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A newborn after a few hours of birth started vomiting and presents with epigastric distension.An abdominal X-ray is  taken and is shown below ? (IMPORTANT QUESTIONS FOR AIPGMEE)

 

aipgme.jpg



A. Colon carcinoma
B. Perforation
C. Intussusception
D. Duodenal atresia

Ans.D

Double bubble sign is the characteristic abdominal Xray sign associated with duodenal atresia.  In tis, the stomach and first part of the duodenum are the only parts of the intestine filled with gas giving the characteristic appearance.

Duodenal atresia typically presents in the first hour of life. Children presents with bilious vomiting and epigastric distention within a few hours of birth. Meconium may be passed normally.

It is often associated with other conditions such as esophageal atresia, intestinal atresia, cardiac and renal anomalies.

Ref: Hoffenberg E, Brumbaugh D, Furuta GT, Kobak G, Liu E, Soden J, Kramer R.Gastrointestinal Tract. In: Hay WW, Jr., Levin MJ, Deterding RR, Abzug MJ. eds.CURRENT Diagnosis & Treatment: Pediatrics, 22e.

 

01 DEC 2014 :

Q) Which among the following is the investigation of choice in Chronic Pancreatitis ?(DNB NOV 2014 )

A. MRCP
B. ERCP
C. Spiral CT
D. USG

Ans :  B -  ERCP

ERCP is the investigation of choice.ERCP is useful in chronic pancreatitis to see dilatations ,stictures and altered ductal anatomy.It is mainly to assess structural pathology of pancreas.

Ref: SRB’s Manual of Surgery 4th Ed Pg 741.


29 NOV 2014 :

Q) Which among the following can induce Apoptosis ?(AIIMS NOV 014)

A. Oleic acid
B. Glucocorticoids
C. Myristic acid
D. Isoprenoid

Ans : B - Glucocorticoids

 

The process by which cells are genetically programmed for death is termed apoptosis.

Glucocorticoids play a major role in attenuation of the inflammatory response. These steroid

hormones are able to induce apoptosis in cells of the hematopoietic system such as

monocytes, macrophages, and T lymphocytes that are involved in the inflammatory reaction .


Ref: Chapter 3. Pharmacodynamics: Molecular Mechanisms of Drug Action. In Brunton L.L., Chabner B.A., Knollmann B.C.(Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.

 


28 NOV 2014

Q)  Sunburst appearance in Osteosarcoma is due to ?(AIIMS NOV 2014)

A. Calcification around spindles
B. Calcification around vessels
C. Periosteal reaction
D. Osteoclastic reaction

Ans : C - Periosteal reaction

Sunburst appearance is a type of periosteal reaction giving the appearance of a sunburst secondary to an aggressive periostitis.
The sunburst appearance occurs when the lesion grows too fast and the periosteum does not have enough time to lay down a new layer and instead the Sharpey's fiber stretch out perpendicular to the bone. It is frequently associated with osteosarcoma but can also occur with other aggressive bony lesions such as an Ewing sarcoma or osteoblastic metastases (e.g. prostate, lung or breast cancer).

Ref: Fundamentals of Skeletal Radiology By Clyde A. Helms



27 NOV 2014

Q) Which of the following statement is false about Cavernous sinus Thrombosis ?(AIIMS NOV 2014)

A. Occurs most commonly due to Ethmoid sinusitis
B. Loss of sensation around orbit
C. Loss of Jaw Jerk reflex
D. Fifth nerve palsy

Ans : C

Cavernous sinus thrombosis usually results from direct spread of bacteria from a contiguous focus of infection.It commonly resluts from the contagious spread of infection from nasal furuncles, sphenoidal or ethmoidal sinuses and dental infections. Patients with cavernous sinus thrombosis generally present with the early onset of external ophthalmoplegia with decreased sensation around the eye. The physical examination reveals periorbital edema and chemosis, and as the illness develops, meningismus, altered mental status, and cranial nerve palsies, especially of cranial nerves III, IV, V, and VI, become evident.S. aureus is the cause of cavernous sinus thrombosis in about 60% to 70% of patients.  
Bilateral involvement and fifth nerve palsy, a fixed, dilated pupil, and signs of meningitis are all more likely in cavernous sinus thrombosis.
The jaw jerk reflex or the masseter reflex is a stretch reflex used to test the status of a patient's trigeminal nerve (CN V).

Ref:  Chapter 49. Endocarditis and Other Intravascular Infections..Principles of Critical Care, 3e.


26 NOV 2014 :

Q) A 42 year old man with Primary infertility and on examination his testis is palpable and vas deferens was not palpable.On semen analysis shows Azoospermia,low volume,low pH,High viscosity and liquefaction time.What is the diagnosis ? (AIIMS NOV 2014)

A. Varicocele
B. CFTR mutation
C. Hyperprolactinemia
D. CARD15 mutations

Ans : B - CFTR mutation

 

Cystic fibrosis transmembrane conductance regulator (CFTR) gene on chromosome 7.Most men with with cystic fibrosis have congenital bilateral absence of vas deferens(CBAVD).Infertility in males secondary to absence of vas deferens.


Ref: Chapter 6. Genetic Disorders. InKemp W.L., Burns D.K., Brown T.G. (Eds), Pathology: The Big Picture.


25 NOV 2014 :

Q) A 7 month old infant with pellagra like skin rash with aminoaciduria and a family history of four siblings are affected but Parents are not affected.What is the diagnosis ? (AIIMS NOV 2014)

A. Maple syrup
B. Hartnups disease
C. Phenylketonuria
D. Dent's disease


Ans : B - Hartnups disease

Hartnup disease is an autosomal recessive condition caused by a defect in intestinal and renal transport of neutral amino acids. The major clinical manifestations are cerebellar ataxia and a pellagra-like skin rash. Other than aminoaciduria, the kidneys are unaffected. The defective gene, SLC6A19, encodes a sodium-dependent and chloride-independent neutral amino acid transporter (BoAT1), which is expressed predominantly in the small intestine and proximal tubule of the kidney . Amino acids such as tryptophan that are retained in the intestinal lumen are converted to indole compounds that are toxic to the CNS. Abnormal tryptophan metabolism also leads to a niacin deficiency that accounts for the skin manifestations.

Dent's disease and X-linked recessive nephrolithiasis are unusual forms of Fanconi syndrome due to X-linked mutations of the gene encoding CLC-5, a voltage-gated chloride channel.


Ref : Chapter 284. Polycystic Kidney Disease and Other Inherited Tubular Disorders. Harrison's Principles of Internal Medicine, 18e.
 

24 NOV 2014 :

Q) LeVeen Shunt is used in ? (AIIMS NOV 2014)

 
A. Hydrocephalus
B. Refractory ascites
C. ASD
D. CCF
 
Ans.B -  Refractory ascites

Refractory ascites can be treated with a LeVeen shunt—a subcutaneous Silastic catheter that transports ascitic fluid from the peritoneal cavity to the jugular vein. A small unidirectional valve sensitive to a pressure gradient of 3–5 cm H2O prevents backflow of blood. 
 
Ref: Chapter 24. Liver & Portal Venous System. In: Doherty GM. eds.CURRENT Diagnosis & Treatment: Surgery, 13e.

 


21 NOV 2014 :

Q) Which of the following is the Investigation of choice for evaluation of acute head injury? (AIIMS NOV 2014)

A) NCCT Head
B) CECT Head
C) MRI Brain
D) CT angiography


Ans : A - NCCT Head

Patients with altered mental status, seizures, or cranial nerve or other focal neurologic deficits require emergency imaging of the brain after the initial assessment and stabilization of the ABCs. A noncontrast CT scan of the head is the study of choice to identify intracranial injuries. If the patient has only a history of loss of consciousness and is alert and oriented in the emergency department, head CT scan can be delayed and accomplished in conjunction with other CT scans that may be required to evaluate the patient with possible spinal injury.

Ref: Chapter 27. Vertebral Column & Spinal Cord Trauma. In:Stone C, Humphries RL. eds. CURRENT Diagnosis & Treatment Emergency Medicine, 7e.

 


20 NOV 2014 :

Q) Which of the following Cephalosporin have anti-MRSA action ? (AIIMS NOV 2014)

A. Cephapirin
B. Cefoxitin
C. Cefotetan
D. Ceftobiprole

Ans : D , Ceftobiprole

Ceftobiprole claim activity against MRSA. Ceftaroline has enhanced anti–gram-positive activity, including MRSA and penicillin nonsusceptible pneumococci. Ceftobiprole has a spectrum of activity similar to that of other cephalosporins but, in addition, is active against MRSA, E faecalis, and penicillin-resistant S pneumoniae.

Ref:  Chapter 28. Antimicrobial Chemotherapy. In: Brooks GF, Carroll KC, Butel JS, Morse SA, Mietzner TA. eds. Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.

19 NOV 2014

Q) Infant mortality does not include:

A. Early neonatal mortality
B..Perinatal mortality
C. Post neonatal mortality
D. Late neonatal mortality

Ans.B - Perinatal mortality

Perinatal mortality is not exclusive to infant mortality. It includes both late foetal deaths (stillbirth) and early neonatal deaths.

The WHO definition of perinatal mortality is all stillbirths (however they are defined) plus all early neonatal deaths up to 28 days per thousand births.

Ref: Park’s Textbook Of Preventive And Social Medicine By K. Park, 19th Edition, Page 449; Park’s Textbook Of Preventive And Social Medicine By K. Park, 18th Edition, Page 415; Medical Informatics In Obstetrics And Gynecology By David Parry, Emma Parry, 2009


18 NOV 2014

Q) All the following are used for treatment of chronic Hepatitis B except ?
 
A. Entecavir 
B. Telbivudine 
C. Zidovudine
D. Lamivudine 
 
Answer: C
 
To date, seven drugs have been approved for treatment of chronic hepatitis B: injectable interferon (IFN) α pegylated interferon [long-acting IFN bound to polyethylene glycol (PEG), known as PEG IFN]; and the oral agents lamivudine, adefovir dipivoxil, entecavir, telbivudine, and tenofovir.
 
Ref: Chapter 306. Chronic Hepatitis. Harrison's Principles of Internal Medicine, 18e.
 


15 NOV 2014

Q) Which of the following structures does not pass through foramen ovale ? (AIIMS NOV 2014)
 
A. Lesser superficial petrosal nerve
B. Accessory meningeal artery
C. Mandibular division of the trigeminal nerve
D. Maxillary nerve
 
ANS : D
 
Foramen ovale: It transmits the mandibular division of the trigeminal nerve, the accessory meningeal artery, and the lesser superficial petrosal nerve, is posterior and lateral to the foramen rotundum.
 
Ref: Chapter 11. Ventricles and Coverings of the Brain. In: Waxman SG.eds. Clinical Neuroanatomy, 27e
 


14 NOV 2014

Q) Which of the following manifestations is not seen in Tuberous Sclerosis? (AIIMS NOV 2014)
 
A. Astrocytoma
B. Cerebral cortical hamartomas
C. Subependymal tumors 
D. Duodenal atresia.
 
Ans : D, Duodenal atresia
 
Tuberous Sclerosis:

Mutation: Gene for hamartin on chromosome 9 or tuberin on chromosome 16.

Manifestations:
  • Cerebral cortical hamartomas (tubers).
  • Subependymal giant cell astrocytomas.
  • Seizures and mental retardation.
  • Cardiac rhabdomyomas.
  • Renal angiomyolipomas.
  • Localized leathery thickenings of the skin (i.e., shagreen patches).
  • Hypopigmented regions of skin (i.e., ash-leaf patches).
  • Adenoma sebaceum.

Ref:  Chapter 6. Genetic Disorders. In: Kemp WL, Burns DK, Brown TG. eds. Pathology: The Big Picture.

13 NOV 2014

Q) Drug of choice for acute bacterial meningitis ? (AIIMS NOV 2014)
 
A. Erythromycin 
B. Sulfamethoxazole 
C. Cefotaxime
D. Nefazodone
 
ANS : C
 
Bacterial meningitis is a medical emergency. The goal is to begin antibiotic therapy within 60 min of a patient's arrival in the emergency room. Empirical antimicrobial therapy is initiated in patients with suspected bacterial meningitis before the results of CSF Gram's stain and culture are known. S. pneumoniae and N. meningitidis are the most common etiologic organisms of community-acquired bacterial meningitis. Due to the emergence of penicillin- and cephalosporin-resistant S. pneumoniae, empirical therapy of community-acquired suspected bacterial meningitis in children and adults should include a combination of dexamethasone, a third- or fourth-generation cephalosporin (e.g., ceftriaxone, cefotaxime, or cefepime), and vancomycin, plus acyclovir, as HSV encephalitis is the leading disease in the differential diagnosis, and doxycycline during tick season to treat tick-borne bacterial infections
 
Ref:  Chapter 381. Meningitis, Encephalitis, Brain Abscess, and Empyema. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e
 


12 NOV 2014

Q) Cri-Du-Chat Syndrome is due to the deletion of ? (AIIMS NOV 2014)
 
A. Chromosome 6
B. Chromosome 5
C. Chromosome 2
D. Chromosome 4
 
ANS : B, Chromosome 5
 
Cri-Du-Chat Syndrome :
Mutation: Deletion of 5p.
Features: Microcephaly, mental retardation, high-pitched crying.
 
Ref:  Chapter 6. Genetic Disorders. In: Kemp WL, Burns DK, Brown TG. eds. Pathology: The Big Picture
 


11 NOV 2014 :

Q) H-reflex (Hoffmann reflex) is mediated by ?
 
A. C2-C3
B. T3-T4
C. S1
D. C3-T1
 
Ans : C, S1
 
H-reflex is mediated primarily over the S1 nerve root.The H reflex is particularly helpful in the diagnosis of S1 radiculopathy and of polyradiculopathies. 

Ref :Chapter 45. Electrophysiologic and Laboratory Aids in the Diagnosis of Neuromuscular Disease. In: Ropper AH, Samuels MA, Klein JP. eds. Adams & Victor's Principles of Neurology, 10e
 


10 NOV 2014 :

Q) Fatal human dose of Arsenic ?  

A. 120-200 mg  
B. 30.75 - 35.67 mg  
C. 2-3 mg  
D. 0.456 - 2.345mg 

ANS :
 
Acute ingestion of as little as 100–300 mg of a soluble trivalent arsenic compound (eg, sodium arsenite) can be fatal. 

Ref: Chapter 24. Arsenic. In: Olson KR. eds. Poisoning & Drug Overdose, 6e
 


09 NOV 2014 :

Q) Which of the following is a significant risk factor for heart disease?
 
A. Carnitine
B. Monounsaturated Fatty Acids
C. Creatinine Kinase
D. Intestinal Flora
 
Ans: A
 
Bacteria in the intestines convert carnitine, a protein building block that's especially plentiful in beef, lamb, and venison, into compounds that speed up hardening and thickening of artery walls.
 
Ref:
Stanley Hazan, MD, PhD, Lerner Research Institute and the Miller Family Heart and Vascular Institute at the Cleveland Clinic.
Jason Goldsmith, MD, PhD, University of Michigan.
Andrew Mendelsohn, PhD, president and research director, Regenerative Sciences Institute, Sunnyvale, CA
 


03 NOV 2014 : 

Q) Vaginal epithelium is embryologically derived from:

A. Mesoderm of genital ridge
B. Endoderm of genital ridge
C. Endoderm of urogenital sinus
D. Mesoderm of urogenital sinus


Ans : C - Endoderm of urogenital sinus

Vaginal epithelium is derived from endoderm of urogenital sinus.Embryologically, both the müllerian ducts and the urogenital sinus contribute to form the vagina . Early in fetal development, the caudal ends of the müllerian ducts fuse to form the uterovaginal canal, which is lined by columnar epithelium. Subsequently, squamous cells from the urogenital sinus migrate along the uterovaginal canal and replace this original columnar epithelium. These squamous cells stratify, and the vagina begins to mature and thickeN.
 
Ref: Chapter 32. Vaginal Cancer. Williams Gynecology, 2e.

 



31 OCT 2014 :

Q) All of the following are TRUE regarding myoglobinuria, EXCEPT:

A. Myoglobin is present in striated skeletal and cardiac fibers
B. 200 g of muscle must be destroyed to color the urine visibly
C. Benzidine tests performed on urine is positive
D. The serum is deep red in color

Ans : D , The serum is deep red in color

The red pigment myoglobin, responsible for much of the color of muscle, is an iron-protein compound present in the sarcoplasm of striated skeletal and cardiac fibers. Destruction of striated muscle, regardless of the cause liberates myoglobin, and because of its relatively small size, the molecule filters through the glomeruli and appears in the urine, imparting to it a burgundy-red color. Because of the low renal threshold for myoglobin, excretion of the pigment is so rapid that the serum remains uncolored.

It is estimated that 200 g of muscle must be destroyed to color the urine visibly. As with hemoglobinuria, the guaiac and benzidine tests performed on urine are positive if myoglobin is present. Myoglobinuria should thus be suspected when the urine is deep red and the serum is normal in color.
 
Ref: Ropper A.H., Samuels M.A. (2009). Chapter 45. Electrophysiologic and Laboratory Aids in the Diagnosis of Neuromuscular Disease. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.

 



30 OCT 2014 : 

Q) All of the following are similar features seen in Felty's syndrome and T cell large granular lymphocyte leukemia(T-LGL) Except?

A. Neutropenia
B. Splenomegaly
C. Both develop late in the course of RA
D. Both occurs in association with RA

Ans : C Both develop late in the course of RA

 

Felty's syndrome is defined by the clinical triad of neutropenia, splenomegaly, and nodular RA.T cell large granular lymphocyte leukemia (T-LGL) may have a similar clinical presentation and often occurs in association with RA. T-LGL is characterized by a chronic, indolent clonal growth of LGL cells, leading to neutropenia and splenomegaly.As opposed to Felty's syndrome, T-LGL may develop early in the course of RA.

Ref: Chapter 321. Rheumatoid Arthritis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.
 


 
29 OCT 2014 : 

Q) Which of the following is not a characteristic feature of BARDET-BIEDL SYNDROME ?

A. Mental Retardation
B. Obesity
C. Hexadactyly
D. Diabetes mellitus


Ans : D - Diabetes mellitus
 

Bardet-Biedl Syndrome:

This is a rare genetically heterogeneous disorder characterized by mental retardation, renal abnormalities, obesity, and hexadactyly, brachydactyly, or syndactyly. Central diabetes insipidus may or may not be associated. GnRH deficiency occurs in 75% of males and half of affected females. Retinal degeneration begins in early childhood, and most patients are blind by age 30.

Ref: Chapter 339. Disorders of the Anterior Pituitary and Hypothalamus.Harrison's Principles of Internal Medicine, 18e.
 



28 OCT 2014 : 

Q) The Overall Major Bleeding rate in fibrinolysis is ?

A. About 20%
B. About 10%
C. About 35 %
D. About 2.5 %

Ans : B , About 10%

 

The overall Major bleeding rate for fibrinolysis is about 10% including a 1-3% risk of intracranial hemorrhage.


Ref: Chapter 262. Deep Venous Thrombosis and Pulmonary Thromboembolism. Harrison's Principles of Internal Medicine, 18e.
 



27 OCT 2014 : 

Q) Which among the following is the only therapy to prevent Postphlebitic syndrome ?

A. Low dose Aspirin
B. Low dose Steroid
C. Warfarin
D. Below knee 30-40 mmHg compression stockings 


Ans : D-  Below knee 30-40 mmHg compression stockings

 

The only therapy to prevent Postphlebitic syndrome is daily use of below knee 30-40 mmHg vascular compression stockings.They halve the rate of developing  Postphlebitic syndrome.

 

Ref: Chapter 262. Deep Venous Thrombosis and Pulmonary Thromboembolism. Harrison's Principles of Internal Medicine, 18e.

 



25 OCT 2014

Q) All of the following is used for the treatment of Aortic dissection except?

A. Verapamil
B. Nitroprusside
C. Enalaprilat
D. Diazoxide


Ans : D -  Diazoxide

 

Isolated use of direct vasodilators,such as diazoxide and hydralazine is contraindicated in Aortic dissection because these agents can increase hydraulic shear and may propagate dissection.


Ref:Chapter 248. Diseases of the Aorta. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.



24 OCT 2014 : 

Q) All of the following factors predispose to Aortic dissection except?

A. Systemic Hypertension
B. Cystic Medial necrosis
C. Bicuspid aortic valve
D. Hypertrophic obstructive cardiomyopathy


Ans : D , Hypertrophic obstructive cardiomyopathy

 

The factors that predispose to aortic dissection includes systemic hypertension,cystic medial necrosis.The incidence is also increased in patients with inflammatory aortitis.


Ref:Chapter 248. Diseases of the Aorta. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.



23 OCT 2014 : 

Q) DeBakey and colleagues Classification is used for?

A. Aortic dissection
B. Choledochal cyst
C. Cholangiocarcinoma
D. Abruptio placenta


Ans : A Aortic dissection

 

DeBakey and colleagues Classification is used for Aortic dissection.It classified aortic dissection as

Type I :In which an intimal tear occurs in the ascending aorta but involves in the descending aorta as well.

Type II:In which dissection is limited to the ascending aorta.

Type III: In which the intimal tear is located in the descending aorta with the distal propagation of the dissection.


Ref: Chapter 248. Diseases of the Aorta.Harrison's Principles of Internal Medicine, 18e.



22 OCT 2014 : 

Q) Which among the following Intestinal pathogenic E.coli causes Persistent Diarrhea?

A. Enteropathogenic E.coli
B. Enterotoxigenic E.coli
C. Enteroinvasive E.coli
D. Enteroaggregative E.coli


Ans : D ,Enteroaggregative E.coli

 

Enteroaggregative E.coli(EAEC) causes persistent diarrhea,Traveler's diarrhea & Acute diarrhea.It is transmitted through food,water,children in and travelers to developing countries.


Ref: Chapter 149. Diseases Caused by Gram-Negative Enteric Bacilli. Harrison's Principles of Internal Medicine, 18e.



21 OCT 2014 : 

Q) Which of the following statement is not True regarding association of Lung cancer and smoking?

A. Chance of lung cancer decreases with cessation of smoking and return to non smoker level.
B. Women have a higher relative risk per given exposure than man
C. Relative risk of lung cancer increased 13 fold by active smoking
D. Relative risk of lung cancer increased 1.5 fold by passive exposure to cigarette smoking.

 

Ans : A , Chance of lung cancer decreases with cessation of smoking and return to non smoker level.
 

Chance of lung cancer decreases with cessation of smoking but may never return to non smoker level.Women have a higher relative risk per given exposure than man(1.5fold).Relative risk of lung cancer increased 13 fold by active smoking.Relative risk of lung cancer increased 1.5 fold by passive exposure to cigarette smoking.


Ref: Chapter 89. Neoplasms of the Lung. Harrison's Principles of Internal Medicine, 18e.



20 OCT 2014 : 

Q) Hypertrophic Pulmonary Osteoarthropathy is seen commonly in which type of Lung cancer?

A. Small cell lung carcinoma
B. Large cell carcinoma
C. Adenocarcinoma
D. Squamous cell carcinoma 


Ans : C Adenocarcinoma

Hypertrophic Pulmonary Osteoarthropathy is usually seen in Adenocarcinoma.Adenocarcinomas, which constitute 30% of lung cancers and 60% of non–small cell tumors, are characterized as acinar, papillary, and bronchoalveolar.The incidence of adenocarcinoma of the lung is increasing relative to squamous cell carcinoma, perhaps as a consequence of the rise in lung cancer among women, although the exact cause remains unclear.

Ref: Chapter 89. Neoplasms of the Lung. Harrison's Principles of Internal Medicine, 18e.;  Chapter 18. Thoracic Wall, Pleura, Mediastinum, & Lung. In: Doherty GM. eds. CURRENT Diagnosis & Treatment: Surgery, 13e.

 



15 OCT 2014: 

Q) All of the following are clinical features of Autoimmune hemolytic anemia except?

A. Drop of hemoglobin level to as low as 4g/dl
B. Jaundice
C. Enlarged spleen
D. Normal hemoglobin level

Ans : D , Normal hemoglobin level

 

The onset of Autoimmune hemolytic anemia(AIHA) is very often abrupt.The hemoglobin level can drop within days to as low as 4g/dl;the massive red cell removal will produce jaundice and often the spleen will be enlarged.This triad is very typical of AIHA.


Ref:Chapter 106. Hemolytic Anemias and Anemia Due to Acute Blood Loss. Harrison's Principles of Internal Medicine, 18e.

 



14 OCT 2014 :

Q) Autoimmune haemolytic anemia associated with autoimmune thrombocytopenia is seen in?


A. Alports syndrome
B. Felty’s syndrome
C. Evans syndrome
D. ITP

Ans : C Evans syndrome

 

Evan’s syndrome is an autoimmune disorder characterized by simultaneous or sequential development of Autoimmune Haemolytic Anaemia (AIHA) and Idiopathic Thrombocytopenia

Purpura (ITP) and / or immune neutropenia in absence of any cause.

 

Ref:Chapter 106. Hemolytic Anemias and Anemia Due to Acute Blood Loss.Harrison's Principles of Internal Medicine, 18e.

 



13 OCT 2014 :

Q) Which of the following does not predispose to placental abruption ?

A. IUGR
B. Maternal smoking or cocaine
C. Gestational hypertension
D. Nulliparity


Ans : D Nulliparity

 

Incidence of abruption increases with maternal age.By far the most common condition associated with placental abruption is some type of hypertension—gestational hypertension, preeclampsia, chronic hypertension, or combinations of these.there is an increased incidence of abruption when the membranes rupture before term. Cigarette smoking increased the risk for abruption.Women who used cocaine have an alarming frequency of placental abruption.


Ref: . Chapter 35. Obstetrical Hemorrhage.Williams Obstetrics, 23e.



10 OCT 2014 : 

Q) Spalding's sign is seen in which of the following?

A. Drowning
B. Mummification
C. Adipocere
D. Maceration 


Ans : D , Maceration 

Spalding’s sign refers to loss of alignment and overriding of the bones of cranial vault due to shrinkage of the brain after death. It is a sign of maceration.

Maceration is a process of aseptic autolysis that occur when the dead child remains in the uterus for some period surrounded with liquor amnii but with the exclusion of air. Earliest sign of maceration is skin slippage seen 12 hours after the death of the child in utero.
 
Features of maceration:
  • Fetus is soft and flabby and flattens when kept on the table.
  • Emits sweetish disagreeable smell
  • Skin slippage
  • Skin is sodden and shows red or purple colouration with large blebs containing serous or sero sanguineous fluid. Epidermis is easily peeled off.
  • Joints become abnormally mobile of flexible.
  • Body cavities contain reddish serous fluid.
  • Internal organs become soft and edematous
  • Umbilical cord become red, smooth, soft and thickened.

Ref: Textbook of Forensic Medicine and Toxicology: Principles and Practice, 5/e By Krishan Vij  5th edn page 148.
 

 



09 OCT 2014 : 

Q) A 40 year old woman presents with a three day history of irritation, pain, and watery discharge of her left ear. She has just returned from holiday, where she admits to using her towel, artificial nails, and ear buds to try to alleviate itching in her ear. What is the likely diagnosis?

A. Mastoiditis
B. Otitis Externa
C. ASOM
D. Trigeminal Neuralgia

 

Ans : B Otitis Externa

 

Inflammation of the ear canal with or without infection is the charecteristic of acute otitis externa. The history above is classic of this condition. If symptoms are recurrent or if they last longer than three months, the condition is classed as chronic otitis externa. Acute otitis externa can also be classified according to its cause.

These are split into three main groups:

  • Infective (bacterial, fungal, and viral),

  • Non-infective dermatitis (allergic, eczematous, and irritant), and

  • Mixed infective and non-infective

Exacerbating factors include: Warm humid climates, swimming, frequent hair washing (especially if in the bath), and insertion of foreign bodies can introduce bacterial infection and cause local trauma to the ear canal, making infection more likely. Prolonged use of hearing aids may also predispose to infection.

Ref: Kaushik V, Malik T, Saeed SR. Interventions for acute otitis externa. Cochrane Database Syst Rev2010; Narayan S, Swift A. Otitis externa: a clinical review. Br J Hosp Med2011;72:554-8; Otitis externa; BMJ 2012;344:e3623.
 



08 OCT 2014 : 

Q) A Child is intubated for craniotomy. During surgery after 2 min, bellows of anaesthetic machine collapses. Next step is:

A. Ventilate manually
B. Continue the operation
C. Use bigger size tube
D. Increase flow


Ans : A - Ventilate manually

The bellows in a double-circuit design ventilator takes the place of the breathing bag in the anesthesia circuit. So when the bellows collapses, manual ventilation will be needed.

 

Also know:

  • A leak in the ventilator bellows can transmit high gas pressure to the patient’s airway, potentially resulting in pulmonary barotrauma.

  • This may be indicated by a higher than expected rise in inspired oxygen concentration (if oxygen is the sole pressurizing gas).


Ref: Butterworth J.F., IV, Mackey D.C., Wasnick J.D. (2013). Chapter 4. The Anesthesia Machine. In Butterworth J.F., IV, Mackey D.C., Wasnick J.D. (Eds),Morgan & Mikhail's Clinical Anesthesiology, 5e.

 



07 OCT 2014 : 

Q) Transmission of Ebola virus usually occurs through?

A. Close personal contact
B. Contaminated eggs
C. Rodent Bite
D. Air conditioning 


Ans : A - Close personal contact

 

Epidemics usually begin with a single case acquired from an unknown reservoir in nature (bats are suspected; see “Epidemiology,” below) and spread mainly through close contact with sick persons or their body fluids, either at home or in the hospital.

Ref:  Chapter 197. Ebola and Marburg Viruses. Harrison's Principles of Internal Medicine, 18e.


06 0CT 2014 : 

Q) Ebola Virus particles contains?

A.Negative-sense ssRNA
B.Positive -sense dsRNA
C.Negative-sense ssDNA
D.Negative-sense dsRNA

Ans :  A , Negative-sense ssRNA

 

Typical Ebola virus particles contain a single linear, negative-sense, single-stranded RNA arranged in a helical nucleocapsid. The virions are 790–970 nm in length; they may also appear in elongated, contorted forms.


Ref: Chapter 197. Ebola and Marburg Viruses.Harrison's Principles of Internal Medicine, 18e.


 


04 OCT 2014 : 

Q) Which of the following Ebola virus species is not fatal among humans?

A.Zaire
B.Côte d'Ivoire
C.Bundibugyo
D.Reston


Ans :D -  Reston

 

Ebola Virus has five readily distinguishable species named for their original sites of recognition: Zaire, Sudan, Côte d'Ivoire, Bundibugyo, and Reston. Except for the Reston virus, all the Filoviridae are African viruses that cause severe and often fatal disease in humans.The Reston virus, which has been exported from the Philippines on several occasions, has caused fatal infections in monkeys but only subclinical infections in humans.


Ref: Chapter 197. Ebola and Marburg Viruses.Harrison's Principles of Internal Medicine, 18e.
 


03 OCT 2014 :

Q) Ebola is a member of what family of viruses?

A. Orthomyxovirus
B. Togavirus
C. Coronavirus
D. Filovirus

Ans : D - Filovirus

Ebola is a member of  family Filoviridae.It comprises of two antigenically and genetically distinct genera: Marburgvirus and Ebolavirus.

Ref:  Chapter 197. Ebola and Marburg Viruses.Harrison's Principles of Internal Medicine, 18e.

 


02 OCT 2014 :

Q) The presence and growth of tissue similar to endometrium outside the uterus?

A. Endometritis
B. Fibroids
C. Fibroma
D. Endometriosis

Ans : D , Endometriosis


 

Endometriosis is a common benign gynecologic disorder defined as the presence of endometrial glands and stroma outside of the normal location.Endometriosis is most commonly found on the pelvic peritoneum but may also be found on the ovaries, rectovaginal septum, and ureter, and rarely in the bladder, pericardium, and pleura . Endometriosis is a hormonally dependent disease and as a result is chiefly found in reproductive-aged women. Women with endometriosis may be asymptomatic, subfertile, or suffer varying degrees of pelvic pain. Endometrial tissue located within the myometrium is termed adenomyosis, or sometimes referred to as endometriosis in situ.


Ref: Chapter 10. Endometriosis. Williams Gynecology, 2e.
 


01 OCT 2014 : 

Q) Q1) All are biological agents used to treat inflammatory bowel disease , EXCEPT:

A. Infliximab
B. Natalizumab
C. Adalimumab
D. Bevacizumab

Answer : D ,Bevacizumab

 

Infliximab:
 

  • Chimeric monoclonal antibody.

  • Active against TNF

  • Approved for treatment of Crohns and ulcerative colitis in both pediatrics and adults patients

  • More effective in obtaining mucosal healing

  • Clinical response in 78 % patients

 

Natalizumab:

Humanised monoclonal IgG4 antibody

Evaluated for moderate to severe Crohns disease

 

Adalimumab:

 

  • Fully humanised monoclonal antibody

  • Second line biological therapy for infliximab failures and non responders

     

Bevacizumab

Bevacizumab is a recombinant humanized monoclonal antibody

Mechanism : angiogenesis inhibition by inhibiting vascular endothelial growth factor A Used for the treatment of malignancies like carcinoma pancreass and colon


Ref : GASTROENTEROLOGY & HEPATOLOGY , VOLUME 11, FEBRUARY 2014.
 


30 SEP 2014 : 

Q) Which among the following is a severe complication involving an abnormal attachment of placenta to the myometrium?

A. Placenta premium
B. Placenta abruptus
C. Placenta accreta
D. Placenta Posterium


Ans : C - Placenta accreta

Placenta accreta :
Here the placental villi is in direct contact with myometrium, due to partial or complete loss of decidua.
Risk factors: Low lying placenta or placenta previa; prior cesarean section.
Complications of placenta accreta: Postpartum bleeding as a result of failure of placental separation; perforation of uterus.

Ref: Chapter 17. Pathology of the Male and Female Reproductive Tract and Breast. Pathology: The Big Picture.
 


27 SEP 2014 :

Q) A 30 year old female is diagnosed with cervical intraepithelial neoplasia associated with a previous viral infection. Which of the following viral products are implicated in producing this type of dysplasia?


A. EBNA proteins
B. E1A and E1B proteins
C. E6 and E7 proteins 
D. Large tumor antigen

Ans : c -  E6 and E7 proteins 

Cervical intraepithelial neoplasia (CIN) is associated with human papilloma virus (HPV) infection, particularly types 16 or 18. These papillomaviruses produce E6 and E7 proteins, which induce the expression of cellular p53 and p110Rb oncogenes, respectively.
EBNA proteins are produced by the Epstein-Barr virus and are associated with hepatocellular carcinoma, Burkitt's lymphoma, and carcinoma of the nasopharynx.
E1A and E1B proteins are produced by adenoviruses 12, 18, and 31. They also bind to the p53 and p110Rb oncogenes, respectively.
Large tumor antigen is produced by simian virus 40 (SV40), a papovavirus found in monkeys that is known to produce sarcoma in laboratory hamsters.
 
Ref: Ray C.G., Ryan K.J. (2010). Chapter 19. Papilloma and Polyoma Viruses. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.


26 SEP 2014 : 

Q) A 40y old lady with chronic low backache fall on an outstretched-hand .Her X-ray image is shown here.Identify the fracture shown in the image above ?



A. Jefferson fracture
B. Callow’s fracture
C. Boxer
’s fracture
D. Colle fracture


Ans : D, Colle fracture
Colle Fractures (Distal Radius Fracture):

A fall-on-outstretched-hand (FOOSH) injury can lead to a Colles fracture. Patients typically present with pain, swelling, and tenderness at the distal forearm. On examination a "dinner fork" deformity (dorsal displacement of the distal fragment and volar angulation of the distal intact radius with radial shortening) may be identified.

Note:

  • Boxers fracture: Occurs at 5th Metacarpal Neck

  • Jefferson fracture :Occurs at C1

Ref:Chapter 38. Common Upper & Lower Extremity Fractures. CURRENT Diagnosis & Treatment in Family Medicine, 3e.
 


25 SEP 2014 : 

Q) The risk of pregnancy per 100 woman years of using a given method of contraception?

A. Sapphire Index
B. Chandelers Index
C. Amber Index
D. Pearl Index


Ans : Pearl Index

Contraceptive efficacy is generally assessed by measuring the number of unplanned pregnancies that occur during a specified period of exposure and the use of a contraceptive method.

Pear Index is defined as the number of failure per 100 women years of use.


Ref:Park ,19th Ed Pg 406;20 Ed Page 439,602
 


23 SEP 2014 :

Q) Which of the following is not an absolute indication for an elective caesarean section ?


A. Cephalopelvic disproportion
B. Central placenta praevia
C. Breech presentation
D. Severe Antenatal fetal compromise

Ans : C , Breech presentation

 

Absolute indications includes cephalopelvic disproportion,central placenta praevia, pelvic mass causing obstruction (cervical or broad ligament fibroid), advanced cervical carcinoma and vaginal obstruction (as in atresia, stenosis).
 

Relative indications of Caesarean section are:
 

  • Previous caesarean delivery

  • Non reassuring FHR

  • Dystocia due to relatively large fetus, small pelvis or inefficient contractions

  • Antepartum hemorrhage

  • Malpresentation

  • Failed surgical induction of labour, failure to progress in labour

  • Bad obstetric history

  • Hypertensive disorders

  • Medical gynecological disorders

 

Ref: Textbook of Obstetrics By D.C Dutta, 6th edn, page 589
 


22 SEP 2014 : 

Q) Laceration which involve the anal sphincter and anal mucosa is?

A. First degree Tear
B. Second degree Tear
C. Third degree Tear
D. Fourth degree Tear


Ans :D ,  Fourth  degree Tear

 

Lacerations of the vagina and perineum are classified as first- through fourth-degree lacerations or perineal tears. First-degree lacerations involve the fourchette, perineal skin, and vaginal mucous membrane but not the underlying fascia and muscle. These included periurethral lacerations, which may bleed profusely. Second-degree lacerations involve, in addition, the fascia and muscles of the perineal body but not the anal sphincter. These tears usually extend upward on one or both sides of the vagina, forming an irregular triangular injury. Third-degree lacerations extend farther to involve the anal sphincter. A fourth-degree laceration extends through the rectum's mucosa to expose its lumen.
 

Ref:Chapter 17. Normal Labor and Delivery. Williams Obstetrics, 23e.
 


20 SEP 2014 : 

Q) An accumulation of menstrual blood in uterus is called ?

A. Hematometra
B. Heamavesicus
C. Heamometrium
D. Haematoma

Ans  : A Hematometra

 

Hematometra:

In this condition, menstrual outflow obstruction traps blood and distends the uterus and at times, the proximal cervix. Many cases of hematometra develop at menarche if menstrual flow is obstructed by congenital anomalies. In this setting, a distended vagina, termed hematocolpos, is also commonly associated, and distended fallopian tubes, called hematosalpinx, may be seen. A number of acquired abnormalities such as scarring and neoplasms can also obstruct menstrual flow.


Ref:Chapter 9. Pelvic Mass.  Williams Gynecology, 2e.
 


19 SEP 2014 : 

Q) Which of the following is not a risk factor for preeclampsia?

A. Diabetes Mellitus
B. Antiphospholipid antibody syndrome
C. Multiparity
D. Multiple gestation


Ans : C , Multiparity

 

Risk factors for the development of preeclampsia include nulliparity, diabetes mellitus, a history of renal disease or chronic hypertension, a prior history of preeclampsia, extremes of maternal age (>35 years or <15 years), obesity, antiphospholipid antibody syndrome, and multiple gestation.

 

Ref: Chapter 7. Medical Disorders During Pregnancy; Harrison's Principles of Internal Medicine, 18e.


 


18 SEP 2014 : 

Q) All of the following are hallmarks of Alzheimer's disease, EXCEPT:

A. Central nervous system neoplasms
B. Senile plaques.
C. Frontal and temporal atrophy.
D. Mutation in gene encoding amyloid precursor protein.


Ans : A , Central nervous system neoplasms

 

Central nervous system neoplasms are not a hallmark of Alzheimer's disease. Presence of neurofibrillary tangles, senile plaques, frontal and temporal lobe atrophy, and mutation in gene encoding the amyloid precursor protein are hallmarks of Alzheimer's disease.

Alzheimer's disease(AD)can occur in any decade of adulthood, but it is the most common cause of dementia in the elderly. AD most often presents with an insidious onset of memory loss followed by a slowly progressive dementia over several years. Pathologically, atrophy is distributed throughout the medial temporal lobes, as well as lateral and medial parietal lobes and lateral frontal cortex. Microscopically, there are neuritic plaques containing Aβ, neurofibrillary tangles (NFTs) composed of hyperphosphorylated tau filaments, and accumulation of amyloid in blood vessel walls in cortex and leptomeninges.


Ref: Chapter 371. Dementia.Harrison's Principles of Internal Medicine, 18e.
 

 


17 SEP 2014 : 

Q) Failure of development of lung in utero is called?

A. Pulmonary agraphia
B. Pulmonary atresia
C. Pulmonary hyperelasticity
D. Pulmonary hypoplasia


Ans : D , Pulmonary hypoplasia

 

Pulmonary hypoplasia is incomplete development of one or both lungs, characterized by a reduction in alveolar number and a reduction in airway branches. Pulmonary hypoplasia is present in up to 10%–15% of perinatal autopsies. The hypoplasia can be a result of an intrathoracic mass, resulting in lack of space for the lungs to grow; decreased size of the thorax; decreased fetal breathing movements; decreased blood flow to the lungs; or possibly a primary mesodermal defect affecting multiple organ systems. Congenital diaphragmatic hernia is the most common cause, with an incidence of 1:2200 births.


Ref: Chapter 19. Respiratory Tract & Mediastinum. CURRENT Diagnosis & Treatment: Pediatrics, 21e.


 


16 SEP 2014 : 

Q) Which of the following is not a constituent of bishop’s score?

A. Station
B. Dilatation
C. Temperature
D. Effacement


Ans : C Temperature

 

Bishop Scoring System Used for Assessment of Inducibility

 

Score

Dilatation (cm)

Effacement (Percent)

Station (−3 to +2)

Cervical Consistency

Cervical Position

0

Closed

0–30

−3

Firm

Posterior

1

1–2

40–50

−2

Medium

Midposition

2

3–4

60–70

−1

Soft

Anterior

3

≥5

≥80

+1, +2


Ref: Chapter 22. Labor Induction. Williams Obstetrics, 23e.


15 SEP 2014 :

Q) Which test involves counting a large number of blood cells and calculating a ratio of fetal to maternal cells?

A.Klaxon Test
B.Klinefelter Test
C.Kleihauer Test
D.Klieppenheim Test


Ans : C , Kleihauer Test

The Kleihauer–Betke test detects fetal blood cells in the maternal circulation and placental disruption; it may help identify fetal hypovolemia before obvious fetal distress occurs.

Ref: Chapter 38. Obstetric and Gynecological Emergencies and Rape. In Stone C, Humphries R.L. (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e


12 SEP 2014 :

Q) Which of the following condition is associated with Bracket calcification on a skull X-ray ?

A. Meningioma
B. Lipoma of corpus callosum
C. Tuberous sclerosis
D. Sturge Weber syndrome


Ans : B , Lipoma of corpus callosum

Bracket calcification in skull X ray is seen in a case of lipoma of corpus callosum.

Classification of abnormal intracranial calcification:

Tumors:   Craniopharyngioma, oligodendroglioma, pinealoma, choroid plexus papilloma, pinealoma, chordoma, meningioma, glioma, metastasis and corpus callosum lipoma.
Vascular lesions: Aneurysms, cavernous malformation, arteriovenous malformations and chronic subdural hematoma.
Infections: Tuberculosis, CMV( bilateral periventricular calcification), cysticercosis and hydatid disease.
Metabolic/congenital: Tuberous sclerosis, sturge weber syndrome (cortical subcortical tram track  calcification), lissencephaly ( calcified nodule behind the foramen of munro), pseudoxanthoma elaticum ( dural calcification and platybasia), cockayne's syndrome, hypoparathyroidism and hyperparathyroidism.
Physiological calcification in skull Xray: Pineal gland, Choroid plexus.

Ref: Sutton 6th Ed Page 1473;Chapman 3rd Ed Page 407


11 SEP 2014 :

Q) Which is the manoeuvre employed when there is shoulder dystocia that involves hyperextending the legs on to the abdomen?
 
A. Mcleghanhans manoeuvre
B. McRoberts manoeuvre
C. McDonalds manoeuvre
D. Mccanns manoeuvre
 
ANS : B, McRoberts manoeuvre
 
Explanation :
 
The McRoberts maneuver was described by Gonik and associates (1983) and named for William A. McRoberts, Jr., who popularized its use at the University of Texas at Houston. The maneuver consists of removing the legs from the stirrups and sharply flexing them up onto the abdomen.
 
Ref: Chapter 20. Abnormal Labor. In: Cunningham F, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. eds. Williams Obstetrics, 23e.

 


10 SEP 2014 : 

Q) Limbic system is concerned with?

A. Emotion
B. Behaviour
C. Aggression
D. All of the above.

Ans : D 

 

The limbic system subserves basic survival functions that include feeding behavior, “fight-or-flight” responses, aggression, and the expressions of emotion and of the autonomic, behavioral, and endocrine aspects of the sexual response.


Ref: Chapter 19. The Limbic System. In: Waxman SG. eds. Clinical Neuroanatomy, 27e.


 

09 SEP 2014 :

Q) Normal amount of CSF in brain and spinal cord is:

A. 550ml
B. 250ml
C. 100ml
D. 150ml


Ans : D , 150ml

CSF fills the ventricles and subarachnoid space. In humans, the volume of CSF is about 150 mL and the rate of CSF production is about 550 mL/d. Thus the CSF turns over about 3.7 times a day.


Ref: Barrett KE, Boitano S, Barman SM, Brooks HL. Chapter 33. Circulation through Special Regions. In: Barrett KE, Boitano S, Barman SM, Brooks HL. eds.Ganong's Review of Medical Physiology, 24e.

 


04 SEP 2014 :

Which of the following will not be associated with preeclampsia?

A. Visual disturbances
B. Epigastric pain
C. Seizures
D. Hypertension
 
Ans: C

Explanation :

 
Preeclampsia is characterized by onset of hypertension and proteinuria after 20 weeks' gestation. Other signs and symptoms include headache, visual disturbances, epigastric pain, nausea/vomiting, thrombocytopenia, abnormal liver and kidney function tests. Eclampsia is the occurrence of seizures that cannot be attributed to other causes in women with preeclampsia and is associated with a maternal mortality rate as high as 10%. 
 
Ref: Chapter 16. The Endocrinology of Pregnancy. InGardner D.G., Shoback D (Eds), Greenspan’s Basic & Clinical Endocrinology, 9e.
 

03 SEP 2014 : 

Q) A woman with glucose-6-phosphate dehydrogenase (G6PD) deficiency develops a urinary tract infection. Free radicals generated by responding neutrophils create an oxidant stress, and RBCs are rapidly overwhelmed. As soon as intravascular hemolysis begins, serum levels of which of the following will decrease?

A. Bilirubin
B. C-reactive protein
C. Free iron
D. Haptoglobin

Ans : D ,  Haptoglobin


Haptoglobin (or alpha-2 globulin) is a serum protein that promptly binds to free hemoglobin in the serum, forming a tight complex. The haptoglobin-hemoglobin complex is quickly cleared from the blood by the reticuloendothelial system, which allows the hemoglobin to be salvaged instead of lost into the urine. Intravascular hemolysis from any cause is rapidly followed by a dramatic drop in serum haptoglobin.

 

Bilirubin is synthesized in the liver and spleen as an end-product of heme degradation. Serum bilirubin levels would not change until the haptoglobin in the blood was completely saturated, and free hemoglobin began to circulate. In this circumstance, serum bilirubin would increase, not decrease.

 

C-reactive protein an acute phase reactant produced by the liver in increased quantity in response to inflammation. This patient's urinary tract infection would increase C-reactive protein levels, but the hemolysis would not further affect them.

 

Serum free iron does not change appreciably in intravascular hemolysis. Ferrous iron in the red blood cell is complexed to hemoglobin, and this complex is not broken in hemolysis.


Ref: Beutler E. (2010). Chapter 42. Disorders of Iron Metabolism. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds),Williams Hematology, 8e.
 

 


02 SEP 2014 : 

Q) A 6-year-old presents with mild mental retardation and superiority of musical aptitude and social amiability. There is a distinctive but subtle physical appearance described as “elfin appearance”. Which of the following best describes the child’s condition?

A. Kanner-Asperger Syndrome
B. Williams Syndrome
C. Renpenning Syndrome
D. Partington Syndrome 


Ans: B , Williams Syndrome 

Williams Syndrome is a inherited form of mental retardation is manifest in both males and females. It is characterized by mild mental retardation but with striking retention and even precocity or superiority of musical aptitude and social amiability.
 
The child is physically slow and has minor but distinctive somatic changes (wide mouth, almond-shaped eyes, upturned nose, small pointed ears), together imparting an "elfin appearance."
 
By the use of high-resolution cytogenetics, the disease has been traced in 90 percent of cases to a microdeletion on chromosome 7 in the region of the gene that controls the production of elastin (Nickerson et al).
 
Ref: Ropper A.H., Samuels M.A. (2009). Chapter 38. Developmental Diseases of the Nervous System. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.


01 SEP 2014 :

Q) A 72 year old black woman has the abrupt onset of right-sided weakness affecting the face and arms. MRI is consistent with an infarct in the territory of the middle cerebral artery. Pathologic examination of the patient's brain would likely show?

A. Caseous necrosis
B. Coagulative necrosis
C. Enzymatic fat necrosis
D. Liquefactive necrosis

Ans : D , Liquefactive necrosis

Liquefactive necrosis occurs in brain or other neural tissues and in pancreatic tissue. In this type of necrosis, the tissue appears liquefied under the microscope, without preservation of cell outlines. Liquefactive necrosis can also be seen in some bacterial infections, especially those caused by pyogenic Staphylococci, Streptococci, or certain coliform bacteria.

 

Caseous necrosis is generally an indication of infection by Mycobacterium tuberculosis. The term caseous refers to the appearance of the tissue, i.e., soft, white necrotic areas that have a cheese-like appearance. Microscopically, the necrotic areas are lightly eosinophilic (stain light pink), with little or no discernible cellular detail. The eosinophilia reflects staining of residual cellular proteins.

 

Coagulative necrosis is a more common type of necrosis, characteristic of anoxic injury and most infarcts. Cellular outlines are preserved, but proteins are denatured, and the cells stain in an eosinophilic manner.

 

Enzymatic fat necrosis is seen primarily with pancreatic injury when pancreatic lipases are released and digest fat to form free fatty acids. These fatty acids complex with calcium, resulting in the production of calcium soaps (saponification) in the pancreatic tissue or in extrapancreatic fatty tissues (eg, omentum).

 

Ref: Wyatt C., Butterworth IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 1. Cellular Pathology. In C. Wyatt, J.F. Butterworth IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.

 


30 AUG 2014 : 

Q) Primary bacterial peritonitis is reported in all these conditions, EXCEPT:

A. Chronic active hepatitis
B. Acute viral hepatitis
C. Congestive heart failure
D. Acute nephritis 


Ans : D ,Acute nephritis

Primary bacterial peritonitis (PBP) occurs most commonly in conjunction with cirrhosis 

Other conditions which may cause PBP are

  • Metastatic malignant disease,
  • Postnecrotic cirrhosis,
  • Chronic active hepatitis,
  • Acute viral hepatitis,
  • Congestive heart failure,
  • Systemic lupus erythematosus
  • Lymphedema
  • No underlying disease

Ref: Harrison, E-18, P-1080.


28 AUG 2014 : 

Q) Which of the following is not an antiepileptic agent:

A. Phenytoin
B. Topramate
C. Flunarazine
D. Carbamazepine 


Ans : c , Flunarazine

Flunarizine is a cerebro-selective calcium channel blocker and has a role in the treatment of migraine by reducing the intracellular calcium over load. It has no role is the treatment of epilepsy.
The other options are used as anti-epileptic agents. 

Ref: K D Tripathi Textbook of Pharmacology, 5th Edition, Pages 154, 371, 373, 377; Basic and Clinical Pharmacology By Bertram G. Katzung, 10th Edition, Page 268


27 AUG 2014 : 

Q) What is the percentage of carbohydrates in Human Milk?

A. 4%
B. 6%
C. 5.5%
D. 7%


Ans : D , 7%

Human milk contains 0.8% to 0.9% protein, 4.5% fat, 7.1% carbohydrates, and 0.2% ash (minerals)
Mature human breast milk contains protein, carbohydrate, and fat components and provides approximately 20 kcal/oz and 1 g of protein. The principal protein elements of both mature and premature breast milk are casein (40%) and whey (60%). Breast milk contains approximately 2.5 g/L of casein.
There are approximately 70 g/L of lactose, the primary carbohydrate in mature breast milk. Composed of galactose and glucose, the lactose concentration continues to increase throughout breastfeeding.
The principal electrolytes in breast milk are sodium, potassium, magnesium, and calcium.

Ref:  Chapter 4. Breastfeeding & Infant Nutrition.CURRENT Diagnosis & Treatment in Family Medicine, 3e.


26 AUG 2014 :

Q) The histological hallmark is the presence of noncaseating epithelioid cell granuloma?

A. Ulcerative colitis
B. IBS
C. Celiac disease
D. Crohn’s disease


Ans.D , Crohn’s disease

The pathologic hallmark of Crohn’s disease is focal, transmural inflammation of the intestine, a spectrum of pathologic lesions can be present. The earliest lesion characteristic of Crohn’s disease is the aphthous ulcer. These superficial ulcers are up to 3 mm in diameter and are surrounded by a halo of erythema. In the small intestine, aphthous ulcers typically arise over lymphoid aggregates. Granulomas are highly characteristic of Crohn’s disease and are reported to be present in up to 70% of intestinal specimens obtained during surgical resection. These granulomas are noncaseating and can be found in both areas of active disease and apparently normal intestine, in any layer of the bowel wall, and in mesenteric lymph nodes.

Ref: Chapter 28. Small Intestine.Schwartz's Principles of Surgery, 9e


25 AUG 2014 :

Q) A glycogen storage disorder caused by a defect in the enzyme phosphorylase?

A. Von Gierke Type 1
B. Mcardle Type V
C. Pompe Type 1
D. Cori Type III


Ans.B ,Mcardle Type V

Type V Glycogen Storage Disease (Muscle Phosphorylase Deficiency, Mcardle Disease)
Type V glycogen storage disease is an autosomal recessive disorder caused by deficiency of muscle phosphorylase. McArdle disease is a prototypical muscle energy disorder as the enzyme deficiency limits ATP generation by glycogenolysis and results in glycogen accumulation.

Ref: Chapter 362. Glycogen Storage Diseases,Harrison's Principles of Internal Medicine, 18e.

 


23 AUG 2014 :

Condylomata acuminata is caused by ?

A. Treponema pallidum
B. Neisseria gonorrhoea
C. Chlamydia trachomatis
D. Human papilloma virus

Ans.D , Human papilloma virus

Condyloma Acuminata (Genital Warts)

Clinical Summary:

Caused by human papillomavirus (HPV), these flesh-colored lesions may be flat, sessile, or pedunculated. They often have a cauliflower-like appearance and are usually asymptomatic, but may be seen or felt by patients or their sexual partners. They range in size from 1 to 4 mm to masses that may be several centimeters large.

Treatment and Disposition:

Local caustic agents (eg, podophyllin) are used to treat the lesions; multiple treatment is often needed, and recurrence is common. Other therapies include cryotherapy, electrocautery, and trichloracetic acid. Laser therapy or surgery may be needed in cases of giant warts.

Ref: Chapter 9. Sexually Transmitted Infections and Anorectal Conditions. The Atlas of Emergency Medicine, 3e

22 AUG 2014 :

Q) Snow storm appearance on an ultrasound is seen in :
 
A. Chronic ectopic
B. Vesicular mole 
C. Hydatid cyst
D. Dermoid cyst
 
Ans : B, Vesicular mole

Explanation :

Ultrasound done in a patient with complete hydatidiform mole demonstrates the uterus to be filled with innumerable tiny cysts described as a snowstorm appearance in the first trimester because of its multiple echogenic foci. There will be no evidence of fetal parts.
 
In the case of a partial mole, a fetus can be identified and the placenta will show partial molar changes. 
 
In an ectopic pregnancy, ultrasound shows and empty uterus and an adnexal mass. Free fluid in the pouch of douglas may be noticeable. In an ectopic pregnancy, a tubal ring is seen ( Doughnut or Bogel sign).
 
Ref: Fundamentals of Diagnostic Radiology  edited by William E. Brant,  page 982.


 

21 AUG 2014 : 

Q) A triad of acute renal failure,microangiopathic hemolytic anemia and thrombocytopenia is seen in ?

A. Kells syndrome
B. Fanconi syndrome
C. Haemolytic uremic syndrome
D. Goodpasture's syndrome


Ans : C ,Haemolytic uremic syndrome

Haemolytic uremic syndrome(HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal failure. Dyspnea, weakness, fatigue, oliguria, and purpura are also common initial symptoms and findings. Systemic hypertension and pulmonary edema frequently occur. Severe hypertension, pulmonary edema, and rapid worsening of hemolysis and renal function may occur after a blood or blood product transfusion. Cardiac findings include atrial arrhythmias, pericardial friction rub, and pericardial effusion.

Ref: Chapter 276. Oncologic Emergencies. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.


20 AUG 2014 :

Q) The relationship of the fetus to the long axis of the uterus is termed ?

A. The Presentation
B. The Lie
C. The Engagement
D. The Version


Ans : B , The Lie

The relation of the fetal long axis to that of the mother is termed fetal lie and is either longitudinal or transverse. Occasionally, the fetal and the maternal axes may cross at a 45-degree angle, forming an oblique lie, which is unstable and always becomes longitudinal or transverse during labor. A longitudinal lie is present in greater than 99 percent of labour at term. Predisposing factors for transverse lies include multiparity, placenta previa, hydramnios, and uterine anomalies.
The presenting part is that portion of the fetal body that is either foremost within the birth canal or in closest proximity to it.
The mechanism by which the biparietal diameter—the greatest transverse diameter in an occiput presentation—passes through the pelvic inlet is designated engagement. 

Ref:  Chapter 17. Normal Labor and Delivery. Williams Obstetrics, 23e


19 AUG 2014 : 

Q) Atropine is derived from which of the following plant?

A. Atropa belladonna
B. Hyoscyamus niger
C. Datura stramonium
D. Argemone mexicana


Ans : A , Atropa belladonna

 

  • Plants and mushrooms containing anticholinergic alkaloids include
    • Jimsonweed (Datura stramonium)
    • Deadly nightshade (Atropa belladonna)
    • Fly agaric (Amanita muscaria)
  • The root of Atropa belladonna contains 82-97% of hyoscyamine, 3-15% atropine, and up to 2.5% scopolamine.
  • Anticholinergic agents competitively antagonize the effects of acetylcholine at peripheral muscarinic and central receptors.

Ref: Manning B.H. (2012). Chapter 13. Anticholinergics. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e.

 


18 AUG 2014 : 

Q) Toxic shock syndrome is caused by a toxin producing ?

A. Streptococcus
B. Staphylococcus aureus
C. Salmonella
D. Mycoplasma hominis


Ans : B , Staphylococcus aureus

S aureus produces toxins that cause three important entities: “scalded skin syndrome” in children, toxic shock syndrome in adults, and enterotoxin food poisoning. Toxic shock syndrome is characterized by abrupt onset of high fever, vomiting, and watery diarrhea. Sore throat, myalgias, and headache are common. Hypotension with kidney and heart failure is associated with a poor outcome. A diffuse macular erythematous rash and nonpurulent conjunctivitis are common, and desquamation, especially of palms and soles, is typical during recovery. Fatality rates may be as high as 15%. Although originally associated with tampon use, any focus (eg, nasopharynx, bone, vagina, rectum, abscess, or wound) harboring a toxin-producing S aureus strain can cause toxic shock syndrome. Classically, blood cultures are negative because symptoms are due to the effects of the toxin and not systemic infection.

Ref:  Chapter 33. Bacterial & Chlamydial Infections.CURRENT Medical Diagnosis & Treatment 2014.


16 AUG 2014 : 

Q) Which of the following is not a part of HELLP Syndrome ?

A. Elevated Platelet count
B. Elevated liver enzymes
C. Lowered Platelet count
D. Haemolysis


Ans : A , Elevated Platelet count

HELLP syndrome is defined by the presence of microangiopathic hemolytic anemia, elevated liver enzymes, and low platelets. This disorder occurs more commonly in white women older than age 25 years and is the most common cause of severe liver disease in pregnancy. HELLP shares a number of features with TTP, including the presence of microangiopathic hemolysis and thrombocytopenia. Involvement of the central nervous system is a more prominent feature of TTP, whereas HELLP more commonly displays severe liver function abnormalities.

Ref: Chapter 119. Thrombocytopenia; Williams Hematology, 8e

 


14 AUG 2014 :

Q) White spots on buccal mucosa,seen against a bright red background.Pathognomonic for measles?


A. Kopperman's spot
B. Kupfermann spot
C. Copernican spot
D. Koplik’s spot

Ans.D , Koplik’s spot

Koplik spots are the earliest diagnostic sign of the measles; they are pathognomonic. One or 2 days before the exanthem appears, small white spots appear opposite the molars, and sometimes elsewhere, on the buccal mucosa. Each is surrounded by a narrow red areola.

Ref: Chapter 7. The Head and Neck. DeGowin's Diagnostic Examination, 9e.

 


13 AUG 2014 :

Q) Absent or low motility of sperm is known as ?

A. Teratozoospermia
B. Asthenospermia
C. Azoospermia
D. Aspermia 

 

Ans.B , Asthenospermia

Asthenospermia or decreased sperm motility may be seen alone or in combination with oligospermia or other abnormal semen parameters. In general, asthenospermia does not respond to directed treatments. Expectant management may be considered, especially if the duration of infertility is short and maternal age is less than 35 years. For treatment, IUI and ICSI are preferred, although IUI is generally not successful in severe cases. If fewer than 1 million motile sperm are available for insemination following semen processing, or the couple has experienced >5 years of infertility, then ICSI should be considered as initial therapy.

Teratozoospermia or abnormal sperm morphology is most often seen in conjunction with oligospermia, asthenospermia, and oligoasthenospermia.

Azoospermia is characterized by the total absence of sperm in semen, azoospermia may result from obstruction in the male reproductive tract or from nonobstructive causes.

Aspermia is characterized by a complete lack of semen and results from failure to ejaculate.

 

Ref:  Chapter 20. Treatment of the Infertile Couple.  Williams Gynecology, 2e.
 


11 AUG 2014 : 

Q) Which of the following ECG findings are seen in Hypokalemia?

A. Increased PR interval with ST depression
B. Increased PR interval with peaked T waveIncreased PR interval with peaked T wave
C. Prolonged QT interval with T wave inversion
D. Decreased QT interval with ST depression


Ans : A , Increased PR interval with ST depression

Hypokalemia is associated with increased PR interval, ST depression and prominent U wave.

Ref: Harrison’s Internal medicine 16th Edition, Page 1318; 17th Edition, Page 1395; Essentials of Pathophysiology: Concepts of Altered Health States, Carol Mattson Porth, 3rd Edition, Chapter 8, Page 181; 12 Lead ECG: The Art of Interpretation, Tomas B. Garcia, Chapter 16, Page 500

 


08 AUG 2014 : 

Q) Which of the following is diagnostic of Rabies?

A. Guarneri bodies
B. Negri bodies
C. Cowdry A body
D. Bollinger bodies


Ans : B , Negri bodies

Negri bodies, in which CNS viral replication occurs, are eosinophilic intracellular lesions found within cerebral neurons and are highly specific for rabies.

Negri bodies are found in about 75% of proven cases of animal rabies. Although their presence is pathognomonic for rabies, their absence does not exclude rabies.
 
Ref: Weber D.J., Wohl D.A., Rutala W.A. (2011). Chapter 152. Rabies. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e

 


07 AUG 2014 : 

Q) Which of the following is not measured in Triple Test?

A. HCG
B. AFP
C. Estriol
D. Progesterone

 

Ans.D , Progesterone
 

The triple screen test is a maternal blood screening test that looks for three specific substances: AFP, hCG, and Estriol.In the second trimester, levels of human chorionic gonadotropin (HCG), α-fetoprotein, and unconjugated estriol in the maternal serum are quantified and used to adjust the maternal age–predicted risk of a trisomy 21 or trisomy 18 fetus.


Ref: Chapter 62. Chromosome Disorders. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e.

 


06 AUG 2014 : 

Q) A Biguanide Oral hypoglycemic used in the treatment of PCOS?

A. Misoprostol
B. Clomiphene
C. Mifepristone
D. Metformin


Ans.D , Metformin


Metformin has been used as a treatment for infertility in women with the polycystic ovarian syndrome. Although not formally approved for this purpose, metformin has demonstrable effects to improve ovulation and menstrual cyclicity and reduce circulating androgens and hirsutism.


Ref: Chapter 43. Endocrine Pancreas and Pharmacotherapy of Diabetes Mellitus and Hypoglycemia. In: Brunton LL, Chabner BA, Knollmann BC. eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.
 

05 AUG 2014 : 

Q) Results from the fertilization of different oocytes by different sperm?

A. Unitrigotic twins
B. Monozygotic twins
C. Dizygotic twins
D. Identical twins

Ans.C , Dizygotic twins

Dizygotic twins (“fraternal twins”) are produced from separately fertilized ova. They bear only the resemblance of brothers or sisters and may or may not have the same blood type. Significant differences usually can be identified over time. Slightly more than 30% of twins are monozygotic; nearly 70% are dizygotic. Twins of different sexes are always dizygotic (fraternal).
About 75% of dizygotic twins are the same sex. Many factors influence dizygotic twinning including age and ethnicity. Race is a factor, with multiple gestations most common in blacks, least common in Asians, and of intermediate occurrence in whites
Dizygotic twinning is more common among women who become pregnant soon after cessation of long-term oral contraception. This may be a reflection of high “rebound” gonadotropin secretion.
Monozygotic twins (“identical twins”) are the result of the division of a single fertilized ovum that subsequently divides into 2 separate individuals.

Ref: Chapter 17. Multiple Gestation. In: DeCherney AH, Nathan L, Laufer N, Roman AS. eds. CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

04 AUG 2014 :

Q) Which among the following chemokine receptor is a HIV-1 co-receptor?

A. CCR1
B. CCR4
C. CCR5
D. CCR7


Ans : B , CCR4

CCR5 and CXCR4 are HIV-1 coreceptors.

Ref : Harrison’s Principles of Internal Medicine, 18th Edition, Introduction to the Immune System Table 314–8


31 JULY 2014 :

Q) Post mortem yellow discoloration is seen in the following poisoning :
 
A. Cyanide
B. CO
C. Aniline
D. Phosphorus
 
Ans : D , Phosphorus

Explanation :

In poisoning by phosphorus the colour is dark-brown or yellow.
 
In CO poisoning, the colour is cherry red.
 
In hydrocyanic acid poisoning and sometimes in burns the colour is bright-red.
 
In poisoning by nitrites, potassium chlorate, potassium bicarbonate, nitrobenzene, acetanilide, bromates, and aniline (causing methemoglobinemia) the colour is chocolate or copper brown.
 
Ref: Essentials of Forensic Medicine by Narayan Reddy, 27th edition, Page 139.

30 JULY 2014 : 

Q) Internuclear ophthalmoplegia is caused due to lesion in which of the following:

A. Occipital lobes
B. Pretectal fibres
C. Medial longitudinal fasciculus
D. Para pontine reticular fibres


Ans : C , Medial longitudinal fasciculus

Internuclear ophthalmoplegia is caused due to lesion in the medial longitudinal fasciculus ascending from the abducens nucleus in the pons to the oculomotor nucleus in the midbrain.
 
Damage to fibers carrying the conjugate signal from abducens interneurons to the contralateral medial rectus motoneurons results in a failure of adduction on attempted lateral gaze. Patient with a left internuclear ophthalmoplegia will show slowed or absent adducting movements of the left eye. Patients with  bilateral injury to the medial longitudinal fasciculus will have bilateral internuclear ophthalmoplegia.
 
One-and-a-half syndrome occur due to a combined lesion of the medial longitudinal fasciculus and the abducens nucleus on the same side. In this patient the only horizontal eye movement is abduction of the eye on the other side.
 
Ref: Harrison's Principles of Internal Medicine, 18e chapter 28


29 JULY 2014 : 

Q) Which of the following anaesthetic agent increases cerebral oxygen consumption?

A. Propofol
B. Ketamine
C. Thiopentone
D. Alfentanil


Ans : B , Ketamine
 

Ketamine is known to increase cerebral oxygen consumption, increase intracranial pressure and cerebral blood flow.
  • It is known to produce dissociative anaesthesia.
  • Most of the anaesthetic, analgesic, amnestic and psychotomimetic effect are due to non competitive antagonism of glutamate at NMDA ligand gated calcium channels.
  • Advantages includes: very rapid onset of effects, cardiorespiratory stability, relative preservation of airway reflexes, dissociative anaesthesia and safety in patients with porphyria.
  • It is contraindicated in raised intracranial pressure or intracranial pathology with a mass effect.
  • Emergence reactions include vivid dreams, surreal experiences and illusions during first hour of recovery.
Ref: Wylie Churchill-Davidson's A Practice of Anesthesia 7th Edition
edited by Thomas EJ Healy, page 576.

 


28 JULY 2014 :

Q) Most common manifestation of clostridium difficile infection is:

A. Fever
B. Leukocytosis
C. Abdominal pain
D. Diarrhea 


Ans : D ,  Diarrhea 

Most common manifestation of clostridium difficile infection is Diarrhea

Stool is soft, watery or mucoid in consistency, with a characteristic odor with 20 bowel movements per day.
 
Other features:
 
Fever in 28%
 Abdominal pain in 22%,
 Leukocytosis in 50%
 Unexplained leukocytosis, with 15,000 white blood cells (WBCs)/L may indicate c. difficile infection.
 
Complications:
 
1. Toxic megacolon and sepsis.
 
Ref: Harrison, Edition-18, page-1092.

 


26 JULY 2014 :

Q) Vitamin which prevents tissue oxidation by free radicals is:

A. Tocopherol
B. Biotin
C. Pyridoxine
D. Vitamin-A

Ans : A , Tocopherol

The main function of vitamin E is as a chain-breaking, free-radical-trapping antioxidant in cell membranes and plasma lipoproteins by reacting with the lipid peroxide radicals formed by peroxidation of polyunsaturated fatty acids. The tocopheroxyl radical product is relatively unreactive, and ultimately forms nonradical compounds.
 
Ref: Bender D.A. (2012). Chapter 44. Micronutrients: Vitamins & Minerals. In Murray R.K., Bender D.A., Botham K.M., Kennelly P.J., Rodwell V.W., Weil P (Eds),Harper's Illustrated Biochemistry, 29e.

 


25 JULY 2014 :

Q) All the following are components of APGAR Score EXCEPT:

A. Muscle tone
B. Color of the body
C. Heart Rate
D. Respiratory Rate

Ans : D , Respiratory Rate

 

Components of APGAR score includes: heart rate, respiratory effort, muscle tone, reflex irritability and color. 
 
Scores between 0 and 2 in each of 5 different categories are assigned at 1 and 5 minutes of life. The score reflects the cardiorespiratory and neurologic status at those time points.  If the 5-minute Apgar score is <7, Apgar scoring is continued at 5-minute intervals until a score of 7 or more has been achieved.
 

apgar_10616033.jpg

Ref: Collin M.F. (2011). Chapter 14. Resuscitation of Neonates. In Tintinalli J.E., Stapczynski J, Ma O, Cline D.M., Cydulka R.K., Meckler G.D., T (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.

 


24 JULY 2014 :

Q)Which characteristic is more common in binge eating disorder than bulimia nervosa?

A. Frequent loss of control while eating, leading to consumption of large amounts of food in a short period of time
B. Higher prevalence in men compared to women
C. Presence of menstrual cycle
D. Obesity


Ans: D , Obesity

Binge eating disorder (BED) is characterized by frequent episodes of eating unusually large amounts of food accompanied by feeling loss of control. In contrast to those with bulimia nervosa, patients with BED do not frequently engage in appropriate behavior to compensate for binge eating. In addition, BED is commonly associated with obesity.
Binge-eating disorder has a higher lifetime prevalence than bulimia nervosa or anorexia nervosa at about 4%. Although more men suffer from binge-eating disorder than other types of eating disorders, women with binge-eating disorder still outnumber men 2:1. Binge-eating disorder and bulimia nervosa share the common characteristic of episodes of eating a large amount of food in a short period of time with a feeling that the eating behavior is out of control. However, patients with binge-eating disorder do not exhibit inappropriate behaviors such as self-induced vomiting or the use of laxatives as a means to control the binge eating. Individuals with binge-eating disorder are more likely to be obese and also have higher rates of anxiety and depression.

Ref: Harrison's Principles of Internal Medicine, 18e.Chapter 79. Eating Disorders.


23 JULY 2014 :

Q) A 23 year old female with cystic fibrosis is diagnosed with chronic pancreatitis. She is at risk for all of the following complications EXCEPT:

A.Vitamin B12 deficiency
B.Vitamin A deficiency
C.Niacin deficiency
D.Pancreatic carcinoma

Ans : C , Niacin deficiency

Chronic pancreatitis is a disease process characterized by irreversible damage to the pancreas as distinct from the reversible changes noted in acute pancreatitis. The condition is best defined by the presence of histologic abnormalities, including chronic inflammation, fibrosis, and progressive destruction of both exocrine and eventually endocrine tissue.As pancreatic enzymes are essential to fat digestion, their absence leads to fat malabsorption and steatorrhea. In addition, the fat-soluble vitamins, A, D, E, and K, are not absorbed. Vitamin A deficiency can lead to neuropathy. Vitamin B12, or cobalamin, is often deficient. This deficiency is hypothesized to be due to excessive binding of cobalamin by cobalamin-binding proteins other than intrinsic factor that are normally digested by pancreatic enzymes. Replacement of pancreatic enzymes orally with meals will correct the vitamin deficiencies and steatorrhea. The incidence of pancreatic adenocarcinoma is increased in patients with chronic pancreatitis, with a 20-year cumulative incidence of 4%. Niacin is a water-soluble vitamin, and absorption is not affected by pancreatic exocrine dysfunction.

Ref: Harrison's Principles of Internal Medicine, 18e.Chapter 313. Acute and Chronic Pancreatitis.



22 JULY 2014 :

Q) Which is false about pulmonary embolism?

A. Chest pain is most common symptom
B. Arises from leg vein
C. More the survival time, more the chance for recovery
D. Neck veins may be distended


Ans : A , Chest pain is most common symptom

Dysponea is the commonest symptom and tachyponea is the commonest sign. The most common presenting symptom of pulmonary embolism is dyspnea. Dyspnea, pleuritic chest pain, and tachypnea were present in 97% of patients with pulmonary embolism. PE most commonly results from deep vein thrombosis. Clinical signs include low blood oxygen saturation and cyanosis, rapid breathing, and a rapid heart rate, left parasternal heave, a loud pulmonary component of the second heart sound, and raised jugular venous pressure. 

21 JULY 2014 :

Q) Which of the following is the most common clinical manifestation of Neisseria meningitidis infection?

A.Chronic meningitis
B.Asymptomatic nasopharyngeal colonization
C.Meningitis
D.Septicemia

Ans , B : Asymptomatic nasopharyngeal colonization

Infection with Neisseria meningitidis most commonly manifests as asymptomatic colonization in the nasopharynx of healthy adolescents and adults.
Asymptomatic infection rates of greater than 25% described in some series of adolescents and young adults and among residents of crowded communities. Despite the high rates of carriage among adolescents and young adults, only 10% of adults carry meningococci, and colonization is very rare in early childhood. Colonization should be considered the normal state of meningococcal infection. Meningeal pharyngitis rarely occurs. Meningococcal disease occurs when a virulent form of the organism invades a susceptible host. The most important bacterial virulence factor relates to the presence of the capsule. Unencapsulated forms of N. meningitidis rarely cause disease. Of patients with meningococcal disease, 30% to 50% present with meningitis, approximately 40% with meningitis plus septicemia, and 20% with septicemia alone. Patients with complement deficiency, who are at highest risk of developing meningococcal disease, may develop chronic meningitis

Ref: Harrison's Principles of Internal Medicine, 18e.Chapter 143. Meningococcal Infections

 


19 JULY 2014

Q) All of the following statements regarding the drug mefloquine are true EXCEPT:


A. Dose adjustment is not necessary in patients with renal insufficiency.
B. It is only available parenterally.
C. It is the preferred drug for prophylaxis of chloroquine-resistant malaria.
D. It should not be administered concurrently with halofantrine.

ANS : B, 
It is only available parenterally.

Explanation : 

Mefloquine remains the preferred drug for malaria prophylaxis in areas where chloroquine resistance is prevalent. High doses may be used for treatment. Drug resistance has been reported in parts of Africa and Southeast Asia. Mefloquine, similar to quinine and chloroquine, is only active against the asexual erythrocytic stages of malarial infection. Mefloquine is poorly water soluble and is not available parenterally. Oral absorption is enhanced when taken with or after food. Mefloquine is excreted mainly in the bile and feces; therefore, no dose adjustment is needed in persons with renal insufficiency.Sleep abnormalities, psychosis, and seizures have been reported with mefloquine administration.  Quinine, quinidine, and beta-blockers may interact with mefloquine to cause significant electrocardiographic abnormalities or cardiac arrest. Halofantrine must not be administered with mefloquine within 3 weeks because of the potential for fatal QTc prolongation. Mefloquine may also alter ritonavir pharmacokinetics.
 
Ref: Harrison's Principles of Internal Medicine, 18e.Chapter e26. Pharmacology of Agents Used to Treat Parasitic Infections.

18 JULY 2014 :

Q) ST elevation on an ECG is seen in all of the following conditions, EXCEPT:

A. Myocardial infarction
B. Coronary artery spasm
C. Constrictive pericarditis
D. Ventricular aneurysm


Ans . C , Constrictive pericarditis

There are no specific ECG changes in constrictive pericarditis. Usually ECG shows low voltage QRS complexes and inverted T waves. 2D echo done in them shows pericardial thickening and abnormal ventricular septal motion.
 
Conditions associated with ST segment elevation are:
  • STEMI
  • Left ventricular aneurysm
  • Prinzmetal’s angina
  • Acute pericarditis
  • Left bundle branch block
  • Brugada syndrome
Ref: Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e  chapter 59. Making Sense of the ECG: A Hands-on Guide, Third Edition  By Andrew Houghton, page 159.

 


17 JULY 2014 : 

Q) What is the optimal percentage of daily caloric intake derived from carbohydrates?

A. <25%
B. 25–35%
C. 45–55%
D. 65–75%


Ans : C ,45–55%

Carbohydrates comprise the greatest percentage of calories in the diet as they are the major fuel source for the brain and most tissues. The brain requires 100 g/d of glucose, with the rest of the body requiring about 50 g/d of glucose. Although glucose can be derived from proteolysis or fats, carbohydrates remain the primary energy source of the body and should comprise 45–55% of the total caloric intake. Fats should comprise no more than 30% of caloric intake, and proteins typically should comprise about 15%.

Ref: Harrison's Principles of Internal Medicine, 18e.Chapter 73. Nutrient Requirements and Dietary Assessment.

 


16 JULY 2014 : 

Q) Esophageal hiatus of the diaphragm lies at the level of:

A. T10
B. T9
C. T8
D. T12


Ans : A , T10

The esophageal hiatus lies immediately anteriorly and slightly to the left at the level of the tenth thoracic vertebra and is separated from the aortic hiatus by the decussation of the right crus of the diaphragm. Through this hiatus pass the esophagus and the vagus nerves.
 
Also know:
The aortic hiatus lies posteriorly at the level of the 12th thoracic vertebra, and through it pass the aorta, the thoracic duct, and the azygos venous system.
At the level of the ninth thoracic vertebra and slightly to the right of the esophageal hiatus is the vena caval foramen, which allows passage of the inferior vena cava and small branches of the phrenic nerve.

Ref: Patti M.G., Fisichella P.M. (2010). Chapter 20. Esophagus & Diaphragm. InDoherty G.M. (Eds), CURRENT Diagnosis & Treatment: Surgery, 13e.

 


15 JULY 2014 : 

Q ) Sentinel surveillance is best described as a method to:

A. Notify cases of infection or disease
B. Determine the changing trends in the health status of a population
C. Provide feedback to help modify the existing policy and system
D. Quantify the total amount of disease in a community

Ans : D , Quantify the total amount of disease in a community

Sentinel surveillance is a method used to identify all cases of disease or infection by identifying the missing cases and then supplementing the routinely notified cases. The sentinel data is extrapolated to the entire population to estimate disease prevalence in the total population. It is done by physicians or institutions in selected areas by reporting all the cases of disease in their areas.
 
Surveillance:
 
Surveillance is defined as “the continuous scrutiny of the factors that determine the occurrence and distribution of disease and other conditions of ill-health”. Surveillance programmes include epidemiological surveillance, demographic surveillance, nutritional surveillance, etc.
 
Objectives of Surveillance:
 
The main objectives of surveillance are to provide information about new and changing trends in the health status of a population, to provide feedback which may be expected to modify the policy and the  system and lead to redefinition of objectives, and to provide timely warning of public health disasters so that interventions can be mobilized.
 
Sentinel Surveillance:
 
A method for identifying the missing cases and thereby supplementing the notified cases is required. This is known as “sentinel surveillance”. The sentinel data is extrapolated to the entire population to estimate disease prevalence in the total population. Sentinel surveillance agencies could be interested and competent physicians, or institutions, in selected areas to report the cases of disease in their areas.
 
Ref : Park’s Textbook Of Preventive And Social Medicine, By K. Park, 19th Edition, Page 37.



 


14 JULY 2014 : 

Q) Which autoantibody is specific for SLE?

A. ANA
B. Anti-Sm
C. Anti-La (SS-B)
D. Anti-RNP


Ans : B  , Anti-Sm

Anti-Sm :  Specific for SLE; no definite clinical correlations; most patients also have anti-RNP. More common in African Americans and Asians than Caucasians. High titres of Anti-dsDNA is also specific for SLE.

 


11 JULY 2014 : 

Q) Rabies free country is:

A. USA
B. Russia
C. Australia
D. France


Ans :C , Australia 

Australia, Taiwan, Cyprus, Iceland, Japan, Malta, New Zealand, UK., Finland, Norway, Sweden are Rabies free.

Ref: Park 22ed; p 252


10 JULY 2014 : 

Q) The best available treatment for portal hypertensive gastropathy is:

A. Beta blocker
B. TIPS
C. Surgical portacaval shunt
D. Liver transplantation 


Ans : D , Liver transplantation

Portal hypertensive gastropathy (PHG) is the ectatic blood vessels in the proximal gastric body and cardia causing oozing of the blood.
Less severe grades of PHG appear as a mosaic or snakeskin pattern and are not associated with bleeding.
Severe PHG with diffuse bleeding is treated by β-adrenergic receptor blockers or possibly with placement of a TIPS or surgical portacaval shunt.
The best treatment is liver transplantation
 
Ref:Sleisenger and Fordtran's,E-9,P-300.

09 JULY 2014 :

Q) Which of the following Mycoplasma species ferments glucose:

A. M. pneumonia
B. M. salivarium
C. M. orale
D. M. hominis

Ans : A , M. pneumonia

 

  SPECIES

  GLUCOSE

 ARGININE

M. pneumoniae

         +

          -

M. salivarium

          -

         +

M. orale

          -

         +

M. hominis

          -

         +

U. urealyticum

          -

          -

M. fermentans

         +

         +

M. genitalium

         +

          -

A. laidlawii

         +

          -

Ref: Mackie & Mc Cartney’s Practical Medical Microbiology; 14th edition

 


08 JULY 2014 :

Q) Barrett's esophagus is characterised by which of the following histologic change?

A. Squamous metaplasia
B. Intestinal metaplasia
C. Squamous dysplasia
D. Intestinal dysplasia


Ans .B ,  Intestinal metaplasia


Barrett’s esophagus is a condition in which squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium containing goblet and columnar cells in some patients with GERD.
 
Barrett's epithelium is a major risk factor for adenocarcinoma of the esophagus due to proximal displacement of the squamocolumnar junction. In patients with more than 10 year history of GERD should undergo a screening EGD for Barrett's esophagus.
 
Endoscopic biopsy is the gold standard for confirmation of Barrett's esophagus, and for dysplasia or cancer arising in Barrett's mucosa.
 
Ref: Harrison's Principles of Internal Medicine, 18e chapter 291

 


07 JUNE 2014 :

Q) A boy presents with complaints of hypoaesthesia and wasting of thenar eminence. The nerve most likely to damaged in this patient:

A. Musculocutaneous nerve
B. Median nerve
C. Ulnar nerve
D. Radial nerve


Ans . B , Median nerve

Carpal tunnel syndrome is caused by swelling of the flexor digitorum superficialis, profundus, and flexor pollicis longus tendons, resulting in pressure on the median nerve. Repetitive motions of the fingers and wrist, hormonal changes, and vibration can be causes of tendon swelling. It results in tingling, numbness, and pain in the cutaneous distribution of the median nerve (lateral side). In more severe cases, atrophy of the thenar eminence may be present.
 
Ref: Morton D.A., Foreman K.B., Albertine K.H. (2011). Chapter 33. Hand. In D.A. Morton, K.B. Foreman, K.H. Albertine (Eds), The Big Picture: Gross Anatomy.

 


05 JUNE 2014 : 


Q) Which of the following organism is known to cause endocarditis?
 
A. Coxiella
B. Chlamydia
C. HACEK 
D. Salmonella
 
ANS : C, HACEK

Explanation :


Most common organisms known to cause endocarditis are staphylococcus, viridans streptococcus, and HACEK. HACEK includes Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella; Haemophilus aphrophilus and Actinobacillus.
  • Oral cavity, skin and respiratory tract are the primary portal of entry of staphylococcus, viridans streptococcus, and HACEK. 
  • S bovis originates from the GIT, where it is associated with polyps and colonic tumors.
  • Enterococci enters bloodstream from the genitourinary tract.
  • Healthcare associated NVE, is commonly caused by Staphylococcus aureus, coagulase-negative staphylococci and enterococci.

Ref : Karchmer A.W. (2012). Chapter 124. Infective Endocarditis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds),Harrison's Principles of Internal Medicine, 18e.
 

04 JULY 2014 :

Q) All are true about the features of erythromelalgia , EXCEPT:

A. Unknown aetiology
B. Thrombocytosis is seen
C. Digital infarction is seen
D. Treatment is steroids

Ans . D , Treatment is steroids

Erythromelalgia 

  • Syndrome of unknown etiology 
  • It is associated with thrombocytosis
  • Manifested by erythema, warmth, and pain of the affected appendage and occasionally digital infarction.
  • It usually respond to salicylates. 
Ref: Harrison, E-18,P-903

 


03 JULY 2014 : 

Q) Which quadrant of breast has the least chance of turning malignant?

A. Upper outer
B. Lower outer
C. Lower inner
D. Upper inner

Ans . C , Lower inner

Very high chance of turning malignant is Upper outer quadrant.Least chance of turning malignant is lower inner quadrant.
 
Ref: Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, Calver LE. Chapter 12. Breast Disease. In: Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham F, Calver LE. eds. Williams Gynecology, 2e. New York, NY: McGraw-Hill; 2012.http://accessmedicine.mhmedical

 


02 JULY 2014 : 

Q) A 10 year old boy develops an itchy, vesicular rash, which is maximal on his face and trunk. Physical examination demonstrates a mixture of lesions, with macules, papules, vesicles, and crusted lesions. The mother reports that the lesions seem to be occurring in crops. Which of the following is the most likely diagnosis?

A. Herpes simplex I
B. Herpes simplex II
C. Measles
D. Varicella

Ans . D ,  Varicella

This is varicella (chicken pox), which is the primary form of infection by the herpes zoster (varicella-zoster) virus. Recurrence due to virus harbored in neurons tends to be dermatomal in distribution and is called shingles. Fever, malaise, headache, and myalgia may also be present, particularly in the prodromal phase. Tzanck smear of the base of a vesicle may demonstrate multinucleated giant cells. Immunocompromised patients can be treated with acyclovir to prevent dissemination. Chicken pox may be complicated by secondary bacterial infection, pneumonia, systemic spread (immunosuppressed patients), neurologic involvement (rare), Reye's syndrome (rare), and hemolytic anemia (rare).
 
Herpes simplex I causes oral vesicles and ulcers.
 
Herpes simplex II causes genital vesicles and ulcers.
 
Measles causes a blotchy, non vesicular rash.
 
Ref: Ray C.G., Ryan K.J. (2010). Chapter 14. Herpesviruses. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.

 

01 JULY 2014 : 

Q) The "dose" of dialysis is currently defined as:
 
A.The countercurrent flow rate of the dialysate
B.The hours per week of dialysis
C.The fractional urea clearance
D.The number of sessions actually completed in a month

Ans . C , The fractional urea clearance


The dose is currently defined as a derivation of the fractional urea clearance, factors that are also important include patient size, residual kidney function, dietary protein intake, comorbid conditions, and the degree of anabolism/catabolism. The efficiency of dialysis depends on the counter-current flow rate of the dialysate. The number of hours/sessions prescribed for a patient is derived from the dialysis dose and is individualised.
 
Ref: Harrison's Principles of Internal Medicine, 18e Chapter 281. Dialysis in the Treatment of Renal Failure.
 

30 JUNE 2014 : 

Q) Which of the following sexually transmitted disease is diagnosed by Ito's test?
 
A. Gonorrhoea
B. Herpes
C. Chancroid
D. Granuloma venereum

Ans : C , Chancroid


The Ito-Reenstierna test is an intradermal test, using inactivated Haemophilus ducreyi, for diagnosis of chancroid. Due to limited sensitivities for detection of circulating antibodies to H. ducreyi, serology has currently limited usefulness in the routine diagnosis of chancroid infection but may be useful in population-based epidemiological research as a screening method for past infection.
 
Ref: Lautenschlager S (2012). Chapter 202. Chancroid. In Goldsmith L.A., Katz S.I., Gilchrest B.A., Paller A.S., Leffell D.J., Wolff K (Eds), Fitzpatrick's Dermatology in General Medicine, 8e.

 

28 JUNE 2014 : 

All are examples of tumors associated with absolute erythrocytosis , EXCEPT:
 
A. Hypernephroma
B. Hepatoma
C. Cerebellar hemangioblastoma
D. Ovarian teratoma 

Ans :D , Ovarian teratoma


Tumors associated with absolute erythrocytosis
 

  • Hypernephroma

  • Hepatoma

  • Cerebellar hemangioblastoma

  • Uterine myoma

  • Adrenal tumors

  • Meningioma

  • Pheochromocytoma
     

Familial (with normal hemoglobin function)associated with absolute erythrocytosis
 

  • Erythropoietin receptor mutation

  • VHL mutations (Chuvash polycythemia)

  • 2,3-BPG mutation
     

Ref: Harrison, E-18,P-902
 

27 JUNE 2014 :

Q) Snow storm appearance on an ultrasound is seen in:
 
A. Chronic ectopic
B. Vesicular mole (Correct answer)
C. Hydatid cyst
D. Dermoid cyst
 
Ultrasound done in a patient with complete hydatidiform mole demonstrates the uterus to be filled with innumerable tiny cysts described as a snowstorm appearance in the first trimester because of its multiple echogenic foci. There will be no evidence of fetal parts.
 
In the case of a partial mole, a fetus can be identified and the placenta will show partial molar changes. 
 
In an ectopic pregnancy, ultrasound shows and empty uterus and an adnexal mass. Free fluid in the pouch of douglas may be noticeable. In an ectopic pregnancy, a tubal ring is seen ( Doughnut or Bogel sign).
 
Ref: Fundamentals of Diagnostic Radiology  edited by William E. Brant,  page 982.
 

26 JUNE 2014 : 

Q) All of the following syndromes are associated with obesity EXCEPT:

A. Acromegaly
B. Cushing's syndrome
C. Hypothyroidism
D. Prader-Willi syndrome

Ans . A  , Acromegaly

Prader-Willi syndrome falls into a category of syndromes of obesity associated with mental retardation. Individuals with Prader-Willi syndrome are of short stature with small hands and feet. They exhibit hyperphagia, obesity, and neurodevelopmental delay in association with hypogonadotropic hypogonadism. Endocrine abnormalities or abnormalities of the hypothalamus are also commonly associated with obesity. Patients with Cushing's syndrome have central obesity, hypertension, and glucose intolerance. Hypothyroidism is associated with obesity due to decreases in metabolic rate; however, it is a rare cause of obesity.  Acromegaly is not associated with obesity.

Ref: Harrison's Principles of Internal Medicine, 18e, Chapter 77. Biology of Obesity.

 


25 JUNE 2014 : 

Q) Which of the following species of clostridium causes pseudomembranous colitis?

A. Clostridium difficile
B. Clostridium perfringens
C. Clostridium tetani
D. Clostridium botulinum

Ans . A , Clostridium difficile

Pseudomembranous colitis is diagnosed by detection of one or both Clostridium difficile toxins in stool and by endoscopic observation of pseudomembranes or microabscesses in patients who have diarrhea and have been given antibiotics. Plaques and microabscesses may be localized to one area of the bowel. The diarrhea may be watery or bloody, and the patient frequently has associated abdominal cramps, leukocytosis, and fever. 
 
Most common antibiotics associated with pseudomembranous colitis are,
  • Ampicillin
  • Clindamycin
  • Fluoroquinolones (recently)
The disease is treated by discontinuing administration of the offending antibiotic and orally giving either metronidazole or vancomycin.
 
Also know:
 
Administration of antibiotics results in proliferation of drug-resistant C difficile that produces two toxins. Toxin A, a potent enterotoxin that also has some cytotoxic activity, binds to the brush border membranes of the gut at receptor sites. Toxin B is a potent cytotoxin.
 
Ref: Brooks G.F. (2013). Chapter 11. Spore-Forming Gram-Positive Bacilli: Bacillus and Clostridium Species. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.

 

 


24 JUNE 2014 : 

Q) Chagas disease and is transmitted by the following:

A. Kissing bugs
B. Tsetse flies
C. Dogs
D. Birds

Ans :A ,  Kissing bugs

Chagas disease is transmitted by tsetse flies.
 
There are two distinct types of human trypanosomes:
African, which causes sleeping sickness and is transmitted by tsetse flies (eg, Glossina): Trypanosoma brucei rhodesiense and Trypanosoma brucei gambiense;
American, which causes Chagas disease and is transmitted by kissing bugs (eg, Triatoma): Trypanosoma cruzi.

Ref: (2013). Chapter 46. Medical Parasitology. In Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.

 


23 JUNE 2014 : 

Q) Athlete’s foot infection is caused due to:

A. Trichophyton
B. Candida
C. Papilloma virus
D. E.coli

Ans A , Trichophyton

Athlete’s foot is a health hazard associated with contact with contaminated swimming pool water. It is caused by Epidermophyton or Trichophyton species.

Ref: Park 21st edition page: 673.


21 JUNE 2014 : 

Q) X-ray taken in which of the following malignancy shows a Sun ray appearance?

A. Osteosarcoma
B. Osteoclastoma
C. Osteochondroma
D. Ewing’s tumor


Ans .  A , Osteosarcoma


Xray of affected area in patients with osteosarcoma shows Sunburst appearance due to the extension of the tumor through the periosteum. Reactive new bone formation under the periosteum result in elevation of periosteum which appear as a Codman’s  triangle. Osteosarcoma lesions can be purely osteolytic, osteoblastic or mixture of both.
 
X ray of the affected region in Ewings sarcoma shows a destructive lesion producing a classic moth eaten appearance. As the tumor grows cortex displaces outwards and periosteal reaction will result in classic onion peel appearance.
 
Ref: Textbook of Pathology  By V. Krishna page 974. Place R., Lagoc A.M., Mayer T.A., Lawlor C.J. (2011). Chapter 136. Oncology and Hematology Emergencies in Children. In R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.

 


20 JUNE 2014 : 

Q ) Which of the following pleomorphic coccobacillus shows satellite phenomenon in blood agar?
 
A. Anaerobic staphylococci
B. H. influenzae
C. Corynebacterium diphtheria
D. Brucella abortus

Ans B , H. influenzae


Haemophilus influenzae is a small (1- by 0.3-μm) gram-negative organism of variable shape; hence, it is often described as a pleomorphic coccobacillus. On chocolate agar, flat, grayish brown colonies with diameters of 1–2 mm are present after 24 hours of incubation. H influenzae does not grow on sheep blood agar except around colonies of staphylococci "satellite phenomenon".
 
Ref: (2013). Chapter 18. Haemophilus, Bordetella, Brucella, and Francisella. InBrooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.
 

19 JUNE 2014 :

Q) Article 377 of IPC deals with:

A. Rape
B. Incest
C. Unnatural sexual offence
D. Adultery


Ans.  C Unnatural sexual offence

Section 377 IPC prescribes punishment for unnatural sexual offence. It defines unnatural sexual offenses as voluntary sexual intercourse against the order of nature with any woman, man or animal. The punishment given is imprisonment for 10 years and fine.

 
Sec 375 IPC Enumerates six situations under which sexual intercourse by a man with a woman would amount to rape.
Sec 376 IPC Deals with punishment for rape.
Sec 497 IPC Makes adultery an offence only in case of a person who has had sexual intercourse with a married woman.
Sec 362 IPC Deals with abduction. Abduction takes place when a person by force compels or by any deceitful means induces another person to go from any place. 
 
Ref: The Essentials of Forensic Medicine and Toxicology By K D Tripathi 27 edn chapter 2.

 

 


18 JUNE 2014 :

Q) Vitamin which prevents tissue oxidation by free radicals is:

A. Tocopherol
B. Biotin
C. Pyridoxine
D.Vitamin-A

Ans . A ,Tocopherol

The main function of vitamin E is as a chain-breaking, free-radical-trapping antioxidant in cell membranes and plasma lipoproteins by reacting with the lipid peroxide radicals formed by peroxidation of polyunsaturated fatty acids. The tocopheroxyl radical product is relatively unreactive, and ultimately forms nonradical compounds.
 
Ref: Bender D.A. (2012). Chapter 44. Micronutrients: Vitamins & Minerals. In Murray R.K., Bender D.A., Botham K.M., Kennelly P.J., Rodwell V.W., Weil P (Eds),Harper's Illustrated Biochemistry, 29e.

 


17 JUNE 2014 : 

Q) Double-bubble sign on abdominal X-ray is seen in :
 
A. Colon carcinoma
B. Duodenal atresia
C. Acute pancreatitis
D. Perforation

Ans B , Duodenal atresia


Double bubble sign is the characteristic abdominal Xray sign associated with duodenal atresia.  In tis, the stomach and first part of the duodenum are the only parts of the intestine filled with gas giving the characteristic appearance. 
 
Duodenal atresia typically presents in the first hour of life. Children presents with bilious vomiting and epigastric distention within a few hours of birth. Meconium may be passed normally.
 
It is often associated with other conditions such as esophageal atresia, intestinal atresia, cardiac and renal anomalies. 
 
Ref: Oski's Pediatric Certification and Recertification Board Review  By Carmen Coombs, page 404. Sundaram S.S., Hoffenberg E.J., Kramer R.E., Sondheimer J.M., Furuta G.T. (2012). Chapter 21. Gastrointestinal Tract. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
 

16 JUNE 2014 : 

Q) An allograft is best described as which of the following?

A. Transplant from one species to another species
B. Transplant from one person to a genetically identical person
C. Transplant from one species to the same species
D. Transplant from one region of a person to another


Ans  C , Transplant from one species to the same species

An isograft is the transplant done between monozygotic twins. Allografts are between members of the same species. Xenografts are between members of different species. Transplantation from one region of a person to another region of that same person is an autograft.

 


13 JUNE 2014 : 

Q ) Type 2 lepra reaction occurs in:
 
A. Pauci bacillary leprosy
B. Multi bacillary leprosy
C. Both of the above
D. None of the above

Ans :  B , Multi bacillary leprosy


There are two principal types of Lepra reactions. Type 1 and Type 2. 
 Type 1 Lepra Reaction also known as Reversal Reaction may occur both in Pauci Bacillary (PB) and Multi Bacillary (MB) leprosy. 
 Type 2 reaction is also known as Erythema Nodosum Leprosum (ENL) andoccurs only in MB leprosy.
 
Ref: http://nlep.nic.in/pdf/MO%20training%20Manual.pdf

12 JUNE 2014 : 

Q) When does vertical transmission of Hepatitis B occur during pregnancy?
 
A. First trimester
B. Second trimester
C. Third trimester
D. During delivery
 
Ans D , During delivery 

Hepatitis B is not transmitted transplacentally to the fetus in utero, but it is acquired during the birth process by the swallowing of infected blood or fluids or through abrasions. The rate of transmission of infection is high up to 90% when infants are born to mothers who have acute hepatitis B infection or are HBsAg and HBeAg positive.
 
Hepatitis B is an enveloped DNA virus belonging to the family Hepadnaviridae. Other than vertical route it is also spread parenterally and through sexual contact.  Exposure to hepatitis viruses from direct contact with blood or other body fluids, probably through needlestick injuries, has resulted in a risk of hepatitis B infection in medical personnel.
 
There is strong correlation between chronic hepatitis B infection and hepatocellular carcinoma.
 
Ref: Ray C.G., Ryan K.J. (2010). Chapter 13. Hepatitis Viruses. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
 

11 JUNE 2014 :

Q) Which of the following is the causative organism of Pseudomembranous colitis?
 
A. Clostridium perfringens
B. Clostridium difficile
C. Clostridium tetani
D. Clostridium botulinum

Ans , B Clostridium difficile


Pseudomembranous colitis is caused by Clostridium difficile. It is the most common cause of diarrhea that develops in association with the use of antimicrobial agents (ampicillin, cephalosporin and clindamycin). This condition is associated with intense inflammation and the formation of a pseudomembrane composed of inflammatory debris on the mucosal surface.
 
Diagnosis is made by direct detection of toxins in the stool. Enzyme immunoassays, which demonstrate toxin A and/or B in stool are widely used.
 
Ref: Sherris Medical Microbiology, 5e, Chapter 29

10 JUNE 2014 :

Q) India joined the WHO in:
 
A. 1947
B. 1948
C. 1952
D. 1956

Ans B , 1948


India joined the Who as a member state in 1948
 
Ref: Park 22nd edition pg: 826.

09 JUNE 2014 : 
 
Q) Lachman sign is positive in:
 
A. Anterior cruciate ligament injury
B. Posterior cruciate ligament injury
C. Medial meniscus injury
D. Lateral meniscus

Ans A , Anterior cruciate ligament injury


The Lachman test is the most sensitive test for ACL tears. It is done with the knee flexed at 20 degrees, stabilizing the distal femur with one hand and pulling forward on the proximal tibia with the other hand.With an intact ligament, minimal translation of the tibia occurs and a firm end point is felt. With a torn ACL, more translation is noted, and the end point is soft or mushy.The hamstring muscles must be relaxed during this maneuver to prevent false-negative findings.
 
Ref: McMahon P.J., Kaplan L.D. (2006). Chapter 4. Sports Medicine. In H.B. Skinner (Ed), CURRENT Diagnosis & Treatment in Orthopedics, 4e.
 

07 JUNE 2014 :

Q) Which among the following is the richest source of vitamin D?


A. Milk
B. Egg
C. Green leafy vegetables
D. Fish oil

ANS : 
D, Fish oil

Explanation :

The main natural source of vitamin D in the diet is in the livers of fish, which ingest ultraviolet-irradiated sterols (in phytoplankton and zooplankton) and store the vitamin D produced in their livers. A major source of vitamin D is its synthesis in the skin upon ultraviolet B (UV-B) (wavelength, 290–315 nm) exposure. Except for fish, food (unless fortified) contains only limited amounts of vitamin D. Vitamin D2 (ergocalciferol) is obtained from plant sources and is the chemical form found in some supplements.


06 JUNE 2014 : 

Q) Byssinosis is caused due to inhalation of:

 
A. Cotton fibre dust
B. Coal dust
C. Silica dust
D. Asbestos

Ans . A , Cotton fibre dust


Byssinosis is caused due to inhalation of cotton fibre dust over long periods of time. It leads to pneumoconiosis causing chronic lung disease.
 
Ref: Park 21st edition, page 747.
Chapter: Occupational health.
 

05 JUNE 2014 : 

Q) The length of colon at birth:
 
A. 30-40cm
B. 60-80cm
C. 80-100cm
D. 100-120cm

Ans :  A ,  30-40cm


Colon 
 
30-40cm in length at birth.
In adults it measure 150cm.
The diameter is greatest in the caecum (7.5cm)
It is narrowest at sigmoid.
 
Ref: Sleisenger, E - 9, p-1615.

 


04 JUNE 2014 : 

Q) Which is the longest diameter of fetal skull?
 
A. Biparietal
B. Bitemporal
C. Occipitomental
D. Mentovertical
 
Ans . D , Mentovertical

Mentovertical is the distance between the tip of the mentum or chin and the most distant point of the vertex. It is the longest diameter of the fetal skull and is 14cm long. It is the diameter of engagement in a brow presentation.
 
Diameters of fetal skull:
  • Occipitofrontal: It follows a line extending from a point just above the root of the nose to the most prominent portion of the occipital bone. 11.5cm
  • Biparietal: It is the greatest transverse diameter of the head, which extends from one parietal boss to the other. 9.5cm.
  • Bitemporal: It  is the greatest distance between the two temporal sutures. 8cm.
  • Occipitomental: It extends from the chin to the most prominent portion of the occiput. 12.5cm.
  • Suboccipitobregmatic: It  follows a line drawn from the middle of the large fontanel to the undersurface of the occipital bone just where it joins the neck. 9.5cm.

Ref: Clinical Obstretics (10Th Edn.)  By S. Gopalan,  page 66, Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 4. Fetal Growth and Development. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
 

03 JUNE 2014 : 

Q) Which of the following is the best marker for drug induced lupus?
 
A. Anti histone antibodies
B. Anti DS DNA
C. ANA
D. Anti Smith Ab

Ans . A , Anti histone antibodies

Drug induced lupus is associated with anti histone antibodies which are positive in 95% of cases. 
 
Ref: Harrison’s Principles of Internal Medicine, 17th Edition, Page 2076; 16th/ 1961, 1967; Pathologic Basis of Disease, Robbins, 7th Edition, Page 229 & 235; Drug-Induced Diseases: Prevention, Detection, and Management, James E. Tisdale, 2nd Edition, Section 2, Page 108
 

02 JUNE 2014 :
 
Q) X-ray taken in which of the following malignancy shows a Sun ray appearance?
 
A. Osteosarcoma
B. Osteoclastoma
C. Osteochondroma
D. Ewing’s tumor

Ans . A , Osteosarcoma


Xray of affected area in patients with osteosarcoma shows Sunburst appearance due to the extension of the tumor through the periosteum. Reactive new bone formation under the periosteum result in elevation of periosteum which appear as a Codman’s  triangle. Osteosarcoma lesions can be purely osteolytic, osteoblastic or mixture of both.
 
X ray of the affected region in Ewings sarcoma shows a destructive lesion producing a classic moth eaten appearance. As the tumor grows cortex displaces outwards and periosteal reaction will result in classic onion peel appearance.
 
Ref: Textbook of Pathology  By V. Krishna page 974. Place R., Lagoc A.M., Mayer T.A., Lawlor C.J. (2011). Chapter 136. Oncology and Hematology Emergencies in Children. In R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.
 

31 MAY 2014 : 


Q) Maximum amount of essential fatty acids is found in:

 
A. Coconut oil
B. Sunflower oil
C. Mustard oil
D. Groundnut oil

Ans B , Sunflower oil

Explanation:


Remember the list given below
Safflower oil > corn oil > sunflower oil > soyabean oil > groundnut oil > mustard oil > palm oil > coconut oil.
 
Ref: Park 21st edition, page 566.
 

30 MAY 2014 :

Q) What is the maximum recommended percentage of fat in diet as per WHO?
 
A. 20%
B. 30%
C. 35%
D. 40%

Ans B , 30%


The WHO/ FAO expert group on diet, nutrition, and prevention of chronic diseases endorse that qualitative composition of fats in diet has a significant role to play in modifying risk factors of coronary vascular disease. Total fat should be around 15 to 30 % (% of energy)
 
Ref: Park 22nd edition, page 567

29 MAY 2014 :


Q) Which of the following would be the best morphological feature to distinguish ulcerative colitis from Crohn's disease?
 
A. Diffuse distributions of pseudopolyps
B. Mucosal edema
C. Crypt abscesses
D. Lymphoid aggregates in the mucosa

Ans A, Diffuse distributions of pseudopolyps


Pseudopolyps are more commonly found in ulcerative colitis than Crohn's disease.
 

 

 


These are discrete areas resulting from surviving islands of mucosa or heaped up
 

granulation tissue. Since in ulcerative colitis there is diffuse mucosal inflammation these pseudopolyps are diffusely distributed.


Distinguishing features between Ulcerative colitis and Crohn's disease:


 

Ulcerative colitis

Crohn’s disease

Rectal involvement

Yes

Variable

Distribution

Diffuse

Segmental or diffuse

Terminal ileum

Backwash ileitis

Thickened and stenosis

Serosa

Normal

Creeping fat

Mucosa

Hemorrhagic

Cobblestone and linear ulcers

Pseudopolyps

Frequent

Less common

Strictures

No

Common

Fistulas

No

Common

Lymphoid hyperplasia

Infrequent

Common

Crypt abscess

Extensive

Focal


Ref: Pediatric Inflammatory Bowel Disease  By Petar Mamula page 227.
 

28 MAY 2014 :

Q) Which among the following is the richest source of vitamin D?
 
A. Milk
B. Egg
C. Green leafy vegetables
D. Fish oil

Ans . D , Fish oil


The main natural source of vitamin D in the diet is in the livers of fish, which ingest ultraviolet-irradiated sterols (in phytoplankton and zooplankton) and store the vitamin D produced in their livers. A major source of vitamin D is its synthesis in the skin upon ultraviolet B (UV-B) (wavelength, 290–315 nm) exposure. Except for fish, food (unless fortified) contains only limited amounts of vitamin D. Vitamin D2 (ergocalciferol) is obtained from plant sources and is the chemical form found in some supplements.
 
Ref: Shoback D.M., Sellmeyer D.E. (2010). Chapter 17. Disorders of the Parathyroids & Calcium & Phosphorus Metabolism. In McPhee S.J., Hammer G.D. (Eds),Pathophysiology of Disease, 6e.
 

27 MAY 2014 

Q) Highest concentration of iodine is found in:
 
A. Eggs
B. Fresh water fish
C. Oyster
D. Poultry

Ans. C , Oyster


Fresh water fish do not contain iodine but sea fish do. Highest amount of iodine is found in lobsters and oysters.
 
Ref: Park, 22nd edition pg: 584
 

26 MAY 2014 

Q) Water hammer pulse is also known as:
 
A. Corrigan’s pulse
B. Duroziez pulse
C. Traube’s sign
D. Quincke pulsation

Ans .A,  Corrigan’s pulse


A rapidly rising "water-hammer" pulse, which collapses suddenly as arterial pressure falls rapidly during late systole and diastole (Corrigan's pulse), and capillary pulsations, an alternate flushing and paling of the skin at the root of the nail while pressure is applied to the tip of the nail (Quincke's pulse), are characteristic of free Aortic regurgitation.
 
Ref: Harrison’s principle of internal medicine 17th edition, chapter 230.
 

24 MAY 2014 

Q) The best parameter for assessment, of chronic malnutrition is :
 
A. Weight for age
B. Weight for height
C. Height for age
D. Any of the above

Ans C ,  Height for age

Explanation: 


Low height for age: This is also known as nutritional stunting or dwarfing. It reflects past or chronic malnutrition. The cut-off point commonly taken for the diagnosis of stunting is 90 per cent of the United States NCHS height-for-age values.
 
Ref : Park 22ed; p 503

23 MAY 2014

Q) The best parameter to measure air pollution is :

A. S02
B. C02
C. CO
D. N20

Ans . A , S02

Explanation


SO2 is the best indicator for monitoring air pollution & is estimated in all air pollution surveys.
 
Ref : Park 22ed; p 683

22 MAY 2014 

Q) All the following are pulmonary manifestations of systemic lupus erythematosus EXCEPT:
 

A.Pulmonary hemorrhage

B.Diaphragmatic dysfunction with loss of lung volumes

C.Pleuritis

D.Cavitary lung nodules
 

Ans.D , Cavitary lung nodules

EXPLANATION : 

Systemic lupus erythematosus (SLE) is an autoimmune disease in which organs and cells undergo damage initially mediated by tissue-binding autoantibodies and immune complexes.Pulmonary complications are common in patients with systemic lupus erythematosus (SLE). The most common manifestation is pleuritis with or without effusion. Other possible manifestations include pulmonary hemorrhage, diaphragmatic dysfunction with loss of lung volumes (the so-called shrinking lung syndrome), pulmonary vascular disease, acute interstitial pneumonitis, and bronchiolitis obliterans organizing pneumonia. Other systemic complications of SLE also cause pulmonary complications, including uremic pulmonary edema and infectious complications. Chronic progressive pulmonary fibrosis is not a complication of SLE. Cavitary lung nodules are typical of Wegener's granulomatosis but may also be seen in a variety of necrotizing lung infections.

Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 319. Systemic Lupus Erythematosus.


21 MAY 2014 

Q) Which of the following statements about consent is 'NOT TRUE':

A. Consent can only be valid if it is given by a person who is sane and has attained maturity, ie. age of 18 yrs
B. For sterilization of a married person, consent of both spouse, i.e. husband and wife is required
C. For artificial insemination, consent of the patient alone is required
D. In emergency situation, if no near relative is available, doctors can perform procedure/surgery necessary to save life even without consent, provided that the procedure intended is certified to be essential to save life of the patient by two doctors.

Ans . C , For artificial insemination, consent of the patient alone is required

Explanation : 

For artificial insemination, consent of both the spouses must be taken in writing and the whole procedure should be explained in detail. Other medico legal aspects regarding this are: identity of donor or recipient should not be revealed to each other, doctor conducting artificial insemination should not be involved in childbirth and semen should be obtained only through masturbation not by sexual intercourse.

  • A person above 18 years of age can give a valid consent to suffer any harm which may result from an act not intended or not known to cause death or grievous hurt.

  • Voluntary sterilization procedure is performed on a married person with the consent of both husband and wife.

  • According to doctrine of emergency, a doctor can give the treatment without taking consent from a patient that is gravely sick, unconscious or mentally ill. According section IPC 92 any procedure done in the benefit of a person without his consent in circumstances such as patient being impossible to sign consent, or if he is incapable of giving consent or has no guardian or other person in lawful charge of him is not considered an offence.

Ref: Concise Textbook Of Forensic Medicine & Toxicology  By Sharma page 113, Textbook of Forensic Medicine and Toxicology  By Jaypee Brothers, page 50.


20 MAY 2014 

Q) A 22 year old woman is 35 weeks pregnant and presents for her first evaluation. She is diagnosed with Chlamydia trachomatis infection of the cervix. Upon delivery, for what complication is her infant most at risk?

A.Conjunctivitis
B.Hydrocephalus
C.Hutchinson triad
D.Jaundice

Ans.A , Conjunctivitis
 
Chlamydia trachomatis is associated with up to 25% of exposed neonates who develop inclusion conjunctivitis. It can also be associated with pneumonia and otitis media in the newborn. Pneumonia in the newborn has been associated with later development of bronchitis and asthma. Hydrocephalus can be associated with toxoplasmosis. Hutchinson triad, which is Hutchinson teeth (blunted upper incisors), interstitial keratitis, and eighth nerve deafness, is caused by congenital syphilis. Sensorineural deafness can be associated with congenital rubella exposure. Treatment of C. trachomatis infection in infants consists of oral erythromycin.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 176. Chlamydial Infections.
 

19 MAY 2014  

Q) Which of the following is the immediate sign of death?

A. Fall in body temperature
B. Changes in eye
C. Changes in skin
D. Cessation of circulation and respiration

Ans D , Cessation of circulation and respiration

Explanation: 

Immediate signs of death are,
 

  • Insensibility and loss of voluntary power

  • Cessation of respiration

  • Cessation of circulation
     

Must know:

 

Early signs of death:
 

  • Algor mortis

  • Rigor mortis

  • Eye and Skin changes

  • Postmortem lividity

  • Primary flaccidity of muscles
     

Late signs of death:
 

  • Putrefaction

  • Adipocere formation

  • Mummification

Ref: Essentials of Forensic Medicine by Narayan Reddy, 27th edition, Page 134.
 


17 MAY 2014 

Q) Which of the following condition result in the ECG findings given below?


A. Hypokalemia
B. Hypercalcemia
C. Hypothermia
D. Heart block

Ans C , Hypothermia

ECG in the question is showing Osborn waves or J wave seen in hypothermia. The Osborn wave (J wave) is a positive deflection at the J point. It occur due to altered ventricular action potential characteristics. The height of the Osborn wave is roughly proportional to the degree of hypothermia.

Other ECG changes seen in hypothermia are:

  • Bradyarrhythmias (see below)

  • Prolonged PR, QRS an

  • d QT intervals

  • Shivering artefact

  • Ventricular ectopics

  • Cardiac arrest due to VT, VF or asystole

Ref: Goldberger A.L. (2012). Chapter 228. Electrocardiography. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds),Harrison's Principles of Internal Medicine, 18e.


16 MAY 2014

Q) Q fever is transmitted by:

A. Vector borne
B. Respiratory route
C. Fomite borne
D. None of the above

Ans B , 
Respiratory route

Explanation:

Q fever differs from other rickettsial infections in that there is no arthropod involved in the disease transmission to man. Transmission is most commonly by inhalation of infected dust contaminated by urine or faeces of diseased animals. 

Ref: Park 21st edition, page 276.
 

15 MAY 2014

Q) Dactylography is a:

A. Surest sign of identification
B. Probable sign of identification
C. Presumptive sign of identification
D. Doubtful sign of identification

Ans A , Surest sign of identification

Explanation: 


Dactylography is a study of fingerprints in which impressions of the papillary ridges and and furrows of the fingertips are taken. Its considered to be the surest sign of identification because the pattern, distribution, arrangement and character of the ridges are absolutely individualistic and are present from birth and remain unaltered throughout life.
 
Types of fingerprints are:
  • Loop- 65%
  • Whorl- 25%
  • Arch- 7%
  • Composite- 2-3%
Ridge pattern develops in 16th week of intrauterine life and maximum development is attained at 18-25 week of intrauterine life.
 
Ref: Forensic Medicine And Toxicology (oral, Practical & Mcq) By R. N. Karmakar page 129
 

14 MAY 2014
 
Troponin-T is a serological marker of which of the following condition?
 
A. Renal diseases
B. Muscular dystrophy
C. Cirrhosis of liver
D. Myocardial infarction

Ans D , Myocardial infarction

EXPLANATION


Troponin is a complex of three proteins found in skeletal and cardiac muscle. Plasma levels of Troponin I and T is a sensitive and specific indicator of damage to cardiac muscle. Levels of troponins rise 2-6h after myocardial infarction and will remain elevated for 4-10 days.
 
Troponin I most preferred because Troponin T can also be elevated by renal disease, polymyositis, or dermatomyositis.
 
CK MB isoenzyme of creatine kinase is much more cardiac specific than CK alone and may be useful in early diagnosis of acute MI. It is detected in the serum 4-6 hours after the onset of infarction and peaks in 12 to 24 hours and normalizes in 2-3 days.
 
Ref: Harper's Illustrated Biochemistry, 29e chapter 7.
 

13 MAY 2014

Q) Which of the following pathogens are cardiac transplant patients at unique risk for acquiring from the donor heart early after transplant when compared to other solid organ transplant patients?


A. Cryptococcus neoformans
B. Cytomegalovirus
C. Pneumocystis jiroveci
D. Toxoplasma gondii

ANS : D, 
Toxoplasma gondii

Explanation :


Toxoplasma cysts  reside in the heart. Thus, transplanting aToxoplasma-positive heart into a Toxoplasma-negative recipient may cause reactivation in the months after transplant. Serologic screening of cardiac donors and recipients for T. gondii is important. To account for this possibility, prophylactic doses of trimethoprim–sulfamethoxazole, which is also effective prophylaxis against Pneumocystis and Nocardia spp., is standard after cardiac transplantation. Cardiac transplant recipients, similar to all other solid organ transplant recipients, are at risk of developing infections related to impaired cellular immunity, particularly more than 1 month to 1 year posttransplant. 

 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 214. Toxoplasma Infections
 

12 MAY 2014 

Q) Feer’s disease is caused by toxicity of:

A.Arsenic
B.Antimony
C.Lead
D.Mercury

Ans . D , Mercury

 

Acrodynia is also known as Feer’s disease or pink disease. It is caused by mercury toxicity.
 
Ref : http://www.who.int/mediacentre/factsheets/fs361/en/index.html
 

10 MAY 2014

A mid-systolic click is heard upon auscultation of the chest in a 25 year old female who feels fine, otherwise. Later, echocardiography reveals the lesion depicted in this gross photograph of the heart (mitral valve). What underlying disease do you suspect that she has?

 

 

A. Marfan syndrome
B. Rheumatoid arthritis
C. Acquired immunodeficiency syndrome
D. Diabetes mellitus

Ans . A , Marfan syndrome

Explanation: 

The ballooning of the mitral cusp and long, thin chordae tendineae are typical features of a 'floppy' mitral valve that can be seen with Marfan syndrome.



09 MAY 2014 

Q) Postmortem rigidity first starts in which of the following organs?

A. Eyelids
B. Neck
C. Upper limbs
D. Lower limbs

Ans . A - Eyelids

Postmortem rigidity is first apparent in the smaller muscles such as jaw and eyelids and it then becomes evident in the remainder. 

Postmortem rigidity is the process whereby the muscle stiffens after death. As the amount of ATP within the muscles decreases after death, the actin and myosin fixes together to produce the stiffness of rigor mortis. 
  • In the initial 30 minutes after death there is no rigidity.
  • Between 30min and 3 hrs after death the limbs remain flaccid but there may be evidence of rigidity affecting the jaw and muscles of face.
  • Rigidity becomes established in all muscles groups by the time of 6hrs and remain so until 24-36h after death.
Ref: Oxford Handbook of Forensic Medicine By Jonathan P. Wyatt 

08 MAY 2014

Which of the following is true regarding infection risk after elective splenectomy?
 

A.Patients should be vaccinated 2 weeks after splenectomy.
B.Patients are at no increased risk of viral infection after splenectomy.
C.Splenectomy patients over the age of 50 are at greatest risk for postsplenectomy sepsis.
D.Staphylococcus aureus is the most commonly implicated organism in postsplenectomy sepsis.

Ans.A , Patients should be vaccinated 2 weeks after splenectomy.

The most serious consequence of splenectomy is increased susceptibility to bacterial infections, particularly those with capsules such as Streptococcus pneumoniae,Haemophilus influenzae, and some gram-negative enteric organisms.There is no known increased risk for any viral infections. Vaccination for S. pneumoniae, H. influenzae,and Neisseria meningitidis is indicated for any patient who may undergo splenectomy. The vaccines should be given at least 2 weeks before surgery. The highest risk of sepsis occurs in patients younger than 20 years of age because the spleen is responsible for first-pass immunity and younger patients are more likely to have primary exposure to implicated organisms. 
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 59. Enlargement of Lymph Nodes and Spleen.

07 MAY 2014

Q) All of the following statements regarding BCG vaccination are true EXCEPT:


A. BCG dissemination may occur in severely immunosuppressed patients.
B. BCG vaccination is recommended at birth in countries with high TB prevalence.
C. BCG vaccination may cause a false-positive tuberculin skin test result.
D. BCG vaccine provides protection from TB in HIV-infected patients.

ANS : D, 
BCG vaccine provides protection from TB in HIV-infected patients.

Explanation :

BCG was derived from an attenuated strain of M. bovis and was first administered to humans in 1921.Side effects from the vaccine are rare, but BCG dissemination (BCGitis) may occur in patients with severe combined immunodeficiency or advanced HIV-induced immune suppression. BCG cross-reacts with tuberculin skin testing, but the size of the response wanes with time. BCG vaccination is currently recommended in countries with a high TB prevalence. It is not recommended in the United States because of the low prevalence of disease and cross-reactivity with tuberculin skin testing. Infants with unknown HIV infection status, infants of mothers with known HIV infection, and HIV-infected individuals should not receive BCG vaccination.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 165. Tuberculosis
 

6 May 2014

Cobalamin absorption may occur in all of the following diseases EXCEPT:

 

A.Pernicious anemia
B.Chronic pancreatitis
C.Crohn's disease
D.Ulcerative coliti

Ans.D - Ulcerative coliti

Explanation :


Cobalamin is primarily present in meat, but dietary deficiency is rare except in strict vegans. 
Cobalamin malabsorption may occur due to disease at multiple anatomic sites extending from the stomach to the ileum.Cobalamin absorption has an absolute requirement for intrinsic factor, which allows uptake by specific receptors in the ileum. Intrinsic factor is produced and released by gastric parietal cells. Thus pernicious anemia, the autoimmune atrophy of parietal cells, is a cause of cobalamin malabsorption. Pancreatic protease enzymes lyse the cobalamin–R binder protein complex to release cobalamin in the proximal intestine where it is bound to intrinsic factor for ileal absorption. Thus a deficiency of pancreatic enzymes, such as in chronic pancreatitis, can lead to cobalamin malabsorption. Finally, cobalamin-intrinsic factor is absorbed via an intact epithelium in the ileum. Inflammation (Crohn's disease) or absence (surgical removal) of ileum will cause cobalamin malabsorption. The large intestine is not involved in cobalamin absorption; thus ulcerative colitis confined to the large intestine will not cause malabsorption.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 105. Megaloblastic Anemias.
 


5 May 2014 
 
Q) Which of the following organisms is most likely to be causative in acute appendicitis?

A.Clostridium species
B.Escherichia coli
C.Mycobacterium tuberculosis
D.Yersinia enterocolitica
 
Ans.D - Yersinia enterocolitica

Explanation :

Infection with Yersinia organisms may potentially cause acute appendicitis after obstruction occurs. High complement fixation antibody titers have been found in up to 30% of proven cases of acute appendicitis. Chronic appendicitis is quite rare, but may occur due to tuberculosis, amebiasis, and actinomycosis.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 159. Plague and Other Yersinia Infections.
 


3 May 2014

Q) In stage 5 chronic kidney disease the glomerular filtration rate is below:


A.50 mL/min per 1.73 m2
B.25 mL/min per 1.73 m2
C. 5 mL/min per 1.73 m2   
D. 15 mL/min per 1.73 m2

Ans.D - 15 mL/min per 1.73 m2

Explanation :
 
Chronic kidney disease is classified by glomerular filtration rate. In stage 0 patients, GFR is greater than 90 mL/min per 1.73 m2, stage 2 GFR is 60–89 mL/min per 1.73 m2, stage 3 GFR is 30–59 mL/min per 1.73 m2, and stage 4 GFR is 15–29 mL/min per 1.73 m2. Stage 5 GFR is less than 15 mL/min per 1.73 m2.

Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 280. Chronic Kidney Disease
 


2 MAY 2014

Q) Which of the following is required for the diagnosis of Behçet's disease?


A. Large-vessel vasculitis
B. Pathergy test
C. Recurrent genital ulceration
D. Recurrent oral ulceration

ANS : D, 
Recurrent oral ulceration

Explanation :


Behçet's syndrome is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement.Recurrent oral ulceration is required for the diagnosis of Behçet's disease. The ulcers may be single or multiple, are shallowly based with a yellow necrotic base, and are painful. They are generally small, less than 10 mm in diameter. The diagnosis of Behçet's also requires two of the following: recurrent genital ulceration, eye lesions, skin lesions, and pathergy test. Nonspecific skin inflammatory reactivity to any scratches or intradermal saline injection (pathergy test) is common and specific.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 327. Behçet's Syndrome.



1 MAY 2014 

Q)The pain associated with acute urinary tract obstruction is a result of which of the following?

A.Compensatory natriuresis
B.Decreased medullary blood flow
C.Vasodilatory prostaglandins
D.Increased renal blood flow

Ans.D - Increased renal blood flow

EXPLANATION


In acute urinary tract obstruction, pain is due to distention of the collecting system or renal capsule. Acutely, there is a compensatory increase in renal blood flow when kidney function is impaired by obstruction, which further exacerbates capsular stretch. Eventually, vasodilatory prostaglandins act to preserve renal function when glomerular filtration rate has decreased. Medullary blood flow decreases as the pressure of the obstruction further inhibits the renal parenchyma from perfusing; however, the ensuing chronic renal destruction may occur without substantial pain. When an obstruction has been relieved, there is a postobstructive diuresis that is mediated by relief of tubular pressure, increased solute load (per nephron), and natriuretic factors. There can be an extreme amount of diuresis, but this is not painful.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 289. Urinary Tract Obstruction.


30 APRIL 2014

Q) All of the following factors influence the likelihood of transmitting active tuberculosis EXCEPT :


A. Duration of contact with an infected person
B. Environment in which contact occurs
C. Presence of laryngeal tuberculosis
D. Presence of extrapulmonary tuberculosis

ANS : D, Presence of extrapulmonary tuberculosis

Explanation :

Tuberculosis is most commonly transmitted from person to person by airborne droplets. Factors that affect the likelihood of developing tuberculosis infection include the probability of contact with an infectious person, the intimacy and duration of contact, the degree of infectiousness of the contact, and the environment in which the contact takes place. The most infectious patients are those with cavitary pulmonary or laryngeal tuberculosis with about 105 to 107 tuberculous bacteria per milliliter of sputum. Individuals who have a negative acid-fast bacillus smear with a positive culture for tuberculosis are less infectious but may transmit the disease. However, individuals with only extrapulmonary (e.g., renal, skeletal) tuberculosis are considered noninfectious.

Ref: Harrison's Principles of Internal Medicine, 18e, Chapter 165. Tuberculosis.



29 APRIL 2014
 
Q) All of the following syndromes are associated with obesity EXCEPT:

A. Insulinoma
B. Cushing's syndrome
C. Hypothyroidism
D. Acromegaly

ANS : D, Acromegaly

Explanation :

Patients with Cushing's syndrome have central obesity, hypertension, and glucose intolerance. Hypothyroidism is associated with obesity due to decreases in metabolic rate; however, it is a rare cause of obesity. Individuals with insulinoma often are obese, as they increase their caloric intake to try to prevent hypoglycemia episodes. Finally, individuals with hypothalamic dysfunction due to craniopharyngioma or other disorders lack the ability to respond to typical hormonal signals that indicate satiety, and therefore develop obesity. Acromegaly is not associated with obesity.

 
Ref: Harrison's Principles of Internal Medicine, 18e, Chapter 77. Biology of Obesity.
 

28 APRIL 2014

All of the following laboratory values are consistent with an intravascular hemolytic anemia EXCEPT:

 

A.Increased reticulocyte count
B.Increased lactate dehydrogenase (LDH)
C.Increased haptoglobin
D.Increased unconjugated bilirubin

Ans.C .Increased haptoglobin

Explanation : 


Haptoglobin is an α-globulin normally present in serum. It binds specifically to the globin portion of hemoglobin, and the complex is cleared by the mononuclear cell phagocytosis. Haptoglobin is reduced in all hemolytic anemias because it binds free hemoglobin. It can also be reduced in cirrhosis and so is not diagnostic of hemolysis outside of the correct clinical context. Assuming normal bone marrow and iron stores, the reticulocyte count will be elevated as well to try to compensate for the increased red blood cell (RBC) destruction of hemolysis. Release of intracellular contents from the RBC (including hemoglobin and lactate dehydrogenase) induces heme metabolism, producing unconjugated bilirubinemia. 
Ref: Harrison's Principles of Internal Medicine, 18e, Chapter 106. Hemolytic Anemias and Anemia Due to Acute Blood Loss.
 

26 APRIL 2014

Which of the following organisms is not likely to be found in the sputum of a patient with cystic fibrosis?

A.Haemophilus influenzae
B.Burkholderia cepacia
C.Acinetobacter baumannii
D.Aspergillus fumigatus

Ans.C , Acinetobacter baumannii

Explanation :


CF is an autosomal recessive disease resulting from mutations in the CFTR gene located on chromosome 7. Patients with cystic fibrosis are at risk for colonization and/or infection with a number of pathogens, and in general these infections have a temporal relationship. In childhood, the most frequently isolated organisms are Haemophilus influenzae and Staphylococcus aureus. As patients age, Pseudomonas aeruginosa becomes the predominant pathogen. Interestingly, Aspergillus fumigatus is found in the airways of up to 50% of cystic fibrosis patients. All these organisms merely colonize the airways but occasionally can also cause disease. Burkholderia(previously called Pseudomonas) cepacia can occasionally be found in the sputum of cystic fibrosis patients, where it is always pathogenic and is associated with a rapid decline in both clinical parameters and pulmonary function testing. Atypical mycobacteria can occasionally be found in the sputum but are often merely colonizers.Acinetobacter baumannii is not associated with cystic fibrosis; rather, it is generally found in nosocomial infections.

Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 259. Cystic Fibrosis.



25 APRIL 2014

Q) In patients with established rheumatoid arthritis, all of the following pulmonary radiographic findings may be explained by their rheumatologic condition EXCEPT
:


A. Bilateral interstitial infiltrates
B. Lobar infiltrate
C. Bronchiectasis
D. Solitary pulmonary nodule

ANS : B, Lobar infiltrate

Explanation :

 

Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by a symmetric, peripheral polyarthritis.There is potential involvement of multiple organ systems in RA. The most common pulmonary complication is pleural effusion that is typically exudative and presents with chest pain and dyspnea. RA is associated with a form of diffuse interstitial lung disease that may present with dyspnea and bilateral interstitial infiltrates that may be extensive enough to develop into a honeycomb pattern. Pulmonary nodules associated with RA may be solitary or multiple. They often occur in conjunction with cutaneous nodules. Bronchiectasis and respiratory bronchiolitis may also be due to RA. Many of these manifestations respond to immunosuppressive therapy. Lobar infiltrate has not been described due to RA and is more commonly due to an acute infectious etiology, often as a complication of RA immunosuppressive therapy.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 321. Rheumatoid Arthritis

 


24 APRIL 2014

Q) Which of the following are features of Beck's triad in cardiac tamponade?

A. Hypotension, electrical alternans, prominent x-descent in neck veins
B. Hypotension, muffled heart sounds, electrical alternans
C. Hypotension, muffled heart sounds, jugular venous distention
D. Kussmaul's sign, hypotension, muffled heart sounds

ANS : C, Hypotension, muffled heart sounds, jugular venous distention

Explanation :

Beck's triad can be used to alert clinicians to the potential presence of cardiac tamponade. The principal features are hypotension, muffled or absent heart sounds, and elevated neck veins, often with prominent x-descent and absent y-descent. These are due to the failure of ventricular filling and limited cardiac output. Kussmaul's sign is seen in restrictive cardiomyopathy and pericardial constriction, not tamponade. Friction rub may be seen in any condition associated with pericardial inflammation.


Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 239. Pericardial Disease.


23 APRIL 2014

Q) All of the following are risk factors for the development of peripartum cardiomyopathy EXCEPT:


A. Advanced maternal age
B. Primiparity
C. Malnutrition
D. Twin pregnancy

ANS : B, 
Primiparity

Exaplanation :

Peripartum cardiomyopathy is a rare complication of pregnancy and can occur during the last trimester or within the first 6 months postpartum. Risk factors include advanced age, increased parity, twin pregnancy, malnutrition, use of tocolytic therapy for premature labor, and preeclampsia.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 7. Medical Disorders During Pregnancy.
 

22 APRIL 2014

Q) All of the following are associated with an increased risk for cholelithiasis EXCEPT:


A. Pregnancy
B. Female sex
C. Obesity
D. High-protein diet

ANS : D, High-protein diet

Explanation :

Cholesterol stones are responsible for 80% of cases of cholelithiasis; pigment stones account for the remaining 20%. Cholesterol is essentially water insoluble. Stone formation occurs in the setting of factors that upset cholesterol balance. Obesity, cholesterol-rich diets, high-calorie diets, and certain medications affect the biliary secretion of cholesterol. Intrinsic genetic mutations in certain populations may affect the processing and secretion of cholesterol in the liver. Pregnancy results in both an increase in cholesterol saturation during the third trimester and changes in gallbladder contractility. Pigment stones are increased in patients with chronic hemolysis, cirrhosis, Gilbert's syndrome, and disruptions in the enterohepatic circulation. Although rapid weight loss and low-calorie diets are associated with gallstones, there is no evidence that a high-protein diet confers an added risk of cholelithiasis.

Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 311. Diseases of the Gallbladder and Bile Ducts.
 

21 APRIL 2014

Q) A 22 year old man is diagnosed with post-streptococcal glomerulonephritis. Which of the following is likely to be found in his urine?


A. Greater than 3 g/24-hour proteinuria without hematuria
B. Microscopic hematuria with leukocytes and 24-hour urinary albumin of 227 mg
C. Macroscopic hematuria and 24-hour urinary albumin of 227 mg
D. Positive urine culture for Streptococcus

 

ANS : B, Microscopic hematuria with leukocytes and 24-hour urinary albumin of 227 mg

Explanation :

The hallmark of glomerular renal disease is microscopic hematuria and proteinuria. IgA nephropathy and sickle cell disease are the exception to this when gross hematuria may be present. Proteinuria may be heavy (>3 g/24 hours) or lower quantity with microalbuminuria (30–300 mg/24 hours) depending on the underlying disease or site of the immune lesion. Patients with poststreptococcal glomerulonephritis often have pyuria, but cultures are not expected to be positive as the infection is usually skin or mucosal, and it is the immune reaction that drives the renal lesion.

Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 283. Glomerular Diseases.

 


19 APRIL 2014 

All of the following are characteristic extraarticular manifestations of rheumatoid arthritis EXCEPT:

A.Anemia
B.Cutaneous vasculitis
C.Pericarditis
D.Thrombocytopenia

Ans.D,Thrombocytopenia

Explanation :

 
Subcutaneous nodules, secondary Sjögren's syndrome, pulmonary nodules, and anemia are among the most frequently observed extraarticular manifestations in RA(Rheumatoid arthritis).Anemia is common in RA and parallels the degree of inflammation as measured by C-reactive protein or ESR. Felty's syndrome, typically occurring in late-stage, poorly controlled disease, is characterized by the triad of neutropenic, splenomegaly, and rheumatoid nodules. Rheumatoid vasculitis is not common and typically occurs in long-standing disease. It is associated with hypocomplementemia. The cutaneous signs are typical of vasculitic lesions with palpable purpura, digital infarcts, livedo reticularis, and ulcers. Clinical manifestations of pericarditis occur in 10% of patients, with echocardiographic or autopsy findings in about half of those cases. RA also appears to increase the risk of developing B-cell lymphoma by two to four times in the general population. The risk of lymphoma appears to correlate with high levels of disease activity or the presence of Felty's syndrome. Platelet counts in RA are typically elevated in association with the acute phase response of inflammation. Immune thrombocytopenia is rare.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 321. Rheumatoid Arthritis.


18 APRIL 2014

Q) Which of the following is the most frequent site of joint involvement in established rheumatoid arthritis (RA)?


A.Distal interphalangeal joint
B.Hip
C.Knee
D.Wrist

ANS : D, Wrist

Explanation :

Once the disease process of rheumatoid arthritis is established, the most common joints of involvement are the wrists, metacarpophalangeal joints, and proximal interphalangeal joints. Distal interphalangeal joint involvement is rarely due to rheumatoid arthritis and more often due to coexisting osteoarthritis.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 321. Rheumatoid Arthritis.
 

17 APRIL 2014

Q) A sputum culture from a patient with cystic fibrosis showing which of the following organisms has been associated with a rapid decline in pulmonary function and a poor clinical prognosis?


A.Burkholderia cepacia
B.Pseudomonas aeruginosa
C.Staphylococcus aureus
D.Staphylococcus epidermidis

ANS : A, 
Burkholderia cepacia

Explanation :


B. cepacia gained notoriety as the cause of a rapidly fatal syndrome of respiratory distress and septicemia (the “cepacia syndrome”) in CF patients.

Burkholderia cepacia is an opportunistic pathogen that has been responsible for nosocomial outbreaks. It also colonizes and infects the lower respiratory tract of patients with cystic fibrosis, chronic granulomatous disease, and sickle cell disease. In patients with cystic fibrosis, it portends a rapid decline in pulmonary function and a poor clinical prognosis. It also may cause a resistant necrotizing pneumonia. B. cepacia is often intrinsically resistant to a variety of antimicrobials, including many β-lactams and aminoglycosides. Trimethoprim–sulfamethoxazole (TMP/SMX) is usually the first-line treatment. Pseudomonas aeruginosa and Staphylococcus aureus are common colonizers and pathogens in patients with cystic fibrosis. 
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 152. Infections Due to Pseudomonas Species and Related Organisms.
 

15 APRIL 2014

Which of the following is not one of Bleuler’s symptoms of Schizophrenia?

A. Autism
B. Association
C. Ambivalence
D. Apathy
 
Ans: D. Apathy
 
Explanations:
 
Bleuler specifically identified four components (also known as Bleuler's “four A’s”) as the essence of schizophrenia: Autism (i.e., a disconnect from reality), Ambivalence (of affect and will), Affectivity (in Bleuler's words: an “indifference to everything”), and Association (in Bleuler's words: “the associations lose their continuity”).
 
Ref:
1. CURRENT Diagnosis & Treatment: Psychiatry, 2e. Meltzer H.Y., Bobo W.V., Heckers S.H., Fatemi H.S. (2008). Chapter 16. Schizophrenia. In Ebert M.H., Loosen P.T., Nurcombe B, Leckman J.F. (Eds).

 


14 APRIL 2014
 
2. Which of the following statements is false regarding DSM-5 diagnosis of Anorexia Nervosa?
 
A. Amenorrhea is required for the diagnosis
B. BMI 15–15.99 kg/m2 indicates severe anorexia nervosa
C. Undue influence of body weight or shape on self-evaluation
D. Intense fear of gaining weight
 
Answer: A Amenorrhea is required for the diagnosis
 
Explanation
The core diagnostic criteria for anorexia nervosa are conceptually unchanged from DSM-IV with one exception: the requirement for amenorrhea is eliminated. 
 
Ref:
1. DSM V 307.1, Anorexia Nervosa.


13 APRIL 2014

At least one of the following is necessary for the diagnosis of Schizophrenia according to DSM-5, except?

A. Delusions
B. Hallucinations
C. Disorganized speech
D. Special attribution of bizarre delusions

Ans: D. Special attribution of bizarre delusions

Explanation:

Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or avolition).

 

Note: Changes to Schizophrenia in DSM-5

Two changes were made to Criterion A for schizophrenia:


1) the elimination of the special attribution of bizarre delusions and Schneiderian first-rank auditory hallucinations (e.g., two or more voices conversing), leading to the requirement of at least two Criterion A symptoms for any diagnosis of schizophrenia, and


2) the addition of the requirement that at least one of the Criterion A symptoms must be delusions, hallucinations, or disorganized speech.

Ref:

1. DSM V 295.90 (F20.9), Schizophrenia.

 

11 APRIL 2014

Which of the following biochemical tests is most likely to be within the normal range in a healthy, active individual with Paget's disease?

A. Serum C-telopeptide
B. Serum alkaline phosphatase
C. Serum N-telopeptide
D. Serum calcium

ANS :D, Serum calcium

Explanation :

Paget's disease is a localized bone-remodeling disorder that affects widespread, noncontiguous areas of the skeleton.Pathologically, the disease is initiated by overactivity of osteoclasts leading to high bone turnover and subsequent increase in osteoblastic activity, resulting in both lytic and sclerotic lesions in bone. Biochemically, there is typically evidence of high bone turnover, with an elevation in alkaline phosphatase being the characteristic biochemical abnormality that is used for both diagnosis of Paget's disease as well as response to treatment. Other markers of high bone resorption are the C- and N-telopeptides, which are typically elevated in both the serum and urine. These proteins decline more rapidly in response to therapy than alkaline phosphatase.However, serum calcium is always normal in those with Paget's disease unless the person becomes immobilized.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 355. Paget's Disease and Other Dysplasias of Bone.

10 APRIL 2014

Q) A 25 year old woman is newly diagnosed with systemic lupus erythematosus. Which of the following organ system complications is she most likely to have over the course of her lifetime?

A.Cardiopulmonary
B.Cutaneous
C.Renal
D.Musculoskeletal

ANS : D, 
Musculoskeletal

Explanation :

Systemic lupus erythematosus is a multisystem disease with diverse organ involvement and multiple different manifestations within an organ system. The system most commonly involved is the musculoskeletal system, with 95% of patients having involvement, usually as arthralgias or myalgias. Arthritis is also common and is one of the diagnostic criteria for SLE. Cutaneous disease occurs in approximately 80–85% of patients. Neurological and cardiopulmonary diseases affect approximately 60% of patients, while renal and gastrointestinal diseases occur in less than 50% of cases.


Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 319. Systemic Lupus Erythematosus.


09 APRIL 2014

Most of the patients with chronic hypoventilation disorders often complain of a headache upon awakening. What is the cause of this symptom?


A.Polycythemia
B.Cerebral vasoconstriction
C.Cerebral vasodilation
D.Arousals from sleep

ANS : C, Cerebral vasodilation

Explanation :

The physiologic effects of hypoventilation are typically magnified during sleep because of a further reduction in central respiratory drive. Hypercapnia causes cerebral vasodilation, which manifests as headache upon awakening. The headache typically resolves soon after awakening as cerebral vascular tone returns to normal with increased ventilation.Hypoventilation causes an increase in PCO2 and an obligatory fall in PO2. The hypoxemia can stimulate erythropoiesis and result in polycythemia. With central hypoventilation disorders, patients may also have impaired cranial nerve reflexes or muscular function, causing aspiration.
 
Ref: Harrison's Principles of Internal Medicine, 18e,Chapter 267. Approach to the Patient with Critical Illness.

08 APRIL 2014

Q) Which of the following biochemical tests distinguishes S. aureus from S. epidermidis?


A. Coagulase
B. Catalase
C. Lactose fermentation
D. Oxidase

ANS : A, 
Coagulase

Explanation :

Whereas all staphylococci are catalase positive, streptococci are catalase negative. Whereas S. aureus are coagulase positive, Staphylococcus epidermidis (as well as S. hominis, S. saprophyticus, and others) are coagulase negative. This is the initial result that can make this important clinical distinction. Lactose fermentation is used to distinguish many gram-negative bacteria.Salmonella, Proteus, and Shigella spp. and Pseudomonas aeruginosa are unable to ferment lactose. The oxidase test is commonly used to identify P. aeruginosa.

 
Ref: Harrison's Principles of Internal Medicine, 18e, Chapter 119.Introduction to Infectious Diseases
 

07 APRIL 2014

Q) Which of the following organs putrefy last in a male?


A) Uterus
B) Prostate
C) Testes
D) Liver

ANS : B, 
Prostate

Explanation :


Prostate is the last organ to putrefy in males. In females, non gravid uterus is the last organ to putrefy. Gravid or postpartum uterus putrefies early.

The sequence of putrefaction in internal organs:
Organs which putrefy early are:
  • Brain
  • Mucosa of trachea and larynx
  • Stomach and intestine
  • Spleen
  • Liver
Organs that putrefy late are:
  • Esophagus
  • Diaphragm
  • Heart
  • Lungs
  • Kidney
  • Urinary bladder
  • Uterus
  • Prostate
     
Ref: Principles of Forensic Medicine and Toxicology  By Rajesh Bardale page 155.
 

05 APRIL 2014

Q) The plain X-Ray abdomen shown below was taken after a 36 Year old lady presented with abdominal symptoms. This may be useful in the diagnosis of:


A) Emphysematous cholecystitis
B) Acute cholecystitis
C) Hilar cholangiocarcinoma
D) Periampullary carcinoma



ANS : A, Emphysematous cholecystitis

Explanation :


Plain X-ray abdomen showing gas in the gall bladder suggestive of emphysematous cholecystitis.

Usually, the diagnosis is made by the radiographic presence of air within the gallbladder wall or lumen. 

Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2619
Table 311-2 Diagnostic Evaluation of the Gallbladder.

 

04 APRIL 2014

This is the upper GI scopy finding of a patient with HIV infection who presented with dysphagia. Identify the lesions:

A) Esophageal candidiasis
B) Glycogenic acanthosis of esophagus
C) Esophageal varices
D) Esophageal adenocarcinoma



ANS : A, Esophageal candidiasis

Explanation :

 

Candidiasis, a well-known opportunistic infection of AIDS patients, is the leading cause of infectious esophagitis.
 
Diagnosis of esophageal candidiasis is usually based on the endoscopic appearance of
the typical mucosal lesions Diagnosis of this disease in AIDS patients can be made on clinical findings alone.
 
Ref: Emerging Infectious Diseases;Vol. 5, No. 2, MarchÂ�April 1999
 

03 APRIL 2014

Q) A 20 year old college student working part-time in a pediatric AIDS clinic develops a viral exanthem with a rash. Her blood is drawn and tested for specific antibodies to varicella-zoster (chickenpox). Anti-varicella immunoglobulin belonging to which of the following antibody classes would indicate that she is immune to chickenpox?


A) IgA
B) IgD
C) IgE
D) IgG

ANS : D, 
IgG


Explanation :


The immunoglobulin that represents past exposure to an antigen is IgG. It is the predominant antibody in the secondary response and is an important defense against bacteria and viruses. In the secondary response, a much larger amount of IgG antibody is produced than IgM, and the levels of IgG tend to persist for a much longer time than in the primary response.
IgA , the main immunoglobulin found in secretions, prevents the attachment of bacteria and viruses to mucosal surfaces. It does not bind complement.
IgD probably functions as an antigen receptor. It is found on the surface of many B lymphocytes and is found in small amounts in serum.
IgE is the primary antibody in type I hypersensitivity. It mediates the anaphylactic response and also participates in host defenses against parasites (antibody-dependent cell-mediated cytotoxicity-ADCC).
 
Ref: Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (2013). Chapter 8. Immunology. In G.F. Brooks, K.C. Carroll, J.S. Butel, S.A. Morse, T.A. Mietzner (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.

02 APRIL 2014
 
Q) Protective bacterium in normal vagina is:
 
A) Trichomonas
B) Peptostreptococcus
C) Gardenella
D) Lactobacillus
 
Correct answer : D,  Lactobacillus
 
Vagina is normally colonised by Doderlain’s bacteria which is a lactobacillus that converts the glycogen present in vaginal epithelium into lactic acid. Thus pH of vagina is acidic.
 
Ref: VAGINA Dutta Gyn. 5th edition, page-7

 


 

01 APRIL 2014

Q) What is Mirena?


A. Drug used in inducing abortions
B. Antiprogesterone oral pill
C. Progesterone intra-uterine device
D. Hormonal implant

ANS : C, 
Progesterone intra-uterine device

Explanation :

Mirena is a progesterone intrauterine contraceptive device.

  • Life span is 5 years
  • Failure rate; 0.1-0.4/ HWY



Ref: CONTRACEPTIVE
Shaw 15th edition: page; 228.


31 MARCH 2014

Q) Wernicke’s encephalopathy is caused by deficiency of :


A) Thiamine
B) Niacin
C) Riboflavin
D) All of the abov

ANS : A, 
Thiamine

Explanation :

Alcoholic patients with chronic thiamine deficiency may also have central nervous system manifestations known as Wernicke's encephalopathy, consisting of horizontal nystagmus, ophthalmoplegia (due to weakness of one or more extraocular muscles), cerebellar ataxia, and mental impairment.

Ref: Harrison’s principle of internal medicine 17th edition, chapter 71.
 


29 MARCH 2013

Q) Wilson’s disease is caused by mutation in:


A) ATP7A
B) ATP7B
C) HFE
D) HAMP

ANS : B, 
ATP7B

Explanation :

Wilson disease is an autosomal recessive disorder caused by mutation of the ATP7B gene, resulting in impaired copper excretion into bile and a failure to incorporate copper into ceruloplasmin.

Ref: Robbins 8th edition Chapter 18.
 

28 MARCH 2014 : 

Q) Epornithic is:


A) Epidemic outbreak among birds
B) Epidemic outbreak among fishes
C) Disease imported into a country from foreign country
D) Epidemic outbreak among animals

ANS : A, 
Epidemic outbreak among birds

Explanation :

EPORNITHIC: It is an outbreak (epidemic) of disease in a bird population.

EPIZOOTIC: It is an epidemic of disease in an animal population (often with the implication that it may also affect human populations). Only a few zoonotic agents cause major epidemics. Examples are anthrax, brucellosis, rabies, influenza, Rift valley fever, Japanese encephalitis and equine encephalitis. 

ENZOOTIC: It is an endemic occurring in animals. Examples include anthrax, rabies, brucellosis, bovine tuberculosis, endemic typhus.
 
Ref: Park 21st edition, page 89.
 

27 MARCH 2014

Q) Which of the following is the most common tumours of heart?


A) Myxoma
B) Lipoma
C) Rhabdomyoma
D) None of the above

ANS : A, 
Myxoma

Explanation :

Myxomas are the most common primary tumor of the heart in adults. They are benign neoplasms often associated with clonal abnormalities of chromosomes 12 and 17 that are thought to arise from primitive multipotent mesenchymal cells.

Although they may arise in any of the four chambers, about 90% are located in the atria with a left-to-right ratio of approximately 4:1.

Ref: Robbins 8th edition Chapter 2.
 

26 MARCH 2014

Q) Koilonychia is a feature of which of the following conditions?


A) Iron deficiency
B) Cirrhosis
C) Pancreatitis
D) None of the above

ANS : A, 
Iron deficiency

Explanation :

Koilonychia refers to presence of thin spoon shaped nails. It is a physiologic change in the toe nails of children, but in adults it indicates iron deficiency anemia or occupational damage to the nail plate.
 
Nail pitting: They appear as small punctate depressions of the superficial nail plate, which progress distally and become more evident with nail growth. Deep and irregularly distributed pits are seen in psoriasis and atopic dermatitis. Geometric and superficial pits are seen in alopecia areata.
 
Ref: Tosti A., Piraccini B.M. (2012). Chapter 89. Biology of Nails and Nail Disorders. In L.A. Goldsmith, S.I. Katz, B.A. Gilchrest, A.S. Paller, D.J. Leffell, N.A. Dallas (Eds), Fitzpatrick's Dermatology in General Medicine, 8e.
 

25 MARCH 2014

Q) Highest amount of vitamin D content among the following is seen in :


A) Egg
B) milk
C) butter
D) cod liver oil

ANS : D, Cod Liver Oil

Explanation :

Dietary sources of vitamin D:

DISINFECTANT

Μg/100 g

Egg

1.25-1.5

butterl

10.5-1.5

Milk

0.1

Cod liver oil

200-750

Halibut liver oil

500-10,000

Ref: Park 22nd edition, page 572


24 MARCH 2014

Q) Commonest primary site of Krukenberg tumour is:


A) Stomach
B) Liver
C) Colon
D) Breast

ANS : A, Stomach

Explanation :

Krukenberg tumour is a metastatic tumour of the ovary arising in the gastrointestinal tract, typically the stomach.
 
Ref: OVARIAN CARCINOMA
Shaw 15th edition: page; 426.

 


22 MARCH 2014 

Q) Absolute contraindication to intra-uterine device is:

A) Anaemia
B) History of ectopic pregnancy
C) History of pelvic inflammatory disease
D) None of the above

Correct answer : B , History of ectopic pregnancy

Explanation :

Absolute contraindications to intra uterine devices are:
  • History of ectopic pregnancy
  • Suspected pregnancy
  • Pelvic inflammatory disease
  • Vaginal bleeding of unknown etiology
  • Cancer of cervix, uterus, adnexa and other pelvic tumours

 

Ref: Park, 22nd edition pg: 449;Park 21st Ed Page 460.

 

 

21 MARCH 2014

Q) Which of the following is most commonly implicated in causing genital warts?
 


A) HPV 16
B) HPV 6
C) HPV 18
D) HPV 28

ANS : HPV 6

Explanation :

HPV types 6 and 11 cause nearly all genital warts.

Ref: Williams Gynaecology 1 st edition page 619.


20 MARCH 2014 

 Q) Which among the following is the commonest cause of postpartum haemorrhage?
 
A) Vaginal laceration
B) Cervical tear
C) Coagulopathy
D) Uterine atony
 
Correct answer : D ,Uterine atony
 
Postpartum hemorrhage refers to excessive bleeding more than 500 ml following delivery. Uterine atony is the most common cause of PPH. Atony exist when the myometrium cannot contract and cannot control bleeding by constricting the blood vessels.
 
  • Predisposing causes of atony are:
  • Excessive manipulation of the uterus
  • General anesthesia 
  • Uterine overdistension 
  • Prolonged labor
  • Grand multiparity
  • Uterine leiomyomas, 
  • Previous hemorrhage in the third stage
  • Uterine infection
  • Couvelaire uterus
  • Intrinsic myometrial dysfunction 
Ref: Poggi S.B. (2013). Chapter 21. Postpartum Hemorrhage & the Abnormal Puerperium. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds),CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

19 MARCH 2014


Q) CA-125 is a marker antigen for the screening of the following malignancy:

A) Prostate cancer
B) Breast cancer
C) Brain cancer
D) Ovarian cancer

ANS : D, 
Ovarian cancer

Explanation :

CA125 is a glycoprotein that is not produced by normal ovarian epithelium, but may be produced by both benign and malignant ovarian tumors. Most commonly, cancer antigen 125 (CA125) level measurements and/or transvaginal sonography have been used for screening of ovarian tumors in suspected individuals.
 
Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 35. Epithelial Ovarian Cancer. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.
 

18 MARCH 2014

Q) Which of the following investigation is BEST used for placental localization?


A) X-ray
B) Ultrasonography 
C) Amniography
D) Clinically

ANS : B, 
Ultrasonography

Explanation :

The most accurate method for localisation of placenta is ultrasonogram.

 
Its advantages are:
  • It carries no risk to mother and fetus.
  • It is the only method by which edge of the placenta can be seen, which helps in deciding the mode of delivery.
  • Placental tissue shows up an area of fine speckling. Its fetal surface appear as a fine line and is seen readily when the placenta is attached to the anterior uterine wall. When on the posterior wall it is not so easily seen unless there is a sufficient interface between the pool of liquor and the placenta.
Ref: Manual Of Obstetrics (2Nd Edition)  By Daftary page 233.
 

17 MARCH 2014

Q) Which among the following is the MOST diagnostic sign of pregnancy?


A) Amenorrhoea
B) Quickening
C) Foetal heart sounds
D) Distention of abdomen

ANS : C, 
Foetal heart sounds

Explanation :

Presence of fetal heart sounds is an absolute diagnostic sign of pregnancy.
 
Other absolute signs of pregnancy are:
  • Palpation of fetal parts and perception of active fetal movements
  • Ultrasonographic evidence of gestational sac and embryo in early pregnancy and later.
Probable signs:
  • Change in size, shape and consistency of uterus
  • Softening of cervix
  • Osiander’s sign, Chadwick’s sign, Goodell sign
  • Abdominal enlargement
  • Braxton Hicks contraction
  • External and internal ballottement
Ref: Essential of Obstetrics By Arulkumaran page 39


14 MARCH 2014

Q) Commonest complication following intra uterine device insertion is:


A. Bleeding
B. Pain
C. Pelvic infection
D. Uterine perforation

ANS : A, Bleeding

Explanation :


The commonest complication following IUD insertion is increased vaginal bleeding. Greatest blood loss is caused by larger non medicated devices.

Ref: Park, 22nd edition pg: 459


13 MARCH 2014

Q) The hard chancre is seen in:


A) Syphilis
B) Chancroid
C) LGV
D) Granuloma inguinale

ANS : A, 
Syphilis

Explanation :

The hard chancre /hunterian chancre/primary chancre in syphilis is a single, painless, indurated ulcer. 

NOTE:
 
Other chancres in syphilis:
 
Condom chancre- at root of penis, felon chancre - extragenital chancre in finger, chancre redux- lesion similar to primary at the site of chancre during relapse, Pseudochancre redux- gumma at the site of primary.
 
Other chancres in venereology: 
 
Soft chancre- chancroid, mixed chancre- both hard and soft occuring simultaneously in an individual.
 
Ref: Sexually transmitted infections, Bhushan Kumar, 2nd edition, page 433-435.
 

12 MARCH 2014

Q) Under the RNTCP, sputum culture for MDR TB is to be examined for at least:


A) 4 weeks
B) 8 weeks
C) 10 weeks
D) 12 weeks

ANS : B, 
8 weeks

Explanation :


All cultures should be examined 48-72 hours after inoculation to detect gross contaminants. Thereafter cultures are examined weekly, up to 8 weeks on a specified day of the week. 

 
Ref: http://health.bih.nic.in/Docs/Guidelines/Guidelines-DOTS-Plus.pdf
 

11 MARCH 2013:

Q) India is in which stage of demographic cycle at present?


A) High stationary
B) Early expanding
C) Late expanding
D) Low stationary

ANS : C, 
Late expanding

Explanation :


Third stage (late expanding): The death rate of the population is on declining trend. The birth rates are also falling. The population continues to grow as birth rate exceeds deaths. India is currently in this phase.

 
Ref: Park, 22nd edition pg: 441
 


10 MARCH 2014 : 

Virchow's triad includes all of the following components, EXCEPT:
 
A) Venous stasis
B) Injury to veins
C) Blood hypercoagulability
D) Venous thrombosis

ANS : D , Venous thrombosis


The three primary influences on thrombus formation that constitutes the Virchow’s triad are endothelial injury, venous stasis and hypercoagulability. 
 
Endothelial injury is dominant and can independently cause thrombosis. Thrombosis can result from exposed subendothelial ECM, increased platelet adhesion or procoagulant production or reduced anticoagulant activity.
 
Alteration in normal blood flow: promote thrombosis. Stasis and turbulence:
  • Disrupt laminar flow and brings platelets into contact with the endothelium.
  • Prevent dilution of activated clotting factors by flowing blood.
  • Retard the inflow of clotting inhibitors.
  • Promote endothelial cell activation.
Hypercoagulability is loosely defined as any alteration of the coagulation pathways that predispose to thrombosis.
 
Ref: Pocket Companion to Robbins and Cotran Pathologic Basis of Disease  By Vinay Kumar, page 75.


7 MARCH 2014 : 

Who invented C.T. scan?

A) Godfrey Hounsfield
B) Eric Storz
C) John Snow
D) Takashita Koba

Ans : A ,  Godfrey Hounsfield

Explanation :

CT scan was invented by Godfrey Hounsfield a physicist in 1963. He received a Nobel Prize for this in 1972. The first CAT scan is in the London museum.
 
Advantages of using CT scan are:
  • 1-2 mm sections are possible.
  • Amount of X ray exposure is less.
  • More accurate, sensitive and specific.
  • Small lesions are also detected.
  • Ct guided biopsies are done at present safely.
Ref: Srb's Surgery for Dental Students By Sriram Bhat page 403.


6 MARCH 2014 :

Q) Who is the father of modern Microbiology?

A) Metchnikoff
B) Lord Lister
C) Louis Pasteur
D) Robert Koch

ANS : C, 
Louis Pasteur

Explanation :


Father of Modern Microbiology : Louis Pasteur.

Father of Medical Microbiology : Robert Koch.

Father of Pathology : Rudolph Virchow.


5 MARCH 2014 :

Q) Which of the following inclusion body is seen in a patient with Rabies?


A) Cowdry-B
B) Negri bodies
C) Guarneri bodies
D) Bollinger bodies

ANS : B, 
Negri bodies

Explanation :

Negri bodies are eosinophilic intracellular lesions found within cerebral neurons and are highly specific for Rabies. They are found in about 75% of proven cases of animal rabies.
  • Guarneri bodies are inclusion bodies seen in the cytoplasm of cells infected with small pox virus.
  • Bollinger bodies are found in the cytoplasm of a cell infected with fowl pox virus.
  • In herpes infection giant cells are present, they contain a conglomeration of several nuclei. Each nucleus contain a large inclusion body surrounded by a clear halo.
  • HSV infection is associated with two types of viral inclusions. Cowdry A inclusions are small, round and eosinophilic and are separated from the nuclear material by a halo. Cowdry B inclusions are large, ground glass, eosinophilic, centrally located structures that push nuclear materials to the rim of the nucleus.
     
Ref: Weber D.J., Wohl D.A., Rutala W.A. (2011). Chapter 152. Rabies. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. Microbiology:Application Based Approach  By Pelczar page 427.
 

4 MARCH 2014

Q) Primary health centre was proposed under:


A) Srivastava committee
B) Bhore committee
C) Kartar Singh committee
D) None of the above

ANS : B, Bhore committee

Explanation :

Bhore committee in 1946 gave the concept of primary health care centre as a basic health care unit.
 
Ref: Park 22nd edition pg: 800.
 

3 MARCH 2014

Q) Salt and pepper appearance of the skull on Xray is seen in:


A) Hyperparathyroidism
B) Hypoparathyroidism
C) Osteopetrosis
D) Fluorosis

ANS : A, 
Hyperparathyroidism

Explanation :


Salt and pepper appearance of skull is a radiologic feature of hyperparathyroidism. This appearance is due to resorption of the trabecular bone in the skull and replacement of the resorbed bone by a newly formed connective tissue causing loss of integrity in the shape of skull bones.

 
Other radiologic features of hyperparathyroidism includes:
  • Brown tumors: These are focal areas of bone resorption where the bone has been replaced by fibrous tissue and osteoclasts. 
  • In the spine, appearance of horizontal bands of sclerosis in the vertebral bodies adjacent to the vertebral end plates result in Rugger Jersey spine appearance.
  • Chondrocalcinosis or calcification of the cartilage
  • Subperiosteal bone resorption characteristically involving radial side of the middle phalanx of the middle finger, medial proximal tibia and lateral end of clavicle.
Ref: Radiological Differential Diagnosis  By Bhargava page 59. Skeletal Radiology: The Bare Bones  By Felix S. Chew page 282. Internal Medicine: An Illustrated Radiological Guide  edited by Jarrah Ali Al-Tubaikh page 206.


 


1 MARCH 2014

Q) Thanatology is the science that deals with:


A) Death in all its aspects
B) Solving paternity of the child
C) Identification of the living
D) Detection of lie

ANS : 
 A, Death in all its aspects

Explanation :

Thanatology refers to a scientific study of death in all its aspects including its cause and phenomena. It also includes bodily changes that accompany death and their medico legal significance.
 
Death occur in two stages: Molecular and Somatic
Difference between molecular and somatic death are:
 
Feature Somatic death Molecular death
Definition Complete and reversible cessation of function of brain and stoppage of the circulation and respiration Death of individuals cells and tissues
Onset Precedes molecular death Succeeds somatic death
Response to external stimuli Muscle responds to thermal, electrical or chemical stimulus Does not respond
Confirmation Flat ECG and EEG, absent breath sounds Rigor mortis, algor mortis, postmortem lividity, putrefaction
Resemblance Suspended animation, coma, hypothermia Do not resemble any condition


Ref: Review of Forensic Medicine and Toxicology  By Gautam Biswas page 4.
 



28 FEB 2014

Q) The 1997 bird flu pandemic was caused by which of the following strain?


A) H1N1
B) H5N1
C) H2N1
D) H4N1

ANS : B, 
H5N1

Explanation :

Human infections with avian influenza H5N1 was first reported in Hong Kong in 1997.

Ref: Epidemiology of communicable diseases

Park’s textbook of Preventive and Social Medicine, 21stedition, page-330.
 



27 FEB 2014

Q) Which of the following strain of influenza causes Swine flu which causes serious systemic manifestations?


A) H1N1
B) H5N1
C) H3N1
D) H3N3

ANS : A, 
H1N1

Explanation :

  • Swine flu is caused by swine-origin H1N1 virus.
     
  • Of the 15 HA subtypes found in birds, only a few have been transferred to mammals (H1, H2, H3, and H5 in humans; H1 and H3 in swine; and H3 and H7 in horses). 
     
  • The same pattern holds for NA; nine NA subtypes are known for birds, only two of which are found in humans (N1, N2).
     
  • This pandemic strain of H1N1 causes a broad range of clinical symptoms ranging from typical symptoms (fever, malaise, myalgias, cough, sore throat, rhinorrhea, shortness of breath) commonly accompanied by gastrointestinal manifestations (especially diarrhea) to fulminant viral pneumonia.
 
Ref: Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzneron T.A. (2010). Chapter 39. Orthomyxoviruses (Influenza Viruses). In G.F. Brooks, K.C. Carroll, J.S. Butel, S.A. Morse, T.A. Mietzneron (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 25e.
 


26 FEB 2014

Q) Surfactant is secreted by : 


A) Type I Pneumocytes
B) Type II Pneumocytes
C) Both
D) Kupffer cells

ANS : 
B, Type II Pneumocytes

Explanation :

Surfactant is a mixture of dipalmitoylphosphatidylcholine (DPPC), other lipids, and proteins. Surfactant is synthesized in type II alveolar epithelial cells (and partly in Clara cells) and released at the alveolar surface. Surfactant plays an important role in reducing the alveolar elastic recoil due to surface tension and in stabilizing the alveoli.

Ref: Huang H.J. (2012). Chapter 17. The Respiratory System. In L.W. Janson, M.E. Tischler (Eds), The Big Picture: Medical Biochemistry.
 


25 FEB 2014

Q) Ito cells are found in:


A) Brain
B) Kidney
C) Liver
D) Lung

ANS : C, 
Liver

Explanation :

Hepatic stellate cells are also known as perisinusoidallipocytes or Ito cells and are much less numerous than hepatocytes. They play a major role in pathological processes. In response to liver damage, they become activated and predominantly myofibroblast-like.

They are responsible for the replacement of toxically damaged hepatocytes with collagenous scar tissue - hepatic fibrosis, seen initially in zone 3, around central veins. This can progress to cirrhosis, where the parenchymal architecture and pattern of blood flow are destroyed, with major systemic consequences.

Ref: Gray’s anatomy 40th edition, Chapter 85.
 


24 FEB 2014

Q) In which of the following organs are Kupffer's cells present?


A) Heart
B) Lungs
C) Liver
D) Spleen

ANS : C, 
Liver

Explanation :

Kupffer cells are resident macrophages of the liver. They are located within the lumen of the sinusoids overlapping the thinned endothelial wall.
 
Kupffer cells represents the largest population of macrophages in the mammalian body and are largely responsible for clearing the post mesenteric blood of gut derived bacteria and potent bacterial toxins such as endotoxins or peptidoglycans. Morphologically they are different from other macrophages as they show a characteristic pattern of endogenous peroxidase staining of the rough endoplasmic reticulum and perinuclear envelope. They express CD68 antigen and they also possess cell specific antigens eg: glucose/fructose receptor.
 
Ref: Cooperation of Liver Cells in Health and Disease: With 18 Tables  By Zbigniew KmieÄ� page 21.
 


22 FEB 2014

Q) Requirement of folate per day during pregnancy is:


A) 200 mcg
B) 300 mcg
C) 500 mcg
D) 700 mcg

ANS : C, 
500 mcg

Explanation :

 

Requirement of folate per day

Healthy adults

200 mcg

Pregnancy

500 mcg

Lactation

300 mcg

children

80-120 mcg

 
Ref: Park 22nd edition, page 575.
 


21 FEB 2014

Q) Which of the following has the highest protein energy ratio?


A) Milk 
B) Pulses 
C) Potato 
D) Fish

ANS : D, 
Fish

Explanation :

 

Food item

Protein energy ratio

Fish

80%

Milk

20%

Pulses

24%

Rice

8%

Potato

6%



Ref: Park 21st edition, page 586.


20 FEB 2014

Q) Minamata disease is caused by toxicity of:


A) Arsenic
B) Antimony
C) Lead
D) Mercury

ANS : D, 
Mercury

Explanation :

A significant example of mercury exposure affecting public health occurred in Minamata, Japan, between 1932 and 1968, where a factory producing acetic acid discharged waste liquid into Minamata Bay. The discharge included high concentrations of methylmercury. The bay was rich in fish and shellfish, providing the main livelihood for local residents and fishermen from other areas. For many years, no one realised that the fish were contaminated with mercury, and that it was causing a strange disease in the local community and in other districts. At least 50 000 people were affected to some extent and more than 2 000 cases of Minamata disease were certified. Minamata disease peaked in the 1950s, with severe cases suffering brain damage, paralysis, incoherent speech and delirium.
 
Ref : http://www.who.int/mediacentre/factsheets/fs361/en/index.html
 


19 FEB 2014

Q ) Montenegro test is used for diagnosis of:


A. Kala azar
B. Leprosy
C. Malaria
D. Leptospirosis

ANS : A, 
Kala azar

Explanation :

Montenegro or Leishmanin test is a skin test used for diagnosis of kala azar. Intradermal injection of 0.1 ml leishmanin antigen is given on flexor surface of forearm. The skin is examined for for induration after 48 to 72 hours. A reading of >5 mm is considered positive for kala azar. 

Ref: Park 21st edition, page 281.

 



18 FEB 2014

Q ) The drug of choice for obsessive compulsive disorder (OCD) is:


A) Chlorpromazine
B) Imipramine
C) Fluoxetine
D) Benzodiazepine

ANS : C, 
Fluoxetine

Explanation :

SSRI or Selective Serotonin Reuptake Inhibitors are the drug of choice for OCD. Fluoxetine is the commonly used SSRI. They are useful in a variety of anxiety disorders like PTSD, Generalised Anxiety and Social Anxiety. Higher doses e.g. 60mg and longer treatment is needed for OCD. 

Clomipramine, also a serotonin reuptake inhibitor, but not an SSRI, can be used to treat OCD. Chlorpromazine is an old generation antipsychotic. Benzodiazepines are used for short term management of anxiety like panic attack.

Ref: Kaplan & Sadock’s, Comprehensive Textbook of Psychiatry, 9th Edition, Page 1910

 



17 FEB 2014

Q) Which of the following is the MOST common type of female pelvis?


A) Gynecoid
B) Anthropoid
C) Android
D) Platypelloid

ANS : A, 
Gynecoid

Explanation :

Gynecoid is the most common type of female pelvis. In this type of pelvis the inlet is oval or round. In the midpelvis, sides of the pelvis are straight and the spines are not prominent. At the outlet the pubic arch is wide and the sacrum is neither inclined anteriorly nor posteriorly. The configuration of this type of pelvis suits well for the delivery of the fetus.
 
According to Caldwell and Moloy’s classification, pelvic shapes are classified as:
  • Gynecoid
  • Android
  • Anthropoid
  • Platypelloid
Ref: Clinical Obstretics (10Th Edn.)  By S. Gopalan page 7, Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 2. Maternal Anatomy. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.



15 FEB 2014

Q) The classification system used for barrett's esophagus is:


A. McCormack
B. Tanoue
C. Prague
D. Amsterdam

ANS : C, 
Prague

Explanation :

The Prague Criteria for grading of Barrett's esophagus was named because it was first presented by the IWGCO at the 2004 United European Gastroenterology Week meeting in Prague.

The key steps are:
  • Identify the gastroesophageal junction as at the tops of the gastric mucosal folds
  • For circumferential columnar-appearing mucosa above the gastroesophageal junction define this extent in centimetres above the gastroesophageal junction: - report as the C value
  • For any tongue-like areas of columnar-appearing mucosa, measure the Maximum extent in centimetres above the gastroesophageal junction: - report as the M value

Ref: GASTROENTEROLOGY 2006;131:1392–1399
 


 14 FEB 2014

Q) Anti LKM -3 antibody positivity is seen in
:

A) Chronic hepatitis C
B) Chronic hepatitis D
C) Autoimmune hepatitis
D) Drug associated hepatitis

ANS : B, 
Chronic hepatitis D

Explanation :

Anti-LKM 3 is usually seen in chronic hepatitis D
Anti LKM 1 positive in autoimmune hepatitis and chronic HCV.
 
Ref: Harrisons principles of internal medicine, Edition -18, Page -2567
 

13 FEB 2014

Q) The length of the small bowel in a full term newborn is:


A) 250 cm
B) 500 cm
C) 750 cm
D) 100 cm

ANS : A, 
250 cm

Explanation :

Length of small bowel in newborn : 250 cm.

Length of small bowel in adults : 600 - 800 cm.
 
Ref: Sleisenger, E - 9, P - 1615
 


12 FEB 2014

Q) The normal spleen weighs about:


A) 150 g
B) 250 g
C) 350 g
D) 450 g

ANS : A, 
150 g

Explanation :

The normal spleen weighs approximately 150g(<250g) and decreases its size with age.

Ref: Harisson, Edition - 18, Page - 468
 


11 FEB 2014

Q) Which of the following is the shortest pelvic diameter? 


A) Diagonal conjugate
B) Obstetric conjugate
C) True conjugate
D) All are equal

ANS : B, 
Obstetric conjugate

Explanation :

Obstetric conjugate is the shortest diameter of the pelvic inlet. It measures the distance between the promontory of the sacrum and the symphysis pubis. Normally, it measures 10 cm or more. This cannot be measured directly by examining, it is calculated by subtracting 1.5 to 2 cm from the diagonal conjugate diameter. Diagonal conjugate  is determined by measuring the distance from the lower margin of the symphysis to the sacral promontory.
 
The four diameters of the pelvic inlet are:
  • True conjugate diameter
  • Transverse diameter
  • Oblique conjugate diameter
  • Diagonal conjugate diameter

Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 2. Maternal Anatomy. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
 

10 FEB 2014

Q) Which is the longest diameter of fetal skull?


A) Biparietal
B) Bitemporal
C) Occipitomental
D) Mentovertical

ANS : D, 
Mentovertical

Explanation :

Mentovertical is the distance between the tip of the mentum or chin and the most distant point of the vertex. It is the longest diameter of the fetal skull and is 14cm long. It is the diameter of engagement in a brow presentation.
 
Diameters of fetal skull:
  • Occipitofrontal: It follows a line extending from a point just above the root of the nose to the most prominent portion of the occipital bone. 11.5cm
  • Biparietal: It is the greatest transverse diameter of the head, which extends from one parietal boss to the other. 9.5cm.
  • Bitemporal: It  is the greatest distance between the two temporal sutures. 8cm.
  • Occipitomental: It extends from the chin to the most prominent portion of the occiput. 12.5cm.
  • Suboccipitobregmatic: It  follows a line drawn from the middle of the large fontanel to the undersurface of the occipital bone just where it joins the neck. 9.5cm.


Ref: Clinical Obstretics (10Th Edn.)  By S. Gopalan,  page 66, Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 4. Fetal Growth and Development. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
 


07 FEB 2014

Q) Which of the following congenital heart condition is associated with a figure of 8 appearance in Chest X-ray?


A) TAP VC
B) Tetralogy of Fallot
C) Transposition of great vessels
D) Ebstein's’ anomaly

ANS : A, 
TAP VC

Explanation :

The typical cardiac silhouette  in TAPVC shows a snowman or figure of 8 appearance.  Chest X Ray in this condition shows increased pulmonary blood flow, dilated right heart chamber and dilated pulmonary artery.
  • In TAPVC, there is persistent venous connection between foregut plexus and cardinal system and all the pulmonary veins drain into the right atrium through a vertical vein that arise from  the pulmonary venous confluence. 
  • ECG shows right axis deviation and hypertrophy of right atrium and ventricle.


Ref: Pediatrics Cardiology By Kulkarni page 111.
 


6 FEB 2014

Q) Which is the MOST common type of finger impression?


A) Arch
B) Whorl
C) Loop
D) Composite

ANS :C, Loop

Explanation :

Among the four types of fingerprints loop pattern is the most common type which occur in 65% of cases. There are two loop patterns they are radial loop and ulnar loop. Whorl pattern is the second most common type occurring in 25%, arch type occur in 7% and the least common pattern is composite which occur in 2-3%. 

Dactylography is a study of fingerprints in which impressions of the papillary ridges and and furrows of the fingertips are taken. Its considered to be the surest sign of identification because the pattern, distribution, arrangement and character of the ridges are absolutely individualistic and are present from birth and remain unaltered throughout life.

Ridge pattern develops in 16th week of intrauterine life and maximum development is attained at 18-25 week of intrauterine life.

Ref: Forensic Medicine And Toxicology (oral, Practical & Mcq) By R. N. Karmakar page 129

 



05 FEB 2014

Q) Slow wave sleep is known as:


A. REM sleep
B. NREM sleep
C. Both of the above
D. None of the above

ANS : B, 
NREM sleep
 

Explanation:

This is a straight forward memory question. There are two kinds of sleep: 
rapid eye movement (REM) sleep and non-REM (NREM), or slow-wave sleep.

Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 15.
 



04 Feb 2014

Q) Portal vein is formed by union of which of the following veins?


A. Superior mesenteric vein & Splenic vein
B. Superior mesenteric vein & inferior mesenteric vein
C. Inferior mesenteric vein & Splenic vein
D. inferior mesenteric vein & Hepatic vein

ANS : A, 
Superior mesenteric vein & Splenic vein

Explanation :

Portal vein is formed by the union of SMV and splenic vein posterior to the neck of pancreas. The inferior mesenteric vein drains into the splenic vein. 
  • The hepatic portal vein pass posterior to the first part of duodenum, in the free edge of lesser omentum.
  • At the porta hepatis, it divides into right and left branches supplying the right and left lobes of the liver.
  • Within the sinusoids of the liver, hepatic portal blood and oxygenated blood from the hepatic artery mix together and come into contact with the hepatocytes, where metabolites such as products of digestion are exchanged.
  • Blood from the sinusoids empties into hepatic veins draining the liver and in turn drain into IVC, and blood is returned to heart.

Ref: Crash Course Anatomy4: Crash Course Anatomy  By Louise Stenhouse page 105.
 


03 Feb 2014

Q) Which of the following organism is known to cause pseudomembranous colitis?


A. Clostridium difficile
B. Clostridium perfringens
C. Clostridium tetani
D. Clostridium botulinum

ANS : A, Clostridium difficile

Explanation :

Pseudomembranous colitis is caused by Clostridium difficile a gram positive bacillus. Colitis is thought to result from overgrowth of this organism after depletion of the normal commensal flora of the gut with the use of antibiotics. 
 
Pathogenic changes associated with C difficile result from production of toxin A and B. It can be diagnosed by the presence of these toxins in the stool. It can also be diagnosed endoscopically by detecting the presence of characteristic ulcers, plaques and pseudomembranes.
 
Patients with mild disease are treated with metronidazole. Oral vancomycin is used as second line agent in patients allergic to metronidazole or in patients with recurrent disease.
 
Ref: Bullard Dunn K.M., Rothenberger D.A. (2010). Chapter 29. Colon, Rectum, and Anus. In T.R. Billiar, D.L. Dunn (Eds), Schwartz's Principles of Surgery, 9e.

 



01 Feb 2014

Q) Double-bubble sign on abdominal X-ray is seen in :


A. Colon carcinoma
B. Duodenal atresia
C. Acute pancreatitis
D. Perforation

ANS : B, 
Duodenal atresia

Explanation :

Double bubble sign is the characteristic abdominal Xray sign associated with duodenal atresia.  In tis, the stomach and first part of the duodenum are the only parts of the intestine filled with gas giving the characteristic appearance. 
 
Duodenal atresia typically presents in the first hour of life. Children presents with bilious vomiting and epigastric distention within a few hours of birth. Meconium may be passed normally.
 
It is often associated with other conditions such as esophageal atresia, intestinal atresia, cardiac and renal anomalies. 
 
Ref: Oski's Pediatric Certification and Recertification Board Review  By Carmen Coombs, page 404. Sundaram S.S., Hoffenberg E.J., Kramer R.E., Sondheimer J.M., Furuta G.T. (2012). Chapter 21. Gastrointestinal Tract. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
 


31 Jan 2014

Q) Which of the following is the COMMONEST intraocular tumour in children?


A. Retinoblastoma
B. Malignant melanoma
C. Teratoma
D. Neuroblastoma

ANS : A, 
Retinoblastoma

Explanation :


Retinoblastoma is the most common ocular malignant tumor in children. It primarily occur due to a mutation in the retinoblastoma gene at chromosome 13q14.

Most of the patients presents before 3 years of age. The most common presenting sign in children is leukocoria. Other common presentations includes strabismus, red eye, glaucoma, or pseudohypopyon.
Neuroblastoma arises from neural crest tissue of the sympathetic ganglia or adrenal medulla. It  accounts for 10% of pediatric malignancies and is the most common solid neoplasm outside the CNS. 50% of neuroblastomas are diagnosed before age 2 years and 90% before age 5 years. Clinical manifestations vary with the primary site of malignant disease and the neuroendocrine function of the tumor.

Ref: Braverman R.S. (2012). Chapter 16. Eye. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e. Graham D.K., Quinones R.R., Keating A.K., Maloney K., Foreman N.K., Giller R.H., Greffe B.S. (2012). Chapter 31. Neoplastic Disease. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds),CURRENT Diagnosis & Treatment: Pediatrics, 21e.



30 Jan 2014

Q) X-ray taken in which of the following malignancy shows a Sun ray appearance?


A. Osteosarcoma
B. Osteoclastoma
C. Osteochondroma
D. Ewing’s tumor

ANS : A Osteosarcoma

Explanation :


Xray of affected area in patients with osteosarcoma shows Sunburst appearance due to the extension of the tumor through the periosteum. Reactive new bone formation under the periosteum result in elevation of periosteum which appear as a Codman’s  triangle. Osteosarcoma lesions can be purely osteolytic, osteoblastic or mixture of both.

X ray of the affected region in Ewings sarcoma shows a destructive lesion producing a classic moth eaten appearance. As the tumor grows cortex displaces outwards and periosteal reaction will result in classic onion peel appearance.

Ref: Textbook of Pathology  By V. Krishna page 974. Place R., Lagoc A.M., Mayer T.A., Lawlor C.J. (2011). Chapter 136. Oncology and Hematology Emergencies in Children. In R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.




29 Jan 2014 

Q) Dactylography is a:


A. Surest sign of identification
B. Probable sign of identification
C. Presumptive sign of identification
D. Doubtful sign of identification

ANS : A, 
Surest sign of identification

Explanation :

Fingerprint identification is one of the surest method of identification and no two persons have identical fingerprints.
 
Dactylography also known known as finger print system consists of talking impression of the pulp of the fingers and thumb with printers ink on an unglazed white paper. Fingerprints of even identical twins are different. Chances of two persons having identical fingerprints is about one in thirty times the population of the world. Fingerprints are classified into 4 groups. Fingerprints are classified in 4 groups loops (67%), whorls (25%), arches and composite form.

Ref: Concise Textbook Of Forensic Medicine & Toxicology  By Sharma 2nd edn page 19. Criminal Evidence By Jefferson L. Ingram page 640.
 


28 Jan 2014

Q ) Following agent is implicated in the development of carcinoma of cervix:


A. Herpes simplex

B. Human papilloma virus
C. EB virus
D. Adenovirus

ANS : B, 
Human papilloma virus


Human papilloma virus (HPV) is central to the development of cervical neoplasia. HPV DNA is found in 99.7% of all cervical carcinomas. HPV-16 is the most prevalent HPV type in squamous cell carcinoma and adenocarcinoma, followed by HPV-18 and HPV-45. Other associated risk factors are tobacco use, immunosuppression, infection with HIV or a history of other STIs, high parity, and oral contraceptive use.

Ref: Holschneider C.H. (2013). Chapter 48. Premalignant & Malignant Disorders of the Uterine Cervix. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e. 



27 Jan 2014

Q) Antigenic variation is NOT seen in which type of influenza virus?


A. Type A
B. Type B
C. Type C
D. Type A and B

ANS : C, Type C

Explanation :

Antigenic variation is not seen in type C influenza virus. Antigenic variability is highest in influenza virus type A and less in type B. 
 
Influenza viruses are remarkable because of the frequent antigenic changes that occur in HA and NA. The internal RNP antigen and M protein antigen are stable but both the surface antigens, hemagglutinin and neuraminidase undergo independent antigenic variation of two types called antigenic shift or drift in HA or NA resulting in the appearance of a new subtype.
  • Antigenic drift: refers to minor antigenic changes either in hemagglutinin or neuraminidase or both.
  • Antigenic shift: It is an abrupt, drastic discontinuous variation in the antigenic structure resulting in a novel virus strain unrelated antigenically to predecessor strains.

Ref: Textbook of Microbiology By Surinder Kumar page 563.
 

24 Jan 2014

Q) A patient presents with cervical lymphadenopathy. Biopsy demonstrates a nodular lymphoma with follicle formation. This lesion would most likely be associated with which of the following?


A. bcr-abl hybrid
B. bcl-2 activation
C. c-myc activation
D. t(8, 14)

ANS : B, 
bcl-2 activation

Explanation :

Nodular lymphomas of all types are derived from the B-cell line. The translocation t(14, 18), with bcl-2 activation, is associated with these lymphomas.

Must know:
  • An abl-bcr hybrid and t(9, 22) translocation are associated with chronic myeloid leukemia (CML).
  • c-myc activation and t(8, 14) are associated with Burkitt's lymphoma.

Ref: Robbins Basic Pathology, 8th Ed, page 20-21;198-199
 


23-Jan-2014

Q) Spalding 'sign' occurs because of:


A. Mummification
B. Maceration
C. Hanging
D. Drowning

ANS : B, 
Maceration

Explanation :

Spalding sign occur due to intrauterine maceration. Spalding sign is a radiological sign which indicates the overlapping of skull bones. Overlapping of skull bones occur due to shrinkage of cerebrum and due to violent contractions of the uterus in an attempt to expel the dead fetus.

Characteristic features of intrauterine maceration are:

  • Dead body will be soft, flaccid, edematous, and flattened, when placed on flat surface it will remain straight and flat without showing the normal curvatures.
  • Coppery red or flesh like or brownish red in colour.
  • Emits a sweet but disagreeable smell.
  • Serous cavities will contain turbid reddish fluid. Body surface presents with large blebs resembling pemphigus containing red serous or serosanguinous fluid.
  • Evidence of Spalding’s sign. 

Ref: Forensic Medicine and Toxicology  By R.N. Karmakar page 25.



22-Jan-2014 

Q) The most common cause of Kaposi sarcoma?

 
A. HHV7
B. HHV8
C. HHV9
D. HHV6

ANS : B, HHV8

Explanation :

 
Human herpesvirus type 8 is believed to be the cause of most cases of Kaposi's sarcoma. Roseola Infantum (Exanthem Subitum) has more than one cause: the most common is human herpesvirus type 6 and, less frequently, human herpesvirus type 7.
 
Ref: Harrison's Principles of Internal Medicine, 18e; Madoff L.C., Kasper D.L. (2012). Chapter 119; Introduction to Infectious Diseases: Host–Pathogen Interactions. In Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J, Loscalzo J (Eds)
 




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