positive aiims nov 2007[1]

POSITIVE 2007 1

Dear Doctors, Greetings from POSITIVE. By this time the ‘AIIMS-Fever’ would have subsided. Successful guys would have settled by now in the prestigious institute. POSITIVE’S best wishes and congratulations to all those successful candidates.Guys who couldn’t make it, will be (must be) horning their skills for the next battle-ALL INDIA-2008. At this juncture, we at POSITIVE, did a microscopic audit of the performance of POSITIVE this year, keeping AIIMS-NOV-2007 as the Gold standard.We were very pleased to know that around 150 questions from AIIMS-NOV-2007,has been discussed in the various programmes at POSITIVE,which by any yard stick is a decent performance. As Evidence based medicine is the current concept, we have provided the evidences for our claim. A question from AIIMS-NOV-2007 will be followed by the evidence from POSITIVE-the programme in which the concerned question was discussed. We have divided POSITIVE’s programmes as follows-a)MKM-Must Know MCQS-direct,indirect(22) b)POSITIVE model examinations,pretest,PICU-POSITIVE Intensive Care UNIT(14) c)OPERATION HARRI (62),d)Consultant’s discussion(55),MKT-Must Know Table(9) HAPPY NEW YEAR GREETINGS TO YOU AND YOUR FAMILY FROM THE ‘‘POSITIVE’’ FAMILY. POSITIVE’s advanced congratulations for the candidates who are putting up a sincere effort for ALL INDIA-2008. A POSITIVE request for the next few months from the candidates preparing for the entrance examinations-

POSITIVE 2007 2

EAT MCQ, DRINK MCQ, SLEEP MCQ. With warm regards POSITIVE ‘POSITIVE REVIEW’ AIIMS NOV-2007

POSITIVE

**MKM-DIRECT **MKM-INDIRECT

** MODEL,PRETEST,PICU ** OPERATION HARRI

** CONSULTANT’S DISCUSSION **MKT

POSITIVE 2007 3

**MKM-DIRECT 17. . Tongue develops from: [AIIMS-NOV-2007]

a. Occipital somites b. Mesoderm of the pharyngeal pouch c. Cervical somites d. ..

22. The muscles of the tongue are developed from (TN-1990) a) Occipital somites b) Cervical somites c) Mandibular arch d) Hyoid arch

18. The ureter develops from: [AIIMS-NOV-2007] a. Metanephros b. Mesonephros c. Mesonephric duct d. Paramesonephric duct

106. Hypercalcemia is caused by all except: [AIIMS-NOV-2007] a. Loop diuretics b. Lithium c. Vitamin D intoxication d. ..

95. All are causes of hypercalcemia, EXCEPT: [AIIMS DEC 1997] a) Thyrotoxicosis b) Sarcoidosis c) Vitamin A toxicity d) Phenytoin toxicity

Ans (d) (Also discussed in the sessions by consultant

and in MKT) 176. In which of the following heart diseases is

maternal mortality during pregnancy is found to be the highest? [AIIMS-NOV-2007] a. Coarcatation of aorta b. Eisenmenger’s complex c. Aortic stenosis d. Mitral stenosis

160. In heart patient the worst prognosis during pregnancy is seen in- [AIIMS JUNE 2000] a) Mitral regurgitation b) Mitral valve prolapse c) Aortic stenosis d) Pulmonary stenosis

Ans (c) (Also in consultant’s discussion)

86. OC pills are contraindicated in patients receiving: [AIIMS-NOV-2007] a. Rifampicin b. Ethambutol c. Streptomycin d. Pyrazinamide

Ans[a] 144. A 20 years old nulliparous women is on oral

contraceptive pills. She is currently diagnosed as having pulmonary tuberculosis. Which antituberculous drug decreases the effect of OCP [AIIMS MAY 2001] a) INH b) Pyrazinamide c) Ethambutol d) Rifampicin

Ans (d) 158. Polyhydramnios is associated with all

except: [AIIMS-NOV-2007] a. .. b. .. c. Bilateral renal agenesis d. ..

163. A pregnant woman is found to have excessive accumulation of amniotic fluid. Such polyhdraminos is likely to be associated with all of the following conditions, except: [AIIMS NOV 2003] a) Twinning b) Microanencephaly c) Oesophageal atresia d) Bilateral renal agenesis

POSITIVE 2007 4

Ans (d) 152. Post-operative radiotherapy in a patient

operated for Ca-endometrium is indicated in all of the following except: [AIIMS-NOV-2007] a. Deep myometrial invasion b. Pelvic lymph node involvement c. Enlarged uterine cavity d. Poor tumour differentiation

166. All of the following are indications for post operative Radiotherapy in a case of Carcinoma Endometrium except [AIIMS NOV 2004] a) Myometrial invasion > ½ thickness b) Positive lymph nodes c) Endocervical involvement d) Tumor positive for estrogen receptors

Ans (d) 45. Vitamin K is required for: [AIIMS-NOV-

2007] a. Carboxylation b. Hydroxylation c. .. d. ..

13. Vit K is needed for which of these post translational modification processes- [AIIMS MAY 2001] a) Methylation b) Carboxylation c) Hydroxylation d) Transketolation

Ans (b)

(Also in consultants discussion and in ‘OPERATION HARRI’)

123. Feature of Irreversible cell injury is: [AIIMS-NOV-2007] a. Amorphous deposits in the mitochondria b. .. c. .. d. ..

36. Irreversible cell injury is indicated by: (AI-2000) a) Accumulation of calcium in mitochondria b) Myelin figures c) ATP depletion d) shifting of ribosomes

53. Which finding on electron microscopy indicates irreversible cell injury? (AIIMS-NOV-2002) a) Dilatation of endoplasmic reticulum b) Dissociation of ribosomes from rough

endoplasmic reticulum c) Flocculent densities in the mitochondria d) Myelin figures (Also in consultant’s discussion, OPERATION

HARRI and MKT) 77. A male patient with symptoms of urethritis.

Examination reveals only pus cells but no organisms. Lesions are caused mostly by: [AIIMS-NOV-2007] a. Chlamydia trachomatis b. H.ducreyi c. Treponema pallidum d. ..

31. The ‘c’-waves in JVP are due to: [AIIMS-NOV-2007] a. Atrial contraction b. Bulging of the tricuspid valve into the right atrium c. Ventricular systole when the tricuspid valve is closed d. ..

112. All of the following phases of the jugular venous pulse and their causes are correctly matched, Except:(AI – 2002) a) ‘C’ wave – onset of atrial systole b) ‘a-x’ descent – atrial relaxation c) ‘v-y’ – emptying of blood from right atrium into right ventricle d) ‘y-a’ ascent – filling of the right atrium from the vena cava

POSITIVE 2007 5


78. Lancefield grouping of streptococci is done by using: [AIIMS-NOV-2007] a. M protein b. Group C peptidoglycan cell wall c. Group C carbohydrate antigen d. .. Ans [c]

54. C-Carbohydrate in Streptococcus hemolyticus is important for : [AIIMS JUNE 1998] a) Lancefield classification b) Phagocytic inhibition c) Toxin production d) Haemolysis

Ans (a)


55. Under the National Programme for control of blindness who is supposed to conduct the vision screening of school students? [AIIMS-NOV-2007] a. School teachers b. Medical officers of health centers c. Ophthalmologists d. Health assistants

161. Under the school eye screening programme in India, the initial screening of school children is done by: [AIIMS MAY 2003] a) School teachers b) Primary level health workers c) Eye specialists d) Medical officers

Ans (a)

(Also in consultant’s discussion)

70. Which of the following person is present in a sub centre: [AIIMS NOV 2007] a. Multipurpose worker b. Laboratory technician c. Health educator d. Medical officer

57. . A 18 month old child come to you with history of immunization taken only for a single dose of OPV and DPT. What will you give now? [AIIMS Nov 2007] a.Re-start the immunization according to age b. Give BCG, Measles and booster doses of OPV and DPT c. Give Measles and booster doses of OPV and DPT d. Give BCG and second doses of OPV and DPT

60. Epidemic Dropsy is due to: [AIIMS Nov

2007] a. BOAA b. Sanguinarine c. Aflatoxin d. ..

75. Primary Health Care is: [AIIMS Nov 2007] a. Health for all b. c. d.

133. Pancytopenia with cellular bone marrow is seen in all except: [AIIMS Nov 2007] a. PNH b. Megaloblastic anaemia c. Myelodysplastic anaemia d. Congenital Dyserythropoetic Anaemia (Also in model exam,consultant’s discussion)

MKM-INDIRECT 93. . Uterine relaxant with the least side effect:

[AIIMS-NOV-2007] a. Ritodrine b. MgSO4

POSITIVE 2007 6

c. Nifedipine d. Progesterone

Ans (d) 155. The drug that inhibits uterine contractility

and cause pulmonary edema is- [AIIMS MAY 2001] a) Ritodrin b) Nifedipine c) Indomethacin d) Atosiban

Ans (a) 37. Exercise causes: [AIIMS-NOV-2007]

a. Increased blood flow to the muscles after half minute of minute b. Increase in cerebral blood flow due to increase in systolic blood pressure c. Body temperature rise d. …

68. False statement regarding hemodynamic changes occurring during exercise is which of the following: [AIIMS NOV 1999] a) Venous return is augmented by the pumping action of skeletal muscles b) The increased adrenergic nerve impulses to the heart as well as an increased concertation of circulating catecholamines help to augment the contractile state of the myocardium c) Venoconstriction in exercising muscles as well as increased cardiac output leads to marked increase in systemic blood pressure d) End-diastolic volume increases in the failing heart during exercise

Ans (c) 186. Transparency of the cornea is maintained

by all except: [AIIMS-NOV-2007] a. Hydration b. Wide separated collagen bands c. Mitotic figures in the central cornea d. Unmyelinated nerve fibers

172. The corneal transparency is maintained by [AIIMS NOV 2005] a) Keratocytes b) Bowman’s membrane

c) Descement’s membrane d) Endothelium

Ans (d) 47. Hemoglobin estimation is not done by:

[AIIMS-NOV-2007] a. Drabkin’s method b. Sahli’s method c. Spectrometry d. Wintrobe’s method Ans.d.

71. Anticoagulant of choice for ESR by Wintrobes method: [AIIMS FEB 1997] a) Citrate b) Heparine c) Oxalate d) EDTA

Ans (c) ** MODEL,PRETEST,PICU 20. Meiosis occurs at which of the following

transformation: [AIIMS-NOV-2007] a. Primary spermatocyte to intermediate spermatocyte b. Primary spermatocyte to secondary spermatocyte c. Secondary spermatocyte to round spermatid d. Round spermatid to elongated spermatid

POSITIVE MODEL-12-05-07-QUESTION & DISCUSSION-7

7. During spermatogenesis,which of the following undergo a second meiotic division a) Spermatogonia b) Primary spermatocytes c) Secondary spermatocytes d) Spermatide

7. Ans (c) Name Event

Spermatogenesis Spermatogonia Sperm

Spermato cytogenesis

Spermatogonia Spermatocytes

Sermiogenesis Inert spermatids Actively motile sperms

POSITIVE 2007 7

Spermatogenesis Spermatogonia

Mitosis Primary spermatocyte 1st meiosis∗ Secondary spermatocyte 2nd meiosis

Spermatids Capacitation of sperms

Fallopian tube (Cervix)

Sertoli cells Supporting cells Interstitial cells of leydig

Testosterone

Chromosome number of spermatid

Haploid 22 Autosome + X or Y

Penetration of Zona pellucida

Acrosome

18. The ureter develops from: [AIIMS-NOV-2007] a. Metanephros b. Mesonephros c. Mesonephric duct d. Paramesonephric duct POSITIVE MODEL-12-05-2007-QUESTION

&DISCUSSION-21 21. All are derivatives of mesonephric duct in

males except a) Epididymis b) Vasdeferens c) Appendix of epididymis d) Appendix of Testis

21. Ans (d) (Singh – 297) Mesonephric duct - males

* Ureteric bud - Ureters(AIIMS-NOV-2007***), collecting tubules * Trigone of bladder * Postr. Wall of part of prostatic urethra * Epididymis* * Ductus Deferens* * Seminal vesicle * Ejaculatory Ducts * Mesodermal part of prostrate * Appendix of epididymis *

Appendix of Testis - Remanant of Para mesonephric duct*

9. Gall bladder epithelium is: [AIIMS-NOV-2007] a. Simple squamous b. Simple cuboidal with stereocilia c. Simple columnar d. Simple columnar with brush border

POSITIVE MODEL-12-05-2007-QUESTION &DISCUSSION- 33,40

33. Pick out the odd one out a) Ductus deferens – pseudostratified columnar b) Fallopian tube – ciliated simple columnar c) Vagina – stratified squamous keratinised d) Oesophagus – stratified squamous non keratinized

33. Ans ( c ) Epithelium ↓ ↓

* Simple stratified * Squamous pseudo stratified * Cuboidal * Columnar

POSITIVE 2007 8

A) Simple

Type Site Squamous * Mesothelium (cavities eg.

Pleura) * Blood vessel, lymphatic Lumen – endothelium

Cuboidal * Small excretory ducts * PCT

Columnar * Digestive organs - Stomach - Small Intestine - Large Intestine - Gall Bladder (Microvilli --> striated border)

B) Pseudostratified columnar - A single layer - Not all cells reach the surface

Site * Respiratory passage - Trachea - Bronchi - Bronchioles (Large) * Genital - Epididymis - Vasdeferens (stereo cilia)

C) Stratified epithelium i) Stratified squamous

Keratinised Non keratinised Epidermis (palms and soles)

* Mouth * Pharynx * Oesophagus * Vagina * Analcanal

ii) Stratified Cuboidal and Stratified Columnar - Limited distribution - Excretory ducts of pancreas Salivary gland Sweat gland

Transitional Epithelium - Exclusively in excretory passage of urinary system - Calyx Pelvis Ureters Bladder

Cartilage * Hyaline Trachea * Fibrous Intervertebral Disc * Elastic Epiglottis

Structure Epithelium * Tonsil - Stratified squamous * Tongue papilla - Stratified squamous

– partial keratinisation

* Lip - Stratified squamous keratinised

* Anal canal - upper - lower

- Simple columnar - Stratified squamous

Nose a) Olfactory epithelium

- Psuedo stratified columnar epithelium

b) Respiratory epithelium

- Pseudo stratified ciliated columnar

Respiratory * Terminal bronchiole

- Ciliated columnar (elura cells) Nonciliated cuboidal

* Respiratory Bronchiole

- Simple cuboidal (cilia absent)

* Alveoli - Simple squamous 40. A simple cuboidal or columnar epithelium

with extensive basal infoldings of plasma membrane is characteristically found in a) collecting tubules of kidney b) lining epithelium of small intestine c) striated ducts of the parotid Gland

POSITIVE 2007 9

d) Lining epithelium of the oral cavity 40. Ans.: (c) (Ref. Histology – singh-43-50)

Epithelium Simple – cell surface has no

particular specialization ‘Striated’ - ‘Microvilli’ is regular

‘Brush Border’ – Microvilli’ is irregular

Site Epithelium

• Collecting tubules of Kidney

Cuboidal epithelium with prominent brush border.

• Small intestine • Columnar epithelium with striated border

• Ducts of Glands

• Simple cuboidal*

• Oral cavity • Non kertinized stratified squamous

Parotid ducts Intercalated

ducts Striated ducts Excretory Ducts

o Cuboidal

o columnar o Columnar

(Simple) * Striated Ducts - The cells lining show an interesting ultrastructure

- Extensive deep infoldings of basal part of cell membranes* basal striations

- Numerous mitochondria in between the infoldings.

Squamous – Simple • Alveoli of lungs • ‘Cavities’ – pleura (eg) • Lining of heart (endocardium) • Blood vessels, lymphatics

(endothelium) • Internal Ear • Renal Tubules

A) 1. Simple columnar • Mucous membrane of stomach • Large intestine 2. Columnar – Striated • small intestine – brush border of

GB(AIIMS-NOV-2007***) 3. Columnar - ciliated • Respiratory Tract • Uterus • Uterine Tubes • Efferent ductules of testes • Middle Ear, auditory tube • Ependymal lining • Ventricles 4. Columnar - Pseudo Stratified • Ductus Deferens • Male urethra • Auditory tube (some part) 5. Columnar - ciliated Pseudostratified • Trachea • Large bronchi

B) Cuboidal • Follicles of Thyroid • Ducts of many Glands • Surface of ovary • Inner surface of lens • Pigment layer of Retina • Choroid plexus • PCT (Brush border)

C) 1- Stratified Squamous – Non keratinised • Mouth • Tongue • Pharynx • Esophagus • Vagina • Cornea

POSITIVE 2007 10

2- Stratified Squamous - Keratinized Epidermis Transistional epithelium

• Renal Pelvis • Calyx • Ureter • Urinary bladder • Urethra (Part)

12. Urothelium does not line: [AIIMS-NOV-2007] a. Collecting ducts b. Minor calyx c. Ureter d. Urinary bladder

POSITIVE MODEL-12-05-2007-QUESTION &DISCUSSION- 33,40

33. Pick out the odd one out a) Ductus deferens – pseudostratified columnar b) Fallopian tube – ciliated simple columnar c) Vagina – stratified squamous keratinised d) Oesophagus – stratified squamous non keratinized

33. Ans ( c ) Epithelium ↓ ↓

* Simple stratified * Squamous pseudo stratified * Cuboidal * Columnar

A) Simple

Type Site Squamous * Mesothelium (cavities eg.

Pleura) * Blood vessel, lymphatic Lumen – endothelium

Cuboidal * Small excretory ducts * PCT

Columnar * Digestive organs - Stomach - Small Intestine

- Large Intestine - Gall Bladder (Microvilli --> striated border)

B) Pseudostratified columnar - A single layer - Not all cells reach the surface

Site * Respiratory passage - Trachea - Bronchi - Bronchioles (Large) * Genital - Epididymis - Vasdeferens (stereo cilia)

C) Stratified epithelium i) Stratified squamous

Keratinised Non keratinised Epidermis (palms and soles)

* Mouth * Pharynx * Oesophagus * Vagina * Analcanal

ii) Stratified Cuboidal and Stratified Columnar - Limited distribution - Excretory ducts of pancreas Salivary gland Sweat gland

Transitional Epithelium(AIIMS-NOV-2007***) - Exclusively in excretory passage of urinary system - Calyx Pelvis Ureters Bladder

Cartilage * Hyaline Trachea * Fibrous Intervertebral Disc * Elastic Epiglottis

POSITIVE 2007 11

Structure Epithelium * Tonsil - Stratified squamous * Tongue papilla - Stratified squamous

– partial keratinisation

* Lip - Stratified squamous keratinised

* Anal canal - upper - lower

- Simple columnar - Stratified squamous

Nose a) Olfactory epithelium

- Psuedo stratified columnar epithelium

b) Respiratory epithelium

- Pseudo stratified ciliated columnar

Respiratory * Terminal bronchiole

- Ciliated columnar (elura cells) Nonciliated cuboidal

* Respiratory Bronchiole

- Simple cuboidal (cilia absent)

* Alveoli - Simple squamous 40. A simple cuboidal or columnar epithelium

with extensive basal infoldings of plasma membrane is characteristically found in a) collecting tubules of kidney b) lining epithelium of small intestine c) striated ducts of the parotid Gland d) Lining epithelium of the oral cavity

40. Ans.: (c) (Ref. Histology – singh-43-50) Epithelium

Simple – cell surface has no particular specialization

‘Striated’ - ‘Microvilli’ is regular ‘Brush Border’ – Microvilli’ is irregular

Site Epithelium

• Collecting tubules of Kidney

Cuboidal epithelium with prominent brush border.

• Small intestine • Columnar epithelium with striated border

• Ducts of Glands

• Simple cuboidal*

• Oral cavity • Non kertinized stratified squamous

Parotid ducts Intercalated

ducts Striated ducts Excretory Ducts

o Cuboidal

o columnar o Columnar

(Simple) * Striated Ducts - The cells lining show an interesting ultrastructure

- Extensive deep infoldings of basal part of cell membranes* basal striations

- Numerous mitochondria in between the infoldings.

Squamous – Simple • Alveoli of lungs • ‘Cavities’ – pleura (eg) • Lining of heart (endocardium) • Blood vessels, lymphatics

(endothelium) • Internal Ear • Renal Tubules

B) 1. Simple columnar • Mucous membrane of stomach • Large intestine 2. Columnar – Striated • small intestine – brush border of GB 3. Columnar - ciliated • Respiratory Tract

POSITIVE 2007 12

• Uterus • Uterine Tubes • Efferent ductules of testes • Middle Ear, auditory tube • Ependymal lining • Ventricles 4. Columnar - Pseudo Stratified • Ductus Deferens • Male urethra • Auditory tube (some part) 5. Columnar - ciliated Pseudostratified • Trachea • Large bronchi

B) Cuboidal • Follicles of Thyroid • Ducts of many Glands • Surface of ovary • Inner surface of lens • Pigment layer of Retina • Choroid plexus • PCT (Brush border)

C) 1- Stratified Squamous – Non keratinised • Mouth • Tongue • Pharynx • Esophagus • Vagina • Cornea

2- Stratified Squamous - Keratinized Epidermis Transistional epithelium

• Renal Pelvis • Calyx • Ureter • Urinary bladder • Urethra (Part)

117. In Hyaline cartilage, type of collagen present is: [AIIMS-NOV-2007] a. Type 1 b. Type 2

c. Type 3 d. Type 4 Ans[b]

POSITIVE MODEL-12-05-2007-QUESTION &DISCUSSION- 135

(Also in MKT,OPERATION HARRI) 135. Embryonic Dermis contains ______ Type

collagen a) I b) II c) III d) IV

135. Ans (c) Collagen

Type Distribution I • Skin

• Tendon • Bone • Dentin • Fascia

II • Cartilage **(only)-AIIMS-NOV-2007)

III (Reticulin)

• Skin • Bolld vessels • Uterus • Embryonic Dermis

IV • Basement membrane 115. Not used to stain fats: [AIIMS-NOV-2007]

a. Oil red O b. Congo red c. Sudan III d. Sudan black

POSITIVE MODEL-12-05-2007-QUESTION &DISCUSSION- 112

112. All of the following are stains used to detect lipids except a) Oil red O b) Sudan Black B c) Osmium Tetroxide d) Mucicarmine

112. Ans (d) Stain Tissue

A. Carbohydrate - PAS

POSITIVE 2007 13

- Mucicarmine - Alcian blue (AB) - Combined AB - PAS

- Acid mucin - Acid mucin - Neutral mucin

B. Connective Tissue - Vangieson’s - Masson’s Trichrome - Phospho tungstic acid Hematoxylin - Verhoeff’s elastic - Gordon & sweet

- Collagen - Collagen - Muscle and glial filaments - Elastic fibre - Reticular fibre

C. Lipids - Oil Red O - Sudan Black B - Osmium Tetroxide

- Fats -Fats - Fats

D. Neural Tissue - Luxol fast blue - Bielschowsky’s

- Myelin - Axons

E. Pigment and Minerals - Prussian blue - Masson – Fontana - Alizarin Red - Von kossa - Rubeanic acid - Grimelius

- Iron - Melanin - Calcium - Mineralized bone - Copper - Argyrophilic

Immunoflorescence Source of light – Mercury vapour and xenon Gas Lamp

34. . Metabolic alkalosis is seen in: [AIIMS-NOV-2007] a. Mineralocortoid excess b. Increased excretion of base c. Decreased secretion of H+ ion d. Deficiency of mineralocorticoids

135. Metabolic alkalosis is seen in all except (POSITIVE MODEL 2 2007) a) Thilazide diuretic therapy b) Prolonged vomiting c) Uretero-sigmoidostomy d) Cushing’s disease (Also in OPERATION HARRI)

125. Micronodular cirrhosis is seen in all except: [AIIMS-NOV-2007] a. Chronic hepatitis B with… b. Alcoholic hepatitis c. Chronic cirrhosis secondary to biliary stasis d. Hemochromatosis

POSITIVE MODEL 2 2007-QUESTION-32 32. All of the following can produce macro

nodular cirrhosis except (POSITIVE MODEL -2- 2007-QUESTION-32) a) Viral Hepatitis b) Hemo chromatosis c) α1 antitrypsin deficiency d) Wilson’s

32. Ans (b) (P-644,647, HM) Cirrhosis

Macro (> 3 mm) Micro(AIIMS-NOV-2007***)

• Alchoholic* • Post necrotic - Viral Hepatitis - Drugs, Toxins →CCL4,Phosphorus - Wilson’s* - Clonorchiasis * α1 antitrypsin (micro or macro)

• Primary biliary • Hemochro

matosis** • Alchoholic • Nutritional

198. Hampton’s hump in: [AIIMS-NOV-2007] a. Pulmonary embolism b. Tuberculosis c. Bronchogenic Ca d. ..

POSITIVE 2007 14

POSITIVE MODEL-4-QUESTION-33 33. A 57 year old man develops acute shortness

of breath shortly after a 12-h automobile ride. The patient consults his internist, and findings on physical examination are normal except for tachypnea and tachycardia. An electrocardiogram reveals sinus tachycardia but is otherwise normal. All the following statements regarding this patient’s disease process are true EXCEPT (POSITIVE MODEL-4) a) An arterial blood gas measurement (ABG) is likely to reveal a partial pressure of oxygen (Paco2) of less than 80 torr b) An ABG is likely to reveal a respiratory alkalosis (an elevated pH and reduced partial pressure of carbon dioxide (Paco2) c) The patient should be admitted to the hospital, and if there is no cotraindication to anticoagulation, intravenous heparin should be started pending further testing d) Normal findings upon examination of the lower extremities are extremely unusual in this clinical setting e) The mortality for this condition, when untreated, is very high

33.Ans (d) Pulmonary Thrombo embolism

* The most common source of paradoxical embolism – Calf vein thrombosis * 50% DVT of pelvic veins, proximal leg veins → Pulmonary embolism (asymptomatic)

Physiological effects - ↑ Pulmonary vascular resistance - Impaired gas exchange (↑ dead space) - Alveolar hyperventilation - Increased airway resistance - ↓ Pulmonary compliance

Usual cause of death – Progressive RVF * Wells Diagnostic score - Maximum – 12.5 points - If ≤ 4 points, PE is only 8%

Character Points * Clinical signs and symptoms of DVT

3.0

* Alternative diagnosis is less likely than PE

3.0

* HR > 100 1.5 * Immobilisation or surgery in the previous 4 wks

1.5

* Previous DVT / PE 1.5 * Hemoptysis 1.0 * Malignancy 1.0

Clinical * Massive - Hypotension * Moderate or large

RV Hypokinesis - Normal pressure

* Small -RV Function – Normal-Pressure - Normal

Pulmonary infarction indicates small PE Symptoms & Sign

* Dyspnoea – Most frequent symptom * Tachypnoea – Most frequent sign * Signs of DVT – only in 50%

Investigations * Blood Tests - D-dimer > 500 ng/mL - PaO2, PaCo2 ↓ * ECG - Most frequent - ‘T’ wave inversion in V1 – V4 (RVstrain) - Tachycardia - ‘S’ in lead I - ‘Q’ in lead III Chest Xray A normal Xray in a Dyspnoeic pt → PE

* Westermark’s sign - Focal oligemia * Hampton’s sign(AIIMS-NOV-2007***)

* Peripheral wedge shaped opacity above the diaphragm

* Palla’s sign * Enlarged Right

POSITIVE 2007 15

descending pulmonary Artery

* Ultrasound – Loss of compressibility of vein * CT chest – supersedes lung scan * Lung scan – Two or more segmental perfusion defects in the presence of normal ventilation

ECHO - 50% normal - Mc Conell’s sign* - RV free wall Hypokinesis with normal RV apical motion → specific for PE

Pulmonary angio: - Most specific* - As small as 1-2 mm Intraluminal filling defect

Treatment - Heparin – INR 2.0 – 3.0 - LMWH - IVC filter - Thrombolysis - Embolectomy (Trt of idiopathic DVT – Anticoaggulants indefinitely) 99. Hyperglycemia is caused by all except:

[AIIMS-NOV-2007] a. Beta blockers b. Glucocorticoids c. .. d. ..

POSITIVE-PRETEST-SESSION-30-QUEST-22 22. All the following drugs cause hyperglycaemia

EXCEPT a) Quinine b) Cyclosporine c) L asparaginase d) Tacrolimus

(Also in OPERATION HARRI)

174. In osteomalacia, all are true except: [AIIMS-NOV-2007] a. Increased serum alkaline phosphatase b. Increased serum calcium

c. Looser’s zones d. Proximal myopathy

POSITIVE-MODEL-4-QUEST-126

(Also in OPERATION HARRI) 154. True about Ogilive’s syndrome are all

except: [AIIMS-NOV-2007] a. It is caused by mechanical obstruction of the

colon b. It involves entire / part of the large colon c. It occurs after previous surgery d. It occurs commonly after narcotic use POSITIVE-MODEL-4-QUEST-180,2O2

180. Find the Wrong statement about paralytic ileus a) After a laparotomy paralytic ileus upto 48 hrs is normal b) Colon is most prominently affected c) Small intestine starts action in 16 hrs after laparotomy d) Spinal anaesthesia causes paralytic ileus e) Colonic pseudo-obstruction is called Ogilvie’s syndrome

180. Ans ( d ) Paralytic Ileus

* Absence of Peristalic waves secondary to neuromuscular failure * Post operative

- 24 – 72 hrs - prolonged in hypo proteinemia or

metabolic abnormality * Colonic Pseudo obstruction

- acute – Ogilivie syndrome - marked cecal distention - absence of mechanical cause or

acute intra abdominal disease(AIIMS-NOV-2007∗∗)

- Trt - colonic decompression - 25% - Recurrence

POSITIVE 2007 16

202. Colonic pseudo-obstruction may be associated with all the following, EXCEPT (a) Diabetes (b) Porphyria (c) Hypokalemia (d) Uremia. (e) Hyperthyroidism

202. Ans : E Occurs in hypothyroidism. Septicemia, spinal and pelvic trauma, Phenothiazine therapy, stroke etc. can also cause. Also called Ogilvie’s syndrome. X-ray shows dilated caecum. Usually responds to conservative management. Colonoscopic decompression, resection etc. rarely needed.

2. Uppermost structure seen at the hilus of the left lung is: [AIIMS-NOV-2007] a. Pulmonary artery b. Pulmonary vein c. Bronchus d. Bronchial artery

POSITIVE-MODEL-4-QUEST-229 229. The root of left lung:

a) has eparterial and hyperterial bronchi b) lies opposite to 2-4th costal cartilages c) the pulmonary ligament stretches downward from it to the level of the diaphragm d) is crossed below by the arch of aorta

229. Ans (c) Root of Left Lung

* Contents - Bronchus - Bronchial Artery - Pulmonary Artery - Pulmonary Vein – Upper - Lower - Pulmonary Plexus of Nerves * Arch of Aorta – Crosses above * Eparterial & hyparterial bronchi – Right Lung

(Also in consultant’s discussion) 3. Ulnar injury in the arm leads to all except:

[AIIMS-NOV-2007] a. Sensory loss of the medial 1/3rd of the hand b. Weakness of the hypothenar muscles c. Claw hand d. adduction of thumb Ans[d]

POSITIVE-MODEL-4 QUEST-266 266. Mr.X. Fell from a tree and sustained

injury in his elbow. In the process his ulnar nerve was cut. One of the following is true a) part of the flexor digitorum superficialis (sublimis) is paralysed b) there is a loss of sensation in the back of the index finger c) flexion at the metacarpophalangeal joints of the ring and little fingers is lost if their interphalangeal joints are kept extended d) the distal phalanges of all the fingers are extended at the distal interphalangeal joints

266. Ans (c) · Flex digitorum Superficialis · Median N · Sensation at back of index finger – Posterior cutaneous nerve of fore arm

** OPERATION HARRI 127. What is true about linkage analysis in

familial gene disorders: [AIIMS-NOV-2007] a. Characteristic DNA polymorphism in a family is associated with disorders b. Characteristic DNA polymorphism WITH A CLINICAL PHENOTYPE C.Useful to make pedigree chart to show affected and non-affected family members D.Used to make a pedigree chart to show non-paternity

OPERATION HARRI-PAGE-372-FIG-56-10

(SESSION 26 – 2.9.07)

POSITIVE 2007 17

111. Caspases are involved in: [AIIMS NOV 2007] a. Apoptosis b. .. c. .. d. OPERATION HARRI-PAGE-455-FIG-69.1

(SESSION 27 - 9.9.07) 96. Therapeutic monitoring is done for all of the

following except: [AIIMS-NOV-2007] a. Tacrolimus b. Metformin c. Cyclosporine d. Phenytoin

OPERATION HARRI-APPENDIX-TABLE-A5 76. HACEK group includes all except: [AIIMS-

NOV-2007] a. Hemophilus aprophillus b. Acinetobacter baumanni c. Eikenella corrodens d. Cardiobacterium hominis

OPERATION HARRI--P 867 (SESSION 32 – 7.10.07)

79. The medium used for Vibrio cholerae is:

[AIIMS-NOV-2007] a. Thayer-martin b. TCBS medium c. Scirrow’s medium d. Loeffer’s OPERATION HARRI –P 911 (SESSION 34

– 14.10.07) (also in consultant’s discussion)

78. Lancefield grouping of streptococci is done by using: [AIIMS-NOV-2007] a. M protein b. Group C peptidoglycan cell wall

c. Group C carbohydrate antigen d. ..

OPERATION HARRI -P-823 (SESSION 32 – 7.10.07)

23. . Not seen in SIADH is: [AIIMS-NOV-2007] a. Hyponatremia b. Hypouricemia c. Volume depletion d. ..


(Also in consultant’s discussion) 28. . Bicarbonate is maximally absorbed from:

[AIIMS-NOV-2007] a. PCT b. DCT c. Collecting duct d. Thick ascending loop of Henle

OPERATION HARRI -P-263 (SESSION 26 –

2.9.07) (also in consultant’s discussion) 81. Regarding respiratory viruses all are true

except: [AIIMS-NOV-2007] a. RSV is the most common cause of bronchiolitis in infants b. Mumps causes septic meningitis in adults c. .. d. ..

OPERATION HARRI -P-1063, 1154 (SESSION

9 – 20.5.07) 83. True about polioviruses is: [AIIMS-NOV-

2007] a. Most cases are symptomatic b. Inactivated vaccines given I.M. produce spastic paralysis c. .. d. Inactivated polio vaccine are given to child less than 3 years of age

POSITIVE 2007 18


67. Mirena is: [AIIMS-NOV-2007]

a. Used in abortion b. Anti-progesterone c. Progesterone IUCD d. Hormonal implant

OPERATION HARRI -P-281-TAB, 283

(SESSION 26 – 2.9.07)

107. All of the following can be used for thromboprophylaxis except: [AIIMS-NOV-2007] a. Heparin b. Aspirin c. Warfarin d. Antithrombin-III

OPERATION HARRI -P-687-689 (SESSION 29 – 23.9.07)

108. Used for the treatment of migraine, the triptans act through: [AIIMS-NOV-2007] a. 5HT-1A b. 5HT-1B c. 5HT-1F d. 5HT-3


116. Cryoprecipitate contains all of the following except: [AIIMS-NOV-2007] a. Factor VIII b. Factor IX c. Von Willebrand factor d. Fibrinogen

OPERATION HARRI -P-664 (SESSION 29 –

23.9.07) (Also in MKT)

198. Hampton’s hump in: [AIIMS-NOV-2007] a. Pulmonary embolism b. Tuberculosis c. Bronchogenic Ca d. .. OPERATION HARRI -P-1562 (SESSION 20

– 29.7.07) 190. A female patient presents with diffuse

alopecia to you. She had suffered from typhoid fever 4 months back. Most probable diagnosis is: [AIIMS-NOV-2007] a. Androgenetic alopecia b. Telogen effluvium c. Anagen effluvium d. Alopecia areata

OPERATION HARRI -P-TAB-299 (SESSION 26 – 2.9.07)

191. All of the following are causes of cicatrizing alopecia except: [AIIMS-NOV-2007] a. Lichen planus b. Discoid lupus erythematosus c. Alopecia areata d. Lupus vulgaris

OPERATION HARRI -P-297 (SESSION 26

– 2.9.07) 189. A 30 year old man presents with 6 month

history of nasal discharge, facial pain and fever. On antibiotic therapy, fever subsided. After 1 month again had symptoms of mucopurulent discharge from the middle meatus and the mucosa of the meatus appeared congested and oedematous. Next best investigation would be: [AIIMS-NOV-2007] a. FACIAL MRI b. NCCT of the nose and para-nasal sinuses c. Plain x-ray of the para-nasal sinuses d. Inferior meatus puncture

OPERATION HARRI-P-188 (SESSION 25 – 25.8.07)

POSITIVE 2007 19

187. . A patient presents with Carcinoma of the larynx involving the left false cords, left arytenoids and the left aryepiglottic folds with bilateral mobile true cords. Treatment of choice is: [AIIMS-NOV-2007] a. Vertical hemilaryngectomy b. Horizontal hemilaryngectomy c. Radiotherapy followed by chemotherapy d. Total laryngectomy


183. A 18 year old girl presents with

amenorrhoea, weight loss and milky discharge from the breast. Most likely diagnosis is: [AIIMS-NOV-2007] a. Anorexia nervosa b. Occult carcinoma c. Hypothyroidism d. HIV


178. Following is associated with maximum risk of invasive carcinoma of cervix : [AIIMS-NOV-2007] a. Low grade squamous intraepithelial lesion b. High grade squamous intraepithelial lesion c. Squamous intraepithelial lesion associated with HPV-16 d. Squamous intraepithelial lesion associated with HIV


(In consultants discussion-session-38-18-11-07) 91. Thiazides cause all except: [AIIMS-NOV-

2007] a. Hyperglycemia b. Increased calcium excretion c. Increased uric acid excretion d. Useful in congestive heart failure

OPERATION HARRI -P-254,320-321

(SESSION 26 – 2.9.07) (Also in consultants discussion)

94. Bisphosphonates are not used in: [AIIMS-

NOV-2007] a. Hypercalcemia b. Osteoporosis c. Cancer d. Vitamin D intoxication

OPERATION HARRI P-562,567,1861

(SESSION 28, 9 – 16.9.07) 82. . In active chronic hepatitis B, all are seen

except: [AIIMS-NOV-2007] a.HbsAg b.IgManti-HbcAg c.HbeAg d.Anti-HbsAg Ans


126. Councilman bodies are seen in: [AIIMS-NOV-2007] a. Alcoholic cirrhosis b. Wilson’s disease c. Acute viral hepatitis d. .. OPERATION HARRI-P-1828 (SESSION 9 –

27.5.07)

174. In osteomalacia, all are true except:[AIIMS Nov 2007] a. Increased serum alkaline phosphatase b. Increased serum calcium c. Looser’s zones d. Proximal myopathy

POSITIVE 2007 20


167. A child presents with history of respitory infections. His sweat chlorides levels are 36 and 41mEq/L on two different occasions. Which other test would you do to exclude the diagnosis of cystic fibrosis: [AIIMS Nov 2007] a. Repeat sweat chloride measurements b. Nasal electrode potential difference c. Fat in stool for next 72 hours d. DNA analysis for Δ508 mutation

OPERATION HARRI-P-1546 (SESSION 9 –

27.5.07) 168. A term infant has not passed meconium for

48 hours. He presents with distension of abdomen and emesis since one day. Next most appropriate investigation would be: [AIIMS Nov 2007] a. Genetic testing for cystic fibrosis b. Manometry c. Lower bowel contrast enema d. Oesophagoscopy

OPERATION HARRI -1545 (SESSION 9 –

27.5.07) 149. The best investigation is thromboembolism

is: [AIIMS Nov 2007] a. D-dimer levels b. Multidetector CT angiography c. Colour Doppler USG d. Catheter angiography

OPERATION HARRIP-1490 (SESSION 21 –

5.8.07) 151. All are essential components of TOF except:

[AIIMS Nov 2007] a. Valvular pulmonic stenosis b. Right ventricular hypertrophy

c. Infundibular stenosis d. Aorta overriding


136. With CSF all are true except: [AIIMS Nov 2007] a. Persistent leakage causes headache b. Neutrophils are normally not present c. pH is less than that of blood d. Secreted by the arachnoid villi

OPERATION HARRI-P-A-11,1632 (SESSION 9 – 27.5.07)

138. Primary Pulmonary Hypertension IS CAUSED BY ALL EXCEPT [AIIMS Nov 2007] a. Hyperventilation b. Morbid obesity c. Fenfluramine d. High altitude

OPERATION HARRI-P-1406 (SESSION 21 –

5.8.07) 139. Cushing’s disease includes all except:

[AIIMS Nov 2007] a. Central obesity b. Episodic hypertension c. Easy bruisability d. Glucose intolerance

OPERATION HARRI-2135 (SESSION 13 –

17.6.07) 140. Hypertension with hypokalemia is seen in

all except: [AIIMS Nov 2007] a. renal artery stenosis b. End stage renal disease c. Cushing’s disease d. Primary hyperaldosteronism

POSITIVE 2007 21

OPERATION HARRI-P-258,2139,2131 (SESSION 13 – 17.6.07)

145. VHL syndrome includes all except: [AIIMS Nov 2007] a. Endolymphatic sac tumours b. Pheochromocytoma c. Hemangioendotheliomas d. Islet cell tumours

OPERATION HARRI – P - 2236,2453,2458

(SESSION 14 – 24.6.07, SESSION – 5 – 6.5.07)

44. In Lysosomal Storage Disorders, true is: [AIIMS Nov 2007] a. The lysosomes are deficient in the enzyme hydrolase b. There is a defect in the fusion od lysosomes and phagosomes c. There is a defect in the lysosomal membrane d. ..

OPERATION HARRI P-2318 (SESSION 15 – 1.7.07)

45. Vitamin K is required for: [AIIMS Nov 2007] a. Carboxylation b. Hydroxylation c. .. d. ..

OPERATION HARRI P-683 (SESSION 29 – 23.9.07)

54. Which vaccine should not be given to a child suffering from convulsions? [AIIMS Nov 2007] a. Measles b. BCG c. DPT d. OPV

OPERATION HARRI – P - 835 (SESSION 32 – 7.10.07)

(Also in consultant’s discussion)

56. Active method to detect undiagnosed cases in apparently healthy persons is: [AIIMS Nov 2007] a. Screening b. Surveillance c. Case finding d. Notification

OPERATION HARRI - 26 (SESSION 24 –

19.8.07) (Also in consultant’s discussion)

65. Kala-azar, vector is: [AIIMS Nov 2007]

a. Flea b. Tsetse fly c. Sand fly d. Mite


28.10.07) 66. Scrub typhus is transmitted by: [AIIMS Nov

2007] a. Reduvid bug b. Trombiculid mite c. Enteric pathogens d. Cyclops

OPERATION HARRI – P – 1004 (SESSION 35

– 21.10.07) 72. . Regarding flourosis all are true except:

[AIIMS Nov 2007] a. Flourosis is the most common cause of dental caries in children b Deposition of flurides in the skeletal system and muscles c. Deflouridation is done by Nalgonda technique d. Genu valgum

POSITIVE 2007 22

OPERATION HARRI – P .411 (SESSION 27 – 9.9.07)

73. All of the following are sources of Ω-3 PUFA

except: [AIIMS Nov 2007] a. Mustard oil b. Groundnut oil c. Corn oil d. Fish oil

OPERATION HARRI – P-419,2296,2297 (SESSION 27 – 9.9.07, SESSION 15 – 1.7.07)

80. Prions consist of: [AIIMS Nov 2007]

a. DNA and RNA b. DNA, RNA and proteins c. RNA and proteins d. Only proteins Ans[d]

OPERATION HARRI -2495 (SESSION 4 – 29.4.07)

(Also in consultants discussion) 92. Regarding furosemide, true is: [AIIMS Nov

2007] a. Given by parenteral route only b. Used in pulmonary oedema c. Acts at the PCT d. .

OPERATION HARRI -1616 (SESSION 9 –

27.5.07) 88. True about fibrates is all except: [AIIMS Nov

2007] a. (MOA)….PPARα….lipoprotein lipase…decreased LDL… b. Absorped better on empty stomach and decreased on food intake

c. Side effects include rash, myalgia, impotence and many others d. They are the drug of choice in type III hyperlipidemia and hypertriglyceridemia

OPERATION HARRI P-2297 (SESSION 15 –

1.7.07) 112. . In mitral valve prolapse, the histological

finding is: [AIIMS Nov 2007] a. Hyalinization of the valve b. Fibrinoid necrosis c. Myxomatous degeneration of the valve d. ..


12.8.07) 119. Most common site of subependymal giant

cell astrocytomas is: [AIIMS Nov 2007] a. Foramen of Monro b. Temporal horn of the lateral ventricle c. Trigone of the lateral ventricle


29.4.07) 121. Senile cardiac amyloidosis is due to defect

in: [AIIMS Nov 2007] a. β2 – microglobulin b. Transthyretin c. AANF d. Pyrin

OPERATION HARRI P-2024 (SESSION 10

– 3.6.07)

POSITIVE 2007 23

104. All but one acts via GABA Aexcept: [AIIMS Nov 2007] a. Thiopentone b. Midazolam c. Zolpidem d. Promethazine


29.4.07) 144. Reye’s syndrome is ultrastructurally

characterized by: [AIIMS Nov 2007] a. Mitochondrial blebs and enlarged mitochondria b. Depletion of glycogen c. Dilatation of the endoplasmic reticulum d. Perinuclear staining


27.5.07) 169. A 71/2 year old child presents with non-

blanching rash over the extensor aspect of arm with swelling over knee. Urine analysis shows proteinurea + and hematuris +++. On kidney biopsy which finding will be most commonly seen: [AIIMS Nov 2007] a. Fusion of podocytes b. Acute tubular necrosis c. Deposition of IgA d. Thickened basement membrane


27.5.07) 131. A 23 year old male who is otherwise normal

complains of mild pain in his right iliac fossa in a waveform pattern which increases during the night and he becomes exhausted and is admitted in the hospital. On examination there is mild hematuria. Urine

examination reveals plenty of RBCs, 50WBCs/hpf. Urine pH is 5.5. Most likely diagnosis is: [AIIMS Nov 2007] a. Glomerulonephritis b. Ca-Urinary bladder c. Ureteral calculus d. ..


27.5.07) 137. . Not a feature of DKA is: [AIIMS Nov

2007] a. Tachypnoea b. Bradycardia c. Abdominal pain d. Dehydration

OPERATION HARRI P-2158-TAB (SESSION

14 – 17.6.07) 142. Marker for acute Hepatitis B is: [AIIMS

Nov 2007] a. HBV-DNA polymerase b. IgG anti-HBc c. Core antigen (HbcAg) d. Anti-HbsAg

OPERATION HARRI P-1834-TAB (SESSION 9

– 27.5.07) 132. A patient presents with

hyperparathyroidism. He has a family history of his siblings having pituitary involvement, thyroid nodules, pancreatic involvement, parathyroid hyperplasia and cutaneous angiofibromas. Most likely diagnosis: [AIIMS Nov 2007] a. MEN 1 b. MEN 2A

POSITIVE 2007 24

c. MEN 2B d. MEN 2C


24.6.07)

27. Sertoli cells in the testis have receptors for: [AIIMS Nov 2007] a. FSH b. LH c. Inhibin d. ..

OPERATION HARRI P-2188,2199

(SESSION 14 – 24.6.07) (Also in consultants discussion)

179. According to the new WHO criteria, all are

true in a normal person except: [AIIMS Nov 2007] a. Sperm count > 20 million b. Volume > 1 ml c. Normal morphology in > 15 % (strict criteria) d. Aggressive forward motility in > 25 %

OPERATION HARRI 2188 (SESSION 14 –

24.6.07) 175. A 18 year old primigravida complained of

decreased fetal movements. She delivered a baby weighing 2000gms at 30 weeks of gestation. The APGAR scores of the baby were 4 and 5 at 1 and 5 minutes respectively. The baby died in an hour. Post-mortem examination revealed multiple, peripheral, radially arranged cysts in the kidney. Most common associated finding in the baby would be: [AIIMS Nov 2007] a. Holoprosencephaly b. Hepatic cysts and hepatic fibrosis

c. Ureteral agenesis d. Medullary sponge kidney


27.5.07) 15. Regarding genital development, true is:

[AIIMS Nov 2007] a. Y chromosome is associated with ovary development b. Genital ridge starts developing at 5th week c. Male genitals develop earlier than female genitals d. Genital development is complete by 10th week

OPERATION HARRI P-2198,2214 (SESSION

14 – 24.6.07) 148. Most common site of spinal cord tumour is:

[AIIMS Nov 2007] a. Intradural extramedullary b. Extradural c. Intramedullary d. All have equal distribution

185. Asherman’s syndrome is diagnosed by all except: [AIIMS Nov 2007] a. HSG b. Hysteroscopy c. Endometrial culture d. Saline infusion USG


24.6.07)

CONSULTANT DISCUSSION

POSITIVE 2007 25

95. . True about protease inhibitors are all except: [AIIMS Nov 2007] a. Acts as a substrate for P-glycoprotein(P-gp) and action is mediated by MDR-1 gene b. Hepatic oxidative metabolism c. All protease inhibitors interfere with metabolism by drug interactions d. Saquinavir causes maximum induction of CYP3A4 (consultant’s discussion-)

194. All are characteristics of schizophrenia

except [AIIMS-NOV-2007] a. Third person auditory hallucinations b. inappropriate emotions c. Long stretches of mood changes d. Formal thought disorder

SESSION-36- 28-10-07 PSYCHIATRY-

Question79 79. All are features of schizophrenia except

a) Altered affect b) Incongruity of emotion c) Altered intellectual functions d) Neologisms

Most common Hallucination: Auditory Hallucination

Schneider’s First Rank Symptoms: 1. Thought Echo 2. Thought insertion 3. Thought withdrawal 4. Thought broadcasting 5. Made affect 6. Made impulse 7. Made volution 8. Hallucinations 9. Somatic passivity 10. Delusional perception

195. Altered perception of real objects is: [AIIMS-NOV-2007] a. Illusion b. Delusion c. Hallucination d. Delirium

SESSION-36 (28-10-07) PSYCHIATRY DISSCUSSION

Perception without stimuli – Hallucination misinterpretation – illusion 53. . In tandem [bleep] number of [bleep] fired

[AIIMS-NOV-2007] a.1 b.2 c. 3 d.

SESSION-FM (13.5.07) 13. According to Couinaud’s classification the

4th segment of the liver is: [AIIMS-NOV-2007] a. Caudate lobe b. Quadrate lobe c. Left lobe d. Right lobe

Session-19-Page-19-Q.No-21 21. Pick the WRONG statement regarding

hepatic anatomy (a) Liver sinusoids are developed from Endodermal bud (b) The basis of segmental division is on hepatic arterial branches (c) Segment I corresponds to Caudate lobe (d) Normal liver function test after transplant 3-5 weeks. (e) Only hepatic vein to join liver outside liver is Right hepatic.vein (f) Central structure of Hepatic lobules is central vein

21. Ans:B. Is based on French. Couinaud.

POSITIVE 2007 26

“Portal scissurae” -> “Hepatic venous planes”. Caudate lobe I. Quadrate IV.

Caudate has direct drainage to IVC. Central structure is central vein.–Direction of blood flow away Components of portal tract bileduct, hepatic artery and portal vein. Development Liver endothelium – Vitelline + umbilical vein. Bud. Connective tissue, kuppfercells -> septum transversum. Haemopoeitic cells Hepatic anatomy a) It is the largest solid organ in the body (b) The hepatic blood supply is 80% portal vein & 20% hepatic artery (d) Majority of arterial supply is from right hepatic artery (e) Abnormal left hepatic artery arises from celiac(trunk Liver. Largest organ 1.5kg 2% body Wt 5% New borns Capsule of liver (Glisson). Devt starts from 3rd week. Rate of liver regeneration 25±1.2 m/kg or 70ml/day. Cell division complete in 72 hrs. Major art supply hepatic artery. Right > Left Abnormal right hepatic 17% from sup. Mesenteric artery.

Abnormal left hepatic celiac trunk. Hepatic duct with longest extra hepatic course is left. Free edge relation CBD, PV posterior, Hepat Anterior + Left. Only hepatic vein to join liver outside liver – Right hepatic. 193. Regarding type A personality, false is:

AIIMS-2007 a. Hostility b. Time pressure c. Competitiveness d. Mood fluctuations

SESSION-36 (28-10-07) PSYCHIATRY DISCUSSION

90. In a patient with post partum hemorrhage with rheumatic heart disease , which is contraindicated: [AIIMS-NOV-2007] a. Misoprostol b. Methyl ergometrine c. Oxytocin d. Carboprost

SESSION 38 (18.11.07) 186. Transparency of the cornea is maintained

by all except: [AIIMS-NOV-2007] a. Hydration b. Wide separated collagen bands c. Mitotic figures in the central cornea d. Unmyelinated nerve fibers

SESSION-30 (30-09-2007) 6. Occlusion occurs at the 2nd part of Axillary

artery, blood flow is maintained by anastomosis between: [AIIMS-NOV-2007] a. Anterior and posterior circumflex humoral artery b. Suprascapular and posterior circumflex artery c. Deep branch of the transverse cervical artery and Subscapular artery d. Anterior circumflex artery and subscapular artery

Session-1-Page-14 – Q.No-2 2. A 62-year-old woman has a neoplasm of the

left coracoid process completely compressing the axillary artery. However, the left radial arterial pulse is normal. An anastomotic connection between which of the following arteries best explains this finding? a) Anterior and posterior humeral circumflex arteries b) Subscapular and brachial arteries c) Subscapular and posterior humeral circumflex arteries d) Suprascapular and subscapular arteries e) Thoracoacromial and supreme thoracic arteries

POSITIVE 2007 27

2. Ans(d) In this case, the second part of the axillary artery is being compressed. Therefore, the anastomotic connection must be between a branch from the first part of the subclavian artery on one side and a branch from the third part of the axillary artery on the other side. Answer D is the only one that fits this requirement. The suprascapular artery, a branch of the thyrocervical trunk of the subclavian artery anatomoses with the circumflex scapular artery, a branch of the subscapular artery. The subscapular artery is a branch of the third part of the axillary artery.

189. A 30 year old man presents with 6 month history of nasal discharge, facial pain and fever. On antibiotic therapy, fever subsided. After 1 month again had symptoms of mucopurulent discharge from the middle meatus and the mucosa of the meatus appeared congested and oedematous. Next best investigation would be: [AIIMS-NOV-2007]

SESSION 22 - ENT (11.8.07) [snip]. Regarding Phenytoin,false is: [AIIMS-

NOV-2007] a. Induces microsomal enzymes b. At very low doses, zero order kinetics occurs c. Higher the dose,higher is the half life d. Highly protein bound

Session-35 (21.10.07) Page-8-Q.No -24 24. False statement about the pharmacokinetics

of anti epileptic drugs is a) Oxcarbazepine is a prodrug b) Ethosuximide is highly plasma protein bound c) High doses of Phenytoin are eliminated by zero order kinetics d) Gabapentin is excreted unchanged in urine

24. Ans (b) Anti epileptics are given orally.All have good oral bioavailability. Fosphenytoin & Oxcarbazepine are prodrugs.Plasma protein binding is less for most drugs. Phenytoin

(90%)& Valproate (90%) are highly bound to plasma protein. Most undergo metabolism. Gabapentin, lopiramate are excreted unchanged in urine. High doses of Phenytoin is eliminated by zero order kinetics.(AIIMS-NOV-2007)

61. In an epidemic the first case of come to the notice of the investigator is: [AIIMS Nov 2007] a. Index case b. Primary case c. Secondary case d. Tertiary case

SESSION -SPM - (9-9-2007)

59. Which of the following will cause an increase

in the prevalence of the disease: [AIIMS Nov 2007] a. Immigration of healthy persons b. Increased cure rate of the disease c. Longer duration of the disease d. ..

SESSION-SPM- (9-9-2007)

58. . Regarding National Polio Surveillance all

are true except: [AIIMS Nov 2007] a. Mopping up is done in areas with active cases found b. .. c. .. d. Acute Flaccid Paralysis(AFP) Surveillance is not done in children < 5years of age


POSITIVE 2007 28

74. Not a measure of central tendency: [AIIMS Nov 2007] a. Mode b. Range c. Variable d. Standard deviation


120. Basement membrane consists of all except:

[AIIMS Nov 2007] a. Laminin b. Nidogenin c. Entactin d. Rhodopsin

SESSION-NEPHROLOGY (22-7-07)

157. A 3-year old girl is posted for tonsillectomy.

On examination it is found that she has a midline cystic swelling extending till below the hyoid bone. It is painless and moves with deglutition. The thyroid examination is normal. What should be done next? [AIIMS Nov 2007] a. Percutaneous aspiration b. I.V. antibiotics c. Surgical removal d. Observation

SESSION-SURGERY – (22-7-2007)

159. A 30 year old male patient presents with a peptic ulcer in the posterior duodenum with a bleeding vessel at the base. The bleeding is not controlled endoscopically. On examination his heart rate is 100/min, BP is 110/76 mm of Hg and Hb is 10 gm/dl after transfusion. Next step in his management will be: [AIIMS Nov 2007] a. Proton pump inhibitors b. Duodenotomy with controlled bleeder and

pyloroplasty c. Duodenotomy with controlled bleeder and truncal vagotomy with antrectomy d. Partial gastrectomy involving the bleeding ulcer

SESSION-19-22-07-07-PAGE-17-Q-12

12. Least chances of complications like dumping

syndromes, and diarrhea is seen in (SESSION-19-22-07-07-PAGE-17-Q-12) (a) Highly selective Vagotomy (b) Truncal vagotomy and Gastrojejunostomy (c) Antrectomy and Truncal vagotomy (d) Vagotomy and pyloroplasty.

12. Ans : A Indications for surgery in bleeding peptic ulcer: Uncontrollable bleeding Inability to identify localize bleeding point. Requirement of blood: >6 units. Treatment: Gastroduodenotomy, suturing of the bleeding vessel and pyloroplasty(AIIMS-NOV-2007****) Duodenal ulcer perforation: Diagnosis: X-ray chest PA with diaphragm erect. Minimal amount of gas for pneumoperitoneum: 10 ml. Pneumoperitoneum is absent in 30% of duodenal ulcer perforation. Treatment is laparotomy & closure with omental patch. Vomiting is usually absent 170. A child presented with respiratory

distress.was brought to emergency with bag and mask ventilation. Now intubated. Chest x ray shows right sided deviation of mediastinum with scaphoid abdomen. His Pulse Impulse has shifted to the right. What is the next step? [AIIMS Nov 2007] a. Remove the Endotracheal tube b. Put a nasogastric tube

POSITIVE 2007 29

c. Surgery d. Tube thoracostomy

SESSION-PEDIATRICS – (6-10-2007)

130. Persistent foetal lobulation of adult kidney

is due to: [AIIMS Nov 2007] a. Congenital renal defect b. Obstructive uropathy c. Intrauterine infections and scar d. Is a normal variety

SESSION-NEPHROLOGY (22.7.07)

177. Clomiphene citrate is associated with all except: [AIIMS Nov 2007] a. Polycystic ovarian disease b. Multiple pregnancies c. Ovarian cancer d. Teratogenecity

SESSION-PHARMOCOLOGY – (6-5-2007)

199. ‘Egg-on-side’ appearance on X-ray chest is

seen in: [AIIMS Nov 2007] a. Tetralogy of Fallot b. Uncorrected TGA c. Tricuspid atresia d. Ebstein’s anomaly

SESSION RADIOLOGY (3-6-2007)

200. Floating ‘Water-Lilly sign is seen in: [AIIMS Nov 2007] a. Hydatid ds. b. Aspergillosis c. Tuberculous cavity d. ..

SESSION-RADIOLOGY (3-6-2007)

5. . Left renal vein crosses the Aorta: [AIIMS

Nov 2007] a. Anteriorly, above the superior mesenteric artery b. Anteriorly, below the superior mesenteric artery c. Posteriorly, at the level of superior mesenteric artery d. Anteriorly, below the inferior mesenteric artery

SESSION-19-22-07-07-PAGE-62,55-Q-20

20. Nut cracker phenomenon is due to

(SESSION-19-22-07-07-PAGE-62,55-Q-20) a) Compression of left renal vein between aorta and superior mesentric artery b) Compression of left renal vein between aorta and inferior mesentric artery c) Compression of right renal vein between aorta and superior mesentric artery d) Compression of right renal vein between aorta and inferior mesentric artery

20. Ans:- (a) Compression of left renal vein between aorta and superior mesentric artery leading to increased pressure in left renal vein. This leads to anoxia in the medulla favouring sickling in left kidney leading to left sided predominance of hematuria.

8. One of the following is the watershed area of the colon between the superior and inferior mesenteric arteries: [AIIMS Nov 2007] a. Ascending colon b. Hepatic flexure c. Splenic flexure

POSITIVE 2007 30

d. Descending colon

SESSION-ANATOMY-ABDOMEN (29.7.07) 11. Dangerous area of the face is: [AIIMS Nov

2007] a. Ciliary body b. Sclera c. Optic nerve d. Retina

SESSION-ANATOMY-HEAD AND NECK (30-9-2007)

14. . If the circumflex artery gives off the posterior interventricular artery, then the arterial supply is called: [AIIMS Nov 2007] a. Right dominance b. Left dominance c. Balanced dominance d. ..

SESSION –CARDIOLOGY (23-9-07) 30. The mechanism of action of surfactant is:

[AIIMS Nov 2007] a. Breaks the structure of water in the alveoli b. Lubricates the flow of CO2 diffusion c. Makes the capillary surface hydrophilic d. ..

SESSION-32—PHYSIOLOGY-7-10-07-Q-6 6. The following statements are true about

surfactant EXCEPT(SESSION-32—Physiology-7-10-07-Q-6) A. It is secreted by Type II alveolar epithelial cells B. It reduces surface tension C. It decreases the compliance of the lung D. Its major constituent is a lipid

6. Answer is C Lipid molecule reduces the surface tension secreted by the type II alveolar cells The smaller alveoli tends to collapse and the larger alveoli tends to expand further according to law of Laplace P=2T/r According to law of Laplace theP1 is less than the P2 But both are exposed to same pressure,When tension is constant, the smaller alveoli tends shrink and larger alveoli tends expand-Alveolar instability.The surfactant molecule get arranged as single molecular layer over the alveolar air fluid interface layer.So the surfactant reduces the tension of smaller alveoli by crowding and increases the surface tension of larger one by separation in the layer

33. Ureteric peristalsis is due to: [AIIMS Nov

2007] a. Sympathetic innervation b. Parasympathetic innervation c. Both sympathetic and parasympathetic innervation d. Pacemaker activity of the smooth muscle cells in the renal pelvis

SESSION-ANATOMY-ABDOMEN (29-7-07) 9. A patient with pericarditis is complaining of chest pain. The pain is mediated through(AIIMS-NOV-2007***) a. Deep cardiac plexus b. Superficial cardiac plexus c. Inter costal brachial nerve d. Phrenic nerve* For explanation, refer to the MCQs of Thorax & Embryology discussed in the class. The fibrous pericardium and the outer layer of the servous pericardium are innervated by the somatic nerve i.e the phrenic nerve in this case and therefore are sensitive to pain. The superficial and deep cardiac plexuses are formed by autonomic fibres and they innervate the heart and the inner layer of the serous pericardium). Note that the outer layer of all three body cavities develops from the somatopleuric mesoderm and therefore are innervated by the nerves of the body wall. Hence sensitive to pain. The inner layer of the body cavities develops from the splanchnopleuric mesoderm and therefore is innervated by the autonomic nervous system. Hence insensitive to pain

POSITIVE 2007 31

21. Violent inversion injury – fracture of 5th metatarsal tuberosity is due to avulsion of the tendon of(AIIMS-NOV-2007****) A. Peroneus longus B. Peroneus brevis* C. Peroneus tertius D. Extensor digitorum brevis (For explanation, refer to the MCQ of lower limb discussed in the class. “Jone’s fracture is due to the avulsion of the tendon of…….”) The tuberosity of the 5th metatarsal bone is a small projection near its base. It gives attachment to the tendon of peroneus brevis 24. Penile fracture with intact Buck’s fascia – haematoma is seen in(AIIMS-NOV-2007*****) A. Butterfly perineum B. Shaft of penis C. Penis, perineum, scrotum, anterior abdominal wall up to umbilicus*! D. Penis and scrotum In this case the blood collects in the superficial perineal space. Therefore it can extend into the scrotum, perineum and the anterior abdominal wall. Refer to MCQs of Abdomen discussed in the class – the question regarding rupture of bulbous urethra 26. Structure not destroyed in tracheostomy(AIIMS-NOV-2007*****) A. Isthmus of thyroid gland B. Inferior thyroid artery* C. Thyroidea ima artery D. Inferior thyroid vein (For explanation, refer to the MCQ of head & neck

discussed in the class). Q.No. “ 62. During tracheostomy inferior to the thyroid gland, the

following structures carry the risk being damaged EXCEPT A. Inferior thyroid artery* B. Inferior thyroid vein C. Arteria thyroidea ima D. Jugular venous arch”

B, C & D lie in front of trachea. Therefore, they carry the risk of being injured during tracheostomy. As the inferior thyroid artery enters the lower pole the gland from lateral side it is least likely to be damaged.

51. All of the following are included in grievous hurt except: [AIIMS Nov 2007] a. Loss of testis b. Loss of eye c. Loss of kidney d. Abrasion of the face

SESSION-FM (13-5-07) 52. Not a part of informed consent is: [AIIMS

Nov 2007] a. .. b. .. c. .. d. Concealed information…..

SESSION-FM (13-5-07) 62. Maternal Mortality Rate is calculated by:

a. Maternal deaths/live birth b. Maternal deaths/1000 live births c. Maternal deaths/100000 live births d. Maternal deaths/100000 population

SESSION-SPM (9-9-07) 64. Not included in the National Immunisation

Programme is: [AIIMS Nov 2007] a. Tetanus toxoid b. Hepatitis B c. BCG d. Measles

SESSION-SPM (9-9-07) 84. Positive Schick’s test indicates that the

person is: [AIIMS Nov 2007] a. Immune to diphtheria b. Hypersensitive to diphtheria c. Susceptible to diphtheria d. Carrier of diphtheria

POSITIVE 2007 32

Ans [c]

SESSION-MICRO-1 (24-06-07) 85. True about Corynebacterium diphtheria is:

[AIIMS Nov 2007] a. Deep invasion is not seen b. Elek’s test is done for toxigenicity c. Metachromatic granules are seen d. Toxigenicity is mediated by chromosomal change

SESSION-MICRO1 (24-06-07)

100. Increased cerebral O2 consumption is

caused by: [AIIMS Nov 2007] a. Propofol b. Ketamine c. Atracurium d. Fentanyl

SESSION-ANESTHESIOLOGY (15-4-2007) 102. All are true about Thiopentone except:

[AIIMS Nov 2007] a. NaCO3 is a preservative b. Contraindicated in Porphyrias c. Agent of choice in shock d. Cerebroprotective

SESSION-ANESTHESIOLOGY (15-4-2007) 122. Shock lung is characterized histologically

by: [AIIMS Nov 2007] a. Diffuse alveolar oedema b. Hemosiderosis c. Interstitial pneumonia d. Pulmonary oedema

SESSION-PATHOLOGY-1 (29-4-07)

124. . In HIV window period indicates: [AIIMS Nov 2007] a. Time period between infection and onset of first symptoms b. Time period between infection and detection of antibodies against HIV c. . d. .

SESSION-MEDICINE-1 (14-7-07) 146. Which of the following is not included in

intensive management of diabetes mellitus: [AIIMS Nov 2007] a. Pregnancy.. b. Postural hypotension due to autonomic neuropathy c. DM with acute MI d. Post kidney transplant

SESSION-MEDICINE-1 (14-7-07) 153. Inflammation of a retrocaecal appendix will

produce pain when there is which of the following movements at the hip: [AIIMS Nov 2007] a. Flexion b. Extension c. Medial rotation d. Lateral rotation

SESSION-SURGERY-1 (10-6-07) 161. Most common type of seizures in neonates

are: [AIIMS Nov 2007] a. Clonic b. Tonic c. Subtle d. Myoclonic

SESSION-PEDIATRICS (6-10-2007)

POSITIVE 2007 33

166. A 2 year old female child developed fever, cough and respiratory distress. On chest x-ray consolidation is seen in right lower lobe. She improved with antibiotics but on follow up at 8 weeks was again found to have increasing consolidation in right lower lobe and fever. Your next investigation would be: [AIIMS Nov 2007] a. Bronchoscopy b. Bacterial culture of the nasopharynx c. CT scan of the chest d. Allergen sensitivity test

SESSION-PEDIATRICS (6-10-2007) 8. A child with recurrent pneumonia should be

investigated for:

A) Cystic fibrosis (B) Foreign body aspiration

(C) Bronchiectasis (D) G.E.reflux (E) All of

the above

171. Kanavel’s sign is seen in: [AIIMS Nov 2007]

a. Tenosynovitis b. Dupuyteren’s contracture c. Carpal tunnel syndrome d. Trigger finger

SESSION-ORTHOPEDICS (19-8-07) 173. Primary impact injury is seen externally

most commonly in the: [AIIMS Nov 2007] a. Head b. Chest c. Legs d. Abdomen

SESSION-FM (13-5-07) 180. A gravida3 female with a history of 2

previous 2nd trimester abortions presents at 22 weeks of gestation with funneling of the

cervix. Most appropriate management would be: [AIIMS Nov 2007] a. Administer Dinoprostone and bed rest b. Administer mifipristone and bed rest c. Apply Fothergill’s stitch d. Apply McDonald’s stitch

SESSION-38 (19-11-2007) 181. Internal Podalic Version done in cases of

transverse lie is associated with the following complication: [AIIMS Nov 2007] a. Uterine rupture b. Vaginal laceration c. Uterine atony d. Cervical laceration

SESSION-38 (19-11-2007) 182. Increase in maternal serum AFP levels is

seen in: [AIIMS Nov 2007] a. Down’s syndrome b. Molar pregnancy c. Over estimated gestational age d. Congenital Nephrotic Syndrome

SESSION-19 (22-07-07) P-48 186. Transparency of the cornea is maintained

by all except: [AIIMS Nov 2007] a. Hydration b. Wide separated collagen bands c. Mitotic figures in the central cornea d. Unmyelinated nerve fibers

SESSION-30 (30-09-07) P-19-Q-5

5. Transparency of cornea is due to

A. Absence of blood vessels B. Regular arrangement of collagen fibres C. Fibres and ground substance having same refractive index

POSITIVE 2007 34

D. All of the above E. A & B Ans (d) 188. child presents with ear infection with foul

smelling discharge. On further exploration a small perforation is found in the pars flaccida of the tympanic membrane. Most appropriate next step in the management would be: [AIIMS Nov 2007] a. Topical antibiotics and decongestants for 4 weeks b. IV antibiotics and follow up after a month c. Tympanoplasty d. Tympano-mastoid exploration

SESSION-ENT - (11-8-07)

MKT

12. Urothelium does not line: [AIIMS-NOV-2007] a. Collecting ducts b. Minor calyx c. Ureter d. Urinary bladder

MKT SESSION-1 (8-04-07 EMBRYOLOGY,HISTOLOGY

38. Which of the following is correctly matched: [AIIMS-NOV-2007] a. B cells – Somatostain b. D cells – Insulin c. G cells – Gastrin d. …..

MKT-SESSION-1 (8-04-07) 11. Principal enteroendocrine cells in the

gastrointestinal tract. Cell Type and Location Hormone Produced A-stomach Glucagon G-pylorus Gastrin(AIIMS-NOV-

2007***) S-small intestine Secretin K-small intestine Gastric inhibitory

polypeptide L-small intestine Glucagon-like

substance (glicentin) I-small intestine Cholecystokinin D-pylorus, duodenum Somatostatin Mo-small intestine Motilin EC-digestive tract Serotonin, substance P D1-digestive tract Vasoactive intestinal

polypeptide 132. A patient presents with

hyperparathyroidism. He has a family history of his siblings having pituitary involvement, thyroid nodules, pancreatic involvement, parathyroid hyperplasia and cutaneous angiofibromas. Most likely diagnosis: [AIIMS-NOV-2007] a. MEN 1 b. MEN 2A c. MEN 2B d. MEN 2C

MKT-POSITIVE SESSION (Also in OPERATION HRRI-P-2231)

2. Multiple endocrine neoplasia (MEN)

Type Genetic locus

Gland affected

POSITIVE 2007 35

Parathyroid hyperplasia / adenoma Pancreatic islet cell hyperplasia/adenoma/carcinoma

Men – 1 Chromo some 11

Pituitary hyperplasia/adenoma;rarely carcinoid,pheochromocytoma, lipomata Medullary thyroid carcinoma Pheochromocytoma (bilateral in 50%)

MEN II (also known as “MEN IIA”

Chromosome 10

Parathyroid hyperplasia/adenoma;rarely cutaneous lichen amyloidosis Medullary thyroid carcinoma Pheochromocytoma (commonly bilateral)

Mucosal/gastrointestinal neuromas

MEN III (also known as ‘MEN IIB’

Chromosome 10

Marfanoid features/thickened ‘bumpy’ lips

All syndromes display autosomal dominant inheritance. Genetic (DNA Polymorphism) testing identifies carriers of MEN II and MEN III with > 90% certainly

106. Hypercalcemia is caused by all except: [AIIMS-NOV-2007] a. Loop diuretics b. Lithium c. Vitamin D intoxication d. ..

MKT-POSITIVE SESSION 8. Causes of Hyper Calcaemia

With normal or elevated (i.e. inappropriate)PTH levels

Primary or tertiary hyperparathyroidism

Lithium-induced hyperparathyroidism

Familial hypocalciuric hypercalcaemia

With low (i.e. suppressed)PTH levels

Malignancy (e.g.lung, breast, renal, ovarian, colonic and thyroid carcinoma)

Multiple myeloma Elevated 1, 25(OH)2 Vitamin

D3 (e.g. intoxication or sarcoidosis)

Thyrotoxicosis Paget’s disease with

immobilisation Milk alkali syndrome Thiazide diuretics Addison’s disease

135. Fractional excretion of Na++ < 1% is seen in: [AIIMS-NOV-2007] a. Pre-renal azotemia b. ATN c. Intrinsic renal failure d. Renal artery stenosis

MKT-POSITIVE SESSION Urine chemistry in differential diagnosis of ARF

Urine Prerenal acute renal failure*

Ischemic Intrinsic acute renal failure

Urine osmolality, Uosm (mOsm/kg H2O)

> 500 < 250

Urine to plasma osmolality

> 1.5 < 1.1

Urine specific gravity > 1.018 < 1.012 Plasma BUN : creatinine ratio

> 20 < 10-15

Urinary urea nitrogen : > 8 < 3

POSITIVE 2007 36

plasma urea nitrogen ratio Urinary creatinine : plasma creatinine ratio

> 40 < 20

Urinary Na+ concentration (mmol/L)

< 10 > 20

Fractional excretion of Na+ (%)c(AIIMS-NOV-

2007***)

< 1 > 2

Renal failure index UNa/Ucr/Pcr

<1 >1

Urine sediment Hyaline casts

Muddy brown granular casts

(Also in OPERATION HARRI) 71. SAFE strategy is recommended for: [AIIMS-

NOV-2007] a. Trachoma b. Glaucoma c. Diabetic retinopathy d. Cataract

SAFE strategy for trachoma: MKT-POSITIVE-2007-OPHTHAL

- Surgery for trichiasis. - Antibiotics - Facial Cleanliness. -Environmental improvement.

114. PAS does not stain: [AIIMS-NOV-2007] a. Fungal cell wall b. Basement membrane of bacteria c. Glycogen d. Lipids

MKT –POSITIVE SESSION Table 5. Common Histochemical / Cytochemical

Stains in Tumour Diagnosis. SUBSTANCE STAIN

1. Basement membrane

* Periodic acid – Schiff (PAS)

lcollagen * Reticulin * Van Gieson * Masson’s trichrome

2. Glycogen * PAS with loss 3. Glycoproteins, glycolipids (epithelial origin)

* PAS with diastase persistence glycomucins

4. Acid mucin (mesenchymal origin)

* Alcian blue

5. Mucin (in general)

* Combined Alcian blue – PAS

6. Argyrophilic argentaffin granules

* Silver stains

7. Cross striations

* PTAH stain

8. Enzymes * Myeloperoxidase * Acid phosphatase * Alkaline phosphatase

9. Nucleolar organizer regions (NORs)

* Colloidal silver stain

110. A 2-year old child presents with scattered lesions in the skull. Biopsy revealed Langerhans giant cells. Most commonly associated is: [AIIMS-NOV-2007] a. CD1a b. CD57 c. CD3 d. CD68 MKT - RADIOLOGY and ONCOLOGY

12. Leukocyte Differentiation Antigens (CDs) CD Hematolymphoid Cell

Expressiona,b Related functions or proteins

POSITIVE 2007 37

CD 1a,b,c Thymomas, Langerhans cell histiocytosis(AIIMS NOV-2007****), Precursor T-LL/L (some) Associated with β2- microglobulin

CD 2 Mastocytosis (some ) E rosette receptor LFA-3

CD 3 Mature T-cell neoplasms (many), Precursor T-LL/L(T-cell ALL); signal transduction

CD 4 Mature T-cell neoplasms (some) HIV Gp 120 receptor; MHC-II receptor recognition

CD 5 CLL / SLL (many) Mature T-cell neoplasms

(many) Mantle cell lymphoma;

T proliferation, CD 72 ligand CD 6 T activation

CD 7 Mature T-cell neoplasms (most), AML (Some) IgM FcR; T and NK activation

CD 8 Mature T-cell neoplasms (some) MHC-1 receptor

CD 9 Tetraspan, signal transduction

CD 10 Precursor B-LL/L (most); follicular lymphomas (most), Neutral endopeptidase

CD 11a LFA – 1; mediates cell adhesion binds 1-CAM

CD 11b C’3bi receptor, αM integrin chain of MAC – I complex

CD 11c HCL ; Marginal zone B-cell lymphoma (some) AML (monoblastic & myelomonocytic) C3bi, C3dg receptor; αX integrin chain, LFA α chain

CD w12 Unknown function

CD 13 Coronavirus receptor, inactivates peptides

CD 14 Lipopolysaccharide receptor Gp-1-linked

CD 15 HL Lewisx, neutrophil adhesion

and phagocytosis

CD 16a Large granular lymphocyte proliferation (NK type)

Fcy R; signal transduction on NK and M

CD 16 b Fcy R; Gp-1-linked; immune complex receptor

CDw17 Lactoceramide

CD 18 Integrin heterodimer with CD11, LFA-1

CD 19 Mature B-cell neoplasms (most), precursor B-LL/L Modulates B responsiveness

CD 20 Mature B-cell neoplasms, Precursor B-LL/L (some);

HL (nodular lymphocyte predominance)

B activation and proliferation CD 21 Follicular dendritic cell

neoplasms (See CD 35); C’ 3D RECEPTOR; EBV receptor; B activation/ proliferation

CD 22 Mature B-cell neoplasms Mediates adhesion

CD 23 CLL/SLL (most) Fc epsilon R; cytotoxicity by M

& Eos CD 24 Gp-1-linked; regulates B

proliferation and differentiation

CD 25 HCL; HL (most) ALCL (most)

POSITIVE 2007 38

Mastocytosis, adult T-cell leukemia/lymphoma; IL-2H

CD 30 ALCL ; HL Ki-1 (Ber-H2) antigen; TNFR-

like protein involved in T activation

CD 31 Platelet-endothelial cell adhesion molecule -1 (PECAM-1), Plat GpIIA

CD 32 Myeloid leukemias Fcy R, regulates B

CD 33 AML (most) Precursor B – ll/l

Function unknown CD 34 AML (most) Precursor B- & T-

LL/L (some) Possible role in stromal adhesion

CD 35 Follicular dendritic cell neoplasms

C’ 3b/C’4b receptor (see CD 21)

CD 36 Plat GpIIIb, Gp-IV; collagen, thrombospondin, and malaria receptor

CD 38 Plasma cell neoplasms, CLL/SLL

Leukocyte activation CD 40 TNFR protein involved in B

differentiation CD 41 Acute megakaryoblastic

leukemia Plat Gp-IIb; fibrinogen &

Von Willebrand’s factor receptor

CD 42 a–d Gps IX, 1bα , 1bβ , V

respectively C 43 Precursor & Mature T-cell

neoplasms, CLL/SLL (some), Mantle cell lymphoma, AML

Leukocyte sialoglycoprotein, adhesion

CD 44 H-CAM, Lymphocyte homing receptor

CD 45 Leukocyte common antigen (LCA)

Signal transduction CD 45

RA, RB, RC

45 RA:B – cell lymphomas, HL (nodular lymphocyte predominant):

Restricted LCA forms with exons A, B, or C

CD 45 RO

Mature T-cell neoplasms, B-cell lymphomas (some)

Restricted LCA forms without exons

CD 49 α Integrin chains; laminin, fibronectin & collagen receptors

CDw52 Campath-1:Target for C’-mediated lysis;

CD 54 --CAM-1: LFA ligand; rhinovirus & malaria receptor

CD 55 Decay accelerating factor; Gp-1-linked; deficiency leads to paroxysmal nocturnal hemoglobinuria (PNH)

CD 56 Subset of NK/T-cell lymphomas

N-CAM ; Gp-1-linked CD 57 Subset of NK/T-cell

lymphomas CD 59 PNH (antigen lost in PNH)

Gp-1-linked ; bubds C8 abd C9, blocks membrane- attack comlex

POSITIVE 2007 39

CD 61 Acute megakaryoblastic leukemia

Plat GpIIb/IIIa; β3 integrin; dimer with CD 41 or CD 51

CD 66b,d

Carcinoembryonic antigen (CEA), biliary glycoprotein

CD 68 Histiocytes (most)(?-AIIMS-NOV-2007***) ; Mastocytosis

Endocytosis or lysosomal traffic CD 72 CD 5 ligand, B-cell activation /

proliferation CD 77 Transmembrane signaling in

apoptosis CD

79a,b

CD 79a: Precursor B-LL/L, B-cell lymphomas, myeloma (some)

B-cell receptor complex signal transduction

CD 83 Marker for DC CD 87 Urokinase plasminogen activator

receptor CD 88 Receptor for C’5a; cell

activation, chemotaxis CD 90 CD 34 proliferation inhibitor ;

Gp-1-linked CD 94 Regulates LFA-1 cytolytic

activity CD 96 CD7+ AML; T-activated

increased late expression (TACTILE)

CD 99 Precursor B - & T- LL/L Adhesion and signalling;

erythrocyte rosetting CD 100 Function unknown CD 103 HCL; Enteropathy-type T-

cell lymphoma Human mucosal lymphocyte

(HML-1) CD 108 HL cell lines CD 114

– 116

G-CSFR and GM-CSFR

CD 117 AML, Mastocytosis Stem cell factor receptor ;

c-kit protein CD

121-132

IL – receptors

CD 138 Myeloma Syndecan-1; extracellular

matrix receptor CD 140 Platelet-derived growth factor CD 141 Thrombomodulin; down-

regulates coagulation, thrombin receptor

CD 143 Angiotensin converting enzyme (ACE)

CD 148 Lost in carcinoma of breast bladder , liver

CD 154 TNF family; B cell help by T cells

CD 155 Polio virus receptor CD 157 Bone marrow stromal antigen

(BST-1) CD 161 NK cell-mediated cytolytic

activity

191. All of the following are causes of cicatrizing alopecia except: [AIIMS-NOV-2007] a. Lichen planus b. Discoid lupus erythematosus c. Alopecia areata d. Lupus vulgaris

POSITIVE 2007 40

MKT-POSITIVE –DERM SESSION 9. Simplified tool for the diagnosis of alopecia

Disease Diffuse loss (non – scarring) Telogen effluvium Diffuse alopecia areata Androgenic alopecia (men) Androgenetic alopecia (women) Systemic disease (thyroid, iron deficiency, systemic lupus erythematosus, dermatomyositis) Patchy loss (scarring) Lichen planopilaris Discoid lupus erythematosus Folliculitis decalvans Pseudopelade Follicular degeneration syndrome Patchy loss (non-scarring) Alopecia localized Tinea capitis Traction alopecia Trichotillomania Syphilis

positive aiims nov 2007[1]

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