toxins.
[2][7]
[7]
[2]
[2]
They may also
[3]
[24]
[2]
[2]
[citation needed]
[8]
[edit]Immunity
[2][4][7][11]
[2][3]
[3][24]
[5]
[5]
[25]
[3]
[2][8][9]
[8]
[7][8][9]
[8]
Products
[7][8][9]
humans,
[8]
[2]
[9]
[8]
[3]
toxins.
[2][7]
[7]
[2]
[2]
They may also
[3]
[24]
[2]
[2]
[citation needed]
[8]
[edit]Immunity
[2][4][7][11]
[2][3]
[3][24]
[5]
[5]
[25]
Some species of gut flora, such as some of those in the Bacteroides genus, are able to change their surface receptors to mimic those of host cells in order to
evade immune response. Bacteria with neutral and harmful effects on the host can also use these types of strategies. The host immune system has also
adapted to this activity, preventing overgrowth of harmful species.
[2][4]
[edit]Metabolic function
The resident gut microflora positively control the intestinal epithelial cell differentiation and proliferation through the production of short-chain fatty acids. They
also mediate other metabolic effects such as the syntheses of vitamins like biotin and folate, as well as absorption of ions including magnesium, calcium and
iron.
[5]
The gut flora plays a major role in metabolizing dietary carcinogens,
[5]
the microcomponents and the macrocomponents. The microcomponents are genotoxic,
and the major focus is on recent advances in heterocyclic amines (HCAs), which are produced by cooking proteinaceous food, such as meat and fish, which
can then induce tumors in organs like the breast, colon and prostate. HCAs are naturally occurring; therefore, the complete avoidance of them is impractical,
which is why the metabolic function of gut flora of such components is of great importance to our body, as this would help in prevention of such tumors that
are difficult to avoid. The macrocomponents consists of the excessive intake of fat and sodium chloride, which can later promote tumors, such as in breasts
and colons, from fat and gastric carcinogenesis from sodium chloride.
[26]
[edit]Preventing allergy
Bacteria are also implicated in preventing allergies,
[1]
an overreaction of the immune system to non-harmful antigens. Studies on the gut flora of infants and
young children have shown that those who have or later develop allergies have different compositions of gut flora from those without allergies, with higher
chances of having the harmful species C. difficile and S. aureus and lower prevalence of Bacteroides and Bifidobacteria.
[1]
One explanation is that since
helpful gut flora stimulate the immune system and "train" it to respond properly to antigens, a lack of these bacteria in early life leads to an inadequately
trained immune system that overreacts to antigens.
[1]
On the other hand, the differences in flora could be a result, not a cause, of the allergies.
[1]
[edit]Preventing inflammatory bowel disease
Another indicator that bacteria help train the immune system is the epidemiology of Inflammatory Bowel Disease, or IBD, such as Crohn's Disease (CD).
Some authors suggest that SCFAs prevent IBD. In addition, some forms of bacteria can prevent inflammation.
[27]
The incidence and prevalence of IBD is high
in industrialized countries with a high standard of livingand low in less economically developed countries, having increased in developed countries throughout
the twentieth century. The disease is also linked to good hygiene in youth; lack of breastfeeding; and consumption of large amounts of sucrose and animal
fat.
[27]
Its incidence is inversely linked with poor sanitation during the first years of life and consumption of fruits, vegetables, and unprocessed foods.
[27]
Also,
the use of antibiotics, which kill native gut flora and harmful infectious pathogens alike, especially during childhood, is associated with inflammatory bowel
disease.
[23]
On the other hand, using probiotics, bacteria consumed as part of the diet that impart health benefits (aside from just nutrition), helps treat IBD.
46. All of the following are criteria for primary hyperaldosteronism except?
A. Diastolic hypertension without edema
B. Metabolic acidosis present
C. Low secretion of rennin
D. High secretion of aldosterone inspite of reduced volume of fluid
Correct answer : B. Metabolic acidosis present
Ref: Harrison 18th ed
Excess activation of the mineralocorticoid receptor leads to potassium depletion and increased sodium retention, with the
latter causing an expansion of extracellular and plasma volume. Increased ENaC activity also results in hydrogen depletion
that can cause metabolic alkalosis.
47. Same amino acid is coded by multiple
codons due to following -
a. Degeneracy ans
b. Frame shift mutation
c. Transcription
d. Mutation
48. poly (A) induced polypeptide synthesis will
give rise to?
a. Polylysine ans
b. Polyglycine
c. Polyalanine
d. PolyGlutamine
49. Technique used to compare a new lab test
with a gold standard test is known as?
a. Regression analysis / Likehood test
b. Correlation analysis / Bland and Altman
analysis
c. Baltin and Altimore method ans
d. Kimorov and Samletor technique
REPEAT AIIMS MAY 2007 Q. 49
50. What percentage of endothelium is
destroyed in keratoplasty/ Cell loss after
descements
stripping in automated endothelial keratoplasty
a. 0-5%
b. 10-20%
c. 30-40% ans
d. 50-60%
Correct answer : C. 30-40%
Cell loss with the usual DSEK technique was found to be 34% at 6 months and 38% at 12 months. Cell loss in modified DSEK (using underfold technique) was found to be 26% at 6 months and
27% at 12 months.
References:
Ophthalmology. 2008 May;115(5):857-65. Epub 2007 Sep 14.
Endothelial cell loss after descemet stripping with endothelial keratoplasty influencing factors and 2-year trend.
Price MO, Price FW Jr.
Mean endothelial cell density was 2000+/-550 cells/mm(2) 6 months after Descemet stripping with endothelial keratoplasty (DSEK), representing cell loss of 34+/-18%.
Ophthalmology. 2010 Mar;117(3):438-44. Epub 2010 Jan 19.
Descemets stripping automated endothelial keratoplasty outcomes compared with penetrating keratoplasty from the Cornea Donor Study.
Price MO, Gorovoy M, Benetz BA, Price FW Jr, Menegay HJ, Debanne SM, Lass JH.
Percent endothelial cell loss was 34+/-22% versus 11+/-20% (6 months) and 38+/-22% versus 20+/-23% (12 months) in the Descemet stripping with endothelial keratoplasty (DSAEK) and
Penetrating keratoplasty (PKP) groups, respectively
Cornea. 2010 Sep;29(9):1022-4.
Endothelial cell damage in descemet stripping automated endothelial keratoplasty with the underfold technique: 6- and 12-month results.
Chen ES, Phillips PM, Terry MA, Shamie N, Friend DJ.
In this study, 305 eyes undergoing DSAEK were evaluated. Average endothelial cell loss was 26% at 6 months and 27%at 12 months, all statistically significant reductions from preoperative values
(P < 0.01).
51. An elderly man presented with fever and
cough. Sputum examination revealed gram
negative organisms that were grown on
Buffered charcoal yeast extract agar. The
organism involved is?
a. H. influenzae
b. Legionella pneumophila
c. Burkholderia cepacia
d.. Brucella
Correct answer : c) Legionella
The patient presented with history of pneumonia. Charcoal yeast medium is the special medium for legionella culture.
52. not true about drug resistance mechanism?
a. Most common mechanism is production of
neutralizing substances
b. If resistance is plasmid mediated, it is always
transferred vertically ANS
c. Alteration of target in pneumococcal
resistance
d. Complete removal of target is cause of
resistance to vancomycin
53. Ozurdex is
a. 0.7% dexamethasone ans
b. 0.7% betamethasone
c. 0.3% triamcinolone
d. 0.7% triamcinolone
54. Which of the following is used to prevent
HIV transmission from an HIV positive
pregnant mother to child?
a. Lamivudine
b. Stavudine
c. Nevirapine ans
d. Didanosine
Correct answer: C. Nevirapine
55. All of the following are required in PCR
except
a. Deoxyribonucleotides ANS
b. Thermostable enzyme /DNA polymerase
c. Dideoxyribonucleotides
d. Magnesium/ssdna /Template DNA
Correct answer : C. Dideoxyribonucleotides
A basic PCR set up requires several components and reagents. These components include:
DNA template that contains the DNA region (target) to be amplified.
Two primers that are complementary to the 3 (three prime) ends of each of the sense and anti-sense strand of the DNA target.
Taq polymerase or another DNA polymerase with a temperature optimum at around 70 C.
Deoxynucleoside triphosphates (dNTPs; nucleotides containing triphosphate groups), the building-blocks from which the DNA polymerase synthesizes a new DNA strand.
Buffer solution, providing a suitable chemical environment for optimum activity and stability of the DNA polymerase.
Divalent cations, magnesium or manganese ions; generally Mg
2+
is used, but Mn
2+
can be utilized for PCR-mediated DNA mutagenesis, as higher Mn
2+
concentration increases the error rate
during DNA synthesis
Monovalent cation potassium ions.
56. Isoenzyme have all the properties except
a.interact with the same receptor
b. have same number and sub naming
c. have equal affinity for target /Same
quaternary structure ans
d. Same classification/ same rate of work
ref http://en.wikipedia.org/wiki/Isozyme
Isozymes (also known as isoenzymes) are enzymes that differ in amino acid sequence but catalyze the same chemical reaction. These enzymes usually
display different kinetic parameters (e.g. different K
M
values), or different regulatory properties. The existence of isozymes permits the fine-tuning of
metabolism to meet the particular needs of a given tissue or developmental stage (for example lactate dehydrogenase (LDH)). In biochemistry, isozymes (or
isoenzymes) are isoforms (closely related variants) of enzymes. In many cases, they are coded for by homologous genes that have diverged over time.
Although, strictly speaking, allozymes represent enzymes from different alleles of the same gene, and isozymes represent enzymes from different genes that
process or catalyse the same reaction, the two words are usually used interchangeably.
An example of an isozyme
An example of an isozyme is glucokinase, a variant of hexokinase which is not inhibited by glucose 6-phosphate. Its different regulatory features and lower
affinity for glucose (compared to other hexokinases), allows it to serve different functions in cells of specific organs, such as control of insulin release by
the beta cells of the pancreas, or initiation of glycogensynthesis by liver cells. Both of these processes must only occur when glucose is abundant, or
problems occur.
57. Which among the following is an incorrect
match?
a. Murder IPC 300
b. Murder attempt IPC 307
c. Suicide attempt IPC 309/304-culpable
homicide not amounting to murder
d. 306-suicide ans
Murder: Sect ion 300 IPC
Culpable homicide is murder:
I f the act by which the death is caused is done wi th the intent ion of
causing death or ,
I f i t is done wi th the intent ion of causing such bodi ly injury as the
of fender knows to be l ikely to cause death or ,
I f i t is done wi th the intent ion of causing such bodi ly injury which is
suf f icient inthe ordinary course of nature to cause death or ,
I f the person commi t t ing the act knows that i t is so imminent ly
dangerous, that i t must in al l probabi l i ty cause death or such bodi ly
injury as is l ikely to cause death and commi ts such act wi thout any
excuse.
Culpable homicide is not murder:
a) I f the of fender whi lst depr ived of the power of sel f cont rol by grave and
sudden provocat ion causes the death of the person who gave the
provocat ion, or causes the death of other person by mistake or accident .
b) I f in good fai th of the r ight of pr ivate defence of person Or proper ty, the
of fender exceeds the power given to him by law and causes the death of the
person against whom he is exercising such r ight of defence, wi thout premedi
tat ion and wi thout any intent ion of doing more harm than what is necessary -
for the purpose of such defence.
c) I f the of fender , being a publ ic servant or aiding a publ ic servant act ing for the
advancement of publ ic just ice, exceeds the powers given to him by law and
causes death by doing an act which he, in good fai th bel ieves to be lawful
and necessary for the due discharge of his duty and wi thout any i l l-wi l l
towards the person whose death is caused.
d) I f the act is commi t ted wi thout premedi tat ion in a sudden f ight in the heat of
passion or a sudden quar rel , wi thout the of fender having taken any undue
advantage or act ing in a cruel or unusual manner . ( I t is immater ial which
par ty of fers the provocat ion or commi ts the f irst assaul t . )
e) When the person whose death is caused, being above the age of 18 years,
suf fers death or takes the r isk of death wi th his own consent .
301 IPC: Culpable homicide by causing death of a person other than whose
death is intended.
Sect ion 302 IPC: Punishment for murder
Whoever commi ts murder , shal l be punished wi th death or t ranspor tat ion for
l i fe and shal l also be l iable to f ine.
303 IPC: punishment for murder by a l i fe convict .
Sect ion 304 IPC: Punishment for culpable homicide not amount ing to murder
Whoever commi ts culpable homicide not amount ing to murder,
1) shal l be punished wi th impr isonment for l i fe or impr isonment of ei ther
descr ipt ion for a term which may extend to 10 years and shal l also be l iable
to f ine, i f the act by which death is caused is done wi th the intent ion of
causing death or of causing such bodi ly injury as is l ikely to cause death.
or
2) wi th impr isonment of ei ther descr ipt ion which may extend to 10 years or wi th
f ine or both i f the act by which death is caused is done wi th the knowledge
that i t is l ikely to cause death but wi thout any intent ion to cause death or to
cause such bodi ly injury as is l ikely cause death,
Sect ion 304 A IPC: Causing death by negl igence
Whoever , causes the death of a person by doing any rash or negl igent act
r iot amount ing to culpable homicide shal l be punished wi th impr isonment of
ei ther descr ipt ion for a term which may extend to 2 years, or wi th fme or wi th
both,
304 B IPC: Dowry death
when death of a women occurs due to burn or other bodi ly injury or in
circumstances other than normal , wi thin 7 years of mar r iage, and i t is seen
that she was subjected to cruel ty or harassment by her husband or any
relat ive of her husband for or in connect ion wi th the demand of dowry, such
death shal l be cal led dowry death and the husband or his relat ive shal l be
deemed to have caused her death.
305 IPC: Punishment of abetement of suicide of a chi ld under 18 years of
age or an insane shal l be upto 10 years wi th or wi thout f ine.
Sect ion 306 IPC: Punishment for abetment of suicide
Impr isonment of ei ther descr ipt ion for a term which may extend to 10
years and f ine.
Sect ion 307 IPC: Punishment for at tempt to murder
Impr isonment of ei ther descr ipt ion for a term upto 10 years and fme.
Sect ion 309 IPC : At tempt to commi t suicide
Punished wi th impr isonment for 1 year or wi th f ine or wi th both.
Simple Injuries: Al l injur ies which are not gr ievous are simple.
Dangerous Injuries: Dangerous injur ies are those which cause imminent
danger to l i fe, ei ther by involvement of impor tant organs or st ructures, or
extensive area of the body. I f no surgical aid is avai lable, such injur ies may
prove fatal .
58. Receptor based drug design is helpful as
a. It leads to very less lead compound
b. Understanding the structure of receptor can
enhance better target ans
c. It is very easy and less time consuming
d. Not Recalled
59. First step to produce insulin is to
incorporate
a. mRNA of beta pancreatic cell of humans
b. DNA of beta pancreatic cell of humans
c. mRNA of beta pancreatic cell of bacteria ans
d. DNA of beta pancreatic cell of bacteria
modified repeat from aims nov 2005 q.23
Human insulin was the first medicine to be created through recombinant DNA technology. Insulin is a protein hormone produced by the
pancreas that is vital for regulation of blood sugar. In the disease insulin-dependent diabetes mellitus (IDDM), the immune system attacks and
destroys the insulin-producing cells. A person with IDDM requires daily injections of insulin to control blood sugar. Before 1980, insulin was
isolated from pigs or other animals. Animal insulin has a slightly different amino acid sequence from the human form. In the early 1980s,
recombinant DNA technology was used to splice the human insulin gene into bacteria, which were grown in vats to make large amounts of the
human protein. Recombinant human insulin was the first recombinant drug approved for human use. Since then more than two dozen other
drugs have been created in this way, including growth hormone, blood clotting factors, and tissue plasminogen activator, used to break up blood
clots following a stroke. Gene sequence similarities indicate that all living organisms have descended from shared common ancestors, back to
the beginning of life.
Read more: Recombinant DNA - Biology Encyclopedia - cells, body, function, human, process, animal, system, different,
organisms http://www.biologyreference.com/Po-Re/Recombinant-DNA.html#b#ixzz1fleMDA60
60. The most common gene defect in idiopathic
steroid resistant Nephrotic syndrome
a. NPHS 2 ans
b.ACE /ALE
c.HOX 11
d.PAX
61. The transmitters noradrenaline,
adrenaline, dopamine, GABA and serotonin
have
a. Five pass gated Receptor /Two pass ligand
receptor
b. Four pass gated Receptor /One pass ligand
receptor
c. Seven pass Gated Receptor ans
d. Ligand pass gated Receptor
62. Phagocytosis causes complement activation
by
a. C3b and Fc ans
b. Receptor mediated endocytosis
c. Not Recalled
d. Not Recalled
63. Epidermoid cyst is differentiated from arachnoid cyst by?
A. Smooth margin
B. Contrast enhancement
C. Isointense to CSF in FLAIR
D.decrease flair (speed)
D. Restriction on diffusion weighted images ans dams
Correct answer : D. Restriction on diffusion weighted images
Both FLAIR (Fluid attenuated inversion recovery) and Diffusion weighted MRI can be used to differentiate between epidermoid cyst and arachnoid cyst.
Specific to Epidermoid cyst Restriction in diffusion weighted images. (Arachnoid cysts do not restrict on diffusion weighted images)
Specific to Arachnoid cyst Appears isointense to CSF in FLAIR. (Epidermoid cysts are not precisely identical in signal intensity to CSF)
The major differential
64. In a well fed state, carnitine shuttle in outer
membrane of mitochondria is inhibited by?
a. Malonyl CoA
b. Acetyl CoA
c. Pyruvate
d. Glucose
65. Which of the following is used to test the
efficiency of sterilization in an autoclave?
a. Clostridium tetani
b. Bacillus stearothermophilus ans
c. Bacillus pumilus
d. Bacillus subtilis
66. Regular drinking of which of the following
can help prevent UTI?
a. Grape juice
b. Raspberry juice
c. Orange juice
d. Cranberry juice
Correct answer : Cranberry
67. A 6 year old boy presents with non
blanching peticheal rashes all over the body.
Biopsy
shows perivascular neutrophillic infiltrate and
IgA deposition. Which of the following is
true?
a. Henoch scholein purpura
b .Hyper IgA syndrome
c. Mucosal hypersensitivity syndrome
d. Drug reaction
68. Which of the following is not a direct
somatoform disorder /specific somatoform
disorder?
a. Somatization
b. Fibromyalgia dams
c. Chronic fatigue syndrome (speed)
d. Irritable bowel syndrome
69. A 50 year old man with aortic stenosis is
doing exercise for 11 minutes according to
bruce protocol. Exercise had to be stopped due
to fatigue. Regional pressure gradient is
60mmHg between the two sides of the aortic
valve. What is the best management?
a. Angiography
b. Aortic valve replacement
c. Balloon aortic valvuloplasty
d. Medical follow up
Correct answer : D. Medical follow up
Surgery is done only for severe aortic stenosis. For diagnosis of severe aortic stenosis, the peak gradient should be more than 60mm Hg (as per Feigenbaums Echocardiography) / more than
64mm Hg
70. 65 years old patient presented to the
emergency with high grade temperature and
increased respiratory rate. He complained of
pain in the chest and had developed cough
with
expectoration. His sputum was sent to the
laboratory for gram straining which showed the
presence of pus cells and gram positive cocci.
The culture on the blood agar medium was also
positive. Which of the following laboratory tests
will help to differentiate the specific
pathogen from the other commensal gram
positive cocci?
a.Bacitracin sensitivity
b.Oxidase test
c.Bile solubility
d.Coagulase test
Correct answer : Bacitracin sensitivity
71. A newborn presents with congestive heart
failure, on examination has bulging anterior
fontanellae with a bruit on auscultation.
Transfontanellar USG shows a hypoechoic
midline
mass with dilated lateral ventricles. Most likely
diagnosis is
a .Medulloblastoma
b. Encephalocele
c. Vein of Galen malformation
d. Arachnoid cyst
Correct answer C. Vein of Galen malformation
72. A witness who changes his statement
becomes hostile witness and is punishable
undera.
a.Sec 191 IPC
b. Sec 161 IPC
c. Sec 171 IPC
d. Sec 181 IPC
73. Adverse (deleterious) effect of hypothermia
are all except:
a. Cardiac arrhythmia
b. Decrease peripherial resistance ans
c. Reversible coagulopathy
d. Renal failure
74. Which of the following is not involved in
protein synthesis?
a. Ribosome
b. Peptidyl transferase
c. Aminoacyl tRNA
d. RNA polymerase ANS
75. If 4 nucleotide repeats code for a amino
acid...what is no. of amino acid coded possible:
a. 16
b. 64
c. 4
d. 256 ANS
A codon with 3 nucleotides can code for upto 64 amino acids, whereas a codon with 4 nucleotide repeats can code for upto 256 amino acids. For this to be possible, the stop codon should also code
for an amino acid like the start codon coding for methionine.
76. According to organ transplantation act 1994
what punishment for doctor if found guilty?
a. 2 yrs
b. More than 5 yrs
c. 1 yrs
d. 2-5 yrs ANS
Correct answer : D. 2-5 yrs (But presently it is upto 10 years as per 2011 amendment)
THE TRANSPLANTATION OF HUMAN ORGANS ACT, 1994
Punishment for removal of human organ without authority: Any person who renders his services to or at any hospital and who, for purposes of transplantation, conducts associates with, or helps in
any manner in, the removal of any human organ without authority, shall be punishable with imprisonment for a term which may extend to five years and with fine which may extend to ten
thousand rupees.
Ref: http://india.gov.in/allimpfrms/allacts/2606.pdf
THE TRANSPLANTATION OF HUMAN ORGANS (AMENDMENT) BILL, 2011
for the words five years and with fine which may extend to ten thousand rupees, the words ten years and with fine which may extend to twenty lakh rupees shall be substituted
Ref: http://164.100.24.219/BillsTexts/LSBillTexts/PassedBothHouses/transplnt.pdf
77. Drug used for non infectious uveitis in
LUMINATE clinical trial program
a. Cyclosporin
b. Voclosporin ANS
c. Steroid / Infliximab
d. Methotrexate
Correct answer : D. Voclosporin
Uveitis is an inflammatory, putative Th1-mediated autoimmune disease that affects various parts of the eye and is a leading cause of visual loss. Currently available therapies are burdened with
toxicities and/or lack definitive evidence of efficacy. Voclosporin, a rationally designed novel calcineurin inhibitor, exhibits a favorable safety profile, a strong correlation between pharmacokinetic
and pharmacodynamic response, and a wide therapeutic window. The LUMINATE (Lux Uveitis Multicenter Investigation of a New Approach to TrEatment) clinical development program was
initiated in 2007 to assess the safety and efficacy of voclosporin for the treatment, maintenance, and control of all forms of noninfectious uveitis. If LUMINATE is successful, voclosporin will become
the first Food and Drug Administration-approved corticosteroid-sparing agent for this condition.
Ref: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699819/
78. Bremelanotide used for
a. Erectile dysfunction ANS
b. LUTS
c. Prostate Cancer
d. Metastatic renal cancer
Correct answer : A. Erectile dysfunction
Bremelanotideis a compound under drug development by Palatin Technologies as a treatment for hemorrhagic shock and reperfusion injury. It functions by activating the melanocortin receptors
MC1R and MC4R, to modulate inflammation and limiting ischemia. It was originally developed for use in treating sexual dysfunction but this application was temporarily discontinued in 2008, after
concerns were raised over adverse side effects of increased blood pressure. Currently, Palatin is in negotiations with the FDA to resume Human Phase 2 studies using a new subcutaneous drug
delivery system that appears to have little effect on blood pressure.
In studies, bremelanotide was shown to induce lordosis in an animal model and was also effective in treating sexual dysfunction in both men (erectile dysfunction or impotence) and women
(sexual arousal disorder). Unlike Viagra and other related medications, it does not act upon the vascular system, but directly increases sexual desire via the nervous system.
79. Mizau phenemenon
a. Oguchi ds
b. Fundus apunctaneus
c. Fundus amaculateus
d. Not Recalled
80. Stack method for age estimation from the
dental pattern is used in
a. Infants ans
b. Adult
c. Age 25 - 50 years
d. Age more than 50 years
81. A middle aged female presents with slowly
progressive weakness of lower limbs,
spasticity and recent onset hesitancy of
micturition. On neurological examination there
is
evidence of dorsal myelopathy. MRI scan of
spine reveals middorsal intradural/ subdural
contrast enhancing mass lesion. Diagnosis is:
a.Intradural Lipoma
b.Dermoid Cyst
c.Meningioma (speed)
d.Neuro Epithelial Cyst
ans.c>a
Ref H/17
th
p 2591
82. Systemic steroids are indicated in?
a. Pustular psoriasis
b. Impetigo herpetiformis ans
c. Psoriatic arthropathy
d. Erythamatous Psoriasis
http://www.parkhurstexchange.com/columns/dermatology/aug08/psoriasis
In addition to supportive care, a number of treatment options are available for pustular psoriasis (Table 2). Topical corticosteroids can
work well for limited variants, but systemic corticosteroids are reserved for special cases such as impetigo
herpetiformis, where theyre the safest aggressive option during pregnancy. After delivery, patients can be switched to more potent
therapies such as systemic retinoids or steroid-sparing agents, e.g. methotrexate.
Systemic retinoids are often very effective, and are considered first-line therapy for GPP. Oral acitretin can be quite fast-acting, but
isotretinoin is preferred for women of child-bearing age because it has a shorter period of teratogenicity. Other systemic options with
demonstrated efficacy include methotrexate, usually started at 15 mg weekly, and cyclosporine at 4-5 mg/kg daily. Biologics, e.g. TNF-
alpha inhibitors, may also be a possibility.
Steroids arent contraindicated in child bearing years in general. But, systemic steroids are contraindicated for people with psoriatic arthritis. The reason is that they can
cause a bad flare-up of psoriasis and even change ordinary psoriasis to the generalized form of pustular psoriasis. That can be serious. Intraarticular steroid shots are OK
though (shots into the joint). Another medication commonly used in RA is Plaquenil (anti-malarial). That may also worsen skin psoriasis. In some cases they now chose to use
it anyway and to handle a flare-up of P. if it happens. Commonly used long acting medications (DMARDS) are: Salazopyrine/sulphasalazine Methotrexate Cyclosporine I am
not sure for sulphasalazine or cyclosporine, but methotrexate you can use until 6 months before you try to conceive. While you are on it and 6 months after you have to be on
safe birthcontrol. Other commonly used medications are the non steroidal anti-inflammatory drugs NSAIDS. In light cases that is often the only medication used. I agree with
the others, you should see a rheumatologist! Goto drdocs page for more information. Also make sure to read the page about preparing for a docs visit. Take care!!! > As for
steroids, Prednisone is often a first line of defense in the > treatment of inflammatory arthritis, but as far as I know it is not > contraindicated in child bearing years.
83. Recent direct thrombin inhibitor which can
be used in stroke is
a. Dabigatrin ans (speed)
b. Ximelagatron
c. Lepirudun
d. Saxagliptin
84. Normal functioning ovaries are found in -
a.MRKH ans
b.Sweyer syndrome
c.Turner
d.Mllerian agenesis
85. In a patient presenting with hematuria and
hypercalcuria, which of the following can be
the associated finding -
a. RBC
b. Proteinuria
c. RBC cast
d. Not Recalled
ANS-A
i) Hematuria, Pyuria, and Casts
* Normal red blood cell excretion is up to 2 million RBCs per day.
* Hematuria is defined as two to five RBCs per high-power field (HPF) and can be detected by dipstick.
* Persistent or significant hematuria (>three RBCs/HPF on three urinalyses, or a single urinalysis with >100 RBCs, or gross hematuria).
* Hypercalciuria and hyperuricosuria are risk factors for unexplained isolated hematuria in both children and adults.
* The RBCs of glomerular origin are often dysmorphic when examined by phase-contrast microscopy.
* The most common etiologies of isolated glomerular hematuria are IgA nephropathy, hereditary nephritis, and thin basement membrane disease.
* Hematuria with dysmorphic RBCs, RBC casts, and protein excretion >500 mg/d is diagnostic of glomerulonephritis.
86. Gallow's traction done in
a. Fracture Femur ans
b. Fracture Tibia
c. Fracture Humerus
d. Fracture Ulna
87. IgA deposits in dermal papilla are characteristically seen in?
A. Dermatitits herpetiformis
B. Pemphigus vulgaris
C. Bullous pemphigoid
D. IgA dermatosis of childhood
Correct answer : A. Dermatitits herpetiformis
Dermatitits herpetiformis is diagnosed by a blood test for IgA antibodies, and by a skin biopsy in which the pattern of IgA deposits in the
dermal papillae, revealed by direct immunofluorescence, distinguishes it from linear IgA bullous dermatosis and other forms of dermatitis.
88. A patient has the following lab test-BT=3, PT
15/14, APTT= 45/35, platelet count= 2.5
lacks, factor VIII= 60.The most probable
diagnosis is
a. Factor VIII inhibitor dams
b. Megakaryotic Thrombocytopenia
c. Factor IX Deficiency
d. Factor X Deficiency
Acquired Inhibitors of Coagulation Factors
* FVIII is the most common target of antibody formation.
* Occurs predominantly in older adults.
* Autoimmune diseases, malignancies (lymphomas, prostate cancer), dermatologic diseases, and pregnancy.
* In contrast to hemophilia, hemarthrosis is rare.
* The diagnosis is based on the prolonged aPTT with normal PT and TT.*
The aPTT remains prolonged after mixture of the test plasma with equal amounts of pooled normal plasma for 2 h at 37C.
* Major bleeding is treated with high doses of human or porcine FVIII, PCC/PCCa, or recombinant FVIIa.
* Anti-CD20 monoclonal antibody (rituximab) effective in patients with autoantibodies to FVIII.
* Lupus anticoagulant can be associated with venous or arterial thrombotic disease- a prolonged PTT that does not correct on mixing.
* To distinguish acquired inhibitors from lupus anticoagulants- the dilute Russells viper venom test and the hexagonal-phase phospholipids test will be
negative in patients with an acquired inhibitor and positive in patients with lupus anticoagulants
89. For which of the following conditions giving
Prostaglandins is detrimental
a.Hypoplastic left heart syndrome
b. Pulmonary atresia with VSD
c. Obstructive TAPVC
d. ASD
90. Cricket player hit his base of right thumb
while catching a ball. For which of the
following muscle will you investigate further?
a. Abductor pollicis longus
b. Flexor pollicis brevis
c. Ulnar collateral ligament ans
d. Volar plate
Correct answer C. Ulnar collateral ligament (gamekeepers thumb)
91. Patient complaining of pain and numbness
in middle finger , index finger and thumb of
right hand especially during night time. Which
test is not done for evaluation of this
condition?
a.) Finkelstein test (speed) de quervain tenosynovitis
b.) Phalen's test
c.) Tinel's sign
d.) Torniquette test
92. A diabetic /Alcoholic presents with painless
fixed 15 degree flexion deformity in the little
finger. Management is
a.) Observation (speed)
b.) Percutaneous fasciotomy
c.) Subtotal fasciotomy
d.) Total fasciotomy
pt is old,dm minor flexion ,sx not benifited too much so
93. HAM test is done for
A. G.P.I anchor protein ans
B. Complement defect
C. Spectrin defect
D. Mannose binding protein
Correct answer: A. G.P.I anchor protein
94. Best treatment for kawasaki's disease is
a.) Aspirin
b.) I.V. immunoglobulins ans
c.) Corticosteroids
d.) Methotrexate
95. A Child presents with meningomyelocoele.
Investigation to be done is
a. Blood culture
b. CSF culture
c. Anal culture
d. CBC
96. All are true about myelopathies except
a. Sensory loss of facial area ans
b. Brisk jaw jerk dams
c. Brisk pectoral jerk
d.Bladder urgency
harrisonss 17
th
p-2588
97. 16 year old girl with primary amenorrhoea attends OPD. She has normal sexual development and normal breast but
with absent pubic and axillary hair. Examination shows bilateral inguinal hernias. USG shows absent uterus and blind
vagina. Diagnosis will be:
A. Turner syndrome
B. Mullerian agenesis
C. Star syndrome
D. Androgen insensitivity syndrome
(Repeat question AIIMS May 07)
Correct answer : D. Androgen insensitivity syndrome
98. In which of the following conditions ovary is
functional
a.MRKH ans
b. Androgen insensitivity
c. Turners Syndrome
d. Not Recalled
99. Correct match of drug and its metabolic enzyme are all except?
A. Digoxin P glycoprotein
B. Simvastatin Glucuronidation
C. Verapamil CYP3A4
D. Carvedilol- CYP2D6
Correct answer : B. Simvastatin glucuronidation (Simvastatin is metabolised by CYP2D6 refer table given
below)
Molecular Pathways Mediating Drug Disposition
Molecule
Substrates
Inhibitors
CYP3A
Calcium channel blockers
Antiarrhythmics (lidocaine, quinidine, mexiletine)
HMG-CoA reductase inhibitors (statins)
Cyclosporine, tacrolimus
Indinavir, saquinavir, ritonavir
Amiodarone
Ketoconazole, itraconazole
Erythromycin, clarithromycin
Ritonavir
CYP2D6
Timolol, metoprolol, carvedilol
Phenformin
Codeine
Propafenone, flecainide
Tricyclic antidepressants
Fluoxetine, paroxetine
Quinidine (even at ultra-low doses)
CYP2C9
Warfarin
Phenytoin
Glipizide
Losartan
Amiodarone
Fluconazole
Phenytoin
CYP2C19
Omeprazole
Mephenytoin
Clopidogrel
Omeprazole
Thiopurine S-methyltransferase
6-Mercaptopurine, azathioprine
N-acetyltransferase
Isoniazid
Procainamide
Hydralazine
Some sulfonamides
UGT1A1
Irinotecan
Pseudocholinesterase
Succinylcholine
P-glycoprotein
Digoxin
HIV-protease inhibitors
Many CYP3A substrates
Quinidine
Amiodarone
Verapamil
Cyclosporine
Itraconazole
Erythromycin
Ref: Harrison 18th, chapter 5 : Table 5-1
100. Man with head injury, after 4 days
periorbital and frontal ecchymosis , diagnosis
a. Sphenoidal fracture
b. Internal carotid artery aneurysm
c. Cavernous sinus thrombosis
d. Carotico-cavernous fistula dams
101. Most common complication after ileal
pouch anal anastomosis for IBD is..
a. Small intestine obstruction dams
b. Pelvic abscess
c. Perineal infection
d. Pouchitis
102. ALP is increased in
a.Dysgerminoma
b. Malignant teratoma
c.Ca Ovary
d. Ca Stomach
103. Preleukemic conditions all except
a. PNH
b. PCH dams
c. Aplastic anemia
d. MDS
Paroxysmal Cold Hemoglobinuria (PCH)
* Mostly in children, usually triggered by a viral infection, usually self-limited.
* Donath-Landsteiner antibody.
* Antibody-anti-P specificity and binds to red cells only at a low temperature (optimally at 4C), but when the temperature is shifted to
37C, lysis of red cells takes place in the presence of complement.
Paroxysmal Nocturnal Hemoglobinuria (PNH)
* Intracorpuscular defect acquired at the stem cell level.
* Clinical Triad
Hemolytic anemia.
Venous thrombosis.
Deficient hematopoeisis(Pancytopenia).
* RBC sensitivity to hemolytic action of complement .
* platelet aggregation (due to complement) thrombosis.
* Platelet normal life span.
* Venous thrombosis
40%.
Budd. Chiari.
CVT common cause of death.
* Bone marrow normocellular.*
* 15 30% Aplastic anemia.
* Commonest cause of death has been venous thrombosis followed by infection.
* 12% of all cases PNH may terminate in acute myeloid leukemia.
* Spontaneous recovery from PNH has been well documented.
Pathogenesis
104. Which of the following muscles undergoes wasting first in osteoarthritis knee?
A. Hamstrings only
B. Quadriceps only
C. Both hamstrings and quadriceps
D. Gastrocnemius
(Repeat question AIPGMEE 07 MK q262)
Correct answer : B. Quadriceps only
All muscles around the knee can undergo wasting in advanced osteoarthritis. But quadriceps is the first muscle to be
affected.
105. Not liver capsular plate?
a. Ductal plate ANS
b. Hilar plate
c. Umbilical plate
d. Cystic plate
Correct answer : A
Ref : Anatomy of the hepatic hilar area: the plate system, JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY
To surgically manage hilar bile duct carcinoma successfully, it is important to be familiar with the principal anatomical variations of the biliary and vascular components of the plate system in the
hepatic hilar area, because all the variations in the bile ducts and vessels occur in the plate system. The plate system consists of bile ducts and blood vessels surrounded by a sheath. There are
three plates in the hilar area: the hilar plate, the cystic plate, and the umbilical plate.
106. Not a part of superficial perineal pouch:
a. Posterior scrotal nerves
b. Sphincter urethrae ans
c. Ducts of bulbourethral glands
d. Bulbospongiosus muscle
107. Lateral most to the femoral hernia sac:
a. femoral nerve
b. femoral vein (speed)
c. femoral artery
d. lateral cutaneous nerve of thigh
108. Anticoagulant of choice for coagulation
test?
a. 3.5% sod citrate ans
b. EDTA
c. Heparin
d. Sodium oxalate
Ref http://www.healthline.com/galecontent/coagulation-tests#2
Anticoagulant for coagulation tests
The anticoagulant of choice for coagulation testing is sodium citrate, which reversibly chelates calcium. Evacuated blue-top tubes containing sodium citrate are available
commercially with a 3.8% (129 mmol/L) or3.2% (109 mmol/L) citrate concentration. Blue-stoppered tubes are manufactured to draw nine parts of whole blood to one part of
liquid sodium citrate already present in the tube. Thus, when using an evacuated system, blood must be allowed to flow into the tube until it stops automatically. This provides
for the 90% fill ratio required for coagulation testing. Ideally the plasma specimen is tested within four hours of collection. If this is not possible then the samples should be
frozen until testing. Gross hemolysis is usually a criterion for sample rejection
109. Most common organ to be affected in Post
operative ileus:
a. Stomach
b. Duodenum
c. Ileum dams
d. Colon(last to recover)
110. Palato print commonly taken from
a. Anterior part of palate ANS
b. Lateral wall of palate
c. Medial wall of palate
d. Posterior part of palate
Correct answer : B. Anterior palate
Ref: Reddy, 26th, p77
Palatoprints: In the anterior part of the palate, the structural details like the rugae are individual specific and permanent. The palatoprints can be used in the same way as finger prints
111. Ossification centre first appears
a. End of 2nd month
b. Beginning of 2nd month
c. End of 3rd month
d. End of 4th month
Correct answer : A. First appears at end of 2nd month
Ref: Grays Anatomy, 39th p818
The clavicle begins to ossify before any other bone in the body, and is ossified from three centers. The shaft of the bone is ossified in condensed mesenchyme from two primary centres, medial and
lateral, which appear between the fifth and sixth weeks of intrauterine life, and fuse about the forty-fifth day.
112. Type D personality were recently found to
risk for
a. Coronary artery disease
b. Depression
c. Personality disorder
d. Schizophrenia
Correct answer : A. Coronary artery disease (References from Lancet and American Jounal of Cardiology given below)
Emotional distress has been related to mortality in patients with coronary heart disease (CHD), but little is known about the role of personality in long-term prognosis. We postulated that type-D
personality (the tendency to suppress emotional distress) was a predictor of long-term mortality in CHD, independently of established biomedical risk factors.
Ref: http://www.ncbi.nlm.nih.gov/pubmed/8618481
Lancet. 1996 Feb 17;347(8999):417-21.
Personality as independent predictor of long-term mortality in patients with coronary heart disease.
Denollet J, Sys SU, Stroobant N, Rombouts H, Gillebert TC, Brutsaert DL.
Psychological stress and type D personality have been associated with adverse cardiac prognosis, but little is known about their relative effect on the pathogenesis of coronary heart disease
(CHD). Type D refers to the tendency to experience negative emotions and to inhibit the expression of these emotions in social interactions.
Ref: http://www.ncbi.nlm.nih.gov/pubmed/16563897
Am J Cardiol. 2006 Apr 1;97(7):970-3. Epub 2006 Feb 13.
Usefulness of type D personality in predicting five-year cardiac events above and beyond concurrent symptoms of stress in patients with coronary heart disease.
Denollet J, Pedersen SS, Vrints CJ, Conraads VM.
113. Eosinophilia not seen with?
a. Contrast
nephropathy
b.Drug induced nephropathy
c. Atheromatous Plague
d.Erythema nodosa
114. A 20 year old female presents with Hb-9,
MCV- 50, ferritin-200, TIBC-294. What is the
diagnosis? (N >360 TIBC)
a. Iron deficiency
b. Anemia of chronic disease ANS
c. Thalasemia major
d. Thalasemia minor
115. WHICH OF THE FOLLOWING DOES NOT
AFFECT THE HARDY WINBERG
EQUATION?
a. Small population (speed)
b. Random mating dams
c.gene flow migration
d.gene mutation
c. mutation
d migration
116. The following are components of Brown
Sequard syndrome except:
a. Ipsilateral extensor plantar response
b. Ipsilateral pyramidal tract involvement
c. Contralateral spinothalamic tract
involvement
d. Contralateral posterior column involvement
Correct answer : B. Contralateral dorsal column involvement
Ref: Harrison 16th, p2440, 144
Brown-Squard syndrome, also known as Brown-Squards hemiplegia and Brown-Squards paralysis, is a loss of sensation and motor function (paralysis and ataxia) that is caused by the lateral
hemisection of the spinal cord.
Features of Brown-Squard syndrome:
Ipsilateral pyramidal tract involvement loss of motor function as the neurons cross to opposite in the
117. Structure passing via esophageal hiatus are
all except
a. Left vagus
b. Right vagus
c. Left phrenic ans
d. Left gastric artery
118. Vision 2020, who which them does not
form part of it
a. WHO
b. UNICEF ANS
c. Orbis International
d. International Agency For Prevention of
Blindness
Which of the following is not a member of Vision 2020 program?
A. WHO
B. UNICEF
C. Orbis international
D. International Agency For Prevention of Blindness
Correct answer : B. UNICEF
VISION 2020 is the global initiative for the elimination of avoidable blindness, a joint programme of the World Health Organization (WHO) and the International Agency for the Prevention of
Blindness (IAPB) with an international membership of NGOs, professional associations, eye care institutions and corporations.
Vision 2020 members: (Given below are the group A members. For viewing group B and C, plese visit the official site)
International Council of Opthalmology - Represents and serves professional associations of ophthalmologists throughout the world
World Blind Union - Represents over 160 million blind and partially sighted persons in 177 member countries
cbm - Improving quality of life for the worlds poorest persons with disabilities.
Impact EMR - Leading the Elimination of Blindness and Visual Impairment in EMR.
International Centre for Eyecare Education - Envisioning a world where avoidable blindness and vision impairment do not limit any persons well-being.
Light for the World - A European confederation of national development NGOs committed to saving eyesight, improving the quality of life and advocating for the rights of person with disabilities
in the underprivileged regions of our world.
Lions Clubs International Foundation - LCIF is the charitable arm of Lions Clubs International.
Mectizan Donation Program - Alleviating the suffering caused by river blindness and lymphatic filiarasis (elephantiasis).
Operation Eyesight Universal Canadian international development organization dedicated to eliminating avoidable blindness.
ORBIS International - International organisation working to eliminate avoidable blindness in developing countries.
Royal National Institute of Blind People (RNIB) - Supporting blind and partially sighted people in the United Kingdom
Sightsavers - Sightsavers works to combat avoidable blindness in developing countries.
The Fred Hollows Foundation - Working for a world where no one is needlessly blind and Indigenous Australians enjoy health equality.
Vision CRC - Establishing Australia as a world leader in research, education and delivery of vision correction
World Council of Optometry - Dedicated to the enhancement and development of eye and vision care worldwide.
Ref: http://www.vision2020.org
119. Which of the following is not associated with a defect in neural migration?
A. Lissencephaly
B. Schizencephaly dams
C. Polymicrogyria
D. Focal cortical brain maldevelopment
Correct answer : D. Focal cortical brain maldevelopment
The structural abnormalities found in Neuronal Migration Disorderss (NMD) include schizencephaly, porencephaly, lissencephaly, agyria,
macrogyria, polymicrogyria, pachygyria, microgyria, micropolygyria, neuronal heterotopias (including band heterotopia), agenesis of the
corpus callosum, and agenesis of the cranial nerves.
Ref: National Institute of Neurological Diseases and Stroke Neuronal Migration Disorders Information Page
(http://www.ninds.nih.gov/disorders/neuronal_migration/neuronal_migration.htm)
120. Downs syndrome all are true except
a.Deleted 21 ans
b. Trisomy 21
c. 45,XX,der(14;21)(q10;q10)
d. 46,XX/47,XX,+21
121. A child with fever shows CD 10 positive; CD
19 positive; MPO positive; CD 117
positive; CD 3 negative; CD 33 negative; TC=
6000; Hb= 4.5; Platelet count= 20000. The
most probable diagnosis is
a. ALL
b. AML
c. Biphenotypuic ans
d. Undifferentiated
122. Mechanism of action of efavirenz is?
A. Inhibition of HIV 1 protease
B. Inhibition of HIV 1 reverse transcriptase
C. Inhibition of HIV 1 integrase
D. Preventing HIV entry into cell
Correct answer : B. Inhibition of HIV 1 reverse transcriptase
Ref: KDT 6th p772
Non nucleoside reverse transcriptase inhibitors (NNRTIs) Nevirapine and Efavirenz These are nucleoside unrelated
compounds which directly inhibit HIV reverse transcriptase without the need for intracellular phosphorylation
123. Which retinal layer is most resistant to
radiation
a. RPE ans
b. Layers of rods and cones
c. Bipolar cell layer
d. Ganglion cell layer dams
124. Lid retraction caused by?
a. Bimatoprost
b. Latanoprost
c. Brimonidine
d. Apraclonidine ANS
Correct answer : A. Apraclonidine
Both brimonidine and apraclonidine can cause lid retraction. But it is much less frequent with brimonidine.
Ref: KDT 6th p146
Apraclonidine It is a polar clonndine congener which does not cross blood brain barrier, but applied topically (0.5-1%) it lowers intraocular tension by ~25%. It decreases aqueous production by
primary 2 and subsidiary 1 action in the ciliary body. Itching, lid dermatitis, follicular conjunctivitis, mydriasis, eyelid retraction, dryness of mouth and nose are common side effects.
Brimonidine This recently introduced clonidine congenere is more 2 selective and more lipophilic than apraclonidine. It lowers intraocular tension by 20-27% by reducing aqueous production and
by increasing uveoscleral outflow. Ocular side effects are similar to, but less frequent than with apraclonidine. Because of weaker 1 action, side effects like mydriasis, eyelid retraction,
conjunctival blanching-hyperemia are less prominent, but dry mouth, sedation and small fall in BP have been noted.
125. In a patient with urethral syndrome, urine
microscopy shows full of polymorph, but no
bacteria. The most appropriate culture medium
is?
a. Mc'coy cell
b. Thayer martin s
c. Cooked meat
d. PPLO broth
Correct answer : a) Mc coy cell line
Common causes of urethral discharge in a young male are gonococcus and chlamydia. But in this case, no organisms were found in the pus cells. This indicates that the cause is probably not
gonococcus. So in order to check for presence of chlamydia, we have to use cell culture
126. First chemical barrier encountered for
microorganism for common exposed sites
a. Lysozyme
b.Acidic ph dams
c. Skin
d.Glycogen
127. 5yrs old male child episodic anemia Yellow sclera and jaundice since froma/e
birth
a.PNH
b.G6PD
c.sickle cell anemia dams
d. Hereditory spherocytosis
128. Least significant damage would occur in
case of injury to :
a. Celiac axis
b. Renal artery
c. Superior mesenteric artery
d. Inferior mesenteric artery
129. In Spondylolisthesis which of this
investigation is not useful
a. CT scan
b. MRI
c. Lumbar region x-ray- AP view
d. Lumbar region x-ray - lateral view
Correct answer : A. AP view X-ray
Diagnosis of spondylosisthesis is obtained on lateral plain films of the lumbar spine performed in upright positin, CT with sagittal reformations or sagittal MR imaging of the lumbar spine.
Ref: Spondylolysis, spondylolisthesis, and degenerative spondylolisthesis By Robert Gunzburg, Marek Szpalski (via google books)
Use of AP view X-ray in spondylolisthesis:
The inverted Napoleon hat sign is seen on the AP radiograph of the spine at the level of the fifth lumbar
130. Proven case of renal papillary necrosis -
what investigation on urine you would not do:
a. Urine acidification test
b. Sickling test
c. TB-PCR urine dams
d. Bacterial culture of urine
131. A 75 yrs with focal seizures with normal
renal function, Drug of choice is ?
a. Valporate
b.Pregbalin
c.Levitriacetam
d. oxaCarbazepam dams
LOKPAL LAMO>OXACBZ>PHENYTOIN>LEVETIRACETAM
132. A person had infection due to gram
positive organism treated with methicillin and
then
culture sensitivity shows resistance to it. Hence
all can be given in MRSA except?
a. Vancomycin
b. Cotrimoxazole
c. Cefaclor ans
d. Ciprofloxacin
Correct answer: C. Cefaclor
133. Heterotrophic ossification - most
important investigation you would do for
management:
A.Alkalinephosphatase ans
b. K+
c. Acid phosphatase
d. Calcium
134. A surgeon with less experience of
laproscopic cholecystectomy while doing lap
surgery
founds stone in common bile duct. What should
he ideally do?
a. Open cholecystectomy with
choledocoduodenostomy
b. Lap exploration of CBD and removal
c. Lap removal of stone though bile duct
d.convert to Open cholecystectomy with CBD exploration (speed)
135. All prevent delivery of after coming head
of fetus except
a. Extended head
b. Hydrocephalus
c. Placenta previa ANS
d. Incomplete dilation of cervix
Correct answer : b) Placenta previa
136. Premature baby of 34 weeks was delivered. Baby had bullous lesion on the body. X ray shows periostitis. What is the
next investigation
a) VDRL for mother & baby
b) ELISA for HIV
c) PCR for T.B.
d) Hepatitis surface antigen for mother
( Repeat question AIPGMEE 07 MK q242, also asked in AIIMS May 2007)
Correct answer : a) VDRL for mother & baby
Prematurity, bullous lesions and periostitis point towards the diagnosis of congenital syphilis. VDRL for mother and baby is
the best investigation.
137. Which of the following is not a limb girdle dystrophy
a) Sarcoglycan dystrophy
b) Dystrophin dystrophy ANS
c) Dysferin dystrophy
d) Calpain dystrophy
Correct answer : b) Dystrophin dystrophy
138. Diabetes is best diagnosed by
a. FBS 100 and PPBS 140
b. FBS >125 and PPBS >199 ans
c. HbA1c = 5.5%
d.FBS more than 70
Diagnosis
See also: Glycosylated hemoglobin and Glucose tolerance test
2006 WHO Diabetes criteria
[20]
edit
Condition 2 hour glucose Fasting glucose
mmol/l(mg/dl) mmol/l(mg/dl)
Normal <7.8 (<140) <6.1 (<110)
Impaired fasting glycaemia <7.8 (<140) 6.1(110) & <7.0(<126)
Impaired glucose tolerance 7.8 (140) <7.0 (<126)
Diabetes mellitus 11.1 (200) 7.0 (126)
Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:
[14]
Fasting plasma glucose level 7.0 mmol/L (126 mg/dL).
Plasma glucose 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test.
Symptoms of hyperglycemia and casual plasma glucose 11.1 mmol/L (200 mg/dL).
Glycated hemoglobin (Hb A1C) 6.5%.
[21]
A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a repeat of any of the above-listed methods on a different day. It is
preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance
testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.
[22]
According to the current definition, two fasting glucose
measurements above 126 mg/dL (7.0 mmol/L) is considered diagnostic for diabetes mellitus.
People with fasting glucose levels from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) are considered to have impaired fasting glucose. Patients with plasma glucose
at or above 140 mg/dL (7.8 mmol/L), but not over 200 mg/dL (11.1 mmol/L), two hours after a 75 g oral glucose load are considered to have impaired glucose
tolerance. Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular
disease.
[23]
Glycated hemoglobin is better than fasting glucose for determining risks of cardiovascular disease and death from any cause.
[24]
Glycated hemoglobin (hemoglobin A1c, HbA
1c
, A1C, or Hb
1c
; sometimes also HbA1c) is a form of hemoglobin that is measured primarily to identify the
average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma
glucose. Normal levels of glucose produce a normal amount of glycated hemoglobin. As the average amount of plasma glucose increases, the fraction of
glycated hemoglobin increases in a predictable way. This serves as a marker for average blood glucose levels over the previous months prior to the
measurement.
The 2010 American Diabetes Association Standards of Medical Care in Diabetes added the A1c 48 mmol/mol (6.5%) as another criterion for the
diagnosis of diabetes.
[1]
In diabetes mellitus, higher amounts of glycated hemoglobin, indicating poorer control of blood glucose levels, have been associated with cardiovascular
disease, nephropathy, and retinopathy. Monitoring the HbA
1c
in type-1 diabetic patients may improve treatment.
[2]
139. CV malformations are all of these except:
a. Rheumatoid arthritis
b. Ankylosing spondylitis
c. Odontogenesis
d. Basilar invagination
Correct answer : D. Ankylosing spondylitis (It is least likely associated with CV junction anomaly.)
140. Not a pre malignant among the given is
a.PNH
b. PCH ans
c. Aplastic anemia
d. Myelodysplastic
141. Mechanism of injury in ant shoulder
dislocation
a. Abduction and external rotation ans
b. Adductio0n and internal rotation
c. Abduction and internal rotation
d. Adduction and external rotation
142. Counter transference is
a. Patient feeling towards doctor
b. Doctors feeling towards patient ans
c. Defence mechanism
d. Not Recalled
http://en.wikipedia.org/wiki/Countertransference
. Countertransference is defined as redirection of a psychotherapists feelings toward a client or, more generally, as a
therapists emotional entanglement with a client
The phenomenon was first defined by Sigmund Freud in 1910 in "The Future Prospects of Psycho-Analytic Therapy" as "a result of the patient's influence on
[the physician's] unconscious feelings," but the topic was left to others to develop, as he rarely referred to it himself. Freud stated that since an analyst is a
human himself he can easily lets his emotions into the client
[2][3]
When he did, it was almost invariably in terms of a 'warning against any countertransference
lying in wait' for the analyst: 'every psychoanalyst...must recognize this countertransference in himself and master it'.
[4]
The potential danger of the analyst's countertransference - 'In such cases the patient represents for the analyst an object of the past on to whom past feelings
and wishes are projected'
[5]
- became widely accepted in psychodynamic circles, both within and without the psychoanalytic mainstream. Thus, for
example, Jung warned against 'cases of counter-transference when the analyst really cannot let go of the patient...both fall into the same dark hole of
unconsciousness'.
[6]
Similarly Eric Berne stressed that 'Countertransference means that not only does the analyst play a role in the patient's script, but she
plays a part in his...the result is the "chaotic situation" which analysts speak of'.
[7]
Again, Lacan acknowledged of the analyst's 'countertransference...if he is
re-animated the game will proceed without anyone knowing who is leading'.
[8]
In this sense, the term includes unconscious reactions to a patient that are determined by the psychoanalyst's own life history and unconscious content; it was
later expanded to include unconscious hostile and/or erotic feelings toward a patient that interfere with objectivity and limit the therapist's effectiveness. For
example, a therapist might have a strong desire for a client to get all 'A's' in university because the client reminds her of her children at that stage in life, and
the anxieties that the therapist experienced during that time. Even in its most benign form, such an attitude could lead at best to 'a "countertransference
cure"...achieved through compliance and a "false self" suppression of the patient's more difficult feelings'.
[9]
Another example would be a therapist who didn't receive enough attention from her father perceiving her client as being too distant and resenting him for it. In
essence, this describes thetransference of the treater to the patient, which is referred to as the narrow perspective.
[10]
143. For confirmation of DNA from autopsy
sample is taken from
a. Liver
b. Spleen dams
c. Kidney
d. Brain ans
Ref: http://library-resources.cqu.edu.au/JFS/PDF/vol_38/iss_3/JFS383930686.pdf
DNA Fingerprinting from Tissues after variable postmortem periods:
Out of all tissues tested, the brain cortex appeared to be the most stable tissue for DNA recovery, even after long postmortem periods
144. A 28 year female with infertility had been
investigated with HSG reveled bilateral
cornual block. Next best investigation to be
done is
a. Tuboplasty
b. IVF
c. Hydrotubation
d. Laparoscopy and hyseteroscopy ans
Correct answer : a) Laparoscopy & Hysteroscopy
145. Karyotyping of fetus can be done from all
except
Chronioc villous sampling
b. Cordocentesis
c. Amniocentesis
d. Fetal skin biopsy ANS
Correct answer : D. Fetal skin
In fact, all of the above can be used for karyotyping, but fetal skin is used the least.
146. Which of the following is not true about Xenon anaesthesia
a) Non explosive
b) Minimal cardiovascular side effects
c) Slow induction and slow recovery
d) Low blood gas solubility
Correct answer : c) Slow induction and slow recovery
Xenon is very close to being an ideal anaesthetic agent with multiple advantages like:
Inert
Non toxic
Minimal cardiovascular effects
Low blood solubility
Fast induction and recovery
Non explosive
Does not cause malignant hyperthermia
147.
148. Brinzolamide isa.
competitive and reversible carbonic
anhydrase inhibitor.
b. non-competitive and reversible carbonic
anhydrase inhibitor. ans
c. competitive and irreversible carbonic
d. competitive and irreversible carbonic
149. A patient had enlarged pituitary gland on
MRI scan. His thyroid profile revieled
increased TSH and T4 decreased. What may be
the probabale cause?
a. Primary hypothyroidism ans
b. Pitutary tumor
c. Pitutory throtrophic adenoma
d. Not Recalled
150. Conversion of T4 to T3 is inhibited by all
excepta.
Propanolol
b.Propyl thiouracil
c.Amiodarone
d. Methiimazole ANS
151. A 16 yrs old female has a solid content in
USG finding with normal alpha fetoprotein,
normal hCG, increased alkaline phosphatase .
Most probable cause may be
a.Dysgerminoma ans
b.Teratoma.
c.Endodermal sinus tumor
d.Mucinous cystadenoma
Endodermal sinus tumor --SINCE NORMAL AFP THEN OPTION C EXCLUDED
Mucinous cystadenoma
The peak incidence occurs between 30-50 years of age. Benign tumors are bilateral in 5-10% of cases.
.Dysgerminomaaverage age 20 yrs solid with rubbery consistency but not
Teratoma most commonly occur at 20-40 ys age group
152. A 18 year old female presented in
infertility clinic with bilateral inguinal hernia;
history
reverel- Primary amenorrhea, but had normal
secondary sexual characteristic with absent
pubic hair. Most probable diagnosis is
a. AIS ans
b. Turners
c. MRKH
d. Mullerian duct agenesis
153. Which of the following is true regarding prothrombin time measurement?
A. Should be measured within 2 hours of obtaining the sample
B. Sample should be refrigerated immediately to preserve coagulant factor function
C. Platelet rich plasma is required
D. Activation is done with kaolin
Correct answer : A. Should be measured within 2 hours of obtaining the sample
The plasma should be assayed withing four hours of blood collection.
Ref: Basic medical laboratory techniques By Barbara H. Estridge, Anna P. Reynolds, Norma J. Walters (via google books)
The specimen for measurement of prothrombin time should not be refrigerated.
Ref: Understanding clinical investigations: a quick reference manual By Susan Skinner (via google books)
Platelet rich plasma is not used of measurement of PT. Instead, tissue factor is used.
Ref: Guyton 11th p467
Kaolin is used for APTT measurement.
154. Which of the following drug is used as
Transcranial patch for Parkinsons disease
a. Levodopa
b. Rotigotine ans
c. Selegiline
d. Carbidopa
155. MRI appearance of cavernous angioma
a.Popcorn appearance ans
b. Sun ray appearance
c. Not Recalled
d. Not Recalled
ref http://www.brain-aneurysm.com/cm.html
7. How are cavernous malformations (cavernomas) detected?
Cavernomas are detected best through MRI. They can enhance with contrast, but frequently do not. They are not detectable on a cerebral angiogram (i.e., are
referred to as angiographically occult vascular malformations or AOVMs; however, an associated venous angioma may be detected on the angiogram!). The best
two MRI sequences used to detect cavernomas areregular T2 ("popcorn" appearance) and gradient echo (GRE; "India ink" blotch appearance). These are
shown below. A CAT scan can also show a cavernoma, but the resolution is better with an MRI.
Note that in familia
156. Bremelanotide used for
a. Erectile dysfunction ans
b. Ca prostate
c. LUTs
d. Metastatic RCC
develop from melanotan 2 peptide n actvating MC1R (melanocortin receptor) by nervous system activating
157. A 30 yrs old executive complains of
excessive sleepiness in daytime and lack of
sleep at
night. Once at a party his friends noticed of his
sudden fall due to sleep. He may have
a. Seizures
b. Night mares
c. Apnoea during sleep
d. paralysis during sleep wake transition with haullicination dams
WE CAN EXCLUDE A AND B BUT NOT SURE ABOUT C PLZ CONTRIBUTE US YOUR OPINION
158. A child presented with leaking
menigiomyelocoele. Which of the following
would be
most appropriate for diagnosis?
a. Wound swab and culture
b. Blood culture dams
c. Urine culture
d. CBC
159. 40 mm gap between & tropocollagen is for
which molecule so as to allow deposition in
bone
a.Calcium ans
b. Iron
c. Manganese
d. Phosphorus
160. All changes occurs in pregnancy except
a. Increase in peripheral vascular resistance. ans
b. Increase in stroke volume
c. Increase in cardiac output
d. Increase in blood volume
Correct answer : d) Increase in peripheral vascular resistance
161. All are true about oxygenase except?
a. Incorporates one atom of oxygen
b. Incorporates both atoms of oxygen
c. Hydroxylation
d. Help in carboxylation reaction of steroids ANS
(Repeat question AIPGME 07 MK q30)
Correct answer : Required for carboxylation of drugs
Ref: Harper 27th p96,97
Explanation:
Carboxylation is done by ligases.
Monooxygenases and dioxygenases incorporate 1 and 2 atoms of oxygen respectively
Monoxygenases are required for hydroxylation of steroids
162. A young male who had a road traffic
accident, presented with a non pulsatile
retroperitoneal hematoma. On table
intravenous urogram was done. Right kidney
was not
visualised. Left kidney showed immediate
excretion of dye. What is next step in
management?
a. Nephrectomy
b. Explore proximal renal vessels, open Gerotas
fascia and explore kidney ans
c. Perform on table angiography
d. Retrograde pyelography
163. All are true regarding vitamin D except
a.Hydroxylation occurs in liver
b. 25 hydroxylation occur in kidney ans
c. Vit d 400-600 is required in absence of
sunlight
d. Wilsons syndrome
164.
165. A 25 year old lady on treatment for
rheumatoid arthritis has the following lab
findings.
Haemoglobin 6g, MCV 60fl,RBC= 2.5 lakhs,
Ferritin 200ng/ml. Transferrin 298
mg/dl. Iron -=30 What is the probable
diagnosis?
a. Thalassemia
b. Autoimmune hemolytic anemia
c. Anemia of chronic disease ans
d. Iron deficiency anemia
166. 17 year old female presented with a
history of primary amenorrhoea. She had
bilateral
inguinal hernias. Secondary sexual characters
were present. Pubic hair was absent. Which
among the following is the most probable
diagnosis?
a. Androgen insensitivity ans
b. Star syndrome
c. Mullerian agenesis
d. Turner syndrome
167. Indications of glucose tolerance test in a
pregnant woman are all except?
a. Previous malformation
b. Polyhydramnios
c. Eclampsia ANS
d. Previous unexplained death
168. A 25 year old lady presented with fever of
1 month duration, ataxia and head ache. Brain
imaging showed dilated ventricles with basal
exudates. Which among the following is the
most likely CSF finding?
a. Lymphocytic pleocytosis, low sugar, high
protein ANS
b. Lymphocytic pleocytosis, low sugar, low
protein
c. Lymphocytic pleocytosis, high sugar, low
protein
d. Neutrophilic pleocytosis, low sugar, high
protein
169. Drug not used in multiple sclerosis?
a. Interferon 1 alpha
b. Interferon 1 beta
c. Glatiramer acetate
d. Mycophenolate mofetil ANS
Correct answer : D. Mycophenolate mofetil (Mycophenolate mofetil (MMF) is an immunosuppressant and prodrug of mycophenolic acid, used extensively in transplant medicine.)
FDA Approved Disease Modifying Agents used in multiple sclerosis:
Avonex (interferon beta-1a)
Betaseron (interferon beta-1b)
Copaxone (glatiramer acetate)
Extavia (interferon beta-1b)
Gilenya (fingolimod)
Novantrone (mitoxantrone)
Rebif (interferon beta-1a)
Tysabri (natalizumab)
Ref: http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/treatments/index.aspx
170. Most Common site of cholangiosarcoma
a.Intrahepatic bile duct
b.Origin of cystic duct
c.hilum ans
d.Extrahepatic bile duct
171. The Role of Cap in lac operon is -
a. Positive regulator
b .Negative regulator
c. Attenuation
d. Constituted expression
(Repeat question AIPGME 07 MK q40)
Correct answer : Positive regulator
Ref: Harper
Explanation: CAP acts as the positive regulator in LAC operon and is required for gene expression.
An operon is a functioning unit of genomic DNA containing a cluster of genes under the control of a single regulatory signal or promoter. The lac operon is an operon required for the transport and
metabolism of lactose in Escherichia coli and some other enteric bacteria. The lac operon is
172. Correct match of drug and its metabolic enzyme are all except?
C. Verapamil CYP3A4
below)
173. A new method of measuring Hb
concentration was developed. The ten result of
one
sample are as follows-9.4, 10.4, 9.6, 10.8, 9.1,
12.1, 10.1, 9.8, 9.2 and 9.5. But the Hb level
measured by standard colorimetry was 10.2.
Thus this method hasa.
low validity low reliability
b. low validity and high reliability
c. lowvalidity and low reliability ans
d. high validity and high reliability
174. Direct standardization is used to compare
the mortality rates between two countries
because of differences in:
a. Cause of death
b. Numerators
c. Age distributions ans
d. Denominators
Correct answer : C. Age distributions
Crude death rates when compared can give rise to wrong conclusions. Population A with more proportion of younger people will have a lower crude death rate compared to
Population B which has more proportion of older people. But it does not mean that Population A is more healthy
175. The important fatty acid present in breast milk which is important for growth is
a) Docosahexaenoic acid
b) Palmitic acid
c) Linoleic acid
d) Linolenic acid
Correct answer : a) Docosahexaenoic acid
It is required for development of nervous system and vision in the first 6 months of life
176. The complete amino acid sequence of the
two polypeptide chains of insulin was studied
and a Noble prize was awarded to
a.Frederick Sanger(speed)
b. Banting and Best
c. Not Recalled
d. Not Recalled
177. Drug of choice for infant Congenital Adrenal
Hyperplasia is
a. Dexamethasone
b. Betamethasone
c. Hydrocortisone
d. Predinsolone
178. A patient presents with LDL = 600 and TG=
140; which of the following may be
present?
a. Tender xanthomas ans
b. Plantar xanthomas
c. Tuberoeruptive xanthomas
d. Lipemia retinalis
179. Gold standard study for clinical research is
a. Randomised double blinded clinical trial
b. Systemic meta-analysis ans
c. Ecological study
d. Retrepospective cohort study
180. Depression of EEG is found with
a.Ketamine
b. Hypothermia ans
c. Early hypoxia
d. N2O
181. Doc in multiple sclerosis
a. . IFN
b. IFN ANS
c. IFN
d. Infiliximab
(Repeat question AIIMS Nov 06 AA Q104)
Correct answer : b) Interferon beta
182. A child presents with erythramatous and
itching with redness of both the cheeks. There
was history of sudden onset macule and papule.
Mother has history of bronchial astham.
Most probable diagnosis is
a. Atopic dermatitis ans
b. Infections eczematoid dermatitis
c. Drug eruption
d. Psoriasis
183. All are inaccurate regarding forceps
delivery except?
a. The anteroposterior diameter of head should
not be more than 15 degree to the axis
b. The presentation should be vertex or
mentoanterior
c. The presenting part should be at at zero
station ANS
d. Caput succedaneum is not a contraindication
Correct answer : C. The presenting part should be at at zero station
The question can be rewritten as : Which is true regarding forceps delivery?
Option A is false Kielland forceps is used in deep transverse arrest the sagittal suture will be at 90 degrees to anteroposterior diameter of pelvis
Option B is false Forceps can be used for breech delivery
Option C is true Refer prerequisites for forceps application given below
Option D is false Caput succedaneum is not a contraindication
Prerequisites for Forceps application (Mudaliar, 10th, p327)
-There should be a proper indication
-The cervix must be fully dilated and taken up
-The membranes must be ruptured
-The presentation should be vertex, face or the aftercoming head in a breech case
-The greatest diameter of the head should have passed through the brim of the pelvis and there must be no disproportion between the fetal head and the pelvis anywhere in the cavity or
outlet. No part of the fetal head should be paplable per abdomen
-The position of the head should be ascertained by palpation of the fontanelles and sagittal suture
-Analgesia should be satisfactory
-The uterus must be contracting and relaxing
-The bladder and rectum should be empty
-Informed consent should be obtained from the patient
Contraindications for forceps delivery (Obstetrics and Gynaecology By Sarabatnam Arulkumaran, Lesley Regan, Aris Papageorghiou, David Farquharson, Ash Monga Google books)
-Incompletely dilated cervix
-Unknown fetal position
-Station above ischial spines
-Operator is inexperienced in forceps delivery
-Clinical cephalopelvic disproportion
184. Which among the following is not a
ultrasound feature of Congenital Hypertrophic
Pyloric Stenosis?
a.
95
% sensitivity by ultrasound
b. Thickness of pylorus > 4mm
c. Canal length > 16mm
d. High gastric residue ans
refhttp://www.amcresidents.com/Lectures/peds/CA2/pyloric%20stenosis.pdf
http://www.sonoworld.com/ArticleDetails/Infantile_or_Congenital_Hypertrophic_Pyloric_Stenosis.aspx?ModuleCategoryId=167
The diagnosis is initially suggested by the history. Palpation
of a hypertrophied pyloric muscle, or olive, is diagnostic
and successful in the majority of infants with a 99% positive
predictive value16,17 (Figure 1). Despite the fact that HPS
can be diagnosed solely by palpation, there is a trend toward
increased reliance on imaging as a substitute or complement
to physical examination. In one report, there was a threefold
increase in use of imaging between the periods 1974 to 1977
and 1988 to 1991, with a decrease in cases diagnosed by
palpation (from 87% to 49%) during the two periods, respectively.
18 Although imaging is highly sensitive, it does
not lead to increased accuracy of diagnosis, and it does
increase cost.16 Some have speculated that decline in palpable
HPS and therefore increased use of imaging is related
to earlier presentation of patients in recent times so that
infants are less emaciated, healthier, and more vigorous, and
thus more difficult to examine.19
Other methods of diagnosis must be used when physical
examination is unsuccessful. Fluoroscopic upper gastrointestinal
contrast study was first proposed in 1918, and is
performed with the child drinking from a bottle.5 In patients
with HPS, there is failure of relaxation of the prepyloric
antrum and the pyloric canal is outlined by a string of
contrast material. The thickened muscle causes an external
impression on the gastric antrum, termed the shoulder
sign. Fluoroscopy can be time consuming and involves
radiation. Sensitivity as high as 95% is reported but depends
on experience and skill of the examiner.20 Ultrasonography
is noninvasive, can be performed quickly and there is no
radiation exposure (Figure 2). Accuracy approaches 100%
in experienced hands,20 with 99.5% sensitivity and 100%
specificity.16 Thickened prepyloric antrum can be demonstrated
bridging the distended stomach and duodenal bulb.
The hypertrophied pyloric canal may range from 14 mm to
more than 20 mm in length and the muscle thickness is
variable (from 3 to 5 mm). Real time observation of failure
of relaxation of the pyloric canal is important.21
Imaging
Ultrasound is currently the imaging modality of choice that reliably establishes the diagnosis of hypertrophic pyloric stenosis. There are various
sonographic parameters that can be used to arrive at the diagnosis and include pyloric length, pyloric diameter, muscle thickness and also pyloric
volume. Pyloric muscle thickness of 3 mm or greater, pyloric canal length of 17 mm or greater and the absence of the passage of a peristaltic wave
through the pylorus, during the period of scanning are the diagnostic ultrasound criteria. Classically seen is:
1. A ring on transverse section, resembling a doughnut or a bulls-eye or a target with the echogenic pyloric canal in the center and surrounded by the
hypertrophied pyloric muscle.
Caption : Sagittal image of the epigastric region
Description : The pyloric channel appears significantly long and the thickened, hypoechoic muscular layers are
well appreciated. The pyloric lumen is reduced and the apposed echogenic mucosal layers of both sides are
noted.
185. All are limb girdle dystrophies except?
a. Sarcoglycanopathies
b. Dystrophinopathies ANS
c. Dysferlinopathy
d. Calpainopathy
186. If a doctor indulges in giving a false medical
certificate to a patient, he is liable to be
prosectuted under?
a. 137 IPC
b. 157 IPC
c. 197 IPC
d. 167 IPC
Correct answer : C. Sec 197 IPC
Issuing or signing false certificates:
Section 197 and 198 relate to issue of false certificate. Section 197 makes issuing or signing of a false certificate, and section 198 using as a true certificate a certificate known to be false,
punishable.
Ref: Textbook Of Forensic Medicine And Toxicology: Principles And Practice By Vij
Section 197. Issuing or signing false certificate
Whoever issues or signs any certificate required by law to be given or signed, or relating to any fact of which such certificate is by law admissible in evidence, knowing or believing that such
certificate is false in any material point, shall be punished in the same manner as if he gave false evidence.
Ref: http://www.vakilno1.com/bareacts/indianpenalcode/S197.htm
187. Universal definition of myocardial
infarction includes all except?
a. Sudden death can be due to MI
b. New abnormal wall motion with raised
cardiac biomarkers
c. 3 times rise in troponin levels after coronary artery bypass graft surgery
d. Reperfusion leads to elevation of troponin
levels in 5-7%
Correct answer : C. 3 times rise in troponin levels after coronary artery bypass graft surgery
Given below is the universal definition of myocardial infarction published in Circulation a journal by American Heart Association.
Option A and B are given in the definition.
Option C 5 times rise in troponin levels after coronary artery bypass graft surgery is considered as CABG related MI instead of 3 times
as given in the option. So the statement is wrong and hence not included in the definition.
Option D is correct Analytical values are considered to be different if they are different by 3 SDs of the variance of the measures. For troponin, this value
is 57% for most assays at the levels involved with reinfarction.
Universal Definition of Myocardial Infarction by Kristian Thygesen; Joseph S. Alpert; Harvey D. White; on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of
Myocardial Infarction
Definition of myocardial infarction:
Criteria for acute myocardial infarction
The term myocardial infarction should be used when there is evidence of myocardial necrosis in a clinical setting consistent with myocardial ischaemia. Under these conditions any one of the
following criteria meets the diagnosis for myocardial infarction:
Detection of rise and/or fall of cardiac biomarkers (preferably troponin) with at least one value above the 99th percentile of the upper reference limit (URL) together with evidence of myocardial
ischaemia with at least one of the following:
Symptoms of ischaemia;
ECG changes indicative of new ischaemia [new ST-T changes or new left bundle branch block (LBBB)];
Development of pathological Q waves in the ECG;
Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
Sudden, unexpected cardiac death, involving cardiac arrest, often with symptoms suggestive of myocardial ischaemia, and accompanied by presumably new ST elevation, or new LBBB, and/or
evidence of fresh thrombus by coronary angiography and/or at autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the
blood
For percutaneous coronary interventions (PCI) in patients with normal baseline troponin values, elevations of cardiac biomarkers above the 99th percentile URL are indicative of peri-procedural
myocardial necrosis. By convention, increases of biomarkers greater than 3 x 99th percentile URL have been designated as defining PCI-related myocardial infarction. A subtype related to a
documented stent thrombosis is recognized.
For coronary artery bypass grafting (CABG) in patients with normal baseline troponin values, elevations of cardiac biomarkers above the 99th percentile URL are indicative of peri-procedural
myocardial necrosis. By convention, increases of biomarkers greater than 5 x 99th percentile URL plus either new pathological Q waves or new LBBB, or angiographically documented new graft
or native coronary artery occlusion, or imaging evidence of new loss of viable myocardium have been designated as defining CABG-related myocardial infarction
Pathological Endings of an acute myocardial infarction.
Criteria for prior myocardial infarction
Any one of the following criteria meets the diagnosis for prior myocardial infarction:
Development of new pathological Q waves with or without symptoms
Imaging evidence of a region of loss of viable myocardium that is thinned and fails to contract, in the absence of a non-ischaemic cause
Pathological Endings ofa healed or healing myocardial infarction
Ref: http://circ.ahajournals.org/content/116/22/2634.full.pdf
188. Which is the only drug effective in EDSS in
multiple sclerosis?
a. Interferon gamma
b. Interferon beta
c. Glatiramer acetate
d. Natalizumab dams
plz also confirm abt natalizumab
Seven drugs are approved as Disease-Modifying Therapies for Relapsing Forms of multiple sclerosis by the U.S. Food and Drug Administration (FDA): (1) IFN1a (Avonex), (2) IFN1a (Rebif), (3)
IFN1b (Betaseron), (4) glatiramer acetate (Copaxone), (5) natalizumab (Tysabri), (6) fingolimod (Gilenya), and (7) mitoxantrone (Novantrone). An eighth, cladribine (Leustatin), is currently awaiting
an FDA decision on its approval.
The Expanded Disability Status Score (EDSS) is a useful measure of neurologic impairment in Multiple sclerosis.
-IFN beta reduces the attack rate and improves disease severity measures such as EDSS progression and MRI-documented disease burden.
-Glatiramer acetate reduces the attack rate (whether measured clinically or by MRI) in RRMS. Glatiramer acetate may also benefit disease severity measures, although this is less well established
than for the relapse rate.
-Natalizumab greatly reduces the attack rate and significantly improves all measures of disease severityin MS.
From this we can conclude that all the above drugs can improve EDSS. But according to Table 380-6, the change in disease severity over a 2 year period is as follows:
Natalizumab, 300 mg IV qmo (42%)
Interferon beta 1b, 250 g SC qod (29%)
Interferon beta 1a, 30 g IM qw (37%)
Glatiramer acetate, 20 mg SC qd (12%)
Natlizumab has the maximum decrease in disease severity. So we can take it as the best answer.
The above statements are quoted from Harrison 18th edition.
If you have any better explanation / alternate answer for this question, please post it as a comment below. Thanks!
189. A 4 month pregant lady on treatment with
valproate regularly asked for your advice
regarding taking the drug during pregnancy.
What is the best course of action?
a. Immediately taper off valproate and start
lamotrigine
b. Change to carbamazapine
c. Continue valproate and monitor blood levels ans
d. Give both valproate and lamotrigine
Correct answer : C. Continue valproate and monitor blood levels
The period of organogenesis is over and hence there is not much risk of teratogenecity. And changes to anti epileptic drugs should be done before conception to avoid seizure risk during pregnancy.
Due to altered plasma protein binding during pregnancy, it is recommended that blood levels are measured to maintain a therapeutic range. (Current diagnosis and Treatment). Although Williams
state that blood level monitoring is not very useful, it also states that Free drug level monitoring is useful, though not widely available. Harrison also supports continuing the present medication.
In general, anticonvulsant medication should be maintained at the lowest dosage associated with seizure control. Although some clinicians routinely monitor serum drug levels during pregnancy,
antenatal serum drug levels may be unreliable because of altered protein binding. Free or unbound drug levels, although more helpful, are not widely available. Lander and Eadie (1991)
reported that seizure control is not improved by routine drug level monitoring. For these reasons, drug levels may be measured only following seizures or if noncompliance is suspected. (Williams
22nd)
Treatment of epilepsy should consist of the medication that has been most beneficial for the patient and at the lowest possible dose to maintain seizure control with some caveats. Some antiepileptic
agents are more likely to cause birth defects than are others, and attempts to change medications should be made prior to conception. During pregnancy, anticonvulsant levels change as a
result of decreased protein binding, increased plasma volume, and alterations in the absorption and excretion of drugs. In addition, lamotrigine, phenytoin, phenobarbital, and carbamazepine have
an increased plasma clearance that probably is related to high hepatic metabolism. These factors most often lead to low antiseizure plasma levels. Noncompliance, morning sickness, and
hyperemesis gravidarum are other reasons for low drug levels. Therefore, blood level measurements of antiseizure medications are used to monitor and maintain a therapeutic
range. Levels should be checked at least each trimester and prior to delivery. More frequent monitoring may be needed. Because of decreased protein binding, serum free drug levels rather than
routine serum levels will be more accurate.(Current Diagnosis & Treatment Obstetrics & Gynecology, Tenth Edition)
Since the potential harm of uncontrolled convulsive seizures on the mother and fetus is considered greater than the teratogenic effects of antiepileptic drugs, it is currently
recommended that pregnant women be maintained on effective drug therapy. When possible, it seems prudent to have the patient on monotherapy at the lowest effective dose, especially
during the first trimester. For some women, however, the type and frequency of their seizures may allow for them to safely wean off antiepileptic drugs prior to conception. Patients should also take
folate (14 mg/d), since the antifolate effects of anticonvulsants are thought to play a role in the development of neural tube defects, although the benefits of this treatment remain unproved in this
setting. (Harrison 18th)
Fetal valproate syndrome:
Valproate causes birth defects: exposure during pregnancy is associated with about three times as many major anomalies as usual, mainly spina bifida and, more rarely, with several other defects,
possibly including a valproate syndrome. Characteristics of this valproate syndrome include facial features that tend to evolve with age, including trigonocephaly, tall forehead with bifrontal
narrowing, epicanthic folds, medial deficiency of eyebrows, flat nasal bridge, broad nasal root, anteverted nares, shallow philtrum, long upper lip and thin vermillion borders, thick lower lip and small
downturned mouth. (Wikipedia)
190. All are inaccurate regarding forceps
delivery except?
a. The anteroposterior diameter of head should
not be more than 15 degree to the axis
b. The presentation should be vertex or
mentoanterior
c. The presenting part should be at at zero
station ans
d. Caput succedaneum is not a contraindication
191. Hormone replacement therapy decreases
all of the following except
a)Vaginal dryness
b)Hot flushes
C) Prevention of cardiovascular risk ANS
d)Prevention of osteoporosis
192. Somatic passivity is seen in
a.paranoid Schizophrenia ANS
b. Hypochondriac disorder
c. Body dysmorphic disorder
d. Depression
REF-- http://www.slideshare.net/mabdelghani/schizophreniaa
Kurt Schneider Criteria for Schizophrenia 1. First-rank symptoms a. Audible thoughts b. Voices arguing or discussing or both c. Voices commenting d. Somatic passivity
experiences e. Thought withdrawal and other experiences of influenced thought f. Thought broadcasting g. Delusional perceptions h. All other experiences involving volition
made affects, and made impulses 2. Second-rank symptoms a. Other disorders of perception b. Sudden delusional ideas c. Perplexity d. Depressive and euphoric mood
changes e. Feelings of emotional impoverishment f. "..and several others as well" vi. Karl Jaspers (1883-1969): Jaspers paved the way to understand the psychological
meaning of schizophrenic signs and symptoms such as delusions and hallucinations. vii. Adolf Meyer (1866-1950): Meyer, the founder of psychobiology, saw schizophrenia as
a reaction to life stresses and called it "the schizophrenic reaction". In later editions of DSM, the term reaction was dropped. Epidemiology In U.S.A., the lifetime prevalence of
schizophrenia is about 1%. According to DSM-IV-TR, the annual incidence of schizophrenia ranges from 0.5 to 5.0 per 10,000, with some geographic variation (e.g., the
incidence is higher for persons born in urban areas of industrialized nations). Schizophrenia is found in all societies and geographical areas, and incidence and prevalence
rates are equal worldwide. In U.S.A., about 0.05% of the total population is treated for schizophrenia in any single year, and only about half of all patients with schizophrenia
obtain treatment, despite the severity of the disorder
193. Type 2 bipolar disorder is?
A. Mania and depression
B. Hypomania and depression ANS
C. Hypomania and syndromic depression
D. ?
Correct answer : B. Hypomania and depression
Bipolar II disorder is a bipolar spectrum disorder characterized by at least one hypomanic episode and at least one major
depressive episode; with this disorder, depressive episodes can be more frequent and are more intense than hypomanic
episodes.
Ref: http://en.wikipedia.org/wiki/Bipolar_II_disorder
194. Rheumatoid arthritis is best diagnosed by
a. Anti-ccp antibody ans
b. Ig G antibody
c. Ig A antibody
d. Ig M antibody
Correct answer : a) Anti CCP antibody
195. Acute pancreatitis severity associated with
all except:
a. Glucose
b. Ca+2
c. Amylase
d. Transminases
196. Suppose you are working in a remote PHC
and you have to send a blood sample for
estimation of blood glucose level, following
agent is used
a. E. D. T. A
b. Potassium oxalate
c. K oxalate + NaF ANS
d. K oxalate + NaI
Correct answer : C. NaF + Potassium oxalate
The standard anticoagulant used for glucose estimation is potassium oxalate. But the RBCs in the sample continue utilising glucose for glycolysis. Thus the glucose level drops 1-2% per hour. In a
tertiary care setup, this is not much significant as the sample can reach the lab quickly. But when taking a blood sample in a PHC, there is a delay before reaching the lab. Hence sodium fluoride
should be added. It acts as a glycolysis inhibitor.
197. A child presented with jaundice and history
of passing clay colored stool. The following
enzymes will be elevated except:
a. 5 nucleotidase
b. ALP
c. -GGT
d. ALA ANS
198. You have diagnosed a patient clinically as
having SLE and ordered 6 tests. Out of which
4 tests have come positive and 2 are negative.
To determine the probability of SLE at this
point, you need to know:
a. Prior probability of SLE; sensitivity and
specificity of each test ans
b. Incidence of SLE and predictive value of each
test
c. Incidence and prevalence of SLE
d. Relative risk of SLE in this patient
199. A patient admitted to an ICU is on central
venous line for the last one week. He is on
ceftazidime and amikacin. After 7 days of
antibiotics he develops a spike of fever an his
blood culture is positive for gram positive cocci
in chains, which are catalase negative.
Following this, vancomycin was started but the
culture remained positive for the same
organism even after 2 weeks of therapy. The
most likely organism causing infection is:
a. Staphylococcus aureus
b. Viridans streptococci
c. Enterococcus faecalis ans
d. Coagulase negative staphylococcus
200. With reference to bacterioides fragilis the
following statements are true, except:
a. B. fragilis is the same frequent anaerobe
isolated from clinical samples
b. B. fragilis is not uniformaly sensitive to
metronidazole
c. The lipopolysaccharide formed by B. fragilis is
structurally and functionally
different from the conventional endotoxin
d. Shock and disseminated intravascular
coagulation are common in bacteroides ans
bacteremia
=====.
Correct match of drug and its metabolic enzyme are all except?
C. Verapamil CYP3A4
below)
Molecular Pathways Mediating Drug Disposition
Molecule
Substrates
Inhibitors
CYP3A
Calcium channel blockers
Antiarrhythmics (lidocaine, quinidine, mexiletine)
HMG-CoA reductase inhibitors (statins)
Cyclosporine, tacrolimus
Indinavir, saquinavir, ritonavir
Amiodarone
Ketoconazole, itraconazole
Erythromycin, clarithromycin
Ritonavir
CYP2D6
Timolol, metoprolol, carvedilol
Phenformin
Codeine
Propafenone, flecainide
Quinidine (even at ultra-low doses)
CYP2C9
Warfarin
Phenytoin
Glipizide
Losartan
Amiodarone
Fluconazole
Phenytoin
CYP2C19
Omeprazole
Mephenytoin
Clopidogrel
Omeprazole
Thiopurine S-methyltransferase
6-Mercaptopurine, azathioprine
N-acetyltransferase
Isoniazid
Procainamide
Hydralazine
Some sulfonamides
UGT1A1
Irinotecan
Pseudocholinesterase
Succinylcholine
P-glycoprotein
Digoxin
HIV-protease inhibitors
Many CYP3A substrates
Quinidine
Amiodarone
Verapamil
Cyclosporine
Itraconazole
Erythromycin
Ref: Harrison 18th, chapter 5 : Table 5-1
Q. Which of the following muscles undergoes wasting first in osteoarthritis knee?
A. Hamstrings only
B. Quadriceps only
C. Both hamstrings and quadriceps
D. Gastrocnemius
Correct answer : B. Quadriceps only
All muscles around the knee can undergo wasting in advanced osteoarthritis. But quadriceps is the first muscle to be affected.
Q. All are true about vitamin D metabolism except?
A. 25 alpha hydroxylation occurs in the liver
B. 1 alpha hydroxylation occurs in the kidney
C. In absence of sun light, the daily requirement is 400- 600 IU per day
D. Williams syndrome is associated with mental retardation, precocious puberty and obesity
Correct answer : D. Williams syndrome is associated with mental retardation, precocious puberty and obesity
Williams syndrome (WilliamsBeuren syndrome) is a rare neurodevelopmental disorder characterized by a distinctive, elfin facial appearance, along with a low nasal bridge; an unusually cheerful
demeanor and ease with strangers; developmental
21. Increased level of alanine in serum after fasting suggests? ?(AIIMS-NOV-2011)
A. Increased muscle breakdown
B. Reduced amino acid utilisation from gluconeogenesis
C. Break in continuity of plasma membrane resulting in leakage of amino acids
D.
ANS-A
Gluconeogenesis
* The major aim of protein catabolism during a state of starvation is to provide the glucogenic amino acids (especially alanine and
glutamine)
* In the hypometabolic/starved state, protein breakdown for gluconeogenesis is minimized, especially as ketones derived from fatty
acids become the substrate preferred by certain tissues.
* In the hypermetabolic/stress state, gluconeogenesis increases dramatically
Q.Chromosomal mutations can be identified from all except. ?(AIIMS-NOV-2011
1. single stranded polymorphism
2.dideoxy nucleotide trail sequencing
3.agarosge gel electrophoresis
4.Denaturing Gradient Gel Electrophoresis (DGGE) dams
ANS-C
POSITIVE-OPERATION HARRI PAGE-287
Methods Used for the Detection of Mutations
Method Principle Type of
Mutation
Detected
Commonly Used Techniques
Fluorescent in situ
hybridization(FISH)(AIIMS-
NOV-2010***)
Hybridization to
chromosomes with
fluorescently labeled
probes
Numerical or
structural
abnormalities in
chromosomes
Southern blot cDNA probe Large deletion,
insertion,
rearrangement,
expansions of
triplet repeat,
amplification.
Polymerase chain reaction
(PCR)
Amplification of DNA
segment
Expansion of
triplet repeats,
variable number
of tandem
repeats (VNTR),
gene
rearrangements,
translocations.
Reverse transcriptase PCR
(RT-PCR)
Reverse transcription,
amplification of DNA
segment absence or
reduction of mRNA
transcription
Analyze
expressed
mRNA (cDNA)
sequence;
detect loss of
expression
DNA sefquencing * Direct sequencing of
PCR products
Point mutations,
small deletions
and insertions
Sequencing of DNA
segments cloned into
plasmid vectors
Restriction fragment
polymorphism (RFLP)
Detection of altered
restriction pattern of
genomic DNA (Southern
blot) or PCR products
Point mutations,
small deletions
and insertions
Other Techniques
Single-strand
conformational
polymorphism (SSCP) *
PCR of DNA segment:
Mutations result in
conformational change
and altered mobility
Point mutations,
small deletions
and insertions
Denaturing gradient gel
electrophoresis (DGGE)*
PCR of DNA segment:
Mutations result in
conformational change
and altered mobility
Point mutations,
small deletions
and insertions
RNAse cleavage Cleavage of mismatch
between mutated and
wild-type sequence
Point mutations,
small deletions
and insertions
Oligonucleotide specific
hybridization (OSH)
Hybridization of PCR
products to wild-type or
mutated
oligonucleotides
immobilized on chips or
slides
Point mutations,
small deletions
and insertions
Microarrays
(AI-2010***)
Hybridization of PCR
products to wild-type or
mutated
oligonucleotides
Point mutations,
small deletions
and insertions
Genotyping of
SNPs
Protein truncation test (PTT) Transcription/translation
of cDNA isolated from
tissue sample
Mutations
leading to
premature
truncations
Pyrosequencing Clonal amplification of
single DNA fragments
on microparticles
followed by massive
parallel sequencing
Sequencing of
whole genomes
of
microorganisms,
resequencing of
amplicons
Multiplex ligation-dependent
probe amplification (MLPA)
Quantification of PCR-
generated amplicons
reflecting the number of
copies of a specific DNA
sequence
Copy number
DNA Sequencing
* Capillary electrophoresis-based Sanger method in which dideoxynucleotides are used to randomly terminate DNA polymerization at each of the four
bases
15. Which of the following does not present with eosiniphilia and ARF.. ?(AIIMS-NOV-2011)
a.drug induced interstitial nephritis
b.atheroembolic phenomena
c.contrast nephropathy d.PAN dams
ANS-D.
REF-OPERATION HARRI-PAGE 182,274
Intrinsic Renal Disease
* Ischemic and toxic ATN account for ~90% of acute intrinsic renal failure.
* ATN can often be distinguished from prerenal azotemia by urinalysis and urine electrolyte composition.
* The kidney is vulnerable to toxic injury by virtue of its rich blood supply (25% of cardiac output) .
* Eosinophiluria suggestive of allergic interstitial nephritis or atheroembolic renal disease and is observed by using a Hansel stain.
* Stigmata of atheroemboli (livedo reticularis, distal peripheral infarcts, eosinophilia).
Eosinophilia -1) drugs (iodides, aspirin, sulfonamides, nitrofurantoin, penicillins, and cephalosporins). 2)Allergies such as hay fever, asthma, eczema, serum
sickness, allergic vasculitis, and 3)collagen vascular diseases (e.g., rheumatoid arthritis, eosinophilic fasciitis, allergic angiitis, and periarteritis nodosa) and
4)malignancies (e.g., Hodgkins disease; mycosis fungoides; chronic myeloid leukemia; and cancer of the lung, stomach, pancreas, ovary, or uterus), as well
as in Jobs syndrome and CGD.
Systemic steroids are indicated in? ?(AIIMS-NOV-2011)
A. Pustular psoriasis B. Impetigo herpetiformis
C. Psoriatic arthropathy
D. Psoaritic erythroderma
ANS-C
PARTIAL HELP FROM OPERATION HARRI-page-231
psoriasis -
* Most patients with localized, plaque-type psoriasis can be managed with midpotency topical glucocorticoids.
* A topical vitamin D analogue (calcipotriene) and a retinoid (tazarotene) are efficacious in the treatment of limited psoriasis and have
replaced other topical agents such as coal tar, salicylic acid, and anthralin.
* Ultraviolet B (UV-B) light, narrowband UV-B, and ultraviolet A (UV-A) spectrum with either oral or topical psoralens (PUVA) are
effective.
* The long-term use of UV light is associated with an increased incidence of non-melanoma and melanoma skin cancer.
* UV light therapy is contraindicated in patients receiving cyclosporine.
* Oral glucocorticoids should not be used for the treatment of psoriasis due to the potential for developing life-threatening pustular
psoriasis when therapy is discontinued.
* Methotrexate is an effective agent, especially in patients with psoriatic arthritis.
Intra-epidermal IgG is associated with? (AIIMS-NOV-2011)
A. Pemphigus B. Bullous pemphigoid
C. ? D. ?
ANS-A
REF-OPERATION HARRI-PAGE238, CONSULTANT
Pemphigus Vulgaris
* Intraepidermal blistering diseases characterized by loss of cohesion between epidermal cells (a process termedacantholysis).
* Manual pressure to the skin of these patients may elicit the separation of the epidermis (Nikolskys sign)-also seen in toxic epidermal necrolysis,
Stevens-Johnson syndrome.
* Predominates in patients >40 years.
* PV typically begins on mucosal surfaces.
* PV may be associated with severe skin pain.
* Lesions heal without scarring.
* Postinflammatory hyperpigmentation is usually present at sites of healed lesions.
* Biopsies intraepidermal vesicle formation secondary to loss of cohesion between epidermal cells (i.e., acantholytic blisters).
* Blister formation is within the suprabasal portion of the epidermis.
* Direct immunofluorescence microscopy of lesional or intact patient skin shows deposits of IgG on the surface of keratinocytes.
Disease Protein featured
Official
abbreviation
Alzheimers
disease
Beta
amyloid[6][7][8]
A
Diabetes
mellitus type 2
IAPP
(Amylin)[9][10]
AIAPP
Parkinsons
disease
Alpha-
synuclein[7]
none
Transmissible
spongiform
encephalopathy
e.g. Bovine
spongiform
encephalopathy
PrPSc[11] APrP
Huntingtons
Disease
Huntingtin[12][13] none
Medullary
carcinoma of
the thyroid
Calcitonin[14] ACal
Cardiac
arrhythmias,
Isolated atrial
amyloidosis
Atrial natriuretic
factor
AANF
Atherosclerosis Apolipoprotein AI AApoA1
Rheumatoid
arthritis
Serum amyloid A AA
Aortic medial
amyloid
Medin AMed
Prolactinomas Prolactin APro
Familial
amyloid
polyneuropathy
Transthyretin ATTR
Hereditary
non-
neuropathic
systemic
amyloidosis
Lysozyme ALys
Dialysis related
amyloidosis
Beta 2
microglobulin
A2M
Finnish
Gelsolin AGel
amyloidosis
Lattice corneal
dystrophy
Keratoepithelin AKer
Cerebral
amyloid
angiopathy
Beta amyloid[15] A
Cerebral
amyloid
angiopathy
(Icelandic
type)
Cystatin ACys
systemic AL
amyloidosis
Immunoglobulin
light chain AL[14]
AL
Sporadic
Inclusion Body
Myositis
S-IBM none
Official
abb.
Amyloid
type/Gene
Description
AL
amyloid light
chain
AL amyloidosis /
multiple myeloma.
Contains
immunoglobulin
light-chains (,)
derived from
plasma cells.
AA SAA AA amyloidosis
A
amyloid/APP
Found in Alzheimer
disease brain
lesions.
ATTR transthyretin
A mutant form of a
normal serum
protein that is
deposited in the
genetically
determined familial
amyloid
polyneuropathies.
TTR is also
deposited in the
heart in senile
systemic
amyloidosis.[6]
Also found in
Leptomeningeal
amyloidosis.
A2M
2
microglobulin
Not to be confused
with A, 2m is a
normal serum
protein, part of
major
histocompatibility
complex (MHC)
Class 1 molecules.
Haemodialysis-
associated
amyloidosis
AIAPP amylin
Found in the
pancreas of patients
with type 2
diabetes.
APrP prion protein
In prion diseases,
misfolded prion
proteins deposit in
tissues and
resemble amyloid
proteins. Some
examples are
CreutzfeldtJakob
disease (humans),
BSE or mad cow
disease (cattle),
and scrapie (sheep
and goats).
AGel GSN
Finnish type
amyloidosis
ACys CST3
Cerebral amyloid
angiopathy,
Icelandic-type
AApoA1 APOA1
Familial visceral
amyloidosis
AFib FGA
Familial visceral
amyloidosis
ALys LYZ
Familial visceral
amyloidosis
? OSMR
Primary cutaneous
amyloidosis
ABriADan ITM2B
Cerebral
amyloidangiopathy,
British-type
Danish-type
Pro prolactin Prolactinoma
AKer keratoepithelin
Familial corneal
amyloidosis
AANF
atrial
natriuretic
factor
Senile amyloid of
atria of heart
ACal calcitonin
Medullary carcinoma
of the thyroid
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