Aiims 2002-2015 QP PDF
Aiims 2002-2015 QP PDF
Aiims 2002-2015 QP PDF
PG Medical Entrance
Examinations PGMEE
Review Questions 2002–2015
Over
6000 Qs
PGMEE
PGMEE
PGMEE
PGMEE
AIIMS and All India
PG Medical Entrance
Examinations PGMEE
Review Questions 2002–2015
Over
6000 Qs
ISBN: 978-81-239-2861-6
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including
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T his book has been written keeping in view that many questions are repeatedly asked in subsequent
examinations. The book contains questions in the form of statements from 2002 onwards. Questions from
AIIMS and All India PGMEEs have been compiled. Question–Answers have been written in the form such that
the students remember the facts clearly and no confusion remains in their minds. This book is extremely
valuable for those starting their preparation for postgraduate entrance examinations during internship or
before and for quick revision just before appearing in the PGMEEs. Questions asked repeatedly have been put
only once in the book to make it concise. Around 6000 questions have been included in this book.
While every effort has been made to make this book error-free, readers are requested to point out if they come
across any; in addition, their valuable comments and suggestions for further improvement will be greatly
appreciated and acknowledged.
Arun Kumar
Mob. 09718161947
e-mail id: [email protected]
Acknowledgments
F irst I would like to thank all my teachers who have encouraged and inspired me for hard work. I also want
to thank Dr Nitish, Dr Aporva, Dr Rajdeep and Dr Puneet who have been very supportive of me to write
this book. My inspiration for writing this book is my teacher Dr Arup Kumar Kundu who has been a leading
writer in this field.
My heartfelt thanks to my wife who contributed significantly in writing this book. I would also like to thank
all my family members who have stood by me through thick and thin.
I would also like to thank CBS Publishers & Distributors, Mr YN Arjuna (Senior Vice President—Publishing, Editorial
and Publicity), Mrs Ritu Chawla (Production Manager) and Mr Vikrant Sharma (DTP Operator) to help me realize my
dream of writing the book and publishing the book so beautifully.
I would also like to thank my friend Pawan, Bipulji, Dr Pradeep and others for their valuable support. I would
also like to thank Dr Rahul, Dr Abhishek, Dr Anant, Dr Rajeev, Dr Dharvind, Dr Lokesh and others for helping
me recall questions.
I would also like to thank my teacher Dr MP Sharma for his guidance. Finally, with all my humbleness and
sincerity, I thank one and all who have helped me directly or indirectly in writing this book.
Arun Kumar
Contents
Preface v
1. Anatomy 1
2. Biochemistry 9
3. Physiology 17
4. Pharmacology 25
5. Microbiology 44
6. Pathology 59
9. Ophthalmology 110
Anatomy
1
2 AIIMS and All India PGMEE—Review Questions
C Structures passing through flexor retinaculum are C Fascia around nerve bundle of brachial plexus is
FDP, FDS and median nerve Prevertebral fascia
C Phrenic nerve lies C Brainstem nuclei derived from the alar plate
Anterior to scalenus anterior muscle Inferior olivary, substantia nigra and dentate
C Nerves involved in injury to head of fibula are
C In subclavian artery block at outer border of 1st rib,
Common peroneal nerve, superficial peroneal
following arteries help in maintaining the
nerve and deep peroneal nerve
circulation to upper limb
C Deep peroneal nerve supplies
Subscapular artery, suprascapular artery and
1st web space of foot
thyrocervical trunk
C Meissner’s and Aurbach’s plexus are derived from
Trendelenburg test is positive due to injury to
Neural crest
C
C True about portal venous system C Intrinsic muscles of the tongue are derived from
The whole system is valveless Occipital somites
C Branches of cavernous part of internal carotid C Regarding sexual differentiation of the fetus
artery Gonadal development begins at 5th week of
Meningeal artery, cavernous branch and inferior intrauterine life.
hypophyseal branch. (Mn: MCH) C In emergency tracheostomy, structures damaged are
Isthmus of thyroid, thyroidea ima and inferior
AIIMS NOVEMBER 2007 thyroid vein.
In fracture of penis involving rupture of tunica
In forceful inversion of foot, fracture of the
C
C
albuginea with intact fascia, noted clinically is
tuberosity of 5th metatarsal is due to pull exerted by
Hematoma involving only the shaft of penis
Peroneus brevis
C Primitive streak is initiated and maintained by C In obstruction of second part of axillary artery, the
anastomosis between the following artery will
Nodal gene
maintain the blood supply of upper limb
C Watershed area between SMA and IMA which
Deep branch of transverse cervical artery and
commonly results in ischemia is
subscapular artery.
Splenic flexure
C The normal gallbladder epithelium is
Simple columnar with brush border AIIMS MAY 2007
C Perforators connecting superficial veins to deep C Exposure of left subclavian artery by supraclavicular
veins approach does not require the cutting of
Ankle, mid calf and lower thigh Scalenus medius.
C In a case of chest pain with pericarditis and C Most common site of ectopic pancreatic tissue is
pericardial effusion, pain is referred by Stomach.
Phrenic nerve C Facial nerve stimulation during testing of nerve is
C Pleural tapping in mid-axillary line, muscles indicated by contraction of
pierced are Orbicularis oris muscle.
Internal intercostal, external intercostal and C Cells which migrate from the base of the crypts to
innermost intercostal. ends of villi are
C In post-ductal coarctation of aorta, blood flow to Enterocyte, endocrine cells and goblet cell.
lower limb is maintained through C Renal angle lies between
Intercostal arteries and superior epigastric artery 12th rib and lateral border of sacrospinalis.
C Most cranial structure in root of left lung C Characteristics differentiating a typical cervical
Pulmonary artery vertebra from a thoracic vertebra except
C Ureteric peristalsis is due to intact supply of Has a large vertebral body.
Intrinsic smooth muscle pacemaker activity of renal C Pudendal nerve supplying motor part of external
calyces. sphincter is derived from
C True about left renal vein S2–S3 roots.
Posterior and inferior to superior mesenteric artery.
C If circumflex artery gives the posterior interven- AIIMS NOVEMBER 2006
trical branch, this circulation is described as C Characteristic of oculomotor nerve
Left dominance Enters orbit through superior orbital fissure
C In ulnar nerve injury in arm, following are seen C Common peroneal nerve is related to
Hypothenar atrophy, loss of sensation of medial 1/ Neck of fibula
3rd of hand and claw hand. C A person showing two cell lines derived from two
C Ureter develops from different zygotes is known as
Mesonephric duct Chimerism
Anatomy 7
C In IVC obstruction collaterals which open up are C Posterior relations of head of pancreas are
Superior epigastric vein and inferior epigastric vein CBD, aorta and IVC
Azygos vein and ascending lumbar vein C Urethral crest is situated in
Lateral thoracic vein and prevertebral vein Prostatic urethra
C Component of hypogastric sheath are
ALL INDIA 2012 Uterosacral ligament, transverse cervical ligament
and lateral ligament of bladder.
C Dilator pupillae is supplied by
The bifurcation of common carotid artery occurs at
Post-ganglionic sympathetic fibers from the
C
Biochemistry
10
Biochemistry 11
C Young boy presents with severe abdominal pain, on C Methylation of cytosine leads to
examination he has xanthoma. Blood sample drawn Decreased expression of gene.
has milky appearance of plasma. Lipoprotein C 2, 3 BPG binds to 1 site of hemoglobin and decreases
increased is the affinity for oxygen.
Chylomicrons C The last receiver of electrons in electron transport
C Acrid smell (pear) is found in system is
Paraldehyde O2
C Lactic acidosis due to thiamine deficiency occurs
due to enzyme affected AIIMS NOVEMBER 2013
Pyruvate dehydrogenase
C Most common metabolite of progesterone excreted
C A 10 years old boy presents with pain abdomen,
in urine
muscle weakness and fatigue and increased lead
levels in the serum. Enzyme activity increased is Pregnanediol
ALA synthase C Known as suicidal enzyme
Cyclo-oxygenase
(Note: Self catalysed destructions)
AIIMS NOVEMBER 2014
C Reasons responsible for ketosis in a patient of von
C A 7 months old child develops vomiting after fruit Gierke’s disease
juice feeds and is diagnosed as hereditary fructose Hypoglycemia, low blood sugar levels and oxalo-
intolerance. Enzyme deficiency acetate is required for gluconeogenesis.
Aldolase B C Exact location of a genetic loci is identified by
C Amino acids found in collagen fiber Fluorescent in situ hybridization
Glycine, lysine and proline C True about ribozyme
C A 9 months old child has pellagra like feature and Peptidyl transferase activity
mild aminoaciduria. Her elder sister has the same C Enzyme activity increased in low insulin/glucagon
complaints while four siblings are normal and level
parents asymptomatic. The most likely diagnosis Glucose-6-phosphatse
Hartnup disease C True about NADPH
C A 6 years old African American boy presents with Required for reductive biosynthesis, stabilizes the
recurrent infections, severe abdominal pain and membrane of RBCs
chronic hemolytic anemia. On evaluation, a non- C Component of fatty acid synthase complex
healing ulcer was found on his left leg. Peripheral
Ketoacyl synthase, enoyl reductase and acetoacetyl
smear showed abnormal shape of erythrocytes.
coa transferase
Basic defect
Single nucleotide change in a codon
AIIMS MAY 2013
C The investigation of choice to detect biomolecules is
X-ray crystallography C Enzymes catalyzing the irreversible steps of glycolysis
Glucokinase, phosphofructokinase and pyruvate
kinase
AIIMS MAY 2014
C Ketone bodies can be utilized by
C Not an intermediate product of citric acid cycle Heart, brain and skeletal muscles
Acyl CoA C A person with von Gierke’s disease has ketosis.
C The enzyme common to both glycogenolysis and True for ketosis in this patient
glycogenesis are Lactic acidosis, hypoglycemia and hypertriglyceri-
Phosphoglucomutase demia
C In the entire human genome, coding DNA consti- C Real time PCR is used for
tutes To know how much amplification of DNA has
0.02 occurred
12 AIIMS and All India PGMEE—Review Questions
C Apo B48 and Apo B100 are synthesized from AIIMS NOVEMBER 2009
mRNA, the difference between them is due to
Deamination of cytidine to uridine C In CRP, the C stands for
C Hydrophilic hormones that act on cytosolic receptors C polysaccharide of Streptococcus pneumoniae
Epinephrine, GH and ACTH C Glucose transporter in myocyte stimulated by
C Gene duplication plays an important role in the GLUT 4
evolution of C Karyotyping under light microscopy is done by
mRNA G banding
C Movement of protein from nucleus to cytoplasm can C Western blot detects
be seen by Protein
FRAP C True statements are
C Histone acetylation causes Chemiluminescence is excited electrons in higher
Increased euchromatin formation orbits comes to lower orbits by emitting energy in
C Triplex DNA is due to form of photon, bioluminescence is a form of
Hoogsteen pairing chemiluminescence and phosphorescence is energy
emitted following absorption of EM radiation.
C Acetyl CoA can be directly converted to
C Zinc is a co-factor for
Fatty acid, cholesterol and ketone bodies
Alcohol dehydrogenase
C After digestion by restriction endonucleases DNA
strands can be joined again by
DNA ligase AIIMS MAY 2009
C True about sickle cell disease C Receptors present in liver for uptake of LDL
Single nucleotide change results in change of ApoE and ApoB 100
glutamate to valine, HbS confers resistance against C Thiamine requirement increases in excessive intake
malaria in heterozygotes and RFLP results from a of
single base change. Carbohydrates
C Amino acid migrating fastest on paper chromato-
AIIMS NOVEMBER 2010 graphy on methylcellulose medium
C In phenylketonuria the main aim of first line of Valine
therapy is C NO is synthesized by
Limiting the substrate for deficient enzyme Arginine
C Which binds to CoA and condenses oxaloacetate to C Protein is purified using ammonium sulphate by
inhibit the TCA cycle Salting out
Fluoroacetate C True about eukaryotic protein synthesis
C A 45 years old woman presents with progressive mRNA reads from 5’ to 3’, EF2 shifts between GDP
palmoplanter pigmentation, calcification of to GTP and capping helps in attachment of mRNA
intervertebral discs in X-ray spine and Benedict’s to 40S ribosome.
reagent to urine gives greenish brown precipitate C A patient has isolated increase in LDL. His father
and blue-black supernatant fluid. Diagnosis is and brother had the same disease with increased
Alkaptonuria cholesterol. Diagnosis is
C After overnight fasting, levels of glucose transporter LDL receptor mutation
reduced in C Test using oligomer with single base pair substitution
Adipocytes RFLP
C Splicing activity is a function of
snRNA AIIMS NOVEMBER 2008
C After digestion by restriction endonucleases DNA C Replacing alanine by which amino acid will increase
strands can be joined again by UV absorbance of protein at 280 nm wavelength
DNA ligase Tryptophan
14 AIIMS and All India PGMEE—Review Questions
(Note: other essential amino acids are threonine C Decreased glucose concentration in hepatic cells
isoleucine, valine, phenylalanine, and tryptophan) triggers
C Increased copper excretion in urine is seen in Increased glucagon level in blood, activation of
Primary sclerosing cholangitis, primary biliary fructose 2, 6 bisphosphatase and inhibition of
cirrhosis and Wilson’s disease phosphofructokinase 2
C Active form of vitamin D is C Amino acids undergoing phosphorylation by
1, 25 (OH)2 vitamin D protein kinases
C Triglycerides are maximum in Serine, threonine and tyrosine
Chylomicrons C Autosomal dominant porphyrias are
C Glycolysis occurs in Acute intermittent porphyria, hereditary copropor-
phyria and porphyria cutanea tarda.
Cytosol
C Enzyme involved in both cholesterol and ketone
Following take place in mitochondria
body synthesis
C
Fatty acid oxidation, electron transport chain and HMG CoA synthase
citric acid cycle
C True regarding cytoplasmic mRNA
Vitamin excreted in urine is
It is chiefly translated from nuclear DNA
C
Vitamin C C Restriction enzymes type 2
Cleaves specific palindromic DNA sequence
AIIMS NOVEMBER 2006 C Amino acid in a protein acting as a potential
O-glycosylation site for attachment of an oligo-
C Increased level of lipoprotein (a) predisposes to
saccharide unit
Atherosclerosis.
Serine
C Same amino acid is coded by multiple codon due to
C Structure of protein involved in immune complex
following
formation
Degeneracy
Quaternary
Cytosolic cytochrome C mediates
Seen post 12–24 hours of starvation
C
C
Apoptosis Decreased liver glycogen, increased plasma FFA
C Chymotrypsin is a and increased ketone bodies
Zymogen
C Anticoagulant used to estimate glucose from a
ALL INDIA 2011
sample sent from PHC is
Potassium oxalate and NaF C Vitamin K is involved in post-translational
C Mucopolysaccharide hyaluronic acid is present in modification of
Vitreous humor Glutamate
C The 40 nm gap between the tropocollagen molecule in C Thiamine deficiency causes decreased energy
collagen serving as site of bone formation is occupied by production because
Ca2+ It is a coenzyme for pyruvic acid dehydrogenase
C Steroids act via nuclear receptors which interact and α ketoglutarate dehydrogenase in tricarboxylic
with DNA through acid pathway.
Zinc finger motif C True statement is
C Which estimates blood creatinine level most accurately Fluoroacetate competitively inhibits aconitase
Enzyme assay C Urea cycle occurs in
Liver
C Transfer of an amino group from an amino acid to
ALL INDIA 2012 an α keto acid is done by
C Methods used for protein estimation Transaminases
Bromocresol green method, Biuret method and C Cardioprotective fatty acid is
Lowry’s method ω3 fatty acid
16 AIIMS and All India PGMEE—Review Questions
Physiology
18
Physiology 19
C Receptors stimulated by the load producing reflex C In lungs, true about hyaline membrane disease
in the lungs that maintains the tidal volume FRC is smaller than closing volume
Stretch receptors in the bronchioles (Note: Closing volume > FRC > RV)
C Deleterious effects of hypothermia C Not permeable through blood brain
Cardiac arrhythmias, reversible coagulation and Proteins
renal failure C True about vasopressin receptors
C Primary role of the microbes of the gut flora of humans V1 smooth muscles, V2 collecting duct and V3 anterior
Fermentation of mucous, production of vitamin K pituitary
and formation of short chain fatty acid
(Note: Mnemonics: SCA)
C Gas used to measure the diffusion capacity of lung
AIIMS MAY 2011 CO
C Animals chronically exposed to cold C Hypoxemia is independent of
Increased sympathetic stimulation Hb
C True about shunt vessels C Stimulus for normal/resting ventilation
Play a role in thermoregulation Stretch receptors, pO2 and pCO2
(Note: Finger tips and ear lobule) C CO2 diffuses more easily through the respiratory
C Vasomotor centre of medulla membrane than O2 because it is
Acts with the cardiovagal centre to maintain BP More soluble in plasma
C Energy expenditure in resting state depends on C Pacemaker regulating the rate of respiration
Lean body mass Pre-Botzinger complex
C The primary direct stimulus for excitation of central C Negative intrapleural pressure is due to
chemoreceptor regulating ventilation is Absorption by lymphatics
Increased H+ C Produced by stomach and role in control of food intake
C True regarding myocardial O2 demand Ghrelin
Has constant relation to external cardiac work C True about neuropeptide Y
C Angiotensin 2 causes Mediated through melanocorticotrophin hormone,
Stimulation of thirst, aldosterone secretion and decreases thermogenesis and contains 36 amino
increased ADH secretion. acids.
C Maximum post-prandial motility is seen in C Not absorbed from PCT
H+
Sigmoid colon > Descending colon
C Cyanosis in trauma is interpreted as
C CSF pressure is mainly regulated by
Late sign of hypoxia
Rate of CSF absorption
C A man is given continuous testosterone, it would
True regarding GFR
lead to
C
If clearance of a substance is greater than GFR, then Azoospermia
tubular secretion must be present.
C Nitrogen narcosis is caused due AIIMS MAY 2010
Increased solubility of nitrogen in nerve cell
membrane C Hyperaldosteronism is associated with
Hypernatremia, hypokalemia and hypertension
C Intrinsic factor of Castle is secreted by
AIIMS NOVEMBER 2010
Parietal cells
C Caisson’s disease is C The main cause of increased blood flow to
Gas embolism exercising muscles is
C Vitamin K dependent clotting factor Vasodilatation due to local metabolites
Factor 7 (Note: Adenosine (most important), K+ ions, ATP,
(Note: 2, 7, 9 and 10) lactic acid, CO2)
22 AIIMS and All India PGMEE—Review Questions
Pharmacology
27
28 AIIMS and All India PGMEE—Review Questions
received FDA approval for relapsed indolent C Drugs useful for the treatment of advanced prostate
lymphomas and toxicity is mainly associated with cancer
infusion reactions. Goserelin
C Abatacept, a T cell co-stimulation inhibitor is used
for the treatment of AIIMS NOVEMBER 2013
Rheumatoid arthritis
C Correct match of drug and mechanism of action
Brimonidine decreases aqueous production
AIIMS MAY 2014 C Rho-kinase inhibitor
C Drugs converted into active metabolite are Fasudil
Fluoxetine, cyclophosphamide and diazepam C True about uses of iodine
C Methacholine is a It inhibits release of thyroid hormone, it causes
M2 receptor agonist acute inhibition of iodotyrosine and iodothyronine
C β2 agonist causes synthesis and it can cause iodism.
Analgesia, sedation and anxiolysis C Duration of action of flumazenil
C Peripheral vasospasm is observed with anti- 40 minutes
Parkinsonian drug C Drug having both α and β agonistic activity
Bromocriptine Epinephrine
C Due to potentiating action of lithium to non- C Drug that can be stopped without any withdrawal
depolarizing muscle relaxants, how many days symptom
before lithium should be stopped before adminis- Fluoxetine
tration of the muscle relaxant C Ability of body to eliminate the drug from body is
2 days called as
C True about methadone Clearance
It is a long acting β receptor agonist, it is rapidly C True about carbamazepine
absorbed from the gastrointestinal tract and is Has been known to cause Stevens-Johnson syndrome.
detected in plasma 30 minutes after oral adminis- C Tricyclic anti-depressents produce side effects like
tration and the primary use of methadone is relief of dry mouth, urinary retention due to action on
chronic pain. Muscarinic receptors.
C The site of action of frusemide is C Cholinomimetic drugs are used in
Thick ascending limb of loop of Henle Glaucoma, myasthenia gravis and post-surgical
C Pair of drug and its indication matched correctly ileus/atony
Octreotide VIPoma associated diarrhea, desmo- C Anticholinergic drug not crossing the blood brain
pressin- diabetes insipidus and hCG-infertility in barrier
man and woman. Glycopyrrolate and hyoscine butyl bromide
C Time dependent killing and post-antibiotic effect is C As compared to unfractionated heparin, low
seen with molecular weight heparin has reliable anti-
Clindamycin coagulant action because
C NNRTI includes It is less protein bound
Etravirine, delavirdine and nevirapine
C Antitubercular drug associated with hypothyroidism AIIMS MAY 2013
Ethionamide > rifampicin C Rho-kinase inhibitor
C Anti-cancer drug least likely to cause nausea and Fasudil
vomiting C Opoid receptor responsible for dysphoric effects
Chlorambucil Kappa
C Essential for ameliorating the toxicity of pemetrexed C Ritonavir inhibits
Folic acid and vitamin B12 Amiodarone, cisapride and midazolam
30 AIIMS and All India PGMEE—Review Questions
C Time dependent killing and prolonged post- C Treatment of choice for extended spectrum beta-
antibiotic effect is seen with lactamase producing enterococci
Clindamycin Piperacilin + tazobactam
C True about treatment with iodine C Rho-kinase inhibitor is
It causes acute inhibition of synthesis of diiodotyro- Fasudil
sine and diiodothyronine C In new drug designing, problem arises in
C Orphan drugs are Increasing drug interaction with nontarget proteins
Drugs for treating rare disease C Unfavorable interaction of drug and substrate in
C Trials performed to determine the maximum human beings are all except
tolerated dose of a drug Barbiturates decreases B12 absorption.
Phase 1 C True statement is
C Lithium potentiates the action of non-depolarizing Dobutamine decreases peripheral vascular resistance.
muscle relaxants. Lithium should be stopped how
many days before administration of the muscle AIIMS MAY 2012
relaxant
2 days C Which of the following statements about anti-
epileptics are
C Injection available for subcutaneous administration
Phenytoin and carbamazepine act by prolonging
Terbutaline
Na+ channel activation, carbamazepine is also used
C Drugs causing SLE like syndrome in trigeminal neuralgias and diazepam is an anti-
INH, hydralazine and sulphonamide epileptic.
C One concern of the drug designing is to C Proton pump inhibitors have short half lives
Increase the number of interactions of the drug with (2 hours) but cause a prolonged suppression of acid
the target protein. secretion (up to 48 hours) because
C One of the many mechanism of adverse events is its They irreversibly inhibit the the proton pump
increased binding to secondary targets, usually molecule and hence, acid secretion requires
proteins. With respect to primary target, the synthesis of new proton pumps.
secondary target C Which of the following antipsychotics is available
Should have similar binding sites in a depot injection
C Vasopressin antagonists act on part of the nephron Fluphenazine
Medullary collecting duct C True about first order kinetics is
The rate of elimination is proportional to the plasma
AIIMS NOVEMBER 2012 concentration
C A glaucoma patient is being given systemic beta- C Drug induced colitis is most frequently associated
blockers. What cannot be given with
Levobunolol Clindamycin
C 2nd generation antihistamines are C A female patient under treatment for depression
took a massive dose amitriptyline for suicide. True
Cetrizine, loratadine and fexofenadine
about management.
Drugs used in treatment of erectile dysfunction
Gastric lavage was done, sodium bicarbonate was
C
Prostaglandin E, Vardenafil and alprostadil administered to treat acidosis and diazepam was
C True regarding penicillin G injected to control seizures.
Used for treatment of rat bite fever C Drug used to treat hormone responsive breast
C Therapeutic indications of cholinomimetics cancer
Glaucoma, post-operative atony and myasthenia Tamoxifen
gravis C Drugs banned for players by the International
C Ocular side effects of HAART therapy Olympic Committee (IOC) are
Uveitis Salbutamol, erythropoietin and spironolactone
Pharmacology 31
C Traditional medicines effective in the treatment of C A patient on insulin and acarbose develops
heart failure hypoglycemia. For treatment to be given is
Terminalia Arjuna Glucose
C Amifostine is C Hypoglycemia caused by
Radiorotector Insulin, glimepiride and nateglinide (Mn: Anti-
diabetic drug with-ide cause hypoglycemia)
C True about exenatide
AIIMS NOVEMBER 2011
Decreases glucagon secretion, GLP1 analogue and
C Bremelanotide is used for given subcutaneously.
Erectile dysfunction C Methetrexate is used in
C Most recent oral DTI used for prevention of acute Psoriasis, rheumatoid arthritis and ankylosing
stroke spondylitis.
Dabigatran C Indications of cotrimoxazole are
C Lid retraction is side effect of Lower UTI, prostatitis, and typhoid (Mn: PLT)
Apraclonidine C True about Ifosfamide
C Brinzolamide is Its is a nitrogen mustard, metabolized by CYP 3A4
Highly specific, reversible and noncompetitive to form active metabolite and chloracetaldehyde is
carbonic anhydrase inhibitor. (Mn: NRS) active form.
C OZURDEX C Angina worsened by
0.7 dexamethasone Sumatriptan, dipyridamole and thyroxine. (Mn: STD)
C Peripheral conversion of T4 to T3 inhibited by C Megaloblastic anemia caused by
Phenytoin, sulfasalazine and alcohol and Methotre-
Amiodarone, propylthiouracil and propranolol
xate.
C True about octreotide
C Octreotide is used in
Useful in controlling secretory diarrhea.
Insulinoma, glucagonoma and carcinoids
Drugs used for the treatment of multiple sclerosis
True about ESBL
C
C
Interferon β Sensitive to carbapenems, Ambler classification is
C Drugs approved for the treatment of relapsing based on molecular structure and classification is
remitting multiple sclerosis based on 3rd generation cephalosporin sensitivity.
Interferon α 1a, interferon β 2b and glatiramer C True about diazoxide
acetate K+ channel opener, can be used as antihypertensive
C Only drug found to be beneficial in halting the pro- agent and used in insulinoma.
gression on EDSS (expanded disability status score) C Topical mitomycin C is used in treatment of
Natalizumab Tracheal stenosis
C Drugs used as a transcranial patch for treatment of C Drug used in sickle cell anemia
Parkinson’s disease Hydroxyurea
Rotigotine (Mn: Patch looks like roti) C Bleomycin toxicity is characterized by destruction of
C Factors predisposing to chloroquine toxicity Type 1 pneumocytes
Cumulative dose > 460 gm, daily dose > 250 mg/ C Regarding ACE inhibitor, true is omission of prior
day or > 3 mg/kgand renal failure. diuretic dose decreases the risk of postural
C Efavirenz inhibits hypotension.
HIV-1 reverse transcriptase C Adverse effects of tamoxifen used for breast cancer are
Thromboembolism, endometrial carcinoma, and
cataract.
AIIMS MAY 2011 C Side effects of naloxone are
C True about Pioglitazone Hypertension, pulmonary oedema and ventricular
Metabolized in liver, not given in case of diastolic dysrhythmia.
dysfunction and PPAR gamma agonist (Mn: G for C Muscle rigidity due to opoids is because of its effect on
gamma, g for glitazone). Mu receptor
32 AIIMS and All India PGMEE—Review Questions
C Most common dose limiting toxicity of anticancer It follows zero order kinetics
drugs is C Nitrates are used in
Myelosuppression CCF, esophageal spasm and cyanide poisoning.
C Oligospermia reported in C In India, drugs given under supervised regimen are
Methotrexate Rifampicin, pyrazinamide and clofazimine
C Drug of choice in Zollinger-Ellison syndrome C Prodrugs are
Proton pump inhibitors Quinapril, fosinopril and benzopril
Pharmacology 33
C Antiepileptic drug which decreases the uptake of C Unconscious man brought to hospital suffering
GABA into neuron and glial cells from methyl alcohol poisoning. True are
Tiagabine Kussmaul’s breathing present, papilloedema
C The mu receptor of opioids is responsible for present and plasma bicarbonate might be very low.
Analgesia, sedation and respiratory depression C Drug of choice of Listeria meningitis in patient
C Anticancer drug with selective action on hypoxic allergic to penicillin
tumor cells Trimethoprim-sulphamethoxazole
Mitomycin C. C True about Vincristine
C Anticancer drug most commonly given by Alkaloid, neurotoxicity is side effect and used for
continuous infusion induction of remission in acute lymphoblastic
leukemia.
Cytosine arabinoside
C True about hydralazine
C Nephrotoxicity is side effect of
Causes direct relaxation of blood vessels, increases
Tacrolimus
plasma renin activity and postural hypotension is
C Drug having covalent interaction with target not a common problem.
Aspirin C True about antitubercular drugs
C Radioiodine destroys the neoplastic cell of papillary Ethambutol accumulates in renal failure,
carcinoma thyroid predominantly by hyperuricemia is recognized side effect of
Beta-rays pyrazinamide and red green colour impairment is
C Pemetraxed, useful in breast cancer is classified as an early sign of ethambutol induced optic neuritis.
Antimetabolite C Immediate reversal of warfarin can be done by
Fresh frozen plasma
AIIMS MAY 2005 C Opioids with 90% plasma protein binding capacity
Sulfentanyl
C Indications of ACE inhibitors are
C Indication of ropinirole (non-ergot dopamine agonist)
Hypertension, myocardial infarction and left
Parkinson’s disease
ventricular dysfunction.
C Antihypertensive drug contraindicated in pregnancy
C Zidovudine resistance develops due to
Enalapril
Mutation at reverse transcriptase
C Diuretic not requiring their presence in tubular
Drug of choice for SIADH
lumen for pharmacological effects
C
Demeclocycline Spironolactone
C Alpha adrenoceptor agonist
Guanabenz, guanafacine and clonidine AIIMS MAY 2004
C True about NSAIDS
C Drugs contraindicated in G6PD deficiency
Acetylsalicylic acid (aspirin) is irreversible cox
inhibitor, salicylic acid reduces in vivo synthesis of Cotrimoxazole, furazolidone and nalidixic acid
PGs, and anti-platelet effect of low dose aspirin is C Pro drugs are
related to presystemic cox inhibition. Chloral hydrate, enalapril and oxacarbazepine
C Slow acting schizonticide antimalarial drug is
Pyrimethamine
AIIMS NOVEMBER 2004 C Thalidomide can be used in
C Estrogen increases the risk of ENL
Breast carcinoma, endometrial carcinoma and C Aldosterone antagonist (Spironolactone) is used in
hepatocellular carcinoma. CHF, hirsutism and hypertension
C A 20 years old, 50 kg weight girl consumed 10 gm of C True about lithium
paracetamol with alcohol, 6 hours earlier. Serum Used in bipolar disorder, monitoring of lithium
paracetamol level now is 400 μg/dl. True is concentration in blood is necessary and thiazides
Hepatotoxicity is likely to occur are useful in treatment of lithium induced DI.
Pharmacology 37
C After taking some drug for acute attack of migraine, C True about Ranolazine are
a patient developed nausea and vomiting, deve- Piperazine derived antianginal agent, used as first
loped tingling and numbness in the tip of finger that line agent in chronic angina and may improve
also turned blue. Most likely drug implicated glycemic control.
Dihydroergotamine C True regarding selective estrogen receptor down
C An old aged male patient used a drug for allergic regulator (SERD), fulvestrant are
conjunctivitis that prevents the release of chemical Selective estrogen antagonist, used in treatment of
mediators from mast cells. Mechanism of action of breast cancer and administered as once a month
drug dose.
Inhibition of 5 lipoxygenase C True about erlotinib are
(Note: Zileuton) Tyrosine kinase inhibitor, rash may occur and used
in non-small cell lung carcinoma.
ALL INDIA 2011 C True about aprepitant are
Crosses the blood brain barrier, metabolized by cyp
C Actions of muscarinic antagonists are
3A4 pathway, and ameliorates nausea and
Decrease gastric secretions, decrease respiratory vomiting of chemotherapy.
secretions and facilitates AV conduction.
C Agents used for treatment of thrombocytopenia
Buprenorphine is classified as
secondary to myelosuppressive cancer chemotherapy
C
Partial agonist at mu receptor
Oprelvekin
C Opioid tolerance develops to
C Drugs that should not be used in a patient on
Analgesia, euphoria and nausea and vomiting.
Lithium in order to prevent lithium toxicity
(Exception: 3C convulsion, constipation and
Diuretics
constriction of pupil).
C True about epidural opioids are C Known adverse effects of thalidomide are
Acts on dorsal horn substantia gelatinosa, may DVT, teratogenicity and peripheral neuropathy
cause pruritis and may cause respiratory depre- C Alkalinization of urine is done is case of
ssion. Methotrexate
C Drug most commonly used worldwide in mainte- (Hint: Alkalinisation in acidic drug poisoning)
nance doses for opioid dependence is C Mineralocorticoid receptors are found in
Methadone (Mn: M for M) Colon, hippocampus and kidney
C True about serotonin syndrome are
Not an idiosyncratic reaction, can be caused by SSRI
ALL INDIA 2010
and associated with hyperthermia and hypertension.
C A patient prescribed primaquine develops dark C Narrow therapeutic index is seen in
coloured urine after administration of drug. Lithium
Diagnosis is C Proton pump inhibitor is
G6PD deficiency Omeprazole
C Prolonged treatment with INH leads to deficiency of C Mechanism of action of theophylline in bronchial
Pyridoxine asthma includes
C Amphotericin treatment mandates the monitoring Phosphodiesterase inhibition, Adenosine receptor
of antagonism and increased histone deacetylation.
K+ C Methyldopa is primarily used in
C Integrase inhibitor approved for HIV is Pregnancy induced hypertension
Raltegravir (Mn: tegravir are integrase inhibitor) C True about opioid receptor antagonists are
C True about meglitinides are Naloxone can be used for treatment of opiod
Act by stimulating insulin release, decrease post- induced constipation, naltrexone may be used for
prandial hyperglycemia, and hypoglycemia is less treatment of alcohol dependence and nalmefine has
common than with sulfonylurea. a longer half life than naloxone.
Pharmacology 41
C Therapeutic uses of penicillin G C The major difference between typical and atypical
Bacterial meningitis, syphilis and anthrax antipsychotics is that
C Antipseudomonal penicillin Typical antipsychotic drugs cause tardive dyski-
Piperacillin nesia
C A diabetic patient developed cellulitis due to C Antipsychotic drug induced parkinsonism is
MRSA. Drugs appropriate are treated by
Vancomycin, teicoplanin and linezolid Anticholinergics
C True about mycophenolate mofetil C Oculogyric crisis is known to be produced by
It is a prodrug, it is a selective, uncompetitive and Trifluoperazine, prochlorperazine and perphenazine
Reversible inhibitor and selectively inhibits C Inverse agonist of benzodiazepine
lymphocyte proliferation (Mn: SURI). Beta-carboline
C Protease inhibitors are C Hallucinogens are
Nelfinavir, saquinavir and ritonavir LSD, phenylcyclidine and mescaline
C Nevirapine is a C Topically used sulphonamides are
Non-nucleoside reverse transcriptase inhibitor Sulphacetamide, silver sulphadizaine and mafe-
C Pre-treatment evaluation for lithium therapy includes nide.
Serum creatinine C Penicillinase susceptible are
C Treatment of lithium toxicity includes Amoxicillin, piperacillin and penicillin G
Treating dehydration, ingestion of polystyrene C Antibiotic with anti-inflammatory and immuno-
sulfonate and hemodialysis. modulatory activities is
Macrolides
ALL INDIA 2005 C Best associated with lumefantrine
Antimalarial
C A highly ionized drug
C Drug therapy of toxoplasmosis
Is excreted mainly by kidney
Pyrimethamine
C Hormones with cell surface receptors
C Topoisomerase inhibitor is
Adrenaline, growth hormone and insulin
Irinotecan
True of adrenal suppression due to steroid therapy.
Etanercept acts
C
C
It should be expected in anyone receiving
By blocking TNF
> 5 mg, prednisone daily
C Theophylline has an antagonistic interaction with
Adenosine receptors ALL INDIA 2004
C Drug increasing gastrointestinal motility C Ethical clearance is required in
Neostigmine Phase I, II and III of clinical trial of drugs
C Drug protecting from gastric aspiration syndrome C Sympathomimetic drugs are useful in
in a patient with symptom of flux Acutely decompensated heart failure, hypotension
Metoclopramide and hypertension.
C Drugs with significant drug interaction with C True about biguanides
digoxin are Don’t stimulate insulin release, decrease hepatic
Cholestyramine, thiazide diuretics and guanidine glucose production and can be combined with
C True about nesiritide sulfonylureas.
Brain natriuretic peptide analogue used in C True about an alpha glucosidase inhibitor
acutely decompensated heart failure and has Reduces intestinal absorption of carbohydrates,
short half life effective in both type of diabetes and can be used
C Dry mouth during antidepressant therapy is caused with other oral hypoglycemic drugs.
by blockade of C Anticancer drug causing bone marrow depression
Muscarinic acetylcholine receptor Chlorambucil, daunorubicin and doxorubicin
Pharmacology 45
C Advantages of using Raloxifen over estrogen in C Single most active anticancer drug for leiomyo-
post-menopausal women sarcoma is
Reduces fracture rates, avoids endometrial Adriamycin (Doxorubicin)
hyperplasia and no increase in incidence of breast C Clinically significant drug interaction occurs
carcinoma. between pyridoxine and
C Drugs binding to GABA receptor chloride channel Isoniazide, levodopa, hydralazine
Ethanol, Zolpidem and alphaxolone C True about tacrolimus
C A 60 years old male patient of rheumatic mitral It is a macrolide antibiotic indicated for prophylaxis
stenosis with artial fibrillation is on treatment for fast of organ transplant rejection and glucose intolerance
ventricular rate. He develop a pulse rate of 64/ min, is a well recognized side effect.
regular. Drug given was C BAL used for treating
Digoxin Lead, arsenic and organic mercury poisoning
C Side effects of chronic amiadarone therapy (Note: Not used in Iron and Cadmium poisoning)
Pulmonary fibrosis, hyperthyroidism and hypo-
thyroidism.
C Ranitidine and sucralfate are not prescribed together ALL INDIA 2003
because C True regarding bioavailability of a drug
Sucralfate inhibits absorption of ranitidine Fraction of unchanged drug reaching the systemic
C True about interactions of levodopa circulation, bioavailability can be determined from
It is a prodrug, pyridoxine reduces effects of plasma concentration or urinary excretion data and
levodopa in parkinsonism and phenothiazines bioavailability of oral drug is calculated by
reduce efficacy of levodopa in parkinsonism. comparing the area under curve (0-alpha) after oral
C QT prolongation in a premature baby by and intravenous administration.
Cisapride C Food interferes drug absorption by slowing gastric
C Action ascribed to delta type of opioid receptors emptying and/or by altering degree of ionization of
Supraspinal analgesia drug in stomach. True are
C Morphine can be used in Digoxin absorption delayed by food, food severely
Asthma, hypothyroid and diabetes reduces phenytoin absorption and halofantrine is
more extensively absorbed with food.
C True regarding sulfonamides
Intravenous therapy for hypertensive emergencies
Crystalluria can occur with sulphonamide therapy,
C
are
sulfonamide administration to newborn may cause
kernicterus and sulfonamide can be used in Enalapril, urapidil and fenoldopam
nocardia infection. C CNS/CVS toxicity may result when standard lido-
C Mutually antagonistic antibiotics when used in caine doses are given in patients with circulatory
combination are failure due to
Ampicillin and chloramphenicol Lignocaine concentrations are initially higher in
relatively well perfused tissues like cardic and brain
C Fluoroquninolone not requiring dose adjustment in
tissue.
a patient with creatine clearance of < 50 mg/min
Hemorrhage secondary to heparin use corrected
Trovafloxacin
C
by
C Antipseudomonal cephalosporin
Cefoperazone Whole bloods
C Antitubercular drug not used in pregnancy C Hormone present intracellularly in muscle cells
Streptomycin Corticosteroids
C Patient suffering from multidrug resistant C Hirsutism, gum hyperplasia and granulocytopenia
tuberculosis can be treated with are side effects of
Amikacin, clarithromycin and ciprofloxacin phenytoin
C Hormonal drugs acting against breast cancer C Drugs acting on cell membrane
Letrazole, exemestane and tamoxifen Nystatin, amphotericin B and polymyxin B
46 AIIMS and All India PGMEE—Review Questions
Microbiology
47
48 AIIMS and All India PGMEE—Review Questions
C A 70 years old woman refused to take influenza surrounded by a clear halo. The CD4 count was less
vaccine and later developed influenza and died than 100/mm 3 before demise. The most likely
after 1 week due to pneumonia. The most diagnosis
common cause of acute post-influenza pneumo- CMV pneumonia
nia C Giemsa stained smear of epithelial cells obtained
Staphylococcus aureus from a newborn with hepatosplenomegaly shows
C The avian influenza has the potential to cause intranuclear inclusion surrounded by a clear halo.
human infections with high mortality. Probable Most likely cause of congenital infection
reason for not causing any pandemics CMV
No human to human transmission C An elderly male patient presents with nephropathy,
C True about DHF/DSS 2 months after renal transplantation. Viral etiologi-
It is caused by flavivirus of the arthropod borne cal agent
virus group, Aedes aegypti is the vector and Polyoma virus BK
malnutrition may exert protective effect. C The causative organism for AIDS was identified in
C True about Entamoeba histolytica infection the year
Most infections are asymptomatic, amoebic liver 1983
abscess is more common in man than woman and
C The term recrudescence in malaria refers to
extra-intestinal involvement may include brain,
skin and lungs. Recurrence of sexual parasitemia after completion
of treatment.
C A 15 years old girl returned to her village from
another village after a short stay and complained of
severe headache and fever and was diagnosed as a AIIMS NOVEMBER 2013
case of pyogenic meningitis and admitted but died
C The role played by MHC 1 and MHC 2 is
5 days later. Organism that can be considered in the
diagnosis Present antigens for recognition by T cell antigen
receptors.
Naegleria fowleri.
C Neonatal sepsis is caused by
Group B Streptococci, E. coli and Staphylococcus.
AIIMS MAY 2014
C True regarding staining of microbes AIIMS MAY 2013
Gram-negative bacteria stain red C Rapidly growing atypical Mycobacteria causing
C Both DNA and RNA are present in lung infections
Bacteria M. chelonie, M. fortuitum and M. abscessus
C True about IgE antibodies C A young lady presents with sore throat, fever and
It mediates release of histamine and other chemical headache for 3 days. On examination—severe dehy-
mediators, it is the primary antibody involved in dration, BP—90/50 mm Hg and small red spots on
allergic reaction and it is involved in anti-parasitic the distal aspect of the cuff. Most probable etiology
immune responses. Neisseria meningitides
C A 10 years old child presented with severe sore C A patient with conjunctival infection leading to
throat and a gray pseudomembrane over pharynx corneal perforation, on Gram stain was positive for
and tonsils. The organism causing this infection is Gram-negative coccoid appearance with further
most likely investigation revealing small translucent colorless
A Gram-positive bacillus organism that is oxidase positive. Most probable
(Note: Corynebacterium diphtheriae) causative organism
C The H and E staining of a lung section during Neisseria gonorrhea
autopsy of a patient suffering from AIDS shows C The most sensitive and rapid test for diagnosis of
desquamation of type 1 pneumocytes with CMV retinitis is
prominent intranuclear basophilic inclusion bodies Nucleic acid detection from the intraocular fluid
Microbiology 49
C A method for acquiring infection by Legionella C An abattoir worker presented with a pustule on his
pneumophila hand progressed to ulcer. Smear stain to determine
Consumption of contaminated water the causative agent of the ulcer
C A young male patient presents with loose motion Polychrome methylene blue
and intermittent abdominal pain over the past (Note: Cutaneous anthrax)
1 year. Wet mount stool specimen showing multiple C True about antibiotic resistance
ova > 100 μ in diameter. Causative organisms may be The most common mechanism is production of
Fasciola gigantica, Gastrodiscoides hominis and neutralizing enzymes by bacteria, complete
Echinostima ileocanum. elimination of target is the mechanism by which
enterococci develop resistance to vancomycin and
AIIMS NOVEMBER 2012 alteration of target lesions leads to development of
resistance to antibiotics in Streptococcus pneumonia.
C A farmer from the sub-Himalayan region presents
C Sputum of a pneumonia patient sent for culture
with multiple leg ulcers. The most likely causative
showed Gram-positive cocci in chains and alpha
agent is
hemolytic colonies on sheep agar. Test for confirming
Sporothrix schenkii
the diagnosis
C The endotoxin of following Gram-negative bacteria
Optochin sensitivity
plays a part in the pathogenesis of the natural
A young male patient presented with urethral
disease
C
discharge, pus cells but no organisms on urine
E. coli, Klebsiella and Pseudomonas.
examination. Method best for the culture
C Which of the following features are shared between
McCoy cell line
T cells and B cells
(Note: Chlamydia)
Class 1 MHC expression and antigen specific
receptors. C Synthesis of an immunoglobulin in membrane
bound or secretory form is determined by
C True about Bacteroides fragilis
Differential RNA processing
It is the most frequent anaerobe isolated from
clinical samples, it is not uniformly sensitive to
AIIMS NOVEMBER 2011
metronidazole and lipopolysaccharide formed by it
is structurally and functionally different from the C True about antibiotic resistance
conventional endotoxin. Most common mechanism of resistance is produc-
C True about prions tion of neutralizing substances (enzymes), alteration
Long incubation period of target lesion leads to pneumococcal resistance
C An abattoir worker presented with a malignant and complete elimination of target is cause of
pustule on his hand that progressed to form an resistance to vancomycin.
ulcer. Smear was taken and sample sent for the lab.
Diagnosis AIIMS MAY 2011
Cutaneous anthrax C True about Brucella are
C Aerosol spread leading to epidemics is seen in B. abortus is capnophilic, transmission by aerosol can
infection with occur occasionally and pasteurization destroys it.
Infuenza C True about non-typhoid Salmonella
Poultry is source, can cause invasive diseases in neo-
nates and resistance to fluoroquinolones has emerged.
AIIMS MAY 2012
C Lambda phage true is
C Sputum can be disinfected by Lysogenic phage incorporates in host DNA and
Autoclaving, boiling and cresol remains dormant.
C In a 5 years old male child with history of pyogenic C Streptococcus true are
infections by bacteria with polysaccharide rich Streptodornase cleaves DNA, streptolysin O active
capsules, investigation done is in reduced state and streptokinase is produced
IgG2 deficiency from serotype A, C and K.
50 AIIMS and All India PGMEE—Review Questions
C A 25 years old man with 3 weeks fever presented with C Congenital toxoplasmosis, true are
tricuspid valve vegetation. Most common cause is IgA is better than IgM in detection, diagnosed by
Staphylococcus aureus. detection of IgM in cord blood.
C A young child presenting with intermittent
abdominal cramps, loose stools and ova of size AIIMS NOVEMBER 2008
100 μm on stool examination causes are C Bio safety precaution grade III is practiced in
Fasciola gigantica, Echinostorum ileocaxnum and St. Louis encephalitis virus, Coxiella burnetii and
Gastrodiscoides hominis. (Mn: FEG) Mycobacterium tuberculosis. (Mn: MSC)
C An adult labourer presented with penile ulcer C Most common species of Pseudomonas causing
3 years back not treated. Then he presented with intravascular catheter related infections is
neurological symptom for which he got treated. P. aeruginosa
Test to monitor treatment response is C Most sensitive diagnostic test for dengue is
VDRL Neutralization test
(Note: Neurosyphilis) C A gardener has multiple vesicles on hand and
C Stain used for fungal elements multiple eruptions along the lymphatics. Most
Methanamine silver common fungus responsible is
C Recent Nobel prize for Sporothrix schenckii
RNA viruses are
iRNA
C
Ebola, rabies and vesicular stomatitis virus
C Regarding prior protein true is
AIIMS MAY 2009 It catalyzes abnormal folding of other proteins
C Dimorphic fungi are C True about bacteriophage
Penicillium marneffi, Histoplasma and Blastomyces It is a virus that infects bacteria, it helps in
dermatidis. transduction of bacteria and it imparts toxigenicity
to bacteria.
C Malabsorption caused by
C A girl from Shimla with fever, hypotension, malaise
Giardiasis, Strongyloides and Capillaria phillipen- and axillary and inguinal lymphadenopathy.
sis. Culture in glucose broth shows stalactite growth.
C Gas gangrene is caused by Most likely organism is
Cl. histolyticum, Cl. novyi and Cl. septicum. Yersinia pestis
C Culture media of leptospirosis C True about carbohydrate antigens are
Korthof It has lower immunogenicity, cause polyclonal
C Intermediate host for hydatid disease B cell stimulation, does not require stimulation by
T cells.
Man
C Pertussis toxin acts by mechanisms
C A 25 years old male presented with diarrhea for
ADP ribosylation of proteins associated with
6 months. On examination the causative agent was
receptors, increase cAMP, and acts thorough
found to be acid fast with 12 micrometre diameter.
G alpha submit.
Agent is
C True about isotypic variation
Cyclospora
Changes in heavy and light chain in constant region
C A man on return from a country complains of pain is responsible for class and subclass of immuno-
in abdomen, jaundice, with increased alkaline globulins.
phosphatase and conjugated hyperbilirubinemia. C True about hybridoma technology are
USG shows blockage in billiary tree. Cause is
Specific antibody producing cells are integrated
Clonorchis sinensis with myeloma cells, aminopterin, a folate antago-
C Highest risk of nosocomial infection to a patient is nist inhibits de-novo pathway and HGPRT ase and
in thymidylate synthetase are required for salvage
Patient admitted for elective surgery. pathway.
52 AIIMS and All India PGMEE—Review Questions
diphtheria like organisms on Albert staining. Further C Sulfur granule of actinomycosis contains
processing reveals Organisms
It can grow on potassium tellurite medium. C Conjugate vaccine are available against
C The most suitable clinical sample for ante mortem H. influenzae, S. pneumoniae and N. meningitidis
diagnosis of rabies (group C).
Corneal smear for immunofluorescence stain. C Best method for selective isolation of Nocardia
C Diagnosis of Plasmodium falciparum malaria can be paraffin bait technique
confirmed by detection of antigen C Methods of antitubercular drug susceptibility are
Histidine rich protein II Molecular method, resistance ratio method and
C Urethritis in a 25 years old male patient can be radiometric broth method.
caused by
Neisseria gonorrhoea, Chlamydia trachomatis and
AIIMS NOVEMBER 2003
Trichomonas vaginalis.
C True about Legionella C True about H. influenzae
Can be grown on complex media, not effectively Part of normal flora in some patients, requires
killed by polymorphonuclear leukocytes and haemin and NAD for growth in culture media and
Legionella pneumophila sero group 1 is the most Type b is responsible for invasive disease.
common sero group isolated from human. C Fungal culture of skin scraping of lesion of a patient
C True about Staphylococci showed slow growing colony, which produced a
A majority of infection caused by coagulase few small microconidia. It is a dermatophyte of genera
negative staphylococci and Staph. epidermidis, beta- Trichophyton
lactamase production is under plasmid control and C Most common nosocomial infections are
methicillin resistance is independent of beta- Staphylococcus aureus, P. aerogenes and enterobacteriaceae.
lactamase production. C Bilateral diffuse interstitial pneumonia, 2 months
C The transport media of choice for streptococcal after kidney transplant in a 40 years old man is most
pharyngitis likely caused by
Pike’s media Cytomegalovirus
C Epstein-Barr virus C Irregular branching septate hyphae in Gram smear
Nasopharyngeal carcinoma of the orbital exudates of elderly diabetic patient
C Bilateral fluffy infiltrates on chest X-ray in a patient with left-sided orbital cellulitis and left maxillary
of acute leukemia presenting with febrile neutro- sinusitis on paranasal sinuses CT scan is most
penia. Drug of choice probably
Cotrimoxazole should be added Aspergillus
C Patient from Shimla presents with a series of ulcers
in a row on his leg and biopsy was cultured on
AIIMS MAY 2004 Sabouraud’s dextrose agar. Causative organism
C The protection from smallpox due to previous Sporothrix schenckii
infection with cowpox can be explained by C Gram-negative bacilli with bipolar staining on
Antigenic cross reactivity direct microscopy and rough corrugated grey-
C Class of immunoglobulins is determined by white colonies on blood agar in culture of pus
H-chain aspired from subcutaneous nodules on legs and
C Hepatitis C virus is forearms of a 50 years old alcoholic farmer
Flavivirus presenting with fever, chills and rigor and bilateral
C Painless indurated ulcer on the glans exuding clear crepts and scattered rhonchi. Diagnosis is
serum on pressure and painless inguinal lympha- Meliodosis
denopathy in both groins two weeks after unpro- C True statements are
tected sex in 20 years old male can be diagnosed by Ingested erythrocytes are seen only in Entamoeba
Dark field microscopy of ulcer discharge. histolytica, invasive amoebiasis most commonly
Microbiology 55
affects young adult male of low socio-economic CSF finding of polymorphs 2000/μl, protein
status and electrophoretic study of zymogenes 100 mg/dl, and glucose 10 mg/dl. The possible agent is
differentiates pathogenic and non-pathogenic Haemophilus influenzae
strains of Entamoeba histolytica. C True for Mycoplasma
C Phenomenon responsible for antibiotic resistance in Can grow in cell free media, require sterol for their
bacteria producing slime growth and multiply by binary fission.
Biofilm formation C A man presenting with urethritis and urethral
C Thermally dimorphic fungi are discharge with Gram stain showing numerous pus
Blastomyces dermatitidis, Histoplasma capsulatum and cells but no microbes and also culture negative. The
Sporothrix schenckii most likely responsible organism is
Chlamydia trachomatis
C Most common organism causing cellulitis is
AIIMS MAY 2003
Streptococcus pyogenes
C Virulence factor causing streptococcal toxic shock C Chlamydia trachomatis serovars D-K cause
syndrome Urethritis
Pyrogenic exotoxin C 8 out of 10 develops gastroenteritis within 4–6 hrs of
C Virulence factors of Gonococcus are eating sandwiches. Cook may be the carrier of
IgA protease, outer membrane protein and pilli Staphylococcus aureus
C Malignant pustule is a term used for C Diagnostic test for chronic carrier state in a cook
Anthrax of the skin with history of enteric fever 2 years ago
C True about botulism Vi agglutination test
Botulism is caused by ingestion of preformed toxin,
gene for botulinum toxin encoded by bacteriophage AIIMS MAY 2002
and Clostridium barati may cause botulism. C Antibiotics resistant multiple discharging sinuses
C Pus cells and red cells on stool examination of a patient in the legs of a farmer is
presenting with pain abdomen and mild fever Madurella
followed by gastroenteritis. Organism responsible is C True about Vibrio cholerae is
EIEC Pathogenicity of 0–139 vibrio is due to 0–139 antigens.
C Enrichment medium of choice for stool samples in C Staphylococcus auerus causes vomiting in 16–18 hours.
an outbreak of food borne Salmonella gastroenteritis is Cause is
Selenite F medium/tetrathionate broth. Vagal stimulation.
C Catalase positive and coagulase negative gram- C True about poliovirus
positive cocci on blood culture of a patient in ICU on Very difficult to eliminate type I, type I is responsible
CVP line-organism responsible is for most epidemics and type I is most commonly
Staphylococcus epidermidis associated with paralysis.
C DNA hepatitis virus C Foul smelling pus showing red fluorescence on UV
examination is aspirated from frontal abscess of a
Hepatitis B virus
patient. Most likely organism is
Bacteroides.
AIIMS NOVEMBER 2002 C Detection of Rota virus by
C Young child presenting with fever and cervical Antigen in stool
lymphadenopathy and showing grey membrane on C The most avidly complement fixing antibody is
the right tonsil extending to the anterior tonsil. Ideal IgM
medium for culture of throat swab C The granules discharged in mycetoma contains
Loeffler’s serum slope Fungal colonies
C Gram-negative coccobacilli showing growth of C Hepatitis B vaccination is given to a patient. His
bacteria only on chocolate agar causes fever, serum will reveal
vomiting and neck rigidity in a 2 years old child with Anti-HBsAg antibody
56 AIIMS and All India PGMEE—Review Questions
ALL INDIA 2012 C A 8 years old child with history of pain and
discharge from right ear presents with fever, neck
C A series of ulcers in lower extremities in sub- rigidity and positive Kernig’s sign. Staining reveals
Himalayan area is often caused by Gram-positive cocci. Most likely it is
Sporothrix schenckii Pneumococcus
C Vaccination is based on the principle of C Bacteria having polysaccharide capsule related
Immunological memory antigen–antibody responses are
C EB virus causes autoimmunity by Pneumococus, Meningococcus and H. influenzae.
Polyclonal B cell activation C ‘C’ in CRP stands for
C Cholera toxin stimulates secondary messenger Capsular polysaccharide in Pneumococcus.
cAMP C True about C. diphtheriae
C A characteristic infection of Nocardia asteroides Organism may be identified by tests for toxigenicity,
Brain abscess toxin acts by inhibiting protein synthesis and toxin
C RF in the synovial fluid of patients with RA is most may affect heart and nerves.
frequently found to be C True about Campylobacter jejuni
IgM reacting with IgG Commonest agent responsible for campylobacte-
C True about HUS riosis, paultry is a common source of infection, and
Infection may be transmitted by food, HUS is associated with GB syndrome.
caused by serotoxin producing E. coli and HUS is C Farmer with history of fever and flu-like symptoms,
more common in children. painful inguinal lymphadenopathy and ulcer in the
C Gram-negative bacteria with no role of endotoxin in leg. Stain used to detect suspended bipolar organism
pathogenesis of disease Wayson staining
Vibrio cholerae. C True regarding Clostridium tetani are
C True about interferon β release assays used for the Spores are resistant to heat, incubation period is
diagnosis of TB 6–10 days and person to person transmission does
Second generation quantiferon-TB (gold) used not occur.
ESAT 6 and CPF 10. C MRI scan of a girl with meningitis reveals ring
C Most resistant to actions of antiseptics and disinfec- enhancing lesion in frontotemporal region while
tants CSF shows gram-positive bacilli. Organism is
Prions Listeria monocytogenes
(Note: if cell is mentioned, answer is spore). C True regarding Chlamydia trachomatis
C Gene for bacterial resistance to antibiotics is located It is biphasic, reticulate body divides by binary
in part of the bacterial cell fission and inside the cell it evades phagolysosome.
Chromosome C True about parvovirus B19 is
C Person with AIDS related complex (ARC) is most Respiratory route is primary mode of transmission,
likely suffering from It is a DNA virus and affects erythroid progenitors.
Opportunistic infections C Most common fungal infection in immune competent
patient
ALL INDIA 2011 Candida
C A patient presents with signs of pneumonia. The C Aflatoxins are produced by
bacterium obtained from sputum was a Gram- Aspergillus flavus
positive cocci which showed alpha hemolysis on C A patient with history of persistent fever and
sheep agar. Test to confirm diagnosis is cough, X-ray suggestive of pneumonia, sputum
Bile solubility > Optochin sensitivity shows aerobic branching Gram-positive filaments
C True about Pneumococcus that are partially acid fast. Likely agent is
Capsule aids in virulence, commonest case of otitis Nocardia asteroides
media and respiratory tract of carriers is most C Visceral larva migrans is associated with
important source of infection. Toxocara canis
Microbiology 57
C Complement component that is common link in C Biopsy from multiple polyps with muscle thickening
classical and alternate pathway of complement and impacted secretions in nasal cavities of a young
system is woman complaining of recurrent rhinitis, nasal
C3 discharge and bilateral nasal blockage since one
C Most potent activators of naïve T cells are year shows hyphae with dichotomous branching
Mature dendritic cells typically at 45°.
C True about carbohydrate antigens are Organism is Aspergillus.
Poor immunogenicity, T cell independent immunity
and poyclonal response.
ALL INDIA 2009
C Ovalbumin was injected into a Rabbit. Class of
immunoglobulin likely to be produced initially C True regarding disinfectants
IgE Hypochlorites are bactericidal and inactivated by
organic matter, glutaraldehyde is sporicidal and
ALL INDIA 2010 inactivated by organic matter and formaldehyde is
C Peptide binding site on class I MHC molecules for bactericidal, spermicidal and virucidal.
presenting processed antigens to CD8 T cells is C Culture media used for diagnosis of EHEC 0157: H7 is
formed by Sorbitol MacConkey media
Distal domain of alpha subunit. C True about non-typhoid Salmonella
C True about penicillin binding proteins (PBP) are Transmission is most commonly associated with
PBPs are essential for cell wall synthesis, PBPs act as eggs, poultry and undercooked meat, common in
carboxypeptidase and transpeptidase, alteration in immunocompromised individuals and resistance
PBPs is the primary basis of resistance in MRSA. to fluoroquinolone.
C True regarding penicillin resistances are C True about leptospirosis
B-lactamase production is the most common mecha- Infection acquired by direct contact with infected
nism of resistance, alteration in permeability/ urine, mortality is 5–15% in severe cases, and IV
penetration of antibiotic causes resistance only in penicillin is recommended for treatment of severe
Gram negative bacteria and B lactmase production cases.
causes resistance in both Gram-positive and Gram- C True about transmission
negative bacteria. Legionella may be transmitted through water
C True about Staphylococcus is aerosols, Listeria may be transmitted through
About 30% of general population is healthy nasal refrigerated food and leptospirosis may by trans-
carriers, Epidermolysin and TSS toxin are super mitted through water contaminated with rat urine.
antigens and methicillin resistance is chromoso- C Species of Borrelia not associated with tick-borne
mally mediated. relapsing fever is
C A child presents with sepsis. Bacteria isolated showed Borrelia recurrentis
beta-hemolysis on blood agar, resistance to bacitracin
C Most common mode of transmission of Pasteurella
and a positive cAMP test. Most likely agent is
multocida is
S. agalactiae.
Animal bites or scratches
C True about El Tor Vibrios are
C Maltese cross is a characteristic feature of
Human are the only reservoir, can survive in ice
cold water for 2–4 weeks and killed by boiling for Babesia microti > Cryptococcus neoformans
30 seconds. C True about Chlamydia trachomatis are
C Isolation of Chlamydia from tissue specimen can be Genital chlamydial infections are often asympto-
done by matic, can be cultured and inclusion conjunctivitis
Yolk sac inoculation is caused by C. trachomatis serotypes D-K.
C Varicella zoster remains latent in C True about hepatitis C
Trigeminal ganglion Most common indication for liver transplantation
C Most common genital lesion in HIV patient is C Enteroviruses are associated with
Herpes Aseptic meningitis, pleruodynia and herpangina
58 AIIMS and All India PGMEE—Review Questions
C True about parvovirus B19 C Components of innate immunity that are active
DNA virus, can cause severe anemia and can cause against viral cells include
aplastic crisis. NK cells
C Dengue hemorrhagic fever is caused by C Culture of infective skin lesions of the leg of a child
Reinfection with a different serotype of dengue virus. shows Gram-positive cocci in chains and hemolytic
C Primary receptor for HIV is colonies. Test to identify the organism is
CD4 Bacitracin sensitivity
C Function of CD 4 helper cells are C Vancomycin resistant Gram-positive cocci in
Immunogenic memory, activate macrophages and chains with catalase negative organism causing a
activate cytotoxic cells. spike of fever in a patient in an ICU on central
venous line and on ceftazidime and amikacin for
ALL INDIA 2008
last 7 days is
Enterococcus faecalis
C Most resistant to antiseptics C True about Vibrio cholerae
Prion Nonhalophilic, grows on simple media, and man is
C True about Gram-positive cocci the only natural host.
Staphylococcus saprophyticus causes UTI in females, C Bacteria acting by increasing cAMP are
micrococci are oxidase positive and pneumococci
Vibrio cholerae
are capsulated.
C Component of Streptococcus pyogenes showing cross C Sputum culture showing growth on BCYE in an
reactivity to synovium of human tissues elderly male patient presenting with fever, chest
pain and dry cough. The causative agent is
Capsular hyaluronic acid
C True regarding Enterococcus Legionella
Common species are E. faecalis and E. faecium. It is a C A person working in an abattoir presented with a
cause for peritonitis and it is a cause for intra- papule on hand which turned into an ulcer. Stain
abdominal abscess. used for diagnosis is
C True about V. cholerae 0139 Trichrome methylene blue
Clinical manifestations are similar to Eltor strain, C Brucella is transmitted by
first discovered in Chennai and epidemiologically Through the placenta of animals, aerosol
indistinguishable from 01 Eltor strain. transmission and eating uncooked food.
C True about Pneumocystis jirovecii is C Botulinum affects
May be associated with pneumatocele, usually Neuromuscular junction, preganglionic junction
diagnosed by sputum examination and cause and postganglionic nerves.
disease only in the immunocompromised host. C True about Bacteroides fragilis
True about prions is
It is a frequent anaerobe isolated from clinical
C
They are infectious proteins samples, it is not uniformly sensitive to
C H1N1 may be best described as a metronidazole and LPS formed by Bacteroides
Bird flu virus fragilis is structurally and functionally different
C Parasites causing biliary obstructions are from conventional endotoxins.
Clonorchis, Ascaris and Fasciola C True about Chlamydia psittacosis are
ALL INDIA 2007
Acquired by bird’s droppings, causes pneumonia
and treatment is tetracycline.
C True statement is
Nutrient broth is a basal medium
ALL INDIA 2006
C Urine examination of a young male patient
presented with UTI shows pus cells but no C A veterinary doctor had PUO due to Gram-negative
organism. Method best used for culture is short bacilli oxidase positive. Likely causative agent
McCoy culture Brucella spp
Microbiology 59
C Smear staining done for a young boy with flea bite C Bacterial disease associated with rats, rice fields and
in a wheat grain godown and fever and axillary rainfall is
lymphadenopathy after 5 days Leptospirosis
Wayson staining C Correct incubatory conditions of the culture plates
(Note: Plague) of the stool sample for Campylobacter jejuni is
C True about Mycobacteria Temperature of 42°C and microaerophilic
M. Kansasii can cause a disease indistinguishable C True about meliodosis
from tuberculosis. Caused by Gram-negative aerobic bacteria, bipolar
C VDRL positive woman gave birth to an infant. Risk staining is seen with methylene blue stain, most
of transmission is determined by common form of meliodosis is pulmonary infection.
TPHA test on serum sample of mother, VDRL on C Organisms known to survive intracellularly
paired serum sample of infant and mother and time Neisseria meningitidis, Legionella pneumophila and
interval between treatment of the mother and Salmonella typhi.
delivery. C The most common organism causing acute
C A patient complained of chills and fever for 2 week meningitis in an AIDS patient is
after louse bite with rashes all over the body, Cryptococcus neoformans
delirious and went into coma. Vasculitis due to C The most common pathogen responsible for
Rickettsial infection by nosocomial pneumonias in the ICU are
Rickettsia prowazekii Gram-negative organisms.
C Associated with Epstein-Barr virus infection C Normal microbial flora present on the skin and
Infectious mononucleosis, nasopharyngeal mucous membranes
carcinoma and oral hairy leukoplakia. Endemic trachoma, inclusion conjunctivitis and
C Parasitic infestation leading to malabsorption lymphogranuloma venerum.
syndrome C True about Chlamydia pneumoniae
Giardiasis The group specific antigen is responsible for the
C A vitreous aspirate from a case of metastatic production of complement fixing antibodies.
endophthalmitis on culture yields Gram-positive C High fever, headache, generalized lymphadeno-
round to oval cells, 12–14 micron in size. Gram pathy and erythematous lesion of about 1 cm on leg
staining shows pseudohyphae. Fungus responsible surrounded by small residues in an army jawan
is posted in remote forest area was provisionally
Candida diagnosed as Rickettsial disease. Weil-Felix
reaction diagnostic in setting
High OX-K
ALL INDIA 2005
C Viruses can be cultivated in
C Cholera toxin acts in the small intestine by Animals, embryonated eggs and tissue culture
ADP ribosylation of G-regulatory protein C Virus mediated transfer of genetic material is called
C Halophilic species of Vibrio are Transduction
Vibrio parahemolyticus, V. fluvialis and V. alginolyti- C HIV can be detected and confirmed by
cus RT-PCR
C True regarding Clostridium perfringens C Neuroparasites are
Commonest cause of gas gangrene, normally Acanthamoeba, Naegleria and Taenia solium
present in human faeces, the principal toxin is alpha C The capsule of Cryptococcus neoformans can be seen
toxin. in CSF by
C True about E. coli India ink preparation
EAEC-persistent diarrhea. C The maximum serum concentration of subclass of
EHEC-HUS human IgG is
ETEC-Traveller’s diarrhea. IgG1
60 AIIMS and All India PGMEE—Review Questions
C Infection associated with acute intravascular C Heat stable enterotoxin causing food poisoning is
hemolysis caused by
Babesia microti, Bartonella bacilliformis and Plasmo- Bacillus cereus, Yersinia enterocolitica and Staphylo-
dium falciparum. coccus.
C The earliest Ig synthesized by fetus is C HIV virus contains
IgM ssRNA
C True about HIV
ALL INDIA 2002
Reverse transcriptase present, infect CD4 cells and
C Bacteria may acquire characteristics by T-lymphocytes, cause CD4 count reduction at late
Conjugation, bacteriohage mediated and by taking stage.
up soluble DNA fragments across the cell wall. C CD4 count when CMV retinitis occurs in HIV
C Neonatal thymectomy leads to positive patient is less than
Decreased size of paracortical areas 50
C Staphylococcus aureus differs from Staphylococcus C Narrow angled septate hyphae in corneal scraping.
epidermidis by Fungus responsible is
Coagulase test Aspergillus
C In a patient with typhoid, diagnosis after 15 days of C True about globi in lepromatous leprosy
onset of fever is best done by Consists of macrophages filled with acid fast
Widal test bacilli
C Transmitted by rat urine C Correct matches are
Leptospira Ziehl-Neelsen staining-detection of Mycobacteria
C True about Listeria specific IgM antibodies—detection of acute
Transmitted by contaminated milk, causes abortion infection, immunofluorescence—detection of
in pregnancy and causes meningitis in neonates. Influenza virus.
C True about Bacteroides C IL-1 produces
May cause peritonitis T lymphocyte activation
62 AIIMS and All India PGMEE—Review Questions
Pathology
62
Pathology 63
C An old age man presents with chronic cough and C Example of a syndrome caused by uniparental
hemoptysis. On investigations, a grayish white disomy
tumor located at the central bronchus was found Angelman syndrome, Prader-Willi syndrome and
causing distal bronchiectasis and recurrent Russel-Silver syndrome.
pneumonia. Biopsy may show C ANCA is seen in
Small round cells and hyperchromatic nuclei with Wegener’s granulomatosis.
nuclear moulding. C ARDS is due to a defect in
(Note: Small cell lung cancer) Type 2 pneumocytes.
C A 70 years old man with history of working in the C A 50 years old male patient presents with large
asbestos factory for a long time, on routine bowel type diarrhea and rectal bleeding. On
examination shows a mass in the apex of right sigmoidoscopy, a cauliflower-like growth is seen in
upper lobe. Characteristic electron microscopic the rectum. Colectomy specimen on histopathology
appearance of the mass shows adenocarcinoma. Prognostic investigations
Large tubular cells with long villi on their surface required are
(Note: Mesothelioma) Microsatellite instability, c-myc mutations and
k-RAS mutations.
C Premalignant lesions are
C Verocay bodies are seen in
Barret esophagus, ulcerative colitis and Crohn’s Schwannoma.
disease.
C Histopathologically, rosettes are seen in
C A 16 years old girl underwent FNAC for breast Retinoblastoma, medulloblastoma and PNET.
lump that was well defined, non-tender and mobile.
Pathological feature suggesting benign lesion
AIIMS NOVEMBER 2013
Tightly arranged ductal epithelial cells with
dyscohesive bare nuclei. C Which indicate megaloblastic anemia
C The molecular classification of breast cancer includes Raised bilirubin, mild splenomegaly and nucleated
Hormonal receptor and Her-2 status RBC.
C The characteristic histopathological feature of C Platelet adhesion to collagen occurs via
schwannoma is von Willebrand factor
Antoni A and B areas C Markers of acute kidney injury includes
Cystatin- C, N-gal and kim-1
C Indoor air pollution leads to
AIIMS MAY 2014
Chronic lung disease, adverse pregnancy outcome
C A 50 years old patient presents with weakness and and pneumonia.
bleeding episodes, Hb–10.5 gm/dl, TLC–48 × 109 C Chromosomes are visualized through light micro-
cells/L, platelet 50 × 10 9 cells/L, dysplasia of scope with resolution of
neutrophils with a differential count showing 76% 5 mb
neutrophils, 8% blast cells, 12% myelocytes and C Tensile strength of wound after laparoscopic chole-
metamyelocytes and 4% other cells. Bone marrow cystectomy in a 30 years old women depends upon
showed 14% blast cells. Cytogenetics showed-t(8, 21).
Extensive crosslinking of tropocollagen
The most likely diagnosis
C In a 70 years old person who has worked in asbestos
Chronic myeloid leukemia. factory for 10–15 years, has a mass in right apical
C True about cellular events in acute inflammation region of the lung on routine X-ray. Electron
Components of complement can assist in microscopic finding after biopsy
chemotaxis, neutrophil margination is assisted by Numerous long slender microvilli
selectins and ICAM-1/VCAM-1 is responsible for C Which induces apoptosis
neutrophil adhesion. Glucocorticoid
C Which is morphogenic as well as mitogenic C A 45 years old lady presents with painless
Insulin like growth factor. supraventricular lymphadenopathy, on biopsy
64 AIIMS and All India PGMEE—Review Questions
showing binucleated acidophilic owl eye C 70-years-old patient presents with generalized
appearance with floating lymphocytes in empty lymphadenopathy, WBC count—20,000/mm3 and
space, that was CD 15 and CD 30 positive blood film showing > 70% mature looking
Nodular sclerosis Hodgkin lymphoma lymphocytes. Next done
C Real time polymerase chain reaction is done for Peripheral immunophenotyping
Monitoring amplification of target nucleic acid C Most common fixative used in electron microscopy
Formalin
C Mutation in COL4A5 chain is seen in
AIIMS MAY 2013
Alport’s syndrome
C Apoptosis is characterized by C Person with heterozygous sickle cell trait is
DNA fragmentation, Chromatin condensation and protected from the infection of
cell shrinkage. Plasmodium falciparum
C The role of MHC proteins is to C Hyperacute rejection is due to
Present antigens for recognition by T cell antigen Preformed antibodies
receptors. C In kidney specimen, fibrinoid necrosis is seen and
C Special stain used to diagnose fungal hyphae in onion peel appearance is also present. Most
tissues probable pathology is
Silver methenamine Hyaline degeneration
C In Alzheimer’s disease, the pathology seen in the C CD 95 is a marker of
brain is Extrinsic pathway of apoptosis
Atrophy of parietal and temporal lobes C Staining done for sebaceous cell carcinoma
C A 28 years old lady presents with recurrent Oil red O
abortions and pain in the calves. She is most likely C Flow cytometry is done on
suffering from the deficiency of Lymphocytes
Protein C C Receptor on neuronal membrane that induces
C Special stain used for the diagnosis of rhabdomyo- development of glioma
sarcoma CD 133
Desmin
C A 17 years old girl underwent FNAC for a breast AIIMS MAY 2012
lump, well-defined, non-tender and mobile. The C A young female patient, with no history of RHD, on
diagnosis of benign lesion can be considered by routine examination mid-systolic click is found.
feature Histopathology will show
Tightly arranged ductal epithelial cells with Myxomatous degeneration and prolapse of the
dyscohesive bare nuclei. mitral valve.
C Infection with HIV is associated with atrophy in C Characteristic of irreversible injury on electron
parts of the brain microscopy
Caudate nucleus, lower white matter nucleus and Amorphous densities in mitochondria
globus pallidus. C True statement is
Acute lymphoid leukemia in less than one year old
AIIMS NOVEMBER 2012 has poor prognosis.
C True about Bombay blood group
C Immunological stain used for the diagnosis of Lack of H, A, and B antigens on RBCs, lack of H, A
lymphoma and B substance in saliva and H, A and B antibody
Leukocyte common antigen will always be present in serum.
C Myelofibrosis leading to a dry tap on bone marrow C Hematopoetic stem cells differ from progenitor
aspiration is seen with stem cells in that they can
Acute megakaryocytic leukemia Long term reconstitution of bone marrow
Pathology 65
C In an ablated animal, myeloid stem cell series are reports show transmural coagulative necrosis.
injected. Cells seen after incubation period Further microscopic examination reveals
RBC Neutrophilic infiltration surrounding coagulative
C The role of bradykinin in process of inflammation is necrosis.
Increased vascular permeability > pain. C A 7 years old girl with complaints of generalized
C A 23 years old female patient presents with jaundice swelling of the body. Urinary examination reveals
and pallor for 2 months with peripheral blood grade 3 proteinuria and presence of hyaline and
smear showing spherocytes. Investigation done for fatty casts. She has no history of hematuria. True is
diagnosis No IgG or C3 deposition on renal biopsy.
Coombs’ test C Infraclavicular lesion of TB is called
C The fixative used in histopathology Assmann’s focus
10% buffered neutral formalin C CD4 is important for
C A newborn baby presents with profuse bleeding Antibody production, cytotoxicity of T cells and
from the umbilical stump after birth. Rest of the memory B cells. (Mn: MAC)
examination and PT, APTT are within normal C Cardiac polyp means
limits. Most probable diagnosis Fibrinous clot
Glanzmann thrombasthenia
AIIMS NOVEMBER 2010
C Tumerogenesis in aging is due to C A 30 years old female, RBC count 4.5 million, MCV
Telomerase reactivation 5.5 micron, TLC 8000, no history of blood transfusion
C Finnish of nephrotic syndrome is caused by defect Thalassemia minor
in C Seen in ulcerative colitis is
Nephrin Cryptitis
C MHC restriction is part of C Hematoxylin bodies seen in
Antiviral cytotoxic T cell, antibacterial helper T cell SLE
and allograft rejection. C CD 99 is for
C Paucimmune glomerulonephritis is seen in Ewing’s sarcoma
Microscopic polyangitis C Loss of heterozygosity is associated with
Retinoblastoma
AIIMS NOVEMBER 2008 C AML with gum infiltration, hepatosplenomegaly
C Gene for MHC complex is located on M4
Chromosome 6 C Bone resorption markers are
C BRCA 1 gene is located on TRAP, cross linked N-telopeptide and urine total
free deoxypyridinoline.
Chromosome 17
C FSGS with worst prognosis is
C Gene for folate carrier protein is located on
Diffuse alveolar damage
Chromosome 21
C Tumor suppressor genes are
C Essential for tumor metastasis is
WT1, Rb and p53
Angiogenesis
C Steroid resistant nephrotic syndrome is
C Virchow’s triad includes
Podocin
Injury to vein, venous stasis and hypercoagulability
A patient with Hb-6 gm/dl, TLC-12,500, platelet
of blood. (Mn: HIS)
C
60,000, MCV-112 fl. Diagnosis is
C Minor diagnostic criteria for multiple myeloma are
Megaloblastic anemia
Lytic bone lesions, plasmacytosis greater than 20%
and monoclonal globulin spike on serum
electrophoresis of 2.5 g/dl for IgG and > 1.5 g/dl for AIIMS NOVEMBER 2007
IgA. C Collapsing glomerulopathy, features are
C Antibody independent and dependent complement Hypertrophy and necrosis of visceral epithelium.
pathway converge on C In MVPS, mitral valve histopathology shows
C3 Myxomatous degeneration
C Good prognostic factors for acute lymphoblastic C Prion includes
leukemia are
Proteins
Age of onset between 2 and 8 years, initial WBC
C Councilman bodies are seen in
court > 50000 and hyperploids.
Acute viral hepatitis
Nitroblue tetrazolium test is used for
Stain used for lipid
C
C
Phagocytosis (Mn: PhaNi) Oil red O, Sudan III and Sudan black.
C Hypersensitivity vasculitis are seen most commonly C Acrodyne orange is a fluorescent dye used to bind
in DNA and RNA
Postcapillary venules C PAS stains
Glycogen, lipid and fungal cell wall.
AIIMS MAY 2008
C Ability of stem cells to cross barrier of differentia-
C A patient presenting with mediastinal mass with tion to transform into a cell of another lineage
sheets of epithelial cells giving arborizing pattern of expressing the molecular characteristic of different
reactivity along with interspersed lymphoid cells. cell type with the ability to perform function of new
The diagnosis is cell type is referred as
Thymoma Trans differentiation
68 AIIMS and All India PGMEE—Review Questions
C Components of basement membrane are C Why fetal cells continue to divide but terminally
Nidogen, laminin and entactin. differentiated adult cells don’t divide
C Ultra structural finding of irreversible cell, injury There are many cyclin inhibitors which prevent cell
Amorphous densities in mitochondria to enter into S phase in adult.
C Toll like receptors recognize bacterial products and
C Reye’s syndrome—histological finding is
stimulate immune response by
Glycogen depletion
Transcription of nuclear factor mediated by NFK
C Pancytopenia with cellular marrow is seen in beta which recruit cytokinines.
PNH, megaloblastic anemia and myelodisplastic C C-C beta chemokine includes
syndrome. Eotaxin
C Contraction of endothelial cell cytoskeleton in acute
AIIMS MAY 2007 inflammation results in
C Michaelis Guttman bodies are seen in Early transient increase
Malakoplakia
C Histopathological feature of liver in malaria is AIIMS MAY 2006
Kupffer cell hyperplasia with macrophage
Right ventricular endo-myocardial biopsy of a
infiltration around periportal area laden with
C
50 years old male patient of restrictive heart disease
pigments.
revealed deposition of extra cellular eosinophilic
C Affected in graft versus host disease
hyaline material. On electron microscopy, finding is
Skin, GIT and liver
Non-branching filaments of indefinite length
Brain natriuretic peptide is degraded by
The ideal immunohistochemistry panel for a 30
C
C
Neutral endopeptidase years old female with histopathologic finding from
C B cell markers are solid-cystic unilateral ovarian tumor showing
CD19, CD21 and CD24. diffuse sheets of small cells with doubtful nuclear
C DIC is seen in grooving and scanty cytoplasm (and no Call-Exner
Acute promyelocytic leukemia bodies are seen)
C Gene defect in idiopathic steroid resistant nephrotic CD99, epithelial membrane antigen, inhibin and
syndrome vimentin.
NPHS2 C True about carcinogenesis
Asbestos exposure increases incidence of lung
AIIMS NOVEMBER 2006 cancer, exposure to aniline dyes predisposes to
cancer of the urinary bladder and hepatitis B virus
C Antiapoptotic gene is has been implicated in HCC.
Bcl-X C Histological feature most helpful to differentiate
C Cytosolic cytochrome C plays an important role in between possible enchondroma or chondrosarcoma
Apoptosis in a 50 years old lady presenting with 3 months
C Acid phosphatase is specific for history of pain in lower third of right thigh is
Monocyte Tumor permeation between bone trabeculae at
C Proliferation of which cell occurs in post-transplant periphery.
lymphoma C True about lymphoma
B cell A single classification system for Hodgkin’s disease
is almost universally accepted, HD more often
C Beta pleated sheet is seen in amyloidosis in
tends to remain localized to a single group of lymph
X-ray crystallography nodes and spreads by contiguity and several types
C Natural killer cells attack of NHL may have a leukemic phase.
Cells which are not able to express MHC 1. C Characteristically associated with development of ILD
C Pigments involved in free radical injury Organic dusts, inorganic dusts and toxic gases (e.g.
Lipofuscin chlorine, sulphur dioxide).
Pathology 69
C Obstruction to the flow of CSF at the aqueduct of DLC—Neutrophils 55%, lymphocytes 4%, mono-
Sylvius most likely lead to enlargement of cytes 2%, basophils 6%, Metamyelocytes 10%,
Both lateral and third ventricles. myelocytes 18%, promyelocytes 2% and blasts 3%.
C CD 95 has a major role in The most likely cytogenetic abnormality t(9, 22)
Apoptosis CML
C Example of C-X-C or α chemokine C A 50 years old woman presents with progressive
IL-8 renal failure for past 3 years, renal biopsy showing
glomerular and vascular deposition of pink
C Tectel breaking is found in
amorphous material. It shows apple green
Arnold-Chiari malformation birefringence and polarized light after congo red
C Compatible with diagnosis of chronic myelomono- staining. These deposits are positive for Lambda
cytic leukemia light chain. Diagnosis
Peripheral blood monocytosis more than 1 × 109/L, Multiple myeloma
absence of Philadelphia chromosome and absent or C A 40 years old man has chronic cough with fever for
minimal dysplasia in myeloid lineages. several months. X-ray showing diffuse reticulono-
C Complication of infective endocarditis dular pattern. Focal areas of inflammation
Myocordial ring abscess, myocardial infarction and containing epitheloid cell granuloma, Langerhans
focal and diffuse GN. giant cells and lymphocytes are seen micro-
C A 1 year old boy presented with heptospleno- scopically on transbronchial biopsy. Type of hyper-
megaly and delayed milestones, liver biopsy and sensitivity reaction is
bone marrow biopsy revealing presence of Type IV
histiocytes with PAS positive diastase resistant C Most important factor responsible for rapid healing
material in the cytoplasm. Electron microscopic of a burn injury of hand of an adult man over a few
examination of these histiocytes most likely reveals weeks without the need for grafting
the presence of Remnant skin appendages.
Parallel rays of tubular structures in the lysosomes C An organ section at autopsy shows focal, wedge
Niemann-Pick’s disease shaped, firm area accompanied by extensive hrge
C Classical presentation of craniovertebral junction with red appearance with base on surface of organ.
anomalies are This is typical of
Pyramidal signs, low hairline and short neck Lung with pulmonary thromboemobolism
C In a case of Rh incompatibility, a few days after birth (Hint: Red infarct).
neonate developed jaundice, ascites, hepatomegaly C Tophus is the pathognomonic lesion of
and edema. The likely substance(s) deposited in Gout
skin and sclera in jaundice is C Infertility is a common feature in Sertoli cell syn-
Conjugated and unconjugated bilirubin drome because
There are no germ cells in this condition.
AIIMS MAY 2003 C The most common infectious agent associated with
chronic pyelonephritis is E. coli.
C The light brown perinuclear pigment seen on H/E
staining of the cardiac muscle fibres in grossly
AIIMS NOVEMBER 2002
normal appearing heart of 80 years old man at
autopsy is due to deposition of C Mixed lymphocyte culture is used to identity
Lipochrome MHC Class II antigen.
C Dystrophic gene mutation leads C Feature seen in asbestosis
Duchenne muscular dystrophy Calcific pleural plaques, diffuse pulmonary inter-
C A 60 years old man presented with fatigue, weight stitial fibrosis and fibrous pleural thickening (Mn:
loss, and heaviness in left hypochondrium for 6 CDF).
months with hemogram showing Hb 10gm/dl, C Aschoff bodies in rheumatic heart disease shows
TLC 5 lakhs/mm 3, platelet count 4 lakhs/mm3, Anitschkow cells, fibrinoid necrosis and giant cells.
72 AIIMS and All India PGMEE—Review Questions
C Distinguishing factor between hydrocephalus due C Baby’s blood group is O Rh negative. Blood group
to aqueductal stenosis and that due to Dandy- baby’s parents will not have
Walker malformation AB Rh negative.
Posterior fossa volume C An accident victim urgently needs blood. The blood
(Hint: 4th ventricle is in posterior fossa). bank is unable to determine his ABO group.
C Dystrophic calcification is seen in Emergency transfusion of the patient should be
Atheromatous plaques. O positive RBC and colloids/crystalloid.
C Familial amyloidotic polyneuropathy due to C ABO blood group system is most important in
amyloidosis of nerves is caused by deposition of clinical medicine out of 400 blood groups because
Mutant transthyretin. ABO (H) antibodies are invariably present in plasma
C Lardaceous spleen is due to deposition of amyloid in when person’s RBC lacks the corresponding antigen.
Sinusoids of red pulp. C Complement fixed best by
C A 40 years old man presented with 2 week history IgM
of fever, weakness, bleeding gums, peripheral C The most common cause of Addison’s disease
blood smear showing pancytopenia, bone marrow
Autoimmune adrenalitis.
showing 26% blasts frequently exhibiting. Auer
Gastrointestinal stromal malignancy arises from
rods of mature myeloid cells with occasional
C
Longitudinal ulcers of small intestine alongside of C An infant presents with generalized skin rash with
lymphoid tissues. biopsy suggestive of Langerhans cell histiocytosis.
C Splenomegaly is least likely associated with Immunohistochemical stain to confirm the diagnosis
Essential thrombocytosis CD 1a
C Inherited aplastic anemia is C In normal healthy person blood is prevented from
Fanconi’s anemia clotting due to
C A 2 years old boy presents with skin rashes, Binding of thrombin to antithrombin 3
bleeding, very low platelet counts and decreased C Bone marrow derived stem cells are
IgM. Diagnosis Endothelial progenitor cells, hematopoetic stem
Wiskott-Aldrich syndrome cells and mesenchymal stem cells.
C The amyloid protein in secondary amyloidosis is C A 50 years old male patient with history of
most likely derived from bronchiectasis 5–10 years back, now presents with
Serum amyloid associated protein pedal edema, albuminuria and hypoalbuminemia.
Renal biopsy will show
C Immunohistochemical marker most useful for
establishing diagnosis of a poorly differentiated Amyloid nephropathy (Secondary amyloidosis in
carcinoma brochiectasis—Nephrotic syndrome).
Features shared by B and T lymphocytes
Cytokeratin
C
Positive selection during development, antigen
C A 18 years old male hypertensive patient suddenly
specific receptors and dependence on cytokines
developed severe headache, vomiting, became
secreted by other cells.
unconscious and died within 24 hours. Gross
pathological finding of kidney C A patient with renal tumor is diagnosed by
exfoliative cytology. The most likely histological
Petechial hemorrhages on the surface
subtype
Histopathology of adults with respiratory distress
Transitional cell carcinoma, adenocarcinoma and
C
syndrome
well-differentiated carcinoma—all three subtypes
Diffuse alveolar damage can be easily detected by exfoliative cytology.
C True about DIC C Pyrogenic cytokines are
Increased FDP, prolonged PT, increased thrombin- TNF, IF-α and IL-6
antithrombin complex, decreased antithrombin 3,
reduced platelet count.
C Immune hypersensitivity reaction in myasthenia ALL INDIA 2011
gravis C Organelle playing a pivotal role in apoptosis
Type 2 hypersensitivity reaction. Mitochondria
C Autosomal dominant conditions are C Enzyme contributing in generating free oxygen
Gardener’s syndrome, neurofibromatosis and radicals within neutrophils for killing intracellular
Peutz-Jegher’s syndrome. bacteria is
C A biopsy report shows inflammation of the airways Superoxide dismutase, Fenton’s reaction and
with increased Reid index. Diagnosis NADPH oxidase.
Chronic bronchitis C Enzymes responsible for generating oxygen burst
C An acidified urine sample contains proteins that within neutrophils for killing intracellular bacteria
precipitate on heating at 40–50°C but redissolves on are
further heating. The protein is Oxidase/NADPH oxidase.
Bence-Jones protein C Most important characteristic feature of acute
C A 9 years old female patient presents with primary inflammation is
small round cell tumor in tibia. Most likely genetic Vasodilatation and increased vascular permeability.
abnormality C True about xanthogranulomatous inflammation is
22q12 translocation Foam cells, yellow nodules and multinucleated
(Hint: Ewing’s sarcoma) giant cells are seen.
74 AIIMS and All India PGMEE—Review Questions
C True about blood coagulation C Translocation t (2,8) (p 12: q24) is associated with
Factor X is part of both intrinsic and extrinsic path- Burkitt’s lymphoma
ways, intrinsic pathway can be activated in vitro, and C Plasmacytoid lymphoma is associated with
calcium is required in several steps of coagulation. IgM
C HbH is associated with deletion of C Most friable vegetations in
3 alpha genes Infective endocarditis
C True about platelet function defects C Characteristic pathological finding in carcinoid heart
Normal platelet count with prolonged bleeding disease is
time. Fibrous endocardial thickening of RV, tricuspid
C True regarding Bernard-Soulier syndrome valve and pulmonary valve.
Aggregation with collagen and ADP is normal, C A female patient presents with history of
large platelets and thrombocytopenia. progressive breathlessness. Histology shows
C An antibody most frequently seen in antiphaspho- heterogenous patchy fibrosis with several
lipid syndrome is fibroblastic foci. Diagnosis
Anti-beta 2 glycoprotein antibody Usual interstitial pneumonia.
C Autoimmune diseases are C Chromophobe variant of RCC is associated with
Monosomy 1 and Y
SLE, Graves’ disease and myasthenia gravis.
C Hypercoagulation in nephrotic syndrome is caused
C Necrotizing lymphadenitis is characteristically
by
seen in
Loss of antithrombin III
Kikuchi disease
GIST specific marker is
Neuronal tumors are
C
C
CD 117
Gangliocytoma, ganglioglioma and neurocytoma.
Granulomatous vasculitis are associated with
Psammoma bodies may be seen in
C
C
Wegener’s granulomatosis, Takayasu arteritis and
Papillary carcinoma thyroid, meningioma and
giant cell arteritis.
serous cystadenocarcinoma of ovary.
Electron microscopy is diagnostic in
Most commonly used fixative in diagnostic
C
C
pathology is Alport’s syndrome
Formaldehyde C Most characteristic ultra structural feature of
paraganglioma on electron microscopy is
ALL INDIA 2010 Dense core neruoendocrine granules.
C Marker for Langerhan’s cell histiocytosis is
C Characteristic feature of apoptosis is
CD 19
Nuclear compaction
C Down’s syndrome is most commonly caused by
C Features of apoptosis are
Maternal nondisjunction
Nuclear compaction, intact cell membrane and
A normal couple has one daughter affected with AR
cytoplasmic eosinophilia.
C
disease cystic fibrosis. Chance of another child
Caspases are involved in
being affected by the disease is
C
Apoptosis
¼
Actions of bradykinin include
Males are more commonly affected in
C
C
Vasodilatation, increased vascular permeability
X-linked recessive
and pain.
C Heterozygous sickle cell anemia is protective
ALL INDIA 2009
against
Malaria C Most effective bactericidal system within
C PNH is associated with a deficiency of phagocytes is
DAF, MIRL and GPI anchored protein Reactive oxygen metabolite mediated.
C Burkitt’s lymphoma is associated with C Primary structural defect of an organ is termed
t (8,14) Malformation
Pathology 75
C Kidney biopsy from a child with HUS characteris- C Most common cytogenetic abnormality in adult
tically most likely presents with features of myelodysplastic syndrome
Thrombotic microangiopathy Monosomy 7
C Disease characteristically causing fatty change in C True about hairy cell leukemia
liver Cells are positive for TRAP, splenomegaly is
Chronic alcoholism conspicuous, and cells express CD 25 consistently.
C Feature of liver histology in NCPF C Good prognostic markers for Hodgkin’s disease are
Fibrosis in and around portal tracts, non-specific Hb > 10 gm/dl, WBC count < 15,000/mm3 and age
inflammatory cell infiltrates in the portal tracts and < 45 years.
thrombosis of the medium and small portal vein C A 65 years old male patient presented with acute
branches. chest pain of 4 hrs duration ECG-new Q wave with
C Differential expression of same gene depending on ST wave depression and died within 24 hrs. The
parent of origin is referred to as heart revealed presence of a transmural hemorrhagic
Genomic imprinting area over the septum and anterior wall of left
C The membrane protein, clathrin is involved in ventricle. Light microscopic examination reveals
Receptor mediated endocytosis Necrotic myofibers with presence of neutrophils
C Cellular and flagellar movements are carried out by C Serum C3 is persistently low in
Actin, myosin and tubulin MPGN, lupus nephritis and GN related to bacterial
endocarditis.
C Associated with low complement levels
ALL INDIA 2004 MPGN, lupus nephritis and post-infectious GN.
C Lipoxin belongs to family of chemical mediators of C A 70 years old male addicted to tobacco chewing for
inflammation last 52 years presented with six months history of
Arachidonic acid metabolites. large fungating, soft papillary lesions in the oral
C Procoagulant protein is cavity with lesion penetrating into mandible,
Thrombin lymph nodes not palpable and two biopsies taken
from lesion proper show benign appearing
C Antiapoptotic gene is
papillomatosis with hyperkeratosis and acanthosis
bcl-x
infiltrating subjacent tissues. Diagnosis
The most abundant glycoprotein present in
Verrucous carcinomas
C
basement membrane is
C The blood in the vessels normally does not clot
Laminin because
C Good outcome in neuroblastoma is associated with Vascular endothelium is smooth and coated with
Trk A expression glycocalyx.
C Gene defect associated with medulary carcinoma of
thyroid ALL INDIA 2003
Ret proto-oncogene C Correct sequence of cell cycle
C Males who are sexually underdeveloped with Go-G1-S-G2-M
rudimentary testes and prostate glands, sparse C Procedure used as routine technique for karyotyping
pubic and facial hair, long arms and legs and large using light microscopy
hands and feet have chromosomes G-banding
46, XXY C Trisomy 21 in karyotype suggests
C Possible mode of inheritance in a family where Mrs Down’s syndrome
A is hesitant about having children as her two C An 18 years old female with short stature, wide spread
sisters had sons who died from kinky hair disease as nipples and primary amenorrhea has karyotype of
also her mother’s brother 45X
X-linked recessive C Chances of affected and carrier child when an
C Autosomal dominant metabolic disorder is albino girl marries to a normal boy
Familial hypercholesterolemia None affected, all carriers
78 AIIMS and All India PGMEE—Review Questions
C Risk of child with beta thalassemia for a couple with C Peripheral blood smear examination of a 40 years
family history of beta-thalassemia in a distant old male who had undergone splenectomy 20 years
relative, with husband having HbA2 of 4.8% and ago shows
wife having HbA2 of 2.3% Howell-Jolly bodies
0%
C Chromosomal deletion in hereditary retinoblastoma ALL INDIA 2002
13q14
C The epitheloid cells and multinucleated giant cells
C Gluten sensitive enteropathy is most strongly of granulomatous inflammation are derived from
associated with
Monocytes-macrophages
HLA-DQ2
C Host tissue responses seen in acute infections
C Pan T lymphocyte marker are
CD 3
Exudation, margination and vasodilatation
Memory T cells can be identified by
Feature common to both cytotoxic T cells and NK cells
C
C
CD 45RO
Effective against virus infected cells
C True about NK cells
C A myocardial infract showing early granulation
Derived from large granular cells, comprise about tissue has most likely occurred
5% of human peripheral lymphoid cells and they
within 1 week
express IgG Fc receptors.
Findings expected at autopsy in 10 years old boy
MHC class III gene encodes
C
C
dying of acute rheumatic fever
TNF
Aschoff’s nodules, fibrinous pericarditis and
The HLA class III region genes are important
McCallum patch.
C
elements in
C Seen in asbestosis
Governing susceptibility to autoimmune diseases
Calcify pleural plaques, diffuse pulmonary
C True about lactoferrin
interstitial fibrosis and mesothelioma.
Great affinity for iron, present in secondary
C Macrophages containing large quantities of undi-
granules of neutrophil and present in exocrine
gested and partial digested bacteria in intestine are
secretion of body.
seen in
C The primary defect leading to sickle cell anemia is
Whipple’s disease
Replacement of glutamate by valine in β-chain of
The histological features of coeliac disease include
HbA
C
7
Forensic Medicine and
Toxicology
AIIMS NOVEMBER 2015 C A man throws sulphuric acid on his wife’s face.
True about chemical burns
C A married woman attempts to suicide and is Ulcerated patches are present
admitted in a hospital. The treating doctor gives
Absence of singeing of hairs
false evidence to the police. He can be punished
under Coagulative necrosis.
IPC 193 (Note: Vesicals and blisters are usually absent in
C Boiled lobster syndrome is seen in poisoning with chemical burns)
Boric acid poisoning
C Shoe polish smell AIIMS MAY 2015
Nitrobenzene
C According to criminal amendment act 2013, the age
Autopsy in death due to accident shows two linear
of consent for sexual contact is
C
parietal fractures joining in the midline. Rule to
determine which line appeared first 18 years
Puppe’s rule C Lower two parts of sternum fuse by
(Note: Fracture line appearing later will not cross 14 years
the earlier fracture line) C Postponement of capital punishment in a case of
C Ashley rule is used for pregnant woman comes under Cr. P. C.
Sex determination 416
C Marshal’s triad for blast injury includes C Judicial hanging
Abrasions, bruise and laceration Side of angle of jaw.
C Acids causing coagulative necrosis C A child presents with fatigue and pallor. On
HCl, HNO3 and H2SO4 investigation, microcytic hypochromic anemia was
(Note: HF does not cause coagulative necrosis) found. Serum lead level was also found to be
C Ewing’s postulate is related to elevated. Enzyme level likely to be elevated
Growth at the site following trauma. δ ALA synthatase
C Most common mode of suicide in India C Rat hole tear is found in
Hanging Gunshot injury.
C True about snake bite C Mr X fired gunshot at Mr Y. Mr Y escaped with
Cobra snake is neurotoxic grazing of bullet with thigh which healed but he
Neostigmine can be used in krait bite filed FIR. Mr X is punishable under
Atropine is given before neostigmine. Section 324 IPC
(Note: Polyvalent antisnake venom is NOT effective (Note: Non-grievous hurt by a dangerous wea-
against pit viper) pon)
79
80 AIIMS and All India PGMEE—Review Questions
C A car met with an accident. Driver and front seat C A person is liable for punishment for perjury under
passenger both were lying beside the upturned car. Section 193 IPC
Injuries that will help differentiate between driver C The most important sign of age determination as
and the front seat passenger per Gustafson’s method is
Steering wheel injuries, left shoulder seat belt injury Root transparency
and whiplash injury. C A person of eonism derivs pleasure from
C An orthopedician gave proper instructions to the Wearing clothes of opposite sex.
patient about dressing of his wound. During C Cannabis is the most commonly used illicit drug in
round in the ward, he saw the patient dressing the India. Derived from cannabis
wound with wrong technique but did not say Bhang, ganja and charas
anything to him due to hurry and patient’s wound C The characteristic burnt rope odour is caused by
got infected toxin of
Doctor is guilty under last clear chance doctrine. Cannabis
C After an incised wound, new collagen fibrils are C The active principle of white oleander is
seen along with growing epithelium. The age of the Nerin
wound is C A doctor is treating a patient with viper snake bite.
24–72 hours. Viper venom is
Vasculotoxic (Mn: V for V)
C Fragmentation or segmentation of the blood
columns in the retinal vessels appearing within AIIMS NOVEMBER 2013
minutes after death and persisting for about an
hour C True about methanol poisoning
Kevorkian sign Minimum lethal dose of methanol is 1.25 ml/kg
body weight, formic acid is mainly responsible for
(Note: Rail road sign)
toxicity and methanol causes snow field vision.
C A bomb blast took place in Delhi. 2 persons died
C Disclosing the identity of rape victim is punishable
after sustaining injuries. Following statements can
under IPC
be said to be true about their injuries
Section 228A
Injuries due to burns or air blast, force of explosion
C Lateral traction test is done in unnatural sexual
decrease rapidly and bruise, laceration and
offences in
fractures are triad of main injuries seen.
Habitual passive agent
C According to Delhi Anatomy Act, 1957, a person
AIIMS NOVEMBER 2014 died in road traffic accident, the dead body is said
C If a homicide case comes to the doctor, he/she to be unclaimed after
should inform to the police under Cr. P.C. 48 hours
39 C Imbalming without issuing death certificate is
C Hara-kiri is a form of suicide that consists of cutting punishable under
Abdomen with a sharp weapon. IPC 201
C IPC section dealing with illegal abortion with
C The most common method of parasuicide is
women consent
Drug ingestion
312
C Caliber of a rifle is C Rigor mortis is seen in
Distance between opposite lands Well built male, well built female and old patient >
C On postmortem examination, a person was found 80 years.
to be due to arsenic poisoning. The fatal dose is
120 to 200 mg AIIMS MAY 2013
C A driver wearing seat belt, suddenly applies brakes C A person found dead with suicidal shot on the right
to avoid a collision. Body part most likely to be injured temple with gun in the right hand and skull burst
Mesentery open. There was charring and cherry red coloration
C A young male patient brought to the emergency in the tract inside
with nausea, vomiting and breathlessness 2 hours It is a contact shot.
after insecticide ingestion. On examination there is C Diagnosis of a man found dead with bluish green
pin point pupil and kerosene like smell emiting frothy discharge at the angle of mouth and nostrils
from the patient. True about the patient Copper poisoning.
Activated charcoal has no proven therapeutic role,
Organ tested in Breslau’s second life test
cholinesterase levels do not have prognostic
C
C Certain delegation on the part of doctor under- C The anteroposterior diameter of the skull is minimum
taking postmortem examination in
Meticulous and complete examination, routinely Brachycephaly
recording all positive findings and important
negative findings, and preserving viscera and ALL INDIA 2011
sending for toxicological examination in poisoning.
C Sparrow footmark is seen in
Windshield injury
AIIMS MAY 2002
C Gunpowder and/or soot on blood stained garments
C Sexual asphyxia is associated with can be visualized by
Masochism Infrared rays
C A bullet fired from a gun not released and ejected C Rickshaw tyre passed over the body of an 8 years
out with the subsequent shot is known as old child leaving distinct markings of the tyre
Tandem bullet treads. It is example of
C A patient presenting with colic and constipation, Patterned abrasion
wrist drop and encephalopathy with basophilic C Fracture ala signature or signature fracture is
stippling of RBC in blood Depressed fracture of skull.
Lead poisoning (Mn: Lead poisoing-ABCDE) C A child is brought to the casuality with reports of
C Unknown patient presents with pyrexia, violent shaking by parents. Most likely injury is
constricted pupils, hypotension, cyanosis and Subdural hematoma.
stuper progressing to coma. C Dental numbering is done by
Poisoning is due to phenobarbitone. FDI has two digit system, anatomic and diagrammatic
charting and palmar notation.
C Illuminous, translucent and waxy poison is
ALL INDIA 2012
Yellow phosphorous.
C The Japanese detergent suicide technique involves C Patient with bluish discoloration of conjunctiva,
mixing of household chemicals to produce mucous membranes and nails one hour after
H2S and other poisonous gases ingestion of a poison. Examination reveals tachy-
C Degree of rupture of hymen and whether the cardia and hypotension. Poison likely is
rupture is recent or old in a case of rape is determi- Mercury
ned by C Commonly used as a rave drug
Glastair Keene rod Ecstasy
C For MTP, consent is taken from C Organs/tissues presently being used for transplant
Wife only Blood vessels, lung and liver.
C A man on provocation hits another person with a
ALL INDIA 2010
wooden stick on the arm causing a bruise of size
3 × 3 cm. he will be punished by C Primary impact injury is commonly seen on
Imprisonment of one month or with fine which may Legs
extend to 500 ` or both. C Bullet leaving a visible mark so that a person can see it
C Old blood stains can be best detected by Tracer bullet
Luminal spray C Lightening flash can cause injury by
C The identity of rape victim is not disclosed under IPC Direct effect of electric, superheated air and
228A expanded and repelled air.
C A sodomy accused person brought to you, C Death of woman within 5 years of marriage under
confesses that he is an active agent regularly suspicious circumstances. Her parents complained
practicing it. Findings of medical examination are that her in laws used to demand for dowry. Under
Faecal smell, tear of frenulum and relative constric- which section, magistrate authorize autopsy
tion of the shaft of penis. Section 176 CrPC.
86 AIIMS and All India PGMEE—Review Questions
C A factory worker with excessive salivation, blue C Mechanism of induction of labor with use of
line on gums, tremors, disturbed personality, abortion stick is
insomnia and loss of appetite. Likely poisoning is Stimulation of uterine contraction.
Mercury C False negative hydrostatic test in a liveborn fetus
C Acute poisoning causes may be seen in
Hypersalivation, tingling and numbness and chest Atelectasis
pain. C Corporo basal index is useful for determination of
C Drugs used for narcoanalysis Sex
Scopolamine C Example of polychlorinated hydrocarbons
Endrin
ALL INDIA 2009 C Yellow fatty liver is characteristic of poisoning with
Phosphorus
C Privileged communication is made between
C Heavy metal poisoning that may cause colitis and
Doctor and concerned authority.
resembles diphtheritic colitis is
Disease which permanently alters the fingerprints is
Mercury
C
Leprosy C Alkalinization of urine may be done in cases of
C Casper’s dictum is poisoning with
Estimation of time since death. Barbiturates
C Antemortem burns can confused with
Ant bite marks ALL INDIA 2007
Extensive abrasions are found all over the body of a
Burtonian line is seen in poisoning of
C
C
pedestrian lying by the roadside. Likely cause is
Lead
Secondary injury. C Acrodynia is associated with
C Stellate wounds may be seen in following bullet Mercury
entry wounds C Mercury affects part of renal tubule
Contact shot PCT
C Commonest organ to be injured in primary blast C The drug of choice for mushroom poisoning is
injuries is Atropine
Lung C Aryl phosphates are
C Characteristic of heat rupture is Follidol, parathion and tik 20.
Irregular margins
C Following may cause traumatic asphyxia ALL INDIA 2006
Railway accident, road traffic accident and stampede C Spalding sign occur after
in crowd. Death of fetus in uterus.
C Scab or crust of abrasion becomes brown
ALL INDIA 2008 Between 2 and 3 days.
C Cause of death due to suffocation are C Tests used to detect semen
Choking, gagging and smothering. Barberio’s test
C Fracture of the hyoid bone, thyroid cartilage and C Medical degrees awarded by institutes outside
cricoid cartilage along with extensive bruising of India and recognized by MCI are registered in
neck muscles is suggestive of Second schedule of Indian Medical Council Act.
Fingerprint bureau was first established in
Manual strangulation.
C
C Minimum age at which an individual is responsible C Postmortem caloricity is seen in death due to
for his Criminal Act is 7 years. Septicemia
(Note: According to IPC) C Conter-coup injuries are seen in
C The most reliable method of identification of an Brain
individual is C Disputed maternity can be solved by
Dactylography Blood grouping, HLA typing and DNA finger
C The most comman pattern of fingerprint is printing.
Loop (Mn: LWAC-in decreasing order) C Hydrogen peroxide is used in chemical tests for
C Most reliable criteria in Gustafson method of blood
identification is Benzidine tests, phenolphthalein test
Transparency of root. C A person brought by police from the roadside lying
C True about diatoms is talking irrelevant with dry mouth, hot skin,
Diatoms are aquatic unicellular plants, acid dilated pupil, staggering gait and slurred speech.
digestion technique is used to extract diatoms Diagnosis
and presence of diatoms in the bone marrow is Dhatura poisoning.
an indication of-antemortem inhalation of C A middle aged man presents with paresthesia of
water. hands and feet. On examination, presence of Mee’s
C In a firearm injury, there is burning, blackening, lines on nails and rain drop pigmentation on hands,
tattooing around the wound, along with changed poison causing it is
color of the surrounding tissues, the injury is Arsenic
Close shot injury. C Most reliable method for detecting blood alcohol
C CNS depression, cardiac depression and optic level
nerve atrophy in methyl alcohol poisoning is Gas liquid chromatography.
produced due to C A 39 years old carpenter has taken two bottles of
Formaldehyde and formic acid. liquor from the local shop. After about an hour, he
C In chronic arsenic poisoning, sample sent for lab develops confusion, vomiting and blurring of
examination are vision. He should be given
Nail clippings, hair samples and bone biopsy. Ethyl alcohol
C At autopsy, feature of cyanide poisoning are C Heroin addict labourer was found unconscious. On
Congested organs, erosion and hemorrhage in examination, tachycardia, shallow breathing and
esophagus and stomach and skin may be pinkish or constricted pupils, BP-100/70 mm Hg, brisk
cherry red in color. bilateral deep tendon reflexes and plantar reflex
flexor on both sides. Best treatment given to him can
ALL INDIA 2004 be
C A convict with no known relation and no biological Naloxone
sample escaped from jail. Dead body resembling
ALL INDIA 2003
the convict but with mutilated face was found. The
identity can be established by C Mummification refers to
Anthropometry Desiccation of a dead body.
C Cephalic index of Indian people are between C Cobra snake venom is
70–75 Neurotoxic
C Following injury in right eye, a person developed C Rules related to legal responsibility of an insane
corneal opacity. Vision was restored following person
surgery. Medicolegal injury is McNaughton’s rule, Durham’s rule and Curren’s rule.
Grievous C In a suspected case of death due to poisoning where
C Poison causing deep blue color of hypostasis after cadaveric rigidity is lasting longer than usual, it
death may be a case of poisoning of
Aniline dyes Arsenic
88 AIIMS and All India PGMEE—Review Questions
C Blackening and tattoing of skin and clothing can be C A dead body with copious fine leathery forth in
best demonstrated by mouth and nostrils with increased pressure over
Infrared photography chest. Death was likely due to
C Postmortem lividity develops in Drowning
Drowning in well, postmortem submersion and C Entry wound blackening in firearm injury is due
drowning and drowning in chlorinated swimming to
pool. Smoke
C Postmortem caloricity is seen in C Tentative cut is a feature of
Heat stroke, pontine hemorrhage and septicemia. Suicidal attempt
C Prenatal diagnostic technique 1994, ground for
C Gastric lavage is indicated in all cases of acute
carrying out prenatal test are
poisoning, ideally because of
Pregnant women above age of 35, history of two or
Fear of aspiration
more spontaneous abortion or fetal loss and history
of exposure to potentially teratogenic drugs. C Tests for detection of heavy metal
C Punishment for perjury (Giving wilful false Harrison and Gilroy test, neutron activation
evidence by a witness while under oath) may analysis and atomic adsorption spectroscopy.
extend to C A 60 years old man with opium addiction has given
Imprisonment up to 7 years and comes under IPC up opium for last 2 days. Withdrawal symptom
193. Rhinorrhoea
C The sensations of creeping bug under the body is
ALL INDIA 2002 found in
C Race of individual with skull bone features- Cocaine poisoning
rounded nasal opening, horse shoe shaped palate, (Note: Tactile hallucination)
round orbit and cephalic index above 80 C Linseed plant ingestion causes cattle poisoning of
Mangol Hydrocyanic acid
C A sample to look for uric aid crystal (gouty typhus) C A 10 years old child presents with snake bite since
is submerged in six hours. No systemic signs are found. Lab
Alcohol investigation is normal. There is localized swelling
C Features of brain death over the leg of < 5 cm. Next done is
Complete apnea, absent pupillary reflex and heart Observe the patient for progression of symptoms
rate unresponsive to atropine. and wait for antivenom therapy.
Preventive and Social Medicine/Community Medicine 89
8
Preventive and Social
Medicine/Community Medicine
AIIMS NOVEMBER 2015 C An epidemiologist selected all possible samples
from a population and plotted the means of each
C True about Rashtriya Swasthya Bima Yojna sample on a linear graph. The graph is known as
Cashless benefits in hospitals. Sampling distribution
C Trivalent flue vaccine contains- C According to WHO 2013 malaria treatment
H1N1, H3N2 and Influenza B. guidelines, true statement is
(Note: H1N1 and H3N2 are Infuenza A viruses.) Primaquine is contraindicated in infants and
C Recently approved latex agglutination test shows pregnancy.
following results when compared to previous tests C A patient of diabetes and hypertension comes to the
Test result (+) Test result (–) clinic. Best tool to demonstrate the complications
Diseased 27(TP) 3(FN) and explain him the risks of various complications
Non diseased 5(FP) 95(TN) Venn diagram
Sensitivity and specificity respectively C Temperature for a medicine with a label of ‘store at
90% and 95% a cool place only’
(Note: Sensitivity = TP/TP + FN × 100 8–15°C
Specificity = TN/TN + FP × 100) C True about randomization in a clinical trial
C Free transportation of a 15 years old neonate Reduces confounding
suffering from cough, sneezing and fever comes Ensures comparability of 2 groups
under Decreases selection bias.
Janani Sishu Suraksha Karyakram (JSSK) (Note: External validity can not be ensured by
C Sensitivity means True positives. randomization.)
(Note: Specificity is True negative. Mn: P for N. N C DBP of 125 female patient was noted. Mean = 70
for P) mmHg and SD= 10 mmHg. 5th percentile value
C A method decreasing the mortality of disease but 50.4
not curing it (Note: Mean +/– 1 SD covers 68.4%
Prevalence will increase. Mean +/– 2 SD covers 95.3%
(Note: Prevalence = Incidence × Duraqtion of disease) Mean +/– 3 SD covers 99.7%)
C Best test for the association between exposure and
outcome
AIIMS MAY 2015
Cohort study
C Investigation for latent TB to be done according to C Sensitivity is
WHO in True positives
Patient on TNFα inhibitor, patient on silicosis and C Interpretation of tuberculin test becomes difficult in
patient on dialysis. High BCG coverage area.
89
90 AIIMS and All India PGMEE—Review Questions
C Data is collected and analysed. By mistake, highest more likely to do regular exercise. What type of bias
value is written as 85 which is actually 58. What is likely in this study
change will occur Selection bias
Mean will increase but the median will remain the C True about Japanese encephalitis vaccine are
same. Not given in less than 6 months of age, two primary
C HDI includes doses should be given and protection lasts for 3
Life expectancy at birth, knowledge and decent years.
standard of living.
C Test used for comparing birth weight measurements AIIMS NOVEMBER 2014
of babies of mothers belonging to two group in
which mother of one group received supplemental C Population attributable risk is
diet while mother in other group did not receive Incidence of disease/death in the total population
supplemental diet to those who were not exposed in relation to the
total population.
Student’s T test.
C If the association between smoking and CHD
C DBP of 200 people has been measured and arranged.
increases from low level of physical exercise to high
1st quartile 85, 3rd quartile 110. How many people
level of physical exercise, then physical exercise in
have DBP above 110–50.
relation to the association between smoking and
C Haddon matrix can be used for
CHD is known as
Prevention of injuries and accidents.
Effect modifier
C Nikshay is the software prepared by the government
The objective criteria for detecting community
for
C
spread of pandemic influenza A H1N1 are
Surveillance of TB cases.
One or more cases should be laboratory confirmed
C Food safety and standard authority of India comes
with pandemic influenza A H1N1, cases should be
under
reported over 2 weeks and presence of at least 25
Ministry of Health and Family Welfare.
linked epidemiologically suspect cases.
C Immunization status of children is assessed by
C School closure is a common strategy to keep
District level household survey
pandemics of influenza under control in the
C A child is bitten by the dog unprovoked. Dog is
absence of vaccines in developing countries. This
caught and appears healthy. What should be done
rationale is based on
Start post-exposure prophylaxis and observe the Children are the most susceptible age group,
dog. children are the primary transmitters of influenza
C In a community of 100 people, average of GFR is and contact rates are particularly high in school
measured to be 85 ml/min with standard deviation context.
25, what is 90% confidence range of GFR C Form of vaccine derived polio virus (VDPV)
81–89 iVDPVs, aVDPV and cVDPVs
C A cigarette smoker thinks that he will not have C True about Chandler’s index
cancer as he takes less number of cigarettes and eats Calculates the average number of hookworm eggs
healthy diet and does regular exercise. This theory per gram of faeces for the entire community,
is called as indicates magnitude of public health problem and
Self exclusion indicates effectiveness of mass treatment.
C Over few years, trend is changing from communi- C Under RNTCP, test used for diagnosis of a TB case
cable diseases to noncommunicable diseases in a Sputum staining
community. What type of trend is noted C Strategy employed by the NPCB to evaluate post-
Secular trend operative visual outcomes following cataract
C An epidemiologist is conducting a Cohort study. surgery extraction
He selects a group that includes non-smokers and Passive surveillance
another group of smokers. But he thinks that non C The outcome indicator for NPCB is
smoker persons may be more health conscious and Number of cataract surgeries with restored vision.
Preventive and Social Medicine/Community Medicine 91
C The Chairman of District Blindness Control Society C True about the calculation of HDI
is The minimum value for combined gross enrolment
District Collector ratio is fixed at 0%, the minimum value for adult
C True about cataract surgical rate (CSR) literacy rate is fixed at 0 and the maximum value for
It is the number of cataract surgeries performed per per capita income is fixed at 40,000.
million population per year, a CSR of 3000 is C True about education in HDI
recommended under vision 2020 and it indicates Country’s achievement is computed on the basis of
the effectiveness of cataract services delivery. adult literacy.
C True about Rashtriya Swasthya Bima Yojna(RSBY) C Immune thrombocytopenic purpura is observed as
Only below poverty line families to be covered a complication with vaccine
under RSBY. MMR
C A medical officer wants to estimate the number of C Chemoprophylaxis is indicated for
children in a village. He can get a rough estimate Cholera, meningococcal meningitis and conjuncti-
quickly from vitis.
Adult Folifer consumption in the last 1 year. C True about INH chemoprophylaxis
C The nutritional supplementation recommended It is not feasible to apply on a large scale, it has risk
under ICDS for pregnant woman is of drug induced hepatitis and it is not highly
600 calories and 18–20 grams of protein per day. clinically effective.
C The most effective antilarval measure for control of C Positive predictive value is a function of sensitivity,
urban malaria is specificity and
Filling up of all ditches and cess pools. Prevalence
C True about inertization C True about period of isolation
Waste is mixed with cement, it is relatively inexpensive Chicken pox-6 days after onset of rash, measles-3
and used for disposal of pharmaceutical waste. days after onset of rash and Herpes zoster- 6 days
C Objectives of the National Mental Health Programme after onset of rash.
Availability and accessibility for minimum health C True about OPV
services to all, promote community participation Useful in epidemics, rapid antibody response and
in mental health service development and protective even in presence of maternal antibo-
application of mental health knowledge to general dies.
health care. C HIV sentinel surveillance provides data
C True about Employees State Insurance Act 1948 To monitor disease trends.
The beneficiaries are entitled to funeral expenses up C A boy complained of unprovoked bite by a local
to ` 5000. dog in the community. The dog was later caught by
C In a sampling, from a given sampling frame, every the local animal authorities and appeared to be
10th person is selected starting from a random healthy. The most appropriate action
person. This method of sampling is called as Give post-exposure prophylaxis to the bitten
Systemic sampling person with cell culture derived vaccine.
C The measure of variation used to compare two data C Evidence of decreased risk of cardiovascular
with different scales of measurement is disease is associated with
Coefficient of variation
Low to moderate daily alcohol consumption,
regular physical activity and potassium.
AIIMS MAY 2014
C Under the school vision screening programme,
C The prospectively evaluated, double-blinded, vision screening in schools is done by
randomized clinical trial represents the gold Teacher
standard for providing evidence for therapeutic C Under NRHM, an ASHA will receive financial
decision making. This was first proposed by the renumeration for
father of evidence based medicine Institutional deliveries, 1st dose of DPT and OPV,
Sackett registration of birth.
92 AIIMS and All India PGMEE—Review Questions
C The provision under Janani Shishu Suraksha C True about roll back malaria
Karyakram include Insecticide treated mosquito nets, strengthening
Free food to the mother in the hospital, free health system and training of health workers.
transport to the mother and baby to/from hospital C Recommended daily intake of iodine in pregnancy
and free treatment of the neonate and infant in all 250 μg
public health facilities. C To evaluate post-operative vision effects after
C Calculate the neonatal mortality rate for a cataract extraction surgery under NPCB, what is
population with number of neonatal deaths-450, used
number of stillbirths-212, total number of live Routine check up of all operated cases.
births-12, 450 in the year 2012. C Common causes of epidemic after a disaster
36 Leptospirosis, Rickettsia and acute respiratory
C Infant mortality rate includes infections.
Early neonatal death, late neonatal death and post- C GDP proportion spent on public health in India
neonatal death. 0.012
C A girl is having white hair. 40% of her classmates C Under 5 mortality rate in the world by 2010
are also suffering from the same problem while 8 million
none of the other in the village is suffering from it C According to WHO classification, highly toxic
and her brother living in neighboring village with a insecticide are coded as
aunt is also normal. Which explains the probable Red
cause of her white hair C True about screw feed technology
Environmental Reduce weight by 30%, reduce volume by 80% and
C Severe acute malnutrition (SAM) in India is non-burn heat sterilization technique.
Very low weight for height (below-3Z scores of the C Vaccines given according to national immunization
mean WHO standards for growth), by visible schedule at 5 years of age
severe wasting, or presence of nutritional edema.
DT booster
C The most sensitive indicator of environmental
C Measles vaccination to all 9 months to 14 years
iodine deficiency is
children is part of WHO strategy
Urine iodine excretion
Catch up
C Which can cause epidemic in post-disaster period
Leptospirosis, rickettsiosis and acute respiratory C True about ESI act
infection. State govt’s share of expenditure on medical care is
C The hemoglobin levels of pregnant females in a 1/8, ESI’s share is 7/8 of total cost.
community was found to have a mean of 10.6 g/dl, C Area under normal curve with 1 standard deviation
and a standard deviation of 2 g/dl. What is 0.34
minimum Hb level below which 5% of the pregnant C In a study of 2000 population, mean value of
women would have their Hb levels hemoglobin is 13.5 gm, which follows normal
6.68 distribution curve. Percentage of people having
C Universal health coverage in India was recommen- higher hemoglobin than 13.5 gm is
ded by 50%
High level expert committee C Statistical Q test is used for
C Provisions included in the primary health care To determine outliers
according to the Alma Ata declaration
C In assessing the literacy, the parameter used is
Adequate supply of safe drinking water, provision
Age above 7 years
of food supply and basic sanitation.
C True about folic acid
Present in all grean leafy vegetables, proven to
AIIMS NOVEMBER 2013
decrease the occurrence of neural tube defects when
C True about Rashtriya Swasthya Bima Yojna taken preconceptionally and methyl folate trap is
Applies to BPL only because of methionine synthase defect.
Preventive and Social Medicine/Community Medicine 93
C Most common cause of neonatal mortality in India C True about roll back malaria
Prematurity Develop new insecticides, strengthen health
C True regarding tetanus system, train health workers and insecticide treated
Hard immunity is not of much value, incubation bed nets.
period is 6–10 days and the main reservoir is soil C Screening age for trachoma
and intestine of animals and humans. 1–9 years
C New cancer patient in India reported annually
1 million AIIMS MAY 2012
C In a population of 200 people with normal distribu-
tion, people included in 1 standard deviation C In WHO road to health chart, upper and lower limit
136 represents
C True about Rashtriya Swasthya Bima Yojna (RSBY) 50 percentile for boys and 3 percentile for girls.
Applies to BPL families only C In 13–15 years female child, recommended daily
protein intake is
C HIV sentinel surveillance is for
1
Detecting trend of the disease
C Common to both acute and chronic malnutrition
C Mass chemoprophylaxis is given for is
Lymphatic filariasis, plague and vitamin deficiency. Weight for age
C The pattern of change of disease trends of mortality C Rashtriya Swasthya Bima Yojana is
and morbidity where the pandemics of infection are Government run insurance scheme for all poor.
replaced by degenerative and man made disorders
C In vision 2020, the target for secondary service
as the main cause of morbidity and mortality is
centre is for how much population
known as
5 lakh
Epidemiological transition.
C Leprosy is not yet eradicated because
C Current percentage of GDP of India spent on health
No effective vaccine
1.2%
C Which of the following is best suited for the role of
True about Millenium development goals
social worker
C
Reduce by 2/3rd the under 5 mortality rate by year
Health professional involved in coping strate-
1990–2015.
gies, interpersonal skills and adjustment with
C In a study to assess the prevalence of dating among family.
adolescents, schools were selected at random.
C In acute flaccid paralysis surveillance, evaluation
Among the schools, sections were selected at
for residual paralysis is done at
random and among the sections students were
selected at random. This is an example of 60 days
Multistage sampling C Bias can be eliminated by all except
Multivariate analysis
C In a population of 5000, 500 are myopic before 1st
January 2011 and number of new cases till 31st C Food with maximum cholesterol content
December 2011 is 90. Incidence is Egg
2% C Not helpful for elimination of filariasis
C According to blindness assessment, a person with a Larvae are deposited on skin surface where they
best corrected vision of 4/60 in both eyes is having cannot survive.
a disability of C Applications of incubation period
75% To differentiate co-primary cases from secondary
C True about national programme for prevention and cases, to find out time for quarantine and to
control of cancer, diabetes, CVD and stroke prevent infection to the contacts of the infected
(NPCDCS) person.
Cardiac care unit and cancer care facility is to be C True about Indian reference male
established at the district level hospital. Age 18–29 years.
Preventive and Social Medicine/Community Medicine 95
C True about vaccines Prematurity > infection > birth asphyxia > congenital
anamolies (Mn: PIBC)
Thiomersal is preservative in DPT vaccine,
magnesium chloride as stabilizer is used in OPV C Smallpox eradication was due to
and kanamycin is preservative in measles. Highly effective vaccine, subclinical infection do
C Larval control measures not transmit the disease and life long immunity.
Paris green, Gambusia and intermittent irrigation. C Sputum can be disinfected by
C True about DDT Autoclaving, boiling and cresol.
Pyrethrum has synergistic action, it is a contact C True regarding Clostridium tetani
poison and residual effect lasts for 18 months. The main reservoir is soil and intestine of animals
C Incineration is done for and humans, herd immunity is of not much
Cytotoxic drugs, cotton contaminated with blood importance and the main mode of transmission is
and human tissue. through trauma and contaminated wound.
96 AIIMS and All India PGMEE—Review Questions
C Vaccine with maximum efficacy C A temporary provisional view held by the people
Measles on a point of view is
C Arbovirus true is Opinion
Chikungunya is transmitted by Aedes aegypti. C Most common mode of lead poisoning
Inhalation
AIIMS NOVEMBER 2009
C Specificity of a test refers to its ability to detect
True negatives
C Effective leprosy control programme may be C Prevalence of cataract at one point of time can be
indicated by determined by
Decreasing grade 2 disability, low MDR resistant, Cross sectional study
multibacillary cases and high new case detection C License to blood bank is given by
rate.
Drug controller general of India
The vaccines that can be given during pregnancy
Association can be measured by
C
C
is
Correlation coefficient, P value and odds ratio.
Rabies, hepatitis B and diphtheria.
C Targeted intervention for HIV is done for
C Included in NRHM are
Commercial sex worker, migrant laborers and street
Strengthening of JSY, state and district health
children.
mission and recruitment and training of ASHA.
C WHO stage 4 HIV includes
C Impact indicator for evaluation of ASHA’s
performance Toxoplasmosis, Pneumocystis carini and HIV
wasting syndrome.
Infant mortality rate
C About NPCB true are
C True about standard error of mean
Increase cataract surgery rate to 450 operation per
Based on normal distribution, it depends on
lakh population, intraocular lens implantation in
standard deviation of mean and used to estimate
more than 80% cataract surgery cases and
confidence limit.
development of 50 pediatric ophthalmic units.
C A learned behavior which is permanent and
consistent but liable to change C According to CDC recommendations, HIV screening
of pregnant women is
Practice
Opt out testing
C True about Japanese encephalitis
Putting profit ahead of health as a cause of disease
Transmitted by culex mosquito, pigs are ampli-
C
is provided by which theory of sociology
fiers and primary dose of vaccine consists of two
dose. Marxist
C Reliability of a screening test refers to C True about confounding factor
Gives same values even on repeated testing It is itself a risk factor for the disease.
(Note: Reliability is repeatability) C Best contraceptive for the newly married couple
is
C Disposal method of outdated cytotoxic drugs is
Oral contraceptives
Destruction and dumping in a secured landfill.
C Nested case control study is a type of
C Recall bias is most commonly associated with
Prospective study
Case control study
C Approaches to the health education are
C Positive predictive value of a test is Service approach, regulatory approach and health
TP/TP + FP education approach.
C Cyclo developmental lifecycle is seen in C Mean bone density amongst two groups of 50
Filaria people each is compared with each other. The test of
C Post-pasteurized milk quality is tested by significance used would be
Phosphatase test Student t-test
C Best index for measuring contraceptive efficacy is C After applying a statistical test, an investigator gets
the P value as 0.01. It means that
Life table analysis.
The difference is not significant 1% times and
C Goals of national population policy are
significant 99%.
Bring IMR to below 30 per 1000 live births, bring
C If mean is less than the median, than the data is said
MMR to below 100 per 100,000 live births and
to be
achieve 100% registration of births, deaths,
marriage and pregnancy. Negatively skewed
C Shortest incubation period is seen in C Study done on a group of patients showed
coefficient of variance for BP and serum creatinine
Influenza
to be 20% and 15% respectively. Inference is
C In leprosy patient, lepromin test is used for Variation in BP is more than in serum creatinine.
Prognosis C In a study done in UK, association between sale of
C Kaplan Meier method is used for antiarrythmic drugs and increase in death due to
Survival asthma was found. It is example of
C True about Indian reference female Ecological study
Age 20–39 years, weight 55 kg and walking or other C Occupational cancer involves
activities for 2 hours daily and 8 hours of moderate Lung, liver and bladder.
or active work.
C Included in SAFE strategy AIIMS NOVEMBER 2007
Antibiotics, face washing and improvement of the C Kala-azar is transmitted by
environment. Sandfly
C Plastic wrapper of surgical syringe should be C Dietary reference intake recommendations include
discarded in Recommended dietary allowances, adequate intake
Black bag and upper tolerable level.
C Toxins responsible for epidemic dropsy
AIIMS MAY 2008 Sanguinarine
C In epidemiological study, the first case that comes
Problem village is defined in national water supply
to the attention of the investigator is
C
and sanitation programme as all
Index case
Distance of safe water greater than 1.6 km, water
C Staff present at the subcentre level, under primary
exposed to the risk of cholera and water source has
health care
excess iron and heavy metals.
Multipurpose health worker
C Endemic ascites is associated with
C Primary health care, true are
Pyrrolizidine
Essential health care for all, placing people’s health in
C Criteria for normal Indian reference male are people’s hand and sectors like agriculture, animal
60 kg, 8 hours in bed and 20–39 years of age husbandary, food industry and communication are
C Adjuvant used in DPT vaccine is involved.
Aluminium C Under NPCB, screening of school children is first
C Overall survival is increased by screening procedure in done by
Colon carcinoma School teacher
C Best distribution to study the daily admission of C Active search for disease in an apparently healthy
head injury patients in a trauma care centre is individual is known as
Poison distribution Screening
Preventive and Social Medicine/Community Medicine 99
AIIMS MAY 2006 those with BCG scar. If this is so and an association
is found between TB and not having BCG scar, the
C Brucellosis can be transmitted by association may be due to
Contact with infected placenta, ingestion of raw Interviewer bias
vegetables from infected farms and inhalation of C The risk ratio in a study is
infected dust or aerosol. Incidence among exposed/incidence among non-
C True about leptospirosis exposed.
It is a zoonosis, man is an accidental host and man C Incidence of tuberculin infection in a community is
is the dead end host. most appropriately assessed by
C The mechanism by which cholera may be Identifying new converters to tuberculin test.
maintained during interval between peak cholera C When an intervention is applied to community to
seasons is evaluate its usefulness it is called
Continuous transmission in man. Effectiveness
C Disability limitation C Drug of choice for cholera treatment in pregnancy
Example is resting affected limbs in neutral
Furazolidone
position.
C Most common cause of blindness in India is
C Vitamin A deficiency is considered a public health
problem if prevalence rate of night blindness in Cataract
children between 6 months and 6 years is > 1%. C Under national programme for prevention of
C The highest percentage of PUFA is present in nutritional blindness, a child in the age group of
Soybean oil 6–11 months is given a dose of vitamin A equal of
C Chronic carrier state is found in 1 lakh IU
Typhoid, hepatitis B and gonorrhea C Incubation period for pertussis is
C RCT comparing efficacy of two regimens showed 7–14 days
that difference is statistically significant with P < C Maximum risk of damage of fetus by maternal
0.001 but in reality the two tests do not differ in their rubella is in
efficacy. This is example of Type I (alpha) error 6–13 weeks of pregnancy
C Degree of freedom is C Deficit in weight for height in a 3 years old child
(Row-1) × (Column-1) indicates
C A diagnostic test for a particular disease has a Acute malnutrition
sensitivity of a 0.90 and a specificity of 0.80. A single C A study shows that 85% of cases of lung cancer are
test is applied to each student in the population in due to cigarette smoking. It is a measure of
which the diseased population is 30%. What is the Attributable risk
probability that a person, negative to this test has no
The distribution of random plasma sugar
disease
C
measurements from 100 first year students have
95%
mean of 3.0 mmol/L with a standard deviation of
C Histogram describes 3.0. True about shape of the distribution curve
Quantitative data for a group of patients Nothing can be said conclusively
C If birth weight of each of 10 babies born in a hospital C The age group of children surveyed for assessment
in a day is found to be 0.8 kg, then the standard of primary immunization coverage in WHO
deviation of this sample will be recommended EPI cluster sampling
Zero
12–23 months
C Specificity of a test is the ability of a test to detect
C According to a joint study “Health care in India:
True negatives
Road ahead” by CII and McKinsey and CO in 2002
India’s exisiting bed population ratio is 1.4 : 1000
AIIMS NOVEMBER 2005 C True about childhood mortality rates in India
C It is probable that physician have a higher index of Almost 3/5th of IMR occur in neonatal period,
suspicion for TB in children without BCG scar than almost 3/4th of under five mortality occur in
Preventive and Social Medicine/Community Medicine 101
infancy and about one in ten children die before C National family health survey has successfully
they reach the age of five years. completed
C The best design to study the association between 3 rounds
risk factor and disease is of C The age and sex structure of a population may be
Cohort study described as a
C A known HIV patient is admitted in a ward Population pyramid
following surgery. The resident doctor who C The carrying capacity of any given population is
changed the dressing next day found it to be soaked determined by its limiting resources.
in blood. Right method of discarding the dressing is C True about prevalence and incidence
Put the dressing material directly in an appropriate Incidence is a rate but prevalence is not
bag and send for incineration. C The most common cancer, affecting both male and
C Distribution of FEV in 300 smokers-Median—2.5 L, female of the world is
First quartile—1.5, Third quartile—4.5 L. No. of Lung cancer
persons in the sample expected to have FEV C The most common cause of maternal mortality in
between 1.5 L and 4.5 L is India is
150 Hemorrhage
C If the distribution of IOP seen in 100 glaucoma C The rate adjusted to allow the age distribution of the
patients has an average 30 mm with SD of 1. Lower population is
limit of average IOP that can be expected 95% of Age standardized mortality rate
times C Characteristic of a single exposure common vehicle
28 outbreak
C A test for a disease has sensitivity 0.90 and Explosive
specificity 0.90. Diseased person in the population
C Drug of choice for chemoprophylaxis of cholera
in which single test is applied is 10% probability
that a person positive to this test has the disease is Tetracycline
50% C The national level system that provides annual,
national as well as state level reliable estimates of
fertility and mortality
AIIMS MAY 2005
Sample registration system.
C A bacterium divides every 30 minutes. Number of C Pulse with highest content of iron
bacteria after exponential growth for 3 hours, Soyabean
starting with a single bacterium C True regarding pre-post clinical trial
512 They use the patient as his or her own control
C One day census of inpatients in a mental hospital
could give good information about
The patients in that hospital at that time. AIIMS NOVEMBER 2004
C After applying a statistical test an investigator gets C Indian state with maximum number of AIDS cases
the p value as 0.01. It mean that reported
The difference is not significant 1% times and Tamil Nadu
significant 99% times. C In two studies for association between natural
C For a negatively skewed data nutritional states and birth weight of members, p
Mean will be less than the medium value 0.02 and 0.04 were found. Inference about
C If the prevalence is very low as compared to the magnitude of association
incidence for a disease, it implies The magnitude of association in study with p = 0.02
Disease is very fatal and/or easily curable. is more than that in study with p = 0.04
C Mean and standard deviation can be worked out if C Weakest study design to test the association
data is on between risk factor and disease
Interval/ratio scale Ecological study
102 AIIMS and All India PGMEE—Review Questions
C A physician notes down SBP of 50 patients and then Eradicate polio by year 2005, achieve zero level
administers an antihypertensive drug to them. He transmission of HIV/AIDS by 2010 and eliminate
measures the SBP after one week again. Most lymphatic filariasis by 2015.
appropriate statistical test of significance C The incubation period of yellow fever is
Paired T-test 3–6 days
C Population is the unit of study in C Mode of transmission of Q fever is
Ecological study Inhalation of erosol
C A leprosy patient treated with paucibacillary C Characteristic features of staphylococci food
multidrug therapy for 6 months had persistent poisoning
erythema and indurations in the plaque. The next Optimum temperature for toxins formation is 37°C,
step of recommendation by WHO intradietetic toxins are responsible for intestinal
Stop antileprosy treatment symptoms and incubation period is 1–6 hours.
C As compared to routine case control study, nested C Nodal ministry for integrated child development
case control study avoids problem related to Scheme (ICDS) programme centre
Temporal association Ministry for HRD
C The literacy rate of Indian population as per census C The systemic distortion of retrospective studies that
2001 is can be eliminated by a prospective design is one of
65.4% the following
C Arboviral diseases reported in India Recall bias
Japanese encephalitis, Chikungunya fever and C Null hypothesis true and rejected is
Kyasanur Forest disease. Type I error (Mn: NTR)
C Orthotoludine test is used to determine C If a new effective treatment is initiated and all other
Free and combined chloride in water. factors remain the same, true is
C Weight of Indian reference woman Incidence will not change
55 kg C Relationship between different parameters of a
C True about quarantine performance of a test
Absolute quarantine is restriction during the Sensitivity is inversely proportional to specifi-
incubation period, exclusion of children from city.
schools is modified quarantine and quarantine C 20 years old female with category II tuberculosis
should not be longer then the longest incubation (sputum positive relapse). The treatment regimen
period. recommended under DOTS is
C True about mosquito 2 (HRZES)3 + (HRZ)3 + 5 (HR)3
Definitive host in malaria, life cycle is completed in C Sampling method for assessment of immunization
3 weeks and the female can travel up to 3 km. status of children
C True regarding dracunculiasis Cluster sampling
India has eradicated this disease. The disease is C True about break point chlorination
limited to tropical and subtropical regions and no Free chlorine is released in water after breakpoint
animal reservoir has been proved. chlorination, chlorine demand is the amount
Preventive and Social Medicine/Community Medicine 103
needed to kill bacteria, oxidize organic matter and C Entire village was asked to participate in a study to
neutralize ammonia. identify cholera carrier and everyone present at the
C An investigator wants to study the association time submitted to examination due to recent
between maternal intake of iron supplements (yes cholera deaths. The proportion of people who were
or no) and incidence of low birth weight (<2500 or > carriers were computed and compared with regard
2500 gm) in 100 pregnant women. Appropriate to water supply. This is a type of
statistical test of significance is Cross sectional study
Chi-square test C True about ‘New family’
C Medical colleges are classified as eye care centers of All nuclear families of less than 10 years duration.
(under National Programme for Control of Blindness C A new pregnancy test was applied on 100 pregnant
in India) (Known) women and 100 non-pregnant women. 99
Tertiary level and 10 showed positive result in respective groups.
C Taking the definition of blindness as visual acuity Sensitivity of the test is
less than 3/60 in the better eye, the number of blind 99%
persons per 100,000 population in India is estimated C A man with fever and chills 2 weeks after a louse
to be …… bite. There was a maculopapular rash on the trunk
C In a double blind, clinical drug trial which spread peripheraly. The cause of this
The patients do not know which treatment they are infection can be
receiving. Epidemic typhus
(Note: Doctors also do not know which treatment C True regarding Q fever
they are giving) Zoonotic infection, human disease is characteri-
C The most sensitive index of recent transmission of zed by an interstitial pneumonia and no rash is
malaria in a community is seen.
Infant parasite rate C Reservoir of Indian kala-azar is
C Extra calories required during the first six months
Man
for a lactating woman is
Features suggestive of asbestosis
600 Kcal
C
C Bagassosis is most likely caused due to the The disease progresses even after removal of
inhalation of the dust of contact, can lead to neural mesothelioma and
sputum contains asbestos bodies.
Sugarcane (Mn: Both has g)
C In defining general fertility rate, the denominator is C The proportion of false positive results of a
screening test is lower in population A then
Woman between 15 and 49 years of age.
population B because the prevalence of disease is
C Mites are the vectors of
Higher in population A
Scabies, scrub typhus and rickettsial pox
C An investigator wants to study the association
between maternal intake of iron supplements (yes
AIIMS MAY 2003 or no) and weights (in gm) of newborn babies. He
C Most common cause of neonatal mortality in India collects relevant data from 100 pregnant woman
Low birth weight and their newborn. Test of hypothesis advised
C In calculation of dependency ratio, the numerator is Unpaired or independent T test
expressed as C To test the statistical significance of the difference in
Population under 15 and above 65 years of age. heights of school children among three socio-
C An adult male patient with complaints of cough economic groups, test used is
and fever for 3 months and hemoptysis on and off, One way ANOVA
sputum positive for AFB and had already received C For the field diagnosis of trachoma, the WHO
treatment with HRZ for 3 weeks and discontinued. recommends that follicular and intense trachoma
Categorization for management of patient inflammation should be assessed in
Category 1 and start 2 (HRZE)3. Children aged 0–10 years
104 AIIMS and All India PGMEE—Review Questions
ALL INDIA 2012 C A Cohort study differs from case control study as
Cohort studies require longer time frame (years)
C Intervention trials with individual as a randomiza- but case control studies not.
tion unit C DALY expresses years of life lost to
Drug, surgery and vaccine Premature death and years lived with disability
C The sex ratio for age group 0–6 years as per 2011 adjusted for the severity of disability.
census
914
ALL INDIA 2011
C The concept of design effect is applied to
Cluster sampling C Indicators of HDI
C A state of disease endemicity where the disease Life expectancy at birth, education and GDP.
transmission has been stopped but the agent is C Good index of severity of acute disease
present in the environment is called Case fatality rate
Elimination C Denominator in estimating MMR
C Efficacy of a new drug with an existing drug for Total number of live births
treatment of particular disease is compared in C Chronic carrier state is seen in
Phase 3 trial Diphtheria, typhoid and gonorrhea.
C The p value stands for C Tetracycline is used in prophylaxis of
The probability of concluding that a difference Cholera
exists, while, in reality, such a differentiation does C Vectors may transmit infection by methods
not exist. Regurgitation, rubbing of infected feces and
C Median is a good measure for central tendency of contamination with body fluids.
Health expenditure, incubation period and survival C Non-deliberate cultural practice leading to anti-
time. mosquito effect
C Surveillance summaries are prepared Use of alkaline detergent
To provide information on disease patterns and C Factors responsible for resurgence of malaria
trends. Drug resistance in parasite, insecticide resistance in
C In natural history of the disease, true about vectors and antigenic mutations in parasite.
pathogenesis phase are C Insects that have developed resistance to DDT are
Start after entry of agent into host body, subclinical Musca domestica, Xenopsylla species and Anopheles
phase of an illness is included and tertiary species.
prevention is applicable. C Arboviral disease not found in India
C Aedes/anopheles and Aedes culex are vectors for Yellow fever virus
which disease worldwide C True about Japanes encephalitis
Lymphatic filariasis Two to three cases per village suggest an epidemic,
C True about millennium development goals children are more frequently affected than adults and
Reduce MMR by 3/4th between 1990 and 2015, ratio of inapperent to apperent infection is > 100:1.
reduce under 5 mortality rate by 2/3rd between C True about leptospirosis
1990 and 2015 and have halted by 2015 and Rats are prime reservoirs.
reversed, the spread of HIV/AIDS.
C A sewage worker presents to the emergency
C Vaccination recommended for elderly population department with fever and jaundice. Lab findings
Tetanus, influenza and pneumovax. are elevated BUN and serum creatinine suggestive
C Larvicidal for malaria control of renal failure. Antibiotics recommended is
Abate, copper acetoarsenite and malathion. Penicillin G
C The resource persons for training ASHA under C True about yaws
NRHM are Caused by Treponema pertenue, transmitted non-
AWW and ANM venerally and secondary yaws can involve bone.
106 AIIMS and All India PGMEE—Review Questions
C According to McKeonn’s theory, reduction in C Biological agent carrying the highest potential for use
mortality from tuberculosis was a consequence of as a biological weapon for microbial bioterrorism is
Social and environmental factors. Plague (Yersinia pestis)
C Tests performed to assess the efficiency of C Biological weapon with least potential for use as a
Pasteurization biological weapon
Phosphatase test Brucellosis
C Orthotoluidine test is used for detecting
ALL INDIA 2010
Chlorine
C Causes of indoor air pollution C Movement across socioeconomic level is termed as
Carbon monoxide, nitrogen dioxide and radon. Social mobility
C Diseases with national screening control programme C Associated with emotional valence and most likely
are to be influenced by motivation is
Diabetes mellitus, refractive errors and carcinoma Practice
cervix. C ASHA is posted at
C Reform proposed by World Health Report (2008) Village level
Policy reform, leadership reform, service reform C JSY stands for
and universal reform (Mn: PLUS) Janani Suraksha Yojna
C Direct standardization is done to compare the C Provision of primary health care was done by
mortalty rates between 2 countries. This is done Alma Ata declaration
because of difference in C Essential components of primary health care are
Age distributions Provision of essential drugs, immunization
C A village is divided into 5 relevant subgroups for against major infectious diseases and health
purpose of a survey. Individuals from each education.
subgroup are then selected randomly. This is C Current trend in health care is
Stratified sampling Community participation
C A region is divided into 50 villages for the purpose C Highest level of community participation is
of a survey. 10 villages are then selected randomly Planning of intervention by community.
for the purpose of a study. This is known as C True regarding MMR
Cluster sampling Numerator includes total number of female deaths
C A new test for diabetes mellitus is performed in a within 42 days of delivery, expressed as a rate and
group containing diabetics and non-diabetics. If 120 expressed per 1000.
mg/dl of blood sugar is taken as cut-off, area C Perinatal mortality rate includes
shaded in graph represents Stillborns and death within 7 days of birth.
False negative C IMNCI differs from IMCI in following
C Punett square is used to Malaria and anemia are included, 0–7 days neo-
Predict genotype of offspring nates are included and emphasis on management of
C An investigator observes that 5 independent risk sick neonates over sick older children.
factors influence the occurrence of a disease. C Mass chemoprophylaxis in endemic area is
Statistical test applied to assess the relationship recommended for
between them is Yaws, trachoma and filaria
Multiple logistic regression C Rural and urban difference in prevalence is seen
C Pearson’s coefficient of skewness is defined as in
(Mean-mode)/Standard deviation Lung cancer, mental illness and chronic bronchitis.
C True regarding disposal of biomedical waste C True about TB annual rate of infection(ARI)
Human anatomical waste is disposed in a yellow The average estimated ARI for India is 1.7%, ARI
bag, contents from a red bag may be a source of reflects current trend and effectiveness of control
contamination and black bags are used for disposal measures and ARI represents the percentage new
of ash from incineration. infections.
Preventive and Social Medicine/Community Medicine 107
C Vaccine contraindicated in pregnancy C KAP study in India was first used to study
MMR Family planning
C True regarding live vaccines C Most common occupational cancer in India is
Booster doses are not required when live vaccines Skin cancer
are administered, single dose gives life long C True about Delphi method
immunity and live vaccine contains both major and Method involves formation of a team to undertake
minor antigens. and monitor a Delphi on a given subject, selection
C The completed family size may be estimated by of one or more panels to participate in the exercise,
Total fertility rate customarily the panelists involved are experts
C As per RCH, the community health center is in the area to be investigated and first round
First referral unit of Delphi method involves development of
C True about nutritional surveillance questionnaire.
It is a diagnostic approach, assessment involves C Standard deviation is a measure of
precise measurement of weight and height and Deviation from the mean value.
assessment is done by trained persons.
C True about recommended daily allowance ALL INDIA 2007
RDA is decided by a panel of experts and is based
on scientific research, RDA is often higher than C Indicators included in PQLI are
recommended minimum requirement and RDA is IMR, literacy rate and life expectancy at age one.
based on estimated average requirement. C 85% of lung cancer among smokers was due to their
C Highest amount of saturated fatty acid is seen in smoking. This is an example of
Palm oil Attributable risk
C Psychrometer is used to measure C True regarding herd immunity are
Humidity Mostly due to subclinical infection, can be acquired
C Concurrent list encompasses by immunization and spread of epidemic is
Prevention of extension of communicable disease influenced by it.
from one unit to another, prevention of adulteration C Vaccines included in EPI schedule are
of food stuffs and regulation and development of OPV, BCG and DPT
medical profession. C Under eradication of congenital Rubella syndrome
C Following are zoonosis programme, the first priority group for rubella
Plague, Japanese encephalitis and TB. vaccination is
C Soil forms an important reservoir for infections All non-pregnant woman of 15 to 34 years of age.
Coccoidomycosis, anthrax and tetanus. C Strategies for prevention of neonatal tetanus
C Soft tick transmits includes
Relapsing fever 5 clean practices, 2 doses of TT to all pregnant
woman and immunizing all married woman.
C Isolation is strictly recommended for
Case finding in RNTCP is based on
Pneumonic plague
C
Sputum microscopy
C True about measles
High secondary attack rate, only one strain auses C True regarding endemic typhus
infection and infection confers life long immu- Flea is a vector of the disease
nity. C Common causes of blindness in children in India
C True about yaws are are
Caused by Treponema pertenue, has cross immunity Malnutrition, ophthalmia neonatarum and glaucoma.
with syphilis and cannot be differentiated C BMI to classify obesity should be?
serologically from Treponema pallidum. 30
C Dharmendra’s index and Jopling classification C Impact and efficiency of iodine control programme
deals with can be estimated by
Leprosy Neonatal thyroxine levels
Preventive and Social Medicine/Community Medicine 109
C Compared to cow’s milk, mother’s milk has more C Transplantation of human organs act was passed
Lactose in
C The highest percentage of PUFA are present in 1994
Soyabean oil C The extra-callories allowances needed per day
during pregnancy is
C The major purpose of randomization in clinical trial
is to 350
Reduce selection bias in allocation of treatment. C The premium of community based universal health
insurance scheme launched during 2003–04 is
C A study conducted to test if use of herbal tree
` 1 per day for poor and individual to ` 2 per day for
played any role in prevention of common cold. Data
a family of seven.
was collected on the number of people who
developed cold. The analytical test of choice to test
this study is ALL INDIA 2005
Chi square test C Infant mortality rate includes
Early neonatal mortality, late neonatal mortality
ALL INDIA 2006 and post-neonatal mortality.
C Endemic disease
C True about standardization
Constantly present in a given population group.
It allows comparisons to be made between two
C True regarding herd immunity for infectious
different population, for direct standardization
diseases
age specific death rates of study populations are
used and for indirect standardization, age In case of tetanus, it is affected by the presence and
specific death rates of standard population are distribution of alternate animal hosts and it refers to
used. group protection beyond offered by the protection
of immunized individuals.
C The double blinding in clinical trials is to avoid
observer and subject bias. C A 2 years girl with cough and fever for 4 days,
inability to drink, 5 kg weight and 45/min respi-
C True about randomized controlled trial
ratory rate. The girl is defined as
Baseline characteristic of control group and
Very severe disease
intervention group should be same, sample size
required depends on the hypothesis and C True regarding treatment of class III dog bite
investigator’s bias is minimized by double patient
blinding. Immediately wash wound with soap and water,
C Positive predictive value of diagnostic test in a give ARV and give immunoglobulins for passive
population is immunity.
TP/TP + FP C Drug of choice for cholera treatment in an adult
with a single dose of
C Sensitivity of a diagnostic test is
Doxycycline
TP/TP + FN
C True about congenital rubella syndrome
C Strongly associated with coronary heat disease
Diagnosed when infant IgM antibodies at birth,
Apolipoproteins
diagnosed when IgG antibodies persists for > 6
C Vision screening of school children is conducted months and most common congenital defects are
under National Programme for Control of sensorineural deafness, cardiac malformations and
Blindness by cataract.
School teachers C The most common cancer affecting Indian women
C WHO definition of blindness is in Mumbai and Delhi is
Visual acuity of < 3/60 in the better eye with best Breast cancer
correction. C BMI of a male whose weight is 89 kg and height 172
C Most common cause of ocular morbidity in India is cm is
Refractive error 30 (kg/m2)
110 AIIMS and All India PGMEE—Review Questions
C True regarding influence of smoking or risk of C Percent prevalence of disease = Total diseased/
coronary heart disease total population × 100
Smoking is independent risk factor, smoking is C The best indicator for monitoring the impact of
synergistic to other risk factors and influence of iodide deficiency disorders control programme is
smoking is directly related to number of cigarettes Neonatal hypothyroidism
per day. C Under the WHO vision 2020 programme, SAFE
C Viral infection transmitted by tick is strategy is adopted for
KFD Trachoma
C Anti-larval measures are C WHO definition of adolescent age is between
Intermittent irrigation, Paris green and Gambusia 10–19 yrs of age
affinis (and Malathion though as antilarval not C Information Technology Act was passed by
recommended).
Government of India in 2000
C Tools for checking efficiency of pasteurized milk are
C Source of manager’s power is
Phosphatase test, standard plate count and
Reward, coercive and legitimate
coliform count (Mn: PSC).
C The RDA of energy intake for an adult woman with
heavy work is ALL INDIA 2004
2790 kcal C A study beginning in 1975 with a group of 5000
C Color of bag for human anatomical waste adults asking about their alcohol consumption and
Yellow occurrence of cancer was studied in 1995–2000. This
C True about standard normal distribution study is
Has variance 1.0 Concurrent Cohort study
C The PEFR of a group of young girl following normal C Proxy measures for incubation period are
distribution has mean 300 L/min and standard Latent period, serial interval and generation time.
deviation 20 L/min C A 3 1/2 years old child has not received primary
True is 95% of the girls have PEFR between 260 and immunization. Best vaccination advice to such a
340 l/min. child is
C Z score is BCG, DPT, OPV, measles, vitamin A
Observed value - mean value/standard deviation. C True about DPT vaccine
C The events A and B are mutually exclusive, Aluminum salt has an adjuvant effect, whole cell
therefore, prob (A or B) = Prob (A) + Prob (B). killed bacteria of Bordetella pertussis has an adjuvant
C The diagnostic power of a test to correctly exclude effect and presence of a cellular pertussis component
the disease is reflected by increases its immunogenecity.
Negative predictivity C A 37 weeks pregnant woman attends an antenatal
C Highly significant correlation coefficient (r = 0.90, p clinic at PHC. No antenatal visit prior to it. Tetanus
= 0.01) between the systolic blood pressure values immunization in this case can be best approached
and serum cholesterol values of patients were by
found. Correct interpretations are Give a dose of TT and explain to her that it will not
A patient with high level of SBP is also likely to protect the newborn and she should take the second
have a high level of serum cholestrol, a patient dose after four weeks even if she has delivered in
with low level of SBP is also likely to have a low the meantime.
level of serum cholesterol and about 80% of the C A 4 months old child had cough, fever, chest
variation in SBP among his patients can be indrawing and respiratory rate 45 per minute. Best
explained by their serum cholesterol values and way to manage the child is
vice versa. Refer urgently to hospital after giving the first dose
C Total cholesterol level = a + b (calorie intake) + c of an antibiotic.
(physical activity) + d (body mass index) is an C The most appropriate test to assess the prevalence
example of of TB infection in a community
Multiple linear regression Tuberculin test
Preventive and Social Medicine/Community Medicine 111
C According to international health regulations, there C Dietary changes advocated by WHO for prevention
is no risk of spread of yellow fever if the of heart diseases include
Aedes aegypti index remains below 1%. Reduction in fat intake to 20–30 percent of caloric
C Mode of transmission of leprosy are intake, consumption of saturated fats to be limited
to less them 10% of total energy intake and
Breast milk, insect bite and droplet infection.
consumption of cholesterol to below 100 mg per
C True regarding leprosy 1000 kcal per day.
Multi-bacillary leprosy is diagnosed when there are C Multipurpose worker scheme in India was
> 5 skin patches, new case detection rate is an introduced following the recommendation of
indicator for incidence of leprosy and the target for Kartar Singh committee.
elimination of leprosy is to reduce the prevalence to
C If each value of a given group of observations is
less than 1 per 10,000 population.
multiplied by 10, standard deviation of new
C A 10 months old child weighing 8 kg has Bitot’s observation is original standard deviation × 10.
spots in both eyes. Most appropriate schedule to C If SBP in a population has mean = 120 mm Hg and
prescribe vitamin a to this child is median 125 mm Hg, the distribution is said to be
1 lakh units IM on day 0, 1 and 14 Negatively skewed.
C The current recommendation for breastfeeding is C It prevalence of diabetes mellitus is 10% the
that probability that three people selected of random
Exclusive breastfeeding should be continued till from the population will have diabates is
6 months of age followed by supplementation with 0.001
additional foods. C The usefulness/utility of a screening test in a
C True for breast milk community depends on
The coefficient of uptake of iron in breast milk is Sensitivity
70%, calcium absorption of human milk is better
than that of cow’s milk and it provides about 65 kcal ALL INDIA 2003
per 100 ml.
C Denominator in secondary attack rate is
True about intrauterine devices
All susceptibles amongst close contact.
C
The pregnancy rate of lippes loop and Cu 250 are
C Necessary for calculation of sample size for a
similar, IUD can be used for emergency
prevalence study
contraception within 5 days and LNG releasing
Prevalence of disease in population, significance
IUD has an effective life of 5 years.
level and desired precision.
Goals of the national population policy of India
The parameters of sensitivity and specificity are
C
C
includes
used for assessing
To reduce IMR to 30 per thousand live births, to Criterion validity
reduce MMR to 100 per 100000 live births and 100 C True about meningococcal meningitis
percent registration of births, deaths marriages and The disease is more common in dry and cold
pregnancies. months, chemoprophylaxis of close contacts of
C Essential component of RCH programme in India cases is recommended and the vaccine is not
includes effective in children below 2 years of age.
Prevention and management of unwanted C A 24 months old child with cough, fever for 2 days,
pregnancies, maternal care including antenatal 11 kg weights, respiratory rate 38/min, and chest
delivery and postnatal services and management of indrawing present. Management is
reproductive tract infection and sexually transmitted Classify as severe pneumonia, start antibiotics and
infections. refer urgently.
C Five clean practices under strategies for elimination C For controlling an outbreak of cholera, measures
of neonatal tetanus includes recommended are
Clean surface for delivery, clean hand of the Proper disposal of excreta, chlorination of water
attendant and new blade for cutting the cord. and early detection and management of cases.
112 AIIMS and All India PGMEE—Review Questions
C The best method to show the association between C In a study, variation in cholesterol was seen before
height and weight of children in a class is by and after giving a drug. The test of significance is
Scatter diagram Paired t test
C The correlation between two variable was found to C Ram and Shyam stay in the same hostel. Ram
be 1.1 in a study. This is developed infection with group B meningococci
and Shyam developed infection due to group C
Computational mistake in calculating correlation.
meningococci. True statements are
The biological oxygen demand indicates
Educate students about meningococcal transmission
C
Organic matter and take preventive measures, chemoprophylaxis
C In a surveillance centre for hepatitis B, in a low to all against both group B and group C and vaccine
prevalence area, method for testing for hepatitis prophylaxis of contacts of Shyam.
B changed from single ELISA to double testing C Common causes of post-neonatal infant mortality
in series. The parameters of the test affected in India are
are Malnutrition, diarrheal diseases and acute respira-
Specificity and positive predictive value tory infection.
114 AIIMS and All India PGMEE—Review Questions
Ophthalmology
114
Ophthalmology 115
C Reciprocal inhibition of antagonistic muscle upon C The afferent pathway for light pupillary reflex is
lateral gaze is explained by Optic nerve
Sherrington law. C True about intraocular retinoblastoma
94% of cases are sporadic, calcification in the tumor
AIIMS NOVEMBER 2007 can be detected on ultrasound scan and Reese
Ellsworth classification is useful in predicting
C Ionic pump in corneal endothelium is necessary for visual prognosis following radiotherapy.
maintaining deturgescence of the cornea and thus
C Factors of prognostic significance in choroidal
transparency. It can be blocked by
melanoma
Inhibition of anaerobic glycolysis.
Size of tumor, cytology of tumor cells and presence
C SAFE strategy is used for of extra-ocular extension.
Trachoma
C Corneal transparency is maintained by AIIMS NOVEMBER 2005
Relative dehydration, unmyelinated nerve fibers
and uniform spacing of collagen fibrils. C Drug of choice in a 50 years old lady presenting
C Dangerous zone of eye is with history of severe eye pain, redness, diminution
Ciliary body of vision, on examination-visual acuity 6/60,
circumcorneal congestion, corneal edema, shallow
anterior chamber
AIIMS NOVEMBER 2006
IV mannitol
C Oculomotor nerve palsy causes C A 30 years old male patient presenting with history
Ptosis, diplopia and outward eye deviation. (Mn: of recurrent headaches, on fundus examination,
OPD) generalized arterial attenuation, multiple cotton
wool spots and flame shaped hemorrhages in both
AIIMS MAY 2006 eye. Diagnosis
Hypertensive retinopathy.
C Ocular structures derived from surface ectoderm
C A female patient presents with loss of vision in both
Corneal epithelium, crystalline lens and epithelium
eyes, on examination-normal pupillary responses,
of lacrimal glands.
normal fundus, and visually evoked response
C True stereopsis is perceived due to examination showing extinguished response.
Binasal disparity. Diagnosis
C True regarding PHPV Cortical blindness
It is generally unilateral C The most common retrobulbar orbital mass in
C Mucin layer tear film deficiency occurs in adults is
Keratoconjunctivitis sicca. Cavernous hemangioma
C The laser procedure, commonly used for treatment C Drug contraindicated in patient with history of
of iris neovascularization is sulfa allergy presenting with acute attack of angle
Panretinal photocoagulation. closure glaucoma
C Most important factor in prevention of endophthal- Acetazolamide
mitis in cataract surgery C The most common systemic association of scleritis is
Preoperative preparation with povidone iodine. Rheumatoid arthritis
C The crystalline lens derives its nourishment from C Angioid streaks in the eyes are seen in
Aqueous and vitreous. Pseudoxanthoma elasticum.
C Histopathology of recurrent chalazion is done to C The corneal transparency is maintained by
exclude- Sebaceous cell carcinoma. Endothelium
C Band shaped keratopathy is caused by C A 50 years old patient complains of decreased
Calcium distance vision now does not need his near glasses
C Bitemporal heminopic field defect is characteristic of for near work. Diagnosis is
Pituitary tumor Nuclear sclerosis
120 AIIMS and All India PGMEE—Review Questions
C A patient presenting with right homonymous C On refraction testing using a plane mirror in a
hemianopia with saccadic pursuit movements and patient with refractive error of 3D sphere and 2D
defective optokinetic nystagmus has lesion in cylinder at 900 from 1 metre distance under no
Parietal lobe cycloplegia, the reflex is seen to move
C Idiopathic nyctalopia is due to Against the movement in both the axes.
Hereditary absence of rod function. C A 25 years old male patient presents with history of
redness, pain and mild diminution of vision in one
AIIMS MAY 2005 eye for past 3 days, history of low backache for past
one year, on examination- circumcorneal
C Donor tissue in human cornea transplantation is congestion, cornea is clear apart from a few fine
Donation human cadaver eyes. keratic precipitates on the corneal endothelium, 2 +
C Berlin’s edema is seen cells in the anterior chamber, IOP within normal
After concussional trauma limits. Diagnosis is
C Saccade is defined as HLA B-27 related anterior uveitis.
Abrupt involuntary rapid eye movements. (Mn. C Initial management of a soft contact lens user
AIR). presenting with pain, watering, photophobia and a
C Painless sudden visual loss is seen in white spot in the centre of the cornea
CRAO, retinal detachment and vitreous Start frequent antibiotic eye drops after disconti-
hemorrhage. nuing the contact lens.
C The conversion of CO2 and H2O into carbonic acid C Appropriate management of a 3 years old child
during the formation of aqueous humor is catalysed presenting with right convergent squint of 6
by months duration
Carbonic anhydrase Proper refractive correction, amblyopia therapy
C Laser used for treating aftercataract followed by surgical correction.
Nd-YAG (Mn: AND). C A 30 years old immunocompetent farmer from a
rural community presents with difficulty in vision
AIIMS NOVEMBER 2004 in the left eye for last 10 days and history of trauma
to his left eye with vegetative matter 10–15 days
C Best refractive surgery for a 20 years old girl student
back, on examination ulcerative lesion in the
presenting with myopia of-2.0 D and post-
cornea, whose base has raised soft creamy infiltrate,
traumatic nebular corneal opacity in right eye
ulcer margin is feathery and hyphate and a few
Photorefractive keratectomy. satellite lesion. Etiology is
C A 50 years old man undergoing chemotherapy for Fusarium
non-Hodgkin’s lymphoma one year back, now
C Cranial nerve lesion in a patient presenting with
presents with painful weeping rashes over the right
normal eye sight absence of direct and consensual
upper eyelid and forehead for last 2 days along with
light reflexes
ipsilateral acute punctate keratopathy. Diagnosis is
Oculomotor nerve.
Herpes zoster
C A 20 years old girl student using spectacles for last
10 years presents with history of photopsia and AIIMS NOVEMBER 2003
sudden loss of vision in right eye. Clinical C Old age patient presents with history of increasing
examination performed to clinch the diagnosis pain and diminution of vision after an initial
Indirect ophthalmoscopy improvement, coming to eye emergency after 3
C A 30 years old IDDM patient on insulin for the past days of cataract surgery. Cause is
10 years presents with gradually progressive Endophthalmitis
painless loss of vision. Diagnosis C Signs resulting from infection within the right
Cataract cavernous sinus are
C Drugs used in glaucoma Loss of pupillary light reflex, ptosis and right
Dipivefrine, physostigmine and timolol ophthalmoplegia.
Ophthalmology 121
C Condition likely to be worsened in a case of POAG, C Types of glaucoma commonly seen in the orbit
when treated with timolol maleate 0.5% eye drops Burkitt’s lymphoma, NHL (mixed lymphocytic and
are histiocyctic) and NHL (lymphocytic poorly
Bronchial asthma, depression and hypercholeste- differentiated).
rolemia.
C Management of a 25 years old executive presenting AIIMS NOVEMBER 2002
with metamorphosis in right eye, on examination
fundus showing shallow detachment at the macula, C Most visually handicapping type of cataract
fluorescein angiography showing a smoke stack Posterior subcapsular
sign C A 2 years old child presents with leucocoria in left
Just wait and watch for spontaneous recovery. eye for 2 months. On examination—Total retinal
C A patient presents with sudden loss of vision in the detachment in same eye, US/B scan showing
right eye following injury to right brow due to fall heterogeneous subretinal mass with calcification.
from scooter, on examination the pupil shows Diagnosis
absent direct light reflex but normal consensual Retinoblastoma
pupillary reflex present, fundus is normal. C A premature infant was delivered at 27 weeks of
Treatment is gestation with birth weight 1500 gm. Fundus
Intensive IV corticosteroids as prescribed for spinal examination is requested by an ophthalmologist
injuries to be instituted within six hours. At 34 weeks gestation age.
C A patient with spectacle correction of 6.0 and 8.0
AIIMS MAY 2003 one morning complains of seeing some opacities
floating in front of his eye with history of slight
C Anisokonia means decrease in vision over last few days. Investigation
Difference in the size of images formed by the two advised
eyes. Indirect ophthalmoscopy.
C Common ocular manifestation in Trisomy 13 is C According to NPCB surgery (1938–1989), the
Bilateral microphthalmos. highest prevalence of blindness in India is in
C Optic nerve injury results in J and K
Loss of vision in that eye, loss of light reflex and C In trachoma grading, Trachomatous inflammation-
dilation of pupil. follicular is defined as the presence of 5 or more
C Enucleation of eyeball is contraindicated in follicles in the upper tarsal conjunctiva.
Panophthalmitis C An 8 years old boy presents with swelling in the left
C The differential diagnosis of retinoblastoma eye for 3 months duration, on examination-proptosis
includes of left eye with preserved vision. Right eye is
Coat’s disease, PHPV, and retinal astrocytoma. normal. CT- intraorbital extraconal mass lesion,
biopsy embryonal rhabdomyosarcoma, metastatic
C Management of congenital glaucoma is
work up normal. The standard line of treatment is
Trabeculotomy with trabeculectomy.
Chemotherapy and radiation therapy.
C Under school eye screening progamme in India,
C Risk factor for acanthamoeba keratitis in 18 years
initial vision screening of school children is done by
old girl presenting with keratitis and severe pain in
School teachers. the eye are
C World bank provided assistance to NPCB (1924– Extended near contact lens, exposure to dirty water
2001) for and corneal trauma.
Cataract C Significant loss of vision in a patient with hyper-
C Disease under vision 2020 goals,WHO are tension can occur due to
Refractive errors, cataract and trachoma. Anterior ischemic optic neuropathy, occipital
C Gene mutation that may give rise to hereditary infarct and retinal hemorrhage.
glaucoma C Diagnosis of a 30 years old male patient presenting
Optineurin with a history of injury to the eye with a leaf 5 days
122 AIIMS and All India PGMEE—Review Questions
ago and pain, photophobia and redness of eye for 2 blurred vision, history of trauma with vegetative
days matter, on examination dentiritic ulcer in cornea,
Fungal corneal ulcer microscopic examination of corneal scraping shows
C A 60 years old man present with watering from his macrophage like cells on culturing the corneal
left eye since 1 year, syringing revealing patent scraping over a non-nutrient agar enriched with E.
drainage system. Rest of ocular examination coli, there were plaque formations. Organisms most
normal. A provisional diagnosis of lacrimal pump likely is
failure was made. Confirmed by Acanthamoeba trophozoites
Dacryoscintigraphy
C Incision in a standard sutureless cataract surgery ALL INDIA 2012
done with phaco-emulsification and foldable job is
3 mm–3.5 mm C A malnourished child from poor socioeconomic
C Most common cause of ocular morbidity in the status, living in overcrowded dirty areas presented
community with a nodule around limbus with hyperemia of
Refractive error conjunctiva and axillary and cervical lymphadeno-
pathy. Diagnosis
Phlyctenular conjunctivitis.
AIIMS MAY 2002
C Cause of CRAO
C Uveitis is most commonly associated with Orbital mucormycosis
Pauciarticular JRA C Fundoscopy of a patient shows chalky white optic
C Fluorescein angiography is used to identify lesion disc, the rest of retina absolutely normal. Diagnosis
in Primary optic atrophy.
Iris, optic nerve and retina C A 20 years male patient presents with night blindness,
C If axial length of eyeball change by 1mm, then the tubular vision, IOP 18 mm Hg, fundoscopy-
power changes by attenuation of arteries and waxy pallor of optic disc,
3D perimetry—Ring scotoma, ERG subnormal.
C Lens contains the oldest cells in Diagnosis
Nucleus Pigmentary retinal dystrophy.
C Recurrent chalazion is predisposed to develop C Most common mode of spread retinoblastoma
Adenocarcinoma of Meibomian gland Optic nerve
C Optic radiation lesion involving Meyer’s loop causes C A patient complains diminished vision, 3 weeks
Superior quadrantanopia after IOL implantation and fundus fluorescein
C Horner’s syndrome consists of angiography—Flower petal hyperfluorescence of
Miosis and ptosis > Miosis and exophthalmos. macula. Diagnosis
C Internuclear ophthalmoplegia is caused due to Aphakia
lesion in C A patient presents with diplopia in one eye. On
Medial longitudinal fasciculus examination with oblique illumination- Golden
C The best irrigating fluid during ECCE crescents and on axial illumination- Black/dark
Balanced salt solution and glutathione. crescents. Diagnosis
C A 30 years old male patient presenting with history Ectopia lentis. (Mn: Ectopic Ab Go)
of proptosis in right eye and pain on eye movement C A child presents with bilateral white pupillary
for last 15 days with difficulty in upward and down reflex. On slit lamp examination, there is zone of
ward gaze movement with CT scan showing cystic opacity around fetal nucleus with spokes of wheel
lesion with a hyperdense opacity with it, located in like arrangement toward centre. Diagnosis
superior oblique muscle. Diagnosis Lamellar cataract
Cysticercosis cellulosae. C Following 2 days of successful emulsification and
C A young adult male patient presenting with red IOL placement, a diabetic patient presents with
eye, complains pain, photophobia watering and redness, pain and grey white pupillary reflex.
Ophthalmology 123
Patient also shows hypopyon, retrolental flare and C Young patient with loss of central vision. No
posterior synachiae. Diagnosis obvious family history. ERG and EOG normal
Postoperative endophthalmitis. Stargardt’s disease.
C A 35 years old male patient on slit lamp shows C Young patient with loss of central vision. ERG is
keratic precipitates and aqueous flare in right eye, normal but EOG is abnormal
no synachiae but complicated cataract seen. Best’s vitelline dystrophy.
Diagnosis C Drug used in treatment of diabetic macular edema/
Fuch’s heterochromic iridocyclitis. diabetic retinopathy
C A 35 years old female patient presents with recurrent Ruboxistaurin, pyridazinones and benfotiamine.
chalazion of the upper eyelid and curettage subjec- C The most common cause of bilateral proptosis in
ted to histopathological examination to rule out children
Sebaceous cell carcinoma Chloroma
C An elderly diabetic male patient presents with C The most common malignant orbital tumor in
severe panophthalmitis with orbital cellulitis, children is
sample collected from periorbital region on Gram Rhabdomyosarcoma
staining shows irregularly branching, aseptate and
C A 5 years old boy presents with leucocoria in right
broad hyphae. Etiological agent
eye due to diffuse retinoblastoma involving entire
Apophysomyces elegans.
globe. 2–3 mm tumor in left eye in the periphery
C A regular contact lens user presents with complaints ideal management
of redness, photophobia, blurring of vision in one eye
Enucleation of right eye and focal therapy of left eye.
for more than 2 weeks, not responding to treatment,
Young boy presenting with decreased vision, six
on examination- cornea shows ring shaped lesion along
C
months after being hit by a ball in the eye. Finding
with some overlying epithelial defect. Diagnosis
on optical examination suggestive of blunt injury to
Acanthamoeba keratitis.
the eye
C Wavelength of laser used for shaping cornea in
Vitreous base detachment.
refractive surgery
193 nm (Hint: Excimer laser- UV laser)
ALL INDIA 2010
ALL INDIA 2011
C Endophthalmitis involves inflammation of
C Late onset endophthalmitis after cataract surgery is Uvea, retina and vitreous.
most often caused by C Mechanism of antimicrobial resistance in isolated
Propionibacterium acne Pseudomonas strains in a patient of keratitis after
C A patient presents with history of running nose and prolonged usage of contact lenses
pain over medial aspect of eye, sudden onset fever, Ability of Pseudomonas to produce biofilms.
prostration, chemosis, proptosis and diplopia on
C Least common corneal dystrophy
lateral gaze with congestion of optic disc. It is a case of
Macular dystrophy
Cavernous sinus thrombosis.
C Ophthalmoplegic migraine is best defined by C True regarding corneal transplantation
Recurrent transient 3rd, 4th and 6th nerve palsy Specular microscopy analysis is used to assess
associated with headache. endothelial cell count.
C Diplopia in superior oblique palsy is described as C Relative afferent pupillary defect is characteristically
Vertical on looking down. seen in damage to
C True about Argyll Robertson pupil Optic nerve
Near reflex normal, visual acuity normal and direct C Ptosis with retraction of ptotic eye lid on chewing is
light reflex absent. Marcus Gunn jaw winking syndrome.
C Patient has flashing light, sudden floaters and C A person with known mutation in Rb gene is
perception of a curtain falling in front of eye. Most disease free from retinoblastoma. He is at the
likely diagnosis is highest risk of developing
Rhegmatogenous retinal detachment. Osteosarcoma
124 AIIMS and All India PGMEE—Review Questions
C The most common cause of vitreous hemorrhage in C Diagnosis of 2 years old child presenting with white
adults is reflex in one eye for past 1 month with CT finding
Diabetes mellitus of calcification within the globe is
C Typically bilateral inferior lens subluxations of the Retinoblastoma
lens is seen in C Retinal vascular tumors are often associated with
Homocystinuria intracranial hemangioblastoma in VHL syndrome.
C Uveitic conditions contraindicated for intraocular Site of such vascular abnormalities
lens implantation after cataract surgery Cerebellum
JRA C A 20 years old boy presenting with history of injury
C Autosomal recessive stromal dystrophy with tennis ball, on examination—No perforation
Macular dystrophy but hyphema present. Source of bleeding
Circulus iridis major
C True about pthisis bulbi
Calcification of the lens is common, sclera is
ALL INDIA 2004
thickened and size of globe is reduced.
C The most common retro-bulbar orbital mass in C Maximum density of goblet cells in seen in
adults is Nasal conjunctiva
Cavernous hemangioma C Diagnosis of a 10 years old boy presenting with
C True about optic glioma severe itching of eye and ropy discharge with
Peak incidence in first decade, arises from symptoms aggravating in summer season
oligodendrocytes and associated with type 1 NF. Vernal keratoconjunctivitis.
C The most common second malignancy in survival C Arlt’s line is found in
of retinoblastoma Trachoma
Osteosarcoma C Most important adjuvant therapy in fungal corneal
ulcer
ALL INDIA 2005 Atropine sulphate eye ointment
C Polychromatic lustre is seen in
C Horner’s syndrome is characterized by Complicated cataract
Miosis, enophthalmos and ptosis. C Best management for a two weeks old child
C A 25 years old man presenting with 6/5 vision each presenting with unilateral cataract
eye, unaided, cycloplegic retinoscopy + 1.0 D sph at The best age to operate him to get the best visual
1 metre with complains of blurring of new sprints at results is four weeks.
30 cm that clears up in 30 second. Diagnosis (Note: as early as possible)
Accomdative inertia C Prominent ocular condition associated with
C A 30 years old male presenting with sudden Marfan’s syndrome
painless loss of vision in one eye for past 2 weeks, no Ectopia lentis
history of trauma, on examination normal anterior C Diagnosis of a two months old child presenting
segment but no fundal glow. Diagnosis with epiphora and regurgitation is
Vitreous hemorrhage Congenital dacryocystitis
C True about Acanthameba keratitis C Photodynamic therapy is used in the eye for
Acanthameba does not depend upon a human host Wet AMD (Age related macular degeneration).
for completion of its life cycle. C Ocular emergencies are
C Contact lens have deleterious effect on corneal Angle closure glaucoma, central retinal arterial
physiology. True statements are occlusion and retinal detachment.
Reduction in glucose utilization by corneal epithe- C The most common cause of inherited blindness due
lium, increased production of CO2 in the epithelium to mitochondrial chromosomal anomaly is
and reduction in hemidesmosome density. Leber’s hereditary optic neuropathy.
C Enlarged corneal nerves may be seen in C Differential diagnosis of white pupillary reflex are
Kerotoconus, leprosy and NF. Cataract, retinoblastoma and retrolental fibroplasia.
126 AIIMS and All India PGMEE—Review Questions
bone conduction on both sides with Weber’s test Diabetic and immnocompromised people are more
lateralized to right ear. Next done susceptible, granulation tissue is seen on the floor of
the external auditory canal on otoscopy and ESR is
Schwabach’s test
used for monitoring the disease.
(Note: To confirm the findings of Rinnie’s and
C True about Meniere’s disease
Weber’s test.
Electrocochleography is the gold standard inves-
Positive Rinnie’s test is AC > BC in normal persons
tigation and Semont maneuver decreases giddi-
and sensorineural deafness. Mn: PoRi AB normally
ness.
sensed.
C A child has retained disc battery in the nose. The
Weber’s test-Lateralised in conductive deafness to most appropriate statement
diseased ear. Mn: LCD)
Battery contents might leak resulting into chemical
C Most common type of congenital ossicular damage of the surrounding tissue.
dysfunction
C Condition in which topical steroid is not indicated
Stapes defect with fixation of foot plate and After endoscopic surgery for antrochoanal polyp.
lenticular process involvement. (Main etiology is the infection)
C Auditory neuropathy is an effective modality of C A patient presents with traumatic head injury and
treatment for CSF leak. Next step
Meniere’s disease Wait and watch for 3–5 days.
C The complications of adenoidectomy include
AIIMS MAY 2015 Retropharyngeal abscess, cervical spine injury and
velopharyngeal insufficiency.
C Most common source of bleeding in a case of (Note: also hypernasality)
nasopharyngeal angiofibroma C The most common cause of vocal cord palsy
Internal maxillary artery Malignant disease
C Topical treatment for recurrent respiratory papillo- C An elderly man presents with T3N0 laryngeal
matosis carcinoma. Managed by
Cidofovir Concurrent chemoradiotherapy
127
128 AIIMS and All India PGMEE—Review Questions
C A 58 years old gentleman presents with persistent C In right handed person, direct laryngoscope is held by
fullness of left ear and hearing loss for 3 months. On Left hand
examination, there is fluid behind the tympanic C A 6 years old child presented with history of
membrane. Impedence audiometry shows a type B recurrent upper respiratory tract infections,
audiogram. Next done mouth breathing, nasal obstruction, hearing
Endoscopic examination for any nasopharyngeal impairment with high arched palate; management
pathology. will be
C An elderly lady presents with nasal blockade, nasal Adenoidectomy with grommet insertion.
discharge, diplopia and facial swelling. On
examination, there is blackish discharge from the
nasal cavity with necrosis of nasal mucosa, septum AIIMS MAY 2011
and hard palate. There is elevated blood sugar and C According to European laryngeal society, subliga-
urinary ketones are positive. Best drug for this patient mental cordectomy is classified as
Amphotericin B. Type 2
C Topical mitomycin is used for
AIIMS NOVEMBER 2012 Treatment for laryngeal stenosis.
C Third window effect is seen in C Infection of inner ear spreads through
Superior semicircular canal dehiscence. Cochlear aqueduct
C Laryngeal pseudosulcus is seen in C Microwick and microcatheter sustained release
Laryngopharyngeal reflux. devices are used in
C A necessary criterian for successful cochlear implant Delivering drug to the round membrane.
Presence of auditory nerve
C Initial mechanism of action of intra-tympanic AIIMS NOVEMBER 2010
gentamycin microwick catheter in treatment of
Meniere’s disease C True regarding retropharyngeal abscess
Inactivates Na+/K+ ATPase channels of hair cells. Confined to one side of midline, can be palpable per
C High frequency audiometry is used in orally by pressing the finger on posterior pharyn-
geal wall and presents with dysphagia and
Ototoxicity
difficulty in breathing.
C Initial screening test for newborn hearing disorder
C True about cochlear implant
Otoacoustic emissions
Not contraindicated in cochlear malformation.
C Laser uvulo pharyngo-palatoplasty is the surgery
for C Laparoscopic intranasal approach is used for
Snoring Lacrimal sac, pituitary gland and optic nerve.
C Frontal sinus can be best visualized by
Caldwell’s view
AIIMS MAY 2012
C CSF rhinorrhoea, immediate treatment
C Initial screening test for newborn hearing disorder Antibiotics and wait and watch for 7 days.
Otoacoustic emissions (OAE)
C Vestibular evoked myogenic potential (VEMP) AIIMS MAY 2010
detects lesion of
Inferior vestibular nerve. C Most common site for CSF rhinorrhoea is
C Second primary tumor of head and neck is most Cribriform plate > Ethmoid sinuses
commonly seen in malignancy of C Endolymph in the ear
Oral cavity Is secreted by stria vascularis.
C In electrocohelography C Bell’s palsy patient presenting on day 3. Treatment
Evoked potential generated in cochlea and auditory given is
nerve. Oral steroid and acyclovir
130 AIIMS and All India PGMEE—Review Questions
C A 30 years old lady developed hearing loss during C Route of spread of infection from middle ear
pregnancy with family history from maternal side. Bony invasion, directly through oval and round
Bilateral slowly progressive hearing loss with window and osteothrombotic route.
bilateral tinnitus and pure tone audiometry C An elderly diabetic patient presents with painful
showing conductive hearing loss with Carhart’s ear discharge and edema of external auditory canal
notch. Diagnosis with facial palsy not responding to antibiotics. An
Otosclerosis increased uptake on technetium bone scan is noted.
Diagnosis is
Malignant otitis externa.
AIIMS NOVEMBER 2005
C True about after effects of cochlear implantation
C The treatment of choice for paralysed vocal cord in Improved sound and speech perception, better
a 10 years old boy with hoarseness of voice after chances of developing normal or almost normal
diphtheria auditory and verbal skills and improved scholastic
Wait for spontaneous recovery of vocal cord. performance as compared to profoundly hearing
C Management of large antrochoanal polyp in a 28 impaired patients without the use of a cochlear
years old man implant.
Endoscopic sinus surgery. C Nasal tumors originating from the olfactory
mucosa
C Laryngocele arises from
Esthesioneuroblastoma
Saccule of ventricle.
C True about laryngomalacia
C Objective piece of microscope for ear surgery
Most common congenital anamoly of the larynx,
250 mm.
omega shaped epiglottis and stridor increases on
crying, but decreases on placing the child in prone
AIIMS NOVEMBER 2004 position.
C Packing most useful to prevent synachiae forma- C True about spasmodic dysphoria
tion after nasal surgery Botulinum toxin is the standard treatment, it affects
Mitomycin the muscles of the larynx and multiple sittings of
C Techniques used to control bleeding from bone botulinum toxin A is required for its treatment.
during mastoid surgery
Bone wax, bipolar cautery and diamond drill. ALL INDIA 2011
C True about sodium in otosclerosis
AIIMS MAY 2004 Acts by inhibiting proteolytic enzymes in cochlea, is
C Gray white membrane on tonsil due to contraindicated in chronic nephritis and is
Infectious mononucleosis, streptococcal tonsilitis indicated in patients with a positive Schwartz sign.
and diphtheria. C Vestibular schwannoma arise most commonly
from
ALL INDIA 2012 Superior vestibular nerve
C Species of Vibrio most often associated with ear C Endolymphatic hydrops is seen in
infections Meniere’s disease
V. alginolyticus C Young boy while eating suddenly develops
C Sensory supply of the auricle aphonia and respiratory distress. Next step
Greater auricular nerve, auricular branch of vagus Heimlich’s maneuver
nerve and tympanic branch of glossopharyngeal C Gold standard test for laryngopharyngeal reflux
nerve. 24 hours double probe pH monitoring.
C Conductive hearing loss is seen in C Secondary hemorrhage after tonsillectomy usually
Otosclerosis, otitis media with effusion and presents at
suppurative otitis media. 6 days
132 AIIMS and All India PGMEE—Review Questions
C Pain sensations from ethmoidal sinus are carried by 2 weeks with deafness in affected ear and negative
Nasociliary nerve. fistula test. Rinne’s test will be
C Onodi cells and Haller cells are seen in relation to False negative
structures, respectively (Note: Dead labyrinth)
Optic nerve and floor of orbit. C Troter’s triad includes
Deafness, mandibular neuralgia and palatal palsy.
C Laryngeal pseudosulcus is seen secondary to
ALL INDIA 2010
Laryngopharyngeal sulcus
C Otoacoustic emissions arise from C True about recurrent laryngeal papillamatosis
Outer hair cells Caused by HPV, HPV 6 and 11 are most commonly
(Note: Screening tests) implicated and transmission to neonate occurs
C True about nasopharyngeal carcinoma through contact with mother during vaginal
Bimodal age distribution, IgA antibody to EBV is delivery.
found and squamous cell carcinoma is most
common histologic subtype. ALL INDIA 2008
C True about CSF leak C A newborn presents with bilateral microtia and
Most common site of leak is fovea ethmoidalis, β external auditory atresia. Corrective surgery is
transferrin estimation is highly specific for its performed at
diagnosis and fluorescein dye can be used 5–7 years of age
intrathecally for diagnosis of leak. C In cochlear implants electrodes are most commonly
C Extrinsic laryngeal membranes are placed at
Hyoepiglottic, cricotracheal and thyrohyoid. Cochlea
C Structures seen on bronchoscopy C A 70 years old male patient presents with loss of
Trachea, voal cords and first segmental division of sensation of external acoustic meatus (Histelberg’s
bronchi. sign positive). It is a case of
C True about a child presenting with stridor, barking Vestibular schwannoma
cough, and difficulty in breathing for 2–3 days. He C A 75 years old male patient presents with tinnitus,
has fever and elevated leukocyte count conductive deafness, dull tympanic membrane on
Subglottic stenosis and hypopharyngeal dilatation right side, enlarged lymph node (3 × 3 cm) in
may be seen on X-ray, boys are more commonly posterior triangle of neck and B wave on
affected than girls and symptoms are predomi- tympanogram. It is most likely a case of
nantly caused by involvement of subglottis. Nasopharyngeal malignancy
C Drug of choice in laryngeal stenosis is C Types of joints between the ossicles of ear
Mitomycin C Synovial joint
C Lasers most commonly used in laryngeal surgery C Diagnostic criteria of allergic fungal sinusitis
CO2 laser Area of high attenuation on CT scan, allergic
eosinophilic mucin and type 1 hypersensitivity.
C An adult female patient presents with history of
ALL INDIA 2009
singing, vocal abuse, gastroesophageal reflux and
C Young man presenting with an accident leading to has developed nodules at junction of anterior
loss of hearing in right ear. On otoscopic examina- 1/3rd and middle 3rd of her vocal cords.
tion, TM was intact. Pure tone audiometry shows Treatment is
an air bone gap of 55 dB in right ear with normal Speech therapy and PPI
cochlear reserve. Likely tympanometric finding
Ad type tympanogram
ALL INDIA 2007
C A patient of suspected diagnosis of suppurative
labyrinthitis with positive Rinne’s test and positive C Rhinolalia clausa is associated with
fistula test refused treatment and returned after Allergic rhinitis, adenoids and nasal polyps.
Ear, Nose and Throat 133
C True about Ramsay Hunt syndrome C A 50 years old male smoker presents with
Viral etiology, 7th cranial nerve involvement and hoarseness of voice and keratosis of larynx on
8th cranial nerve involvement. microlaryngoscopic biopsy. Management includes
C An infant presents with failure of gaining weight Cessation of smoking, laser vaporizer and stripping
and noisy breathing which becomes worse when of vocal cord.
child cries with laryngoscopy finding of reddish (Note: Laryngeal keratosis)
mass in subglottis. Management includes C Treatment of a choice of a patient presenting with
CO2 laser treatment, steroid and tracheostomy. T1N0M0 glottic carcinoma
(Note: Subglottic hemangioma) External beam radiotherapy.
Medicine 135
11
Medicine
135
136 AIIMS and All India PGMEE—Review Questions
C A patient suffering from multiple clotting factor C Rheumatic fever is least likely to be associated with
deficiency presents with active bleeding. Type of Pulmonic stenosis.
blood product best for the transfusion in such C True on auscultation in a case of severe MS
situation Loud S1, opening snap and mid diastolic murmur.
Fresh frozen plasma. C Angina, dyspnea and syncope are most commonly
C True about TRALI (transfusion associated acute associated with
lung injury) Aortic stenosis (Mn: SAD)
Mostly seen after sepsis and cardiac surgeries, it’s C A child, known case of bronchial asthma, presents
a cause of non-cardiogenic pulmonary edema with respiratory rate of 48/minute, occasional
and plasma is more likely to cause it than whole wheeze and inability to speak two words. His SpO2
blood. is 95%. He is treated with salbutamol nebulization
(Note: It develops within 6 hours) 3 times. He can now complete a sentence but SpO2
C Window period for post-transfusion potential falls to 85%. Drop in SpO2 can be explained by
exposure is defined as V/Q mismatch
From the receipt of infection to laboratory detection C The feature of idiopathic non-specific interstitial
of disease. pneumonia (NIA) include
C Disease not causing reduced DLCO Good prognosis
Bronchial asthma. C False about obstructive sleep apnea
C Osteoporosis, true is More common in females.
Normal calcium, normal alkaline phosphatase. C Excess calcium intake can lead to
C Most common nephropathy associated with Milk alkali syndrome
malignancy C A patient presents to the emergency with a crush
Membranous nephropathy injury. ECG shows diminished/absent P waves,
wide QRS complexes and tall, wide and symme-
(Note: Particularly carcinoma of the lung and colon
trical T waves. Useful in management
and melanoma)
Calcium gluconate, dialysis and insulin + glucose.
C Surgery was done in a child for EHPVO with
(Note: Hyperkalemia)
hepatojejunal anastomosis. Post-operative bilirubin
level after 2 weeks was 6 mg/dl from a pre-operative C The marker for diagnosing acute hepatitis B
level 12 mg/dl. Cause between 4 and 8 weeks is
Delta bilirubin IgM anti-HBc
A nurse is seropositive for both HBsAg and HBeAg.
A young woman presents with symptoms of
C
C
Most likely diagnosis
hyperthyroidism with elevated T4 and TSH and
bitemporal hemianopia. Next done Acute infectious hepatitis B.
Start antithyroid drugs, and do urgent MRI brain. C A 3 years old child took aspirin for fever after which
he developed raised liver enzymes, elevated
(Note: Pituitary adenoma-best treated by surgery)
bilirubin and microvascular steatosis on liver
biopsy. The molecular level change in this disorder
AIIMS NOVEMBER 2014 is due to
Impaired β oxidation of fatty acids.
C Matched correctly are
C For treatment of ascites, the Le Veen shunt is placed
Tachypnea-acidosis, wheeze-CCF and chest pain- between the peritoneum and
pericarditis.
Superior vena cava.
C Inability to work without any discomfort is (Note: Internal jugular vein)
NYHA class 3 C 90% association with HLA B27 is seen in
(Note: Discomfort at rest is grade 4) Ankylosing spondylitis.
C Marker of heart failure C A person is waiting for a train on a railway platform
Brain natriuretic peptide, CRP and troponin T. starts having seizures. He has a band showing him
Medicine 137
to be an epileptic on medication and his medications C Diagnostic criteria for declaring brainstem death
are in his pocket. Next done Absence of brainstem reflexes, a positive apnea test
Take the person away from the train, make sure he and lack of cerebromotor response to pain in all
does not fall, meanwhile call for medical help and extremities.
transfer him to hospital. C A vascular lesion in the midbrain stem at the level
C The first neural disorder to be associated with the of lateral part of medulla can cause
complete deficiency of a neurotransmitter is Contralateral loss of pain and temperature below
Parkinson’s disease. the neck, nystagmus and paralysis of soft palate.
C Two persons A and B were told to draw a square
AIIMS MAY 2014
from the blank and filled circle, respectively. The
square drawn by A is irregular. Possible causes
C Characteristic features of multiple myeloma Lesion in cerebellum.
Increased Ig levels in serum, plasmacytosis and M C Drugs used in acute bacterial meningitis
spike on electrophoresis.
Ceftriaxone
C A 60 years old obese male patient with a history of
chronic smoking since childhood presents with
pelvic fracture due to fall from height. On 4th day of AIIMS NOVEMBER 2013
the ICU stay, he developed sudden tachypnea, fall
in SpO2 and hypotension. On 2D echo, there was a C A 55 years old diabetic patient presents with
dilation of right ventricle and tricuspid regurgitation. transient obscuration in vision for 2–3 days
Next immediate step followed by sudden loss of vision. Best test to
evaluate him
Systemic thrombolysis.
Serum creatinine levels.
C A 4 years old girl presents with severe vomiting
after a viral fever of 5 days. She is hospitalized and C A drug that can replace valproate as montherapy
develops cerebral edema. Liver biopsy is most likely being taken by a female patient of child bearing age
to show for juvenile myoclonic epilepsy
Marked microvesicular steatosis. Levetiracetam.
C A 40 years old obese female patient presents with C A patient on amphotericin B develops hypokalemia
fullness of right upper quadrant of abdomen. Past of 2.3 mEq/L, supplementation required
medical history shows type 2 DM and hyperlipi- 120–160 mEq/L over 24 hours.
demia. Liver biopsy suggestive of diagnosis C Investigation not done in patient with tubercular
Non-alcoholic steatohepatitis. meningitis on regular ATT for 1 month presenting
C A young female patient presents with jaundice and with altered sensorium
elevated liver enzymes with 2 similar episodes in CSF examination.
the past and on investigation, serum ANA 1:40, and C Recently approved drug by USFDA for treatment of
IgG 2400 IU, serum copper level normal and viral Lennox-Gestaut syndrome
marker negative. Based on liver biopsy report Rufinamide.
immunosuppressant was started and condition
C A patient with native aortic valve disease came with
improved. Most likely diagnosis
right hemiparesisdone.
Autoimmune hepatitis.
Done to prevent further stroke antiplatelet only
C Laxative abuse is associated with
C True about CML in children
Hypokalemia
Protein tyrosine kinase inhibitors are used in
C A 27 years old male patient presents with low
treatment.
backache, that occurs early in the morning, associa-
ted with stiffness, and persists for more than C Coarse tremors of tongue seen in
30 minutes. On examination, his chest expansion is Parkinsonism, alcohol and general paresis.
also restricted. The most likely diagnosis C A lady developed breathlessness, pruritus,
Ankylosing spondylitis. urticaria 1 hour after eating NSAIDS for headache.
138 AIIMS and All India PGMEE—Review Questions
Chest showed rales and BP 80/50 mm Hg. Used for C True about aspiration pneumonia
initial management Aspiration of 20–30 ml of contents with pH < 2.5 is
Early respiratory support and oxygenation, required, posterior segment of the right upper lobe
crystalloids infusion and adrenaline. is most commonly affected in the recombinant
C Which indicates renal impairment in contrast position and aspiration is responsible for 5–15% of
induced nephropathy community acquired pneumonia.
Increase in serum creatinine. C The most common type of Non-Hodgkin’s lym-
phoma in India is
C A 50 years old patient presented with progressive
jaundice. LFT showed total bilirubin—6.7%, direct Diffuse large B-cell lymphoma.
serum bilirubin—4.8%, alkaline phosphatase—550 C True about hemoptysis
IU, SGOT—50, SGPT—65. Most probable diagnosis Massive hemoptysis is bleeding > 600 ml in 24
Jaundice due to choledocholithiasis. hours, in 90% cases, bleeding is from bronchial
arteries and in an unstable patient, rigid broncho-
C A 60 years old male patient with alcoholic liver
scopy is done to identify the lesion.
disease presented to emergency with a history of
Acquired cause of pure red cell aplasia are
hemetemesis. True about his management
C
ABO incompatability in bone marrow transplanta-
Upper GI endoscopy is done initially, somatostatin
tion, lymphoma and drug induced NSAID.
infusion is indicated and negative nasogastric
Criteria for admission in upper GI bleed are
aspirate does not exclude variceal bleed.
C
Frank blood in nasogastric aspirate, BP > 100 mm Hg
C A 50 years old male patient came to the emergency
and shock index > 1.5%.
with right hemiparesis and loss of speech for 2.5
(Note: Shock index = HR/SBP, normal = 0.5 to 0.7)
hours. BP is 180/100. Next best step
C True about iron deficiency anemia
Go for NCCT.
Transferrin saturation < 16%, detected by serum
A 30 years old women from West Bengal presents
ferritin levels even in earlier states and latent
C
with fever for 48 hours with history of irrelevant
anemia is most prevalent in India.
talk and 2 episodes of tonic clonic seizures on
C Drugs given in patients of primary pulmonary
succession on the way to the hospital. Drug given
hypertension
while investigation is being carried out
Bosentan
IV acyclovir.
C A 50 years old lady on junk food diet presented with
(Note: Viral encephalitis due to HSV-Empirical point hemorrhages in scalp, bleeding in joints and
treatment) erythematous lesions in the skin, X-ray of knee joint
C A 14 years old boy presents with abnormal body was suggestive of hemarthrosis. Mechanism defec-
movements with MRI showing signal changes in tive
corpus striatum, thalami, pons, medulla, centrum Hydroxylation of proline and lysine.
semi-ovale and asymmetric diffuse white matter (Note: Vitamin C deficiency)
involvement. Most likely diagnosis
C True about severe malaria
Wilson’s disease. Hypoglycemia, blood sugar < 40 mg/dl, creatinine
C Glucocorticoid is used in more than 3 mg/dl and LDH > 750 U/L.
Severe typhoid. C Old age male patient, hypertensive, presents with
C True about critical illness myoneuropathy sudden onset headache, vomiting, neck rigidity,
Diaphragmatic atony due to prolonged intubation but no focal neurological deficit. Most likely
may cause it. diagnosis
C A patient developed sudden severe headache Sub-arachnoid hemorrhage.
2 hours ago and became unconscious. Upon regai-
ning conscious, patient developed photophobia AIIMS MAY 2013
and neck rigidity. Next done C Division of the chromosome perpendicular to the
NCCT scan. usual axis of division
(Note: Subarachnoid hemorrhage) Isochromosome
Medicine 139
C Cyanosis does not develop in severe anemia because C An asymptomatic boy on ECG is detected to have a
of short PR interval and delta waves. Effective
It requires a critical concentration of reduced measures would be
hemoglobin in blood. Reassurance, Holter monitoring and beta-blockers.
C True about ESR in tuberculosis (Note: WPW syndrome)
ESR values are increased due to formation of larger C A 8 years old boy complains of muscle weakness.
aggregates of RBCs. On examination, his calves are bulky and show
C Most likely probability of a 16 years old girl muscle tightening. His serum creatine kinase levels
presenting with abdominal pain, seizure and are decreasing with age. Most likely diagnosis
incoherent state Dystrophin deficiency
Acute intermittent porphyria. C A person presents with-pCO2: 30 mm Hg, pO2: 105
C Trans-esophageal echocardiography (TEE) is supe- mm Hg, pH: 7.45, he is having partially compensated
rior to trans-thoracic echocardiogram because of Respiratory alkalosis
It is more sensitive in picking up atheromatous C A boy presents with fever, vomiting and headache
plaques in ascending thoracic aorta. for last 3 days, disorientation for 1 day. Neck
C Left bundle branch block can develop suddenly in rigidity is also present. There is 1 episode of GTC
Acute MI, and hyperkalemia. and then he became unconscious. CECT is normal.
C A 55 years old male patient presents with renal CSF shows cell count: 300 cell/mm3 (polymorphs
failure, gives history of mild bone pain for last 7 50–70%), protein 70 mg/dl, sugar 50 mg/dl (blood
years, X-ray pelvis showing osteolytic lesions, M sugar 95 mg/dl). Most likely diagnosis
spike on serum electrophoresis, rouleax formation Pyogenic meningitis
of RBCs with 35% plasma cells on peripheral blood, C Characteristic features of Kluver-Bucy syndrome in
bone marrow showing increase in plasma cells with children
aberrant antigen expression. Most likely diagnosis Visual agnosia, hypermetamorphosis and hyper-
Plasma cell leukemia. sexuality.
C An elderly lady presents with acute onset of C A person is found to be seropositive for both HBsAg
confusion and bumping into things. On exami- and HBeAg. He is suffering from
nation, she is alert, oriented with fluent speech and Acute infection hepatitis B infection.
normal comprehension but impaired writing, right C Vasopressor preferred in a patient of aortic stenosis
left orientation, arithmetic abilities and finger Phenylephrine
identification. MRI shows several foci of cortical C Features helping in distinguishing seizures from
and subcortical increased T2 signals and various syncope
areas of leptomeningeal enhancement. The most Physical weakness with clear sensorium.
probable diagnosis C True about iron deficiency anemia
Gerstmann’s syndrome. Low serum ferritin (<15 mg/dl), elevated RDW
C Modality of treatment showing the best seizure free (>14.5%) and low serum iron levels (< 75 mg/ml).
interval in medically intractable seizures C Bilateral Babinski’s sign is characteristic of
Epilepsy surgery. Pontine hemorrhage.
C Drug effective as monotherapy as a replacement for C A 50 years old male patient presents with ptosis,
sodium valproate in a female patient of child difficulty in chewing and occasional difficulty in
bearing age group for treatment of juvenile swallowing but no history of diplopia or visual loss.
myoclonic epilepsy On examination, there is asymmetric ptosis and
Levetiracetam mild restriction of extraocular muscle movement
C True about treatment of CLL with finger abduction test 60°. Nerve conduction
Can be withheld in asymptomatic patients. study shows decremental response in orbicularis
C The mutation seen in most common type of only. ERG revealed a myopathic pattern. Anti-
maturity onset diabetes of young AChR radioimmunoassay was negative. The most
Hepatocyte nuclear factor 1. probable diagnosis
(Note: MODY-Type 3) Generalized myasthenia gravis.
140 AIIMS and All India PGMEE—Review Questions
C With ageing, a slight decrease in cognitive impair- Burning sensation in hands, plantar extensor and
ment is seen due to increase in level of absent biceps reflex.
Homocysteine C A patient of tubercular meningitis on regular ATT
C True about Grisel syndrome for last 1 month developed deterioration in
Post-adenoidectomy, conservative treatment and sensorium. Investigations required for emergency
inflammation of cervical spine ligaments. evaluation
C Pinna calcification is seen in MRI, NCCT and liver function test.
Ochronosis, frost bite and Addison’s disease. C A 60 years old retired army officer, with good
C In a patient with implanted cardiac pacemaker health, physically quite active and no addictions
(defibrillator) investigation to know the position of presents with complaints of bitemporal throbbing
the misplaced implant headache, worsening on lying flat with feverish but
X-ray never documented and suppressed appetite. He
Medicine 141
feels better on sitting upright and on pressing side C Correctly matched-Neurofibromatosis- renal artery
of his neck. stenosis, Marfan’s disease-dural ectasia and
Giant cell arteritis Mulibrey nanism- constrictive pericarditis.
(Note: GCA can present as PUO) C The most common form of spinocerebellar ataxia
(SCA) in India is
AIIMS MAY 2012 SCA2
C Type of wave in metabolic encephalopathy
C Corticospinal injury is associated with Delta
Babinski’s sign present, superficial abdominal C In 2 patients with atherosclerosis, one is diabetic
reflex absent and clasp knife rigidity. and other is non-diabetic. In relation to non-
C In porphyrias, enzyme defect not leading to diabetic, diabetic patient has 100 times increased
photosensitivity risk of
HMB synthase Lower limb ischemia
C A 50 years old male patient presents in the C In pneumonia severity scale, most important factor is
emergency with unilateral headache, diplopia and Age
difficulty in chewing food with MRI normal and
(Note: CURB-65. Confusion blood urea nitrogen,
ESR persistently high. The most appropriate drug
respiratory rate > 30/min, BP < 90/60 and age > 65
for treatment
yrs)
Prednisolone
C Pseudotumor cerebri is seen in
A 20 years old male patient presents with jaundice
Obese women in the age group 20–40 years
C
for 2 weeks, LFT showing serum bilirubin 0.9 mg/
C Most prominent feature among the following in
dl, SGOT/SGPT-1240/1450 IU, HBsAg and anti-
immunoproliferative small intestinal disease
HEV antibodies positive and IgM anti-HBc negative.
(IPSID)
Most likely, it is a case of
Abdominal pain
Superinfection of hepatitis E virus with chronic
hepatitis B infection. C A 25 years old patient with history of repeated
episodes of rheumatic fever is hypersensitive to
C A patient with previously normal Hb suffered a
penicillin. Drug prescribed
sudden massive acute hemorrhage. He is most likey
to show Sulfisoxazole
High reticulocyte count and high neutrophil count. C A person with following parameters pCO2—30 mm
C Thrombolytic therapy is given in a patient of Hg, pO2—105 mm Hg, pH—7.45 is having partially
myocardial infarction within compensated
24 hours of chest pain Respiratory alkalosis
C True regarding small vessel disease (SVD), cerebral C Post-transplant lymphoma is most associated with
amyloid angiography (CAA) and Alzheimer’s EBV
disease (AD) C Which most significantly increases the risk of
SVD is related to CAA, CAA is associated with AD hepatocellular carcinoma
and SVD is not correlated to AD. Hep B
C A 40 years old lady presented with dyspnea on C A 65 years old suddenly fell in the toilet, BP 90/50
exertion grade 3 and palpitations, ECG- atrial mm Hg, pulse 100/min, stool dark/black in color,
fibrillation with fast ventricular rate, echocardio- past history of hypertension and coronary artery
graphy-severe mitral stenosis with left atrial disease and was regularly taking aspirin, atenolol
appendage clot. She is advised and sorbitrate. The most likely diagnosis is
Diltiazem to control ventricular rate, start warfarin Gastric ulcer with bleeding.
and follow-up with repeat echocardiography and C A study of skin biopsy of SLE patient using FITC
open mitral commissurotomy with clot removal. labeled human IgG antiserum shows deposition of
C Most common clinical presentation of juvenile irregular particles at dermoepidermal junction. It
myoclonic epilepsy shows the presence of
Myoclonus Immune complex deposits.
142 AIIMS and All India PGMEE—Review Questions
C Associated with an intrinsic defect in the RBC C A 25 years old female patient presented with
membrane history of recurrent abortions. The most relevant
Hereditary spherocytosis. investigation to identify the cause
C Fever blisters can occur due to Dilute Russel viper venom test.
Reactivation of HSV 1
C A 40 years old female patient presents with AIIMS NOVEMBER 2011
intolerance to cold, constipation and hoarseness of C Diagnostic criteria for primary hyperaldosteronism
voice with cardiomegaly on chest X-ray. Best
Diastolic hypertension without edema, low plasma
investigation to determine the cause of her
renin activity that is not stimulated by volume
cardiomegaly
depletion and hyperaldosteronism, i.e. increased
Echocardiography aldosterone secretion which is not suppressed by
C An elderly male patient presented with headache, volume expansion.
fever and hemiparesis of right side. On further C Drug of choice for prenatal treatment of CAH due
investigation and examination, a diagnosis of brain to 21 α hydroxylase deficiency
abscess was made. Antibacterial agent effective in Dexamethasone
this condition
C Limb girdle muscle dystrophy includes
A combination of cephalosporin and metronidazole.
Calpainopathy, dysferinopathy and sarcoglycano-
C A 45 years old lady is diagnosed with pneumococcal pathy.
meningitis, blood sample sent for culture and C Exclusively involving neurons
sensitivity. Best drug to start empirically
Corticobasilar degeneration.
Vancomycin + ceftriaxone.
C Physical examination finding in a young male
C Most likely to be affected in an aneurysm of patient presenting with LDL 600 mg/dl and
posterior cerebral artery triglycerides 140 mg/dl
Oculomotor nerve Tendon xenthoma
C An adult hypertensive male patient presents with C True about universal definition of Myocardial
sudden onset severe headache and vomiting, on infarction
examination-marked neck rigidity but no focal Sudden death is MI, new regional wall motion with
neurological deficit. Most probable diagnosis increased biochemical marker is MI and reinfarc-
Subarachnoid hemorrhage tion can be diagnosed if elevation in troponin level
C An elderly female patient presents to the emer- by 20% on serial sampling.
gency and was found to have a transmural C Systemic eosinophiluria with renal failure is
myocardial infarction. Based on her ECG, she was associated with
started on thrombolytic therapy with strepto- Drug induced interstitial nephritis, contrast
kinase. Finding that is risky and for which nephropathy and atheroembolic renal failure.
thrombolysis should be stopped C True statements are
Significant pericardial effusion on echocardiogra- PTH-rP is responsible for hypercalcemia in cancer
phy. patients, Mg2+ influences PTH secretion in the same
C A 60 years old lady presents with decreased direction as Ca2+ but is a less potent secretagogue
movement for 2 years with rigidity and vertical and Ca 2+ ion influences PTH secretion by acting
large square wave jerks. Probable diagnosis is on a calcium sensor G protein coupled receptor
Progressive supranuclear palsy. located in the parathyroid gland.
C True for hepatitis B C Diagnosis of 60 years old male patient of RA with
Age of onset determines prognosis, period of Hb 4.5 gm/dl, platelet count 2 lac/mm3 WBC 6000/
communicability lasts several months and virus can mm3, serum ferritin 250 μg/dl, serum iron 30 mg/
be found in blood 1 month before jaundice. dl, TIBC 270 ng/L
C A boy is suffering from acute pyelonephritis. Most Anaemia of chronic disease.
specific urinary finding (Note: Normal value-serum iron- 50–150 μg/dl,
WBC casts serum ferritin– 50–150 ng/ml, TIBC-300 μg/dl)
Medicine 143
C Investigation needed to find out the cause in a with history of fall while partying with friends.
woman with complaints of abdominal pain and Additional problems he is facing
CECT finding of B/L papillary necrosis are Paralysis during sleep wake transition with
Culture for bacteria, sickling test and urine hallucinations.
acidification. (Note: Narcolepsy)
C Diabetes is diagnosed when
The level of fasting glucose is > 125 mg/dl and that AIIMS MAY 2011
of post-prandial is > 199 mg/dl.
C Reperfusion is useful for
Features seen in myopathies are
Hibernating myocardium
C
Facial sensory impairment, brisk pectoral jerk and (Note: Also known as reversible ischaemia or
urgency and incontinency of micturition. chronic stable angina)
C Diagnosis of 18 years old girl presenting with short C True about atherosclerosis
height, enlarged pituitary gland, low T4 and
Intake of PUFA is associated with decreased risk.
increased TSH
C Most rapid way to decrease serum K+ level in a girl
Primary hypothyroidism. presenting with severe hyperkalemia and peaked T
C Most common cause of Addison’s disease in India waves on ECG
Tuberculous adrenalitis. Insulin + glucose.
C True about Alzheimer’s disease C A 10 years old female patient presents with difficulty
Number of senile plaques correlate with age, in combing hairs and climbing upstairs for 6
underlying tau protein suggest neurodegeneration months, Gower’s sign positive and maculopapular
and number of neurofibrillary tangles is associated rash over MCP joints. Next appropriate investigation
with the severity of dementia. Creatine kinase
C An aortic stenosis patient could perform exercise C A 14 years female patient on exposure to cold
for 10 minutes (stopped due to fatigue) in Bruce develops pallor of extremities followed by pain and
protocol with peak systolic gradient of 60 mm Hg cyanosis. She is prone to develop
across the aortic valve at rest. The best management Scleroderma
is C Defect in Berry’s aneurysm
Medical management Degeneration/defect of media/muscle cell layer.
C Clinical features of demyelinating myelopathy C Pulsatile liver and ascites is found in
suggesting progression to multiple sclerosis TR (Hepatomegaly with liver pulsation, All India
Bilateral visual loss, complete cord transaction and 2009).
poor prognosis. C Positive hepatojugular reflux is found in
C A 30 years old, 4 months pregnant primigravida Increased capillary bed pressure, RHF and TR and
with history of juvenile myoclonic epilepsy is on PS (A/09).
sodium valproate regularly. Opinion C Thrombotic event is seen in
Continue valproate with monitoring of drug level. DIC, HIT (Heparin induced thrombocytopenia)
C Best drug to manage a 70 years old patient presen- and PNH.
ting with new onset focal seizures with normal C True about Horner’s syndrome
renal function Anhydrosis, hyperchromatic iris and miosis.
Oxcarbazapine C Congenital myopathies are
C True about SIADH Central core myopathy, centronuclear myopathy
Vaptans are approved by FDA for its treatment, and Nemalin myopathy.
water loading test can be used for its diagnosis and C Cause of alpha-thalassemia
serum sodium may be as low as 125 mEq/L in these Deletion of alpha gene.
patients. C A patient develops sudden palpitation with heart
C An adult man complains of falling asleep at work rate 150/min, regular cause is
frequently attributing to disturbed sleep at night, PSVT
144 AIIMS and All India PGMEE—Review Questions
Dose gradually increased over weeks, special C Likely cause of young man back from leisure trip
precaution taken in case of NYHA class III and IV has swollen knee joints and foreign body sensation
and carvedilol and metoprolol are preferred drugs. in eyes
C A 35 years old lady presents with normal PT and Reiter’s syndrome
increased aPTT. 2 years back, she was operated C Cause of vasodilatation in spider nevi
for cholecystectomy and did not have any Estrogen
bleading episode. Next investigation for clinical C A patient presented with arthritis and purpura, lab
diagnosis examination showing monoclonal and polyclonal
Antiviper venom assay cryoglobulins. Histopathology shows deposits of
(Hint: APLA) cryoglobulins around the vessels. Patient should be
C Bad prognosis in AML is indicated by tested for
Monosomy 7 HCV
C Cause of nephrocalcinosis in granulomatous C Hepatomegaly is the essential feature of
disease Niemann Pick disease, von Gierke’s disease and
Increased conversion to 1,25 OH. Hurler syndrome.
C True for hepatitis B C Rapid infusion of insulin causes
Age of onset determines prognosis, period of Hypokalemia
communicability lasts several months and virus can C Digitalis toxicity enhanced by
be found in blood 1 month before jaundice. Renal failure, hypercalcemia and hypomagnesemia.
C A 20 years lady complains of headache while C True about hemochromatosis
studying with normal vision. Further evaluation Is genetically heterogenous
Family history of headache, menstrual history and C Strawberry gingivitis seen in
her interest in studies. Wegener’s granulomatosis.
C A child presenting with recurrent episodes of lip
AIIMS MAY 2010 and laryngeal edema and abdominal pain
C Radiological features of left ventricular heart failure associated with stress. Level reduced
are C1 esterase inhibitor.
Kerley B lines, cardiomegaly and increased flow in C Best test for intestinal malabsorption
upper lobe veins. D-xylose test.
C Most common childhood CNS tumor to metastasize C True about temporal arteritis
extraneuronally Can lead to sudden bilateral blindness, more
Medulloblastoma common in females and mostly affects elderly.
C Chang staging is used for C True about a patient presenting with acute
Medulloblastoma rheumatic carditis with fever
C Hypersensitivity vasculitis affects Valve replacement will ameliorate CCF.
Post-capillary venules C Cardiovascular complications of HIV infection
C Hyperextensibility of joint with normal elastic includes
recoil of skin is a feature of Pericardial effusion, cardiac tamponade and
Ehlers Danlos syndrome cardiomypathy.
C True statement about atherosclerosis is
Intake of PUFA is associated with decreased risk. AIIMS NOVEMBER 2009
C A girl presenting with severe hyperkalemia and
peaked T waves on ECG. Fastest way of shifting C Dissociated sensory loss in a case of tumor of central
potassium intracullarly spinal cord is due to lesion of
Insulin + glucose Decussating fibers of lateral spinothalamic tract.
C Features of hypocalcemia are C Rat tissue used in immunofluorescene method to
Numbness and tingling, circumoral paresthesias detect antinuclear antibody
and skin irritability and sensitivity. Liver > kidney
146 AIIMS and All India PGMEE—Review Questions
cortical hyperplasia, pituitary adenoma, islet cell C Associated with pituitary apoplexy
tumor with cutaneous angiofibroma. Diagnosis is DM, HTN and sickle cell anemia.
MENI C HUS is associated with
C Senile cardiac amyloidosis is due to deposition of EHEC, Shigella and Campylobacter.
Transthyretin C Infective endocarditis due to Pseudomonas is most
C Fractional excretion of Na+ < 1 is seen in commonly seen with
Pre-renal azotemia Intravenous drug abuse of pentazocin.
C Features of SIADH C Causes of raised JVP with hypotension are
Decreased sodium, maintaining the concentrating Cardiac tamponade, RV MI and heart failure.
ability of urine osmolality>100 mosm, normal C Water hammer pulse seen in
sodium balance maintained indicating excess AR
urinary sodium is due to efficient sodium intake C Useful to decrease mortality and renal failure in
and hypouricemia. acute liver disease due to alcoholism
C Metabolic alkalosis is seen in Pentoxyfylline
Primary mineralocorticoid excess. C In primary pulmonary HTN basic abnormality in
C Micronodular cirrhosis is seen in gene lies in
Alcoholic liver disease, hemochromatosis and Bone morphogenetic protein receptor-II.
chronic extrahepatic biliary obstruction. C Life threatening complications of DM are
C Seen in chronic active hepatitis B Malignant otitis externa, rhinocerebral mucormy-
Total core antibody, HBsAg, HBeAg. cosis and emphysematous pyelonephritis.
C Marker of acute hepatitis B infection C Digital clubbing is seen in
DNA polymerase Endocarditis, pulmonary arteriovenous fistula and
C Window period in HIV tricuspid atresia.
Period between onset of infection and clinically C Best method to monitor intracranial pressure is
detectable level of antibodies. Intraventricular catheter
C Cryoprecipitate does not contain C Most common site of histiocytosis
Factor IX Bone
C Absence of corpus callosum leads to C Atkin’s diet is
No neurological manifestations. Carbohydrate restricted low calorie diet.
C Most common site of subependymal astrocytoma C In uremic patient nail and half nail sign seen in
(giant cell) Increased capillary density at the distal half of nails.
Foramen of Munro C Earliest phenotypic manifestation of idiopathic
C von Hippel Lindau is associated with hereditary hemochromatosis is
Endolymphatic sac tumors, pheochromocytoma Increased transferrin saturation.
and islet cell tumors. C Reticulocytosis is seen in
C NFI is most commonly associated with PNH, hemolysis and dyserythropoietic syndrome.
Optic pathway glioma C Dietary intervention reducing further risk in MI
patients
AIIMS MAY 2007 n3PUFA
C Arsenic is used in treatment of C Addisons’s disease is associated with
Acute promyelocytic leukemia. Cardiac atrophy, decreased diastolic BP and serum
C Plasmapheresis (plasma exchange therapy) is used cortisol < 8.
in treatment of C Associated with MEN II
TTP Pheochromocytoma, MTC and parathyroid
C Most common catheter induced blood infection is adenoma.
due to C Increased anion gap metabolic acidosic is seen in
Coagulase negative staphylococci. Starvation, salicylate poisoning and lactic acidssis.
150 AIIMS and All India PGMEE—Review Questions
creatinine–0.5 mg/dl, serum albumin–1.5 g/dl, C A child presents with ambiguous genitalia without
serum total calcium–7.5 mg/dl and urine albumin– hyperpigmentation, and normal BP, 2.5 cm phallus
2 g. Most likely cause of symptoms in this patient with no opening at tip , labia developed. Gonads are
Tacrolimus toxicity. not seen in inguinal region and Mullerian structures
C The least common presentation of multiple myeloma are present on USG. Diagnosis
is Maternal virilizing tumor.
Hyperviscosity C Neurofibrillary tangles are seen in case of
C True about fibromyalgia Alzheimer’s disease. Areas of brain resistant to
Associated with EEG abnormalities, increased neurofibrillary tangle formation
cortisol and decreased blood flow to brain. Lateral geniculate nucleus.
C The treatment of acute pulmonary edema includes C The most preferred area of deep brain stimulation
Frusemide, morphine and positive ventilation. in a patient with Parkinson’s disease with intractable
C RTA type 1 tremors
Hypokalemia, nephrocalcinosis and cannot acidify Subthalamic nuclei.
urine to pH < 5.5. C Small fiber neuropathy is seen in
C Most sensitive and specific tests for diagnosis of HIV, Hansen’s and amyloidosis
myocardial infarction in an athelete presenting C Episodic muscle weakness can be caused by
with chest pain are Channel opathies, Lambert Eaton myasthenic
Troponin I and T. syndrome and hyperphosphatemia
C Example of small vessel vasculitis C The triad of strabismus, diplopia and ptosis due to
Microscopic polyangitis damage of
C A young girl is admitted with joint pains and butterfly Oculomotor nerve.
rash and positive urine proteinuria. Test for diagnosis C Sign of brain stem death
Anti-ds-DNA antibody. Fixed non-reactive pupil.
C Diseases that may progress to lymphoma C A patient presents with ataxia, ankle and knee jerk
S j̈ogren syndrome, ataxia telengiectasia and lynch absent and plantar extensor. Diagnosis
2 syndrome.
Friedreich’s ataxia
C True about angioneurotic edema
C A 14 years female patient presents with quadriparesis,
It is due to C1 esterase inhibitor deficiency, occurs facial palsy, winging of scapula and ptosis and
in extremes of temperature and it is due to ACE history of similar but less severe illness in father and
inhibitors. brother, CPK level raised (500 IU/L). Diagnosis
Secondary hemochromatosis occurs in
Scapulofacia humeral dystrophy.
C
β thalassemia, repeated blood transfusions and
C Conduction velocity of nerve affected in
sideroblastic anemia.
Leprosy, hereditary neuropathy and AIDP.
C The occurrence of hyperthyroidism following
administration of supplemental iodine to subjects in C Prader Willi syndrome is associated with
endemic multinodular goitre Ghrelin
Jod Basedow effect. C Age related deterioration of cognitive function is
C True about central hypothyroidism due to increase in
Most common cause is craniopharyngioma, before Homocysteine
starting treatment, checkout for adrenal insufficiency C A patient presents with subarachnoid hemorrhage,
and TSH is not a good marker for diagnosis. NCCT- blood in 4th ventricle. The blood is most
C The third generation TSH detection tests can detect likely to occur from an aneurysm of
TSH at a minimum level of PICA
0.01–0.02 C True about von Hippel Lindau syndrome
C Culture CSF showing Pneumococcus is most likely Hemangiopericytomas are seen in the craniospinal
to show axis, supratentorial lesions are common and tumors
Pleocytosis, high protein and reduced sugar. of Schwann cells are common.
152 AIIMS and All India PGMEE—Review Questions
C True about anterior choroidal artery syndrome C Streptokinase and urokinase are contraindicated in
Hemiparesis, hemisensory loss, and homonymous Intracranial malignancy
hemianopia. C A young male patient presents with pH–7.5, pCO2–
C Sites involved in posterior cerebral artery infarct 30 mm Hg, pO2–102 mm Hg, and HCO3–16 mEq/L.
Midbrain, thalamus and temporal lobe. Compensatory mechanism
C True about delirium tremens are Metabolic acidosis
Visual hallucinations, tremor and clouding of C A 29 years lady with history of progressive
consciousness. breathlessness and exercise intolerance for four
C A 60 years old man with progressive dementia of months, FVC 90%, FEV/FVC 86%. Oxygen
recent onset presenting with intermittent irregular saturation dropped from 92% to 86%. Diagnosis
jerky movements with EEG showing periodic sharp Primary pulmonary hypertension.
biphasic wave. Diagnosis is C A truck driver presented with history of fever for 4
Creutzfeld Jakob disease weeks and dry cough. He also gives history of
C A 30 years old woman presenting with proximal weight loss of about 10 kg with X-ray showing
weakness of muscle, ptosis and easy fatigubility. bilateral reticulonodular infiltrates. Diagnosis
The most sensitive test for diagnosis is Pneumocystis carinii pneumonia.
Single fibre EMG > Edrophonium test. C Cavitary lesions in lung are seen in
C NARP syndrome is a type of Staphylococcal pneumonia.
Mitochondrial function disorder C True about lung carcinoma
Oat cell variant is typically associated with hilar
adenopathy.
ALL INDIA 2010
C Pre-renal azotemia is characterized by
C A 16 years old girl presents with history of fatigua- Fractional excretion of Na+ <1%, urinary osmolality
bility, weakness and lethargy, CBC-Hb–7.0 gm% > 500 mOsm/kg and reversible with replacement
MCV 70, MCH 20 pg/cell and RDW–20. Diagnosis fluids.
Iron deficiency anemia C Plasma urea creatinine ratio of 20:1 may be seen in -
C Major criteria for diagnosis of polycythemia vera Pre-renal failure.
JAK-2 mutations C A woman presents with non-progressive dysphagia
C True about Fanconi’s anemia only for solids. Barium study showing proximal
Congenital anomalies, hypercellular bone marrow esophageal dilatation with distal constriction.
and usually normocytic/macrocytic cell morphology. Diagnosis is
C Investigation done immediately to best confirm a Lower esophageal ring.
non-matched blood transfusion reaction C A young girl presents with abdominal pain and
Direct Coombs’ test recent change in bowel habit, with passage of
C Bence Jones proteinuria may be seen in mucous in stool. There is no associated blood in
μ heavy chain disease. stool and symptoms are increased with stress.
C Bence Jones proteins are derived from Diagnosis
Gamma globulins Irritable bowel syndrome.
C True about third heart sound (S3) C Investigation of choice for an elderly patient
Seen in constrictive pericaraditis, ASD and VSD presenting with a prolonged history of weakness
C A 20 years lady asymptomatic on routine examination and lethargy, on examination-anaemic and stool
is observed to have midsystolic click. Valves may show positive for occult blood
Myxomatous degeneration. (Mn: M for M) Colonoscopy
C Beck’s triad is seen in C A patient presents with positive HBsAg on routine
Cardiac tamponade testing. Other serological test negative. Clinically
C Accelerated idioventricular rhythm (AIVR) is most asymptomatic and liver enzymes within normal
common arrhythmia associated with range. Diagnosis
Myocardial reperfusion Inactive HBV carrier
154 AIIMS and All India PGMEE—Review Questions
C A male patient is observed to have HBsAg +ve, C Associated with hypergonadotrophic hypogonodism
HBeAg-ve, anti-HBeAg antibody +ve. HBV DNA in males
copies 100,000/ml and AST and ALT elevated to 5 Klinefelters’s syndrome, Noonan syndrome and
times upper limit of normal value. Diagnosis viral orchitis.
HBV precore mutant C Associated with peripheral artery disease, coronary
C A patient presents with unconjugated hyperbiliru- heart disease and stroke
binemia and elevated urobilinogen levels in urine. Insulin deficiency
Diagnosis C True about hyponatremia
Hemolytic jaundice Hyponatremia associated with hyperglycemia has
C A patient presents with unconjugated hyperbiliru- high plasma osmolality, hyponatremia associated
binemia and presence of urobilinogen in urine. with SIADH is normovolemic and NSAIDS increase
Least likely diagnosis the potency of vasopressin.
Dubin Johnson syndrome (Mn: UGC-unconjugated C Diagnosis of a patient presenting with dementia,
in Gilbert and Criggler-Najjar syndrome) urinary incontinence and ataxia
C True about Wilson’s disease Normal pressure hydrocephalus.
Low serum ceruloplasmin and high urinary copper. (Note: DUA)
C Gout is a disorder of C Diagnosis of a patient known to have mitral
Purine metabolism stenosis, atrial fibrillation, presents with acute onset
C True about primary gouty arthritis of weakness in left upper limb recovering completely
Uric acid levels may be normal at the time of an in two weeks
acute attack, male > female and definitive diagnosis Ischemic stroke
requires aspiration of synovial fluid. C A 25 years old patient presents with acute onset of
C APLA syndrome is associated with fever and focal seizures. MRI scan showing
Thrombotic disorders, coagulation disorders and hyperintensity in temporal lobe and frontal lobe
recurrent fetal loss. with enhancement. Diagnosis
C True about APLA Herpes simplex encephalitis.
Commonly presents with recurrent fetal loss, may C Brain damage in head injury patient aggrivated by
cause pulmonary hypertension and warfarin given Hyperglycemia, hypercapnia.
as treatment. C Site of lesion in motor neuron disease
C Treatment recommended in a women with APLA Anterior horn cells.
and history of prior abortion/stillbirth C True about GB syndrome
Aspirin + LMW heparin. Ascending paralysis, flaccid paralysis and albumino-
C Associated with thymoma cytological dissociation.
Myasthenia gravis, hypogammaglobulinemia and C Kayser-Fleishner rings (KF rings) are seen in
Cushing’s syndrome. Wilson’s disease
C Plasmapharesis is used in
Myasthenic crisis, GB syndrome and polymyositis. ALL INDIA 2009
C Low calcium and high phosphate is seen in
Hypoparathyroidism C A 20 years female patient asymptomatic, MCV–70,
C True about pseudohypoparathyroidism Ferritin–100 g/L, Hb–10 gm%. Diagnosis
Low serum calcium, high serum phosphate and Thalassemia trait
Albright hereditary osteodystrophy. C Associated with PNH
C A patient presents with symptoms of hypogly- Cerebral thrombosis, Budd-Chiari syndrome and
cemia. Investigation reveals decreased blood pancytopenia.
glucose and increased insulin levels. C-peptide C A 7 years female child presents with repeated
assay is done showing normal levels of C-peptide. episodes of bleeding into joints, APTT prolonged,
Most likely diagnosis PT normal. Diagnosis
Accidental exogenous insulin administration. von Willebrand disease
Medicine 155
C True about coagulation factor VII C Test for mucosal function of GIT
AR, deficiency treated by FFP, and shorter half life D-Xylose test
as compared to Hageman factor (XII). C Non-invasive diarrhea caused by
C True about lupus anticoagulant Bacillus cereus
May present with isolated prolongation of APTT, C Features of secretory diarrhea includes
may present with recurrent abortions and may Stool volume > 1L/day, normal osmotic anion gap
occur with minimal clinical manifestation. and painless.
C Acquired causes of hypercoagulability includes C True about cystic fibrosis
IBD, myeloproliferative disorders and prolonged AR, predisposition to pulmonary infection with
surgery> 1 hour. Pseudomonas and cirrhosis is an established
C Causes of deep vein thrombosis complication of CF.
OCP, PNH and prolonged surgery. C Hepatomegaly is a feature of
C Investigation to clinch the diagnosis in older man von Gierke’s disease, Hurler’s disease and Niemann-
presents with headache, recurrent infections, Pick’s disease.
multiple punched out lytic lesions of X-ray skull C Increased aldosterone leads to
Protein electrophoresis
Hypernatremia, hypokalemia and hypertension.
International prognostic index for lymphoma
A 30 years old male known diabetic patient on oral
C
C
includes
hypoglycemic drugs for last few years has lost
Stage of disease, number of extra-lymphatic sites weight and never had DKA. His grandfather is
involved and LDH. diabetic but his father is non-diabetic. Diagnosis
C wave in JVP is due to
Type II DM (Note: If both father and grand father
C
Bulging of tricuspid valve into the right atrium. diabetic, diagnosis-MODY).
C Features of right sided heart failure
C Change occurring in a patient with severe hyper-
Pulsatile liver, increased JVP and positive hepato-
glycemia given IV insulin
jugular reflux.
Hypokalemia
C Systolic thrill in left 2nd and 3rd intercostal space
may be seen in C Most likely cause of bilateral superior temporal
quadrantopia and galactorrhea in a women
Subpulmonic VSD, PS and Ebstein anomaly.
C Best predictor for risk of cardiovascular events in Pituitary macroadenoma
future C Hypercalcemia is associated with
CRP Hyperparathyroidism, sarcoidosis and milk alkali
C Cardiovascular complications of HIV infection syndrome.
includes C Endocranial causes of carpal-tunnel syndrome
Pericardial effusion, cardiac tamponade and cardio- includes
myopathy. DM, hypothyroidism and acromegaly.
C Seen in idiopathic pulmonary hemosiderosis C Hirsutism is caused by
Iron deficiency anemia, diffuse alveolar hemorrhage Cushing’s syndrome, hyperprolactinemia and
and hemoptysis. acromegaly.
C A male patient presents with swelling of face and C True about temporal arteritis
lips, respiratory distress, intense pruritus, hypoten- More common in females seen in elderly women
sion and feeling of impending doom. Diagnosis and can lead to sudden bilateral blindness.
Anaphylaxis C Recurrent bilateral hypopyon formation associated
C True about small cell carcinoma with thrombophlebitis is consistent with
Chemosensitive tumor. Behçet’s syndrome
C Restless leg syndrome is seen in C False positive rheumatoid factor associated with
CRF HbsAg, VDRL and Coombs’ test
C Positive urinary anion gap helps establish diagnosis of C True about hemochromatosis
Renal tubular acidosis AR
156 AIIMS and All India PGMEE—Review Questions
C A patient presents with acute anterior wall C C-ANCA indicates antibody formed against
infarction and hypotension. Immediate treatment Proteinase 3
modality for this patient (Note: P-ANCA-antibody against M protein)
Angiography and primary angioplasty. C Deposition of Anti-ds DNA Ab in kidney, skin,
C A 70 years male patient develops pneumonia choroid plexus and joints is seen in
and septicemia. Patient goes into renal failure and SLE
has BP of 70/50 mm Hg. Drug used to maintain BP C Best marker for drug induced lupus
is Anti-histone ab
Norepinephrine C True about Raynaud’s disease
C A patient presents with decreased vital capacity Positive antinuclear antibodies (ANA)
and decreased total lung capacity. Most likely C Components of Kawasaki disease
diagnosis
Pedal edema, truncal rash and pharyngeal conges-
Sarcoidosis tion.
C Drugs commonly used in regimens against H. pylori C Increased ICT is associated with
Amoxicillin, bismuth subciatrate and omeprazole. Abducens paralysis, headache and visual blurring.
C A patient with H. pylori infection is treated with C Pontine stroke is associated with
drug. The best method to detect presence of
Bilateral pinpoint pupil, pyrexia and quadriparesis.
residual H. pylori infection in this person is
C True about Benedikt’s syndrome
Urea breath test
Contralateral tremor, 3rd nerve palsy and
C A patient presents with chronic small bowel
involvement of penetrating branch of basilar
diarrhea, duodenal biopsy showing villous
artery.
atrophy. Antiendomysial ab and IgA TTG ab are
Components of Brown-Sequards syndrome
also positive. Treatment of choice
C
Ipsilateral extensor plantar response, ipsilateral
Gluten free diet
pyramidal tract involvement and contralateral
C The test used to diagnose Dubin Johnson syndrome
spinothalamic tract involvement.
is
(Note: Spinothalamic tract crosses more or less at
Bromosulphalein test (BSP) (Mn: DJ in BSP)
the point of entry it self. Dorsal column is also
C Most common cause of nephrotic range proteinuria ascending tract and cross over in medulla.
in an adult is Corticospinal tract/pyramidal tract is descending
DM tract and crosses at medulla and its injury at spinal
C A 30 years male patient presents with generalized cord is ipsilateral)
edema and hypertension. Urine examination shows C Classical CSF finding seen in TBM
subnephrotic proteinuria (<2gm) and microscopic Increased protein, decreased sugar and increased
hematuria. Serum complement levels are decreased lymphocytes.
and he is positive for ANCA. Diagnosis
C Organs involved in leprosy
MPGN > mixed cryoglobulinemia (elderly female Eye, testes and ovary
with skin ulceration favors essential mixed
C Treatment of severe ulnar neuritis in borderline
cryoglobulinemia)
tuberculoid leprosy
Endocrine tumor most commonly seen in MEN I
MDT + steroid
C
Pancreatic polypeptide noma > Gastrinoma
C Treatment of choice for Zollinger-Ellison syndrome
is ALL INDIA 2006
PPI C Megaloblastic anemia due to folic acid deficiency is
C SIADH is associated with commonly due to
Vincristine Inadequate dietary intake
C Hypophosphatemia is seen in C Myelodysplastic syndromes are most common in
Resolving phase of DKA, chronic alcoholism and age group
COPD/respiratory alkalosis. > 50 years of age.
Medicine 159
C A 60 years old lady presenting with backache and C Mycotic abscesses occur due to
recurrent chest infections for last 6 months, Fungal infection.
developing urinary retention and sudden weakness C Smoking is a risk factor for
of legs and Hb–7.3 gm/dl, serum Ca–12.6 mg/dl, Small cell carcinoma, emphysema and respiratory
phosphate–2.5 mg/dl, alkaline phosphatase–95 bronchiolitis.
mcg/L, serum albumin–3.2 mg/dl, serum globulin– C Common features of anorexia nervosa
7.0 gm/dl and urea–180 mg/dl. Diagnosis
Amenorrhoea, self perception of being fat and
Multiple myeloma underweight.
C Major criteria for multiple myeloma C Most common presenting symptom of non-
Plasmacytoma on tissue biopsy, bone marrow cirrhotic portal HTN
plasmacytosis > 30% and M spike > 3 g% for IgG, > Upper GI bleeding
2 g% for IgA.
C Pre-malignant colonic polyps are
B-cell prolymphocytic leukemia patient have a
Villous adenoma, tubular adenoma and hamar-
C
difference from those with B-cell CLL in
tomatous polyps associated with Peutz-Jeghers
Have a shorter survival syndrome.
C True about primary effusion lymphoma C Drug induced lupus
It generally presents in elderly patients, patients are Anti-histone antibodies
commonly HIV positive and there is often an
C Anticentromere antibodies are most commonly
association with HHV-8.
associated with
C A patient with leukemia on chemotherapy develops
CREST syndrome
acute right lower abdominal pain associated with
ASCA is a surrogate marker of
anemia, thrombocytopenia and leukopenia.
C
C Young girl having consumed barium carbonate C A 32 years male patient presenting with complaints
with suicidal intent complains of generalized of weakness in right upper and both lower limbs of
muscle weakness. Electrolyte disturbance that may last 4 months, developing digital infracts involving
occur 2nd and 3rd fingers on right side and 5th finger on
Hypokalemia left side, on examination—BP—160/140 mm Hg,
peripheral pulses palbable, asymmetrical neuro-
pathy, Hb—12 gm/dl, TLC—11500/cmm, platelet—
ALL INDIA 2005
9,30,000, ESR—49 mm, urine- proteinuria, RBC—
C Splenectomy is indicated in 10–15/hpf, no casts most likely diagnosis is
Hereditary spherocytosis, thalassemia and sickle Polyarteritis nodosa
cell disease with large spleen. C Conditions causing osteoporosis
C Causes of relative polycythemia are Hyperparathyroidism, steroid use and thyrotoxicosis.
Dehydration, dengue hemorrhagic fever and C Pancreatitis, pituitary tumor and phacochromo-
Gaisböck’s syndrome. cytoma may be associated with
C Palpable purpura may occur in Medullary carcinoma of thyroid.
Small vessel vasculitis, disseminated gonococcal C Conditions known to cause DI
infection and acute meningococcemia. Head injury, histiocytosis and viral encephalitis.
C Conditions causing ST segment elevation on ECG C Cluster headache is characterized by
Early repolarization variant, ventricular aneurysm Unilateral headache, onset typically in 20–25 years
and prinzmetal angina. of life and associated conjunctival congestion.
C A 60 years male patient with severe myxomatous C Drug useful in prophylaxis of migraine
MR, asymptomatic, LVEF 45% and end systolic Propranolol
diameter index of 2.9 cm/ml. Treatment appropriate is C LMN lesion is associated with
Mitral valve replacement. Flaccid paralysis
C A 55 years male alcoholic patient (with smoking C Most common site of hypertensive hemorrhage in
history to) presents with 3 hour history of the brain
increasing shortness of breath, pain started while Putamen/external capsule.
eating that is constant and radiates to the back and C Normal CSF glucose level in normol gycemic adult
interscapular region, known hypertensive, on 40–70 mg/dl
examination-cold and clammy skin with heart rate C CSF findings present in tubercular meningitis
130/min, BP 80/40 mm Hg, JVP normal, peripheral
Raised protein levels, low chloride levels and cob
pulses normal and equal, breath sounds decreased
web formation.
at left lung base and chest-X-ray-left pleural
Cause of reversible dementia
effusion. Diagnosis
C
Subacute combined degeneration.
Acute aortic dissection
A 40 years male patient heavy alcohol drinker for
Abnormal preoperative PFT in a patient with severe
C
C
last many years presents with visual hallucination,
kyphoscoliosis includes
not recognizing family members, violent behavior
Increased RV/TLC
and tremulousness for few hours, after missing
C Serum ACE may be raised in alcohol for last 2 days, O/E increased BP, tremor,
Sarcoidosis, silicosis and berylliosis. increased psychomotor activity fearful effect,
C Disease commonly predisposing to colonic hallucinatory behavior, disorientation, impaired
carcinoma judgement and insight
Ulcerative colitis Delirium tremens
C 5’-nucleotidase enzyme activity increased in C A 40 years male patient with history of alcohol
Cholestatic jaundice. dependence presents with confusion, nystagmus,
C Serum levels of that help distinguishing acute liver ataxia, on examination—6th cranial nerve palsy.
disease from chronic liver disease Diagnosis is
Albumin Wernick’s encephalopathy.
Medicine 161
C EEG is usually abnormal in of cells with clear cytoplasm and frequent areas of
SSPE, Creutzfeldt Jacob disease and hepatic hemorrhage and necrosis. Cytogenetic abnormality
encephalopathy. may reveal
C Neurologic channel opathies are Chromosome 3
Hypokalemic periodic paralysis, episodic ataxia C First drug of choice for non-gonococcal urethritis
type 1 and familial hemiplegic migraine. Doxycycline
C Vitamin B12 deficiency can give rise to C An HIV patient complains of visual disturbances,
Myelopathy, optic atrophy and peripheral neuro- fundal examination showing bilateral retinal
pathy. exudates and perivascular hemorrhages. Virus
C True about vitamin E deficiency manifestations most likely responsible for retinitis
Hemolytic anemia, posterior column abnormalities Cytomegalovirus
and cerebellar ataxia. C True about HIV infection
C Most sensitive test for diagnosis of myasthenia gravis Following needle stick injury infectivity is reduced
Single fibre EMG > edrophonium test. by administration of nucleoside analogues.
C Nucleoside reverse transcriptase inhibitors are
Zalcitabine, lamivudine and didanosine.
ALL INDIA 2004
C Antiretroviral drug that is avoided in a known
C DIC differs from TTP in the aspect sputum positive pulmonary TB patient undergoing
Decreased coagulation factor levels. treatment with isoniazide, rifampicin, pyrazinamide
C A 5 years old girl presents with history of progressively and ethambutol is HIV positive, CD 4 count 100 and
increasing pallor since birth and hepatospleno- viral load more than 50,000 copies/ml
megaly. Most appropriate test Ritonavir
Hb electrophoresis C Serum HbA1c level explains
C Test picture of elevated serum ferritin, serum iron Long term status of blood sugar
and percent transferrin saturation is consistent with (Note: last 8 week).
the diagnosis of C A 40 years female patient presents with complains
Hemochromatosis of increased appetite and thirst and increased
C Bone marrow transplant is used in treatment of frequency of micturition, impalpable pulses in the
Osteopetrosis, adrenoleukodystrophy and Hurler’s feet and gangrene. OGTT finding showing ketone
syndrome. bodies negative, urinary glucose negative in fasting
C True about sickle cell disease but positive after 1 hour (+++) and 2 hours (++) and
serum glucose respectively 155, 270 and 205 mg/dl
Patient may require frequent blood transfusion,
(fasting, 1 hr and 2 hrs). True statements are
acute infection is the most common cause of
She suffers from NIDDM, treated with oral
mortality before 3 years of age and positive
hypoglycemic drugs only when diet and exercise
correlation between conc. HBS and polymerization
could not control it and family history of DM
of HBS.
predicts the nature of diabetes.
C Features seen in cardiac tamponade
C The best marker to diagnose thyroid related
Pulsus paradoxus, RVDC and electrical alternans. disorders is
C In hematuria of glomerular origin, urine is TSH
characterized by the presence of C The occurrence of hyperthyroidism after supple-
Red cell casts, crenated red cells and dysmorphic mental iodine to patients with endemic thyroid
red cells. deficiency goiter is called as
C Polycystic kidney disease may have cysts in the Jod Basedow effect
Liver, pancreas and spleen. C True about amiodarone induced thyroid dysfunction
C A 40 years male patient presenting with painless Hyperthyroidism is common in iodine deficient
hematuria, bimanual examination revealing areas, amiodarone inhibits deiodinase activity and
ballotable mass over right flank, subsequently amiodarone therapy is associated with initial
undergoing right nephrectomy and mass composed reduction of serum T4 levels.
162 AIIMS and All India PGMEE—Review Questions
C A 50 kg man presents with severe metabolic acidosis, C During CPR, IV calcium gluconate is indicated in
pH-7.05, pCO 2 12 mm Hg, pO 2-108 mEq/L, base Hypocalcemia, calcium channel blocker toxicity
excess-30 mEq/L. Approximate quantity of sodium and electromechanical dissociation.
bicarbonate that he should receive in half hour-½ × C A postoperative cardiac surgery patient developed
body wt (kg) × [Desired HCO2- measured HCO2] sudden hypotension, raised CVP, pulsus
Half of the quantity given within first half hour. paradoxus at 4th postoperative hour. Diagnosis
C Most sensitive and specific test for diagnosis of iron Cardiac tamponade.
deficiency anemia is C The blood gas parameters-pH—7.58, pCO 2—23
Serum ferritin mm Hg, pO2—300? mm Hg, and oxygen saturation
C Leukoerythroblastic picture may be seen in 60% is consistent with
Myelofibrosis, metastatic carcinoma and Gaucher’s Ventilatory malfunction
disease. C DLCO is decreased in-ILD, emphysema and
C Poor prognostic factors for acute myeloid leukemia primary pulmonary HTN.
Age more than 60 years, leukocyte count more than C Diagnostic criteria of ABPA includes
1,00,000/μl and secondary leukemias. Changing pulmonary infiltrates, peripheral eosino-
C A 60 years old gentleman presents with massive philia and serum precipitins against Aspergillosis
splenomegaly, lymphadenopathy, total leukocyte fumigants.
count of 17,000/cmm, flowcytometry-CD19 and C Conditions leading to exudative pleural effusion
CD5 positive, CD 23 negative, monoclonal B-cells Bronchogenic carcinoma
with bright Kappa positivity comprising 80% of C Pulmonary HTN may occur in
peripheral blood lymphoid cells. Diagnosis Toxic oil syndrome, progressive systemic sclerosis
Mantle cell lymphoma. and sickle cell anemia.
C True about ECG in acute pericarditis C A 60 years old gentleman presented with breath-
Global ST elevation in early pericarditis, sinus lessness, facial swelling and dilated veins on the
tachycardia is common and PR segment depression chest wall. Most common cause is
is present in majority. SVC obstruction
C ECG features of severe hyperkalemia C Virus having significant perinatal transmission
Peaked T waves, sine wave pattern and loss of P Hepatitis B
waves. C SIADH is characterized by
C Hypocalcemia is characterized by Hyponatremia and urinary sodium excretion > 20
Numbness and tingling of circumoral region mEq/L.
hyperactive tendon reflexes and carpopedal spasm. C A 23 years old lady presented with episodes of
C Heart sounds occurring shortly after S2 myalgias, pleural effusion, pericarditis, arthralgia
Tumor polyp, opening snap and pericardial knock. without joint deformity over course of several
C An early systolic murmur may be caused by years. Best laboratory test to diagnose
Small VSD, papillary muscle dysfunction and TR. ANA
C Exercise testing is absolutely contraindicated in C Characteristic EEG feature of absence seizure
Aortic stenosis 3 Hz spike and wave.
C Most common cause of TR is secondary to C Most common presentation of neurocysticercosis
Dilatation of right ventricle. Seizures
C Heart valve most likely to be involved by infective C Most common cause of sporadic encephalitis
endocarditis following septic abortion HSV
Tricuspid valve. C Serum total LDH is raised in
C Osler’s node found in Muscle crush injury, MI and hemolysis.
Acute staphylococcal endocarditis. C Thiamine deficiency is known to occur in
C Troponin-T is preferable to CPK-MB in diagnosis of Food faddist, chronic alcoholic and CHF patient on
acute MI in conditions diuretics.
Bedside diagnosis of MI, postoperatively (after C A 30 years old male patient, HIV positive, presents
CABG) and small infarct. with fever, dyspnea, non-productive cough,
164 AIIMS and All India PGMEE—Review Questions
C Characteristically associated with development of glucose decreasing to 100 mg/dl after giving
ILD insulin. Changes in blood level expected
Coal dust, sulphur dioxide and thermophilic Increase in Na+ level
actinomycetes. C A 20 years old boy presents with exertional
C A 38 years male patient presents with HBsAg and dyspnea, headache and giddiness, on examination-
HBeAg positive during screening of blood hypertension and LVH, X-ray-showing notching of
donation and SGPT and SGOT normal. the anterior ends of the ribs. Diagnosis
Next done HBV DNA estimation. Coarctation of aorta
C Rheumatoid factor in RA is important because of
C A 25 years old lady presents with bloody diarrhea
RA factor is associated with bad prognosis.
diagnosed as a case of ulcerative colitis. Conditions
Conn’s syndrome is associated with
associated are
C
Hypertension, muscle weakness and hypokalemia.
Sclerosing cholangitis, iritis and ankylosing
Characteristic triad of Zollinger-Ellison syndrome
spondylitis.
C
Peptic ulceration, gastric hypersecretion and non-β
C Investigation of choice for invasive amoebiasis cell tumor.
ELISA C Feature of phacochromocytoma
C A diabetic patient with blood glucose of 600 mg/dl Hypertensive paroxysm, headache and orthostatic
and Na+ 122 mEq/L treated with insulin with blood hypertension.
166 AIIMS and All India PGMEE—Review Questions
12
Surgery
166
Surgery 167
C Mallory Weiss tear mainly affects C A head injury patient is brought to the emergency
Left gastric artery. in unconscious state. In his pocket antidiabetic drug
C Physiological changes in laparoscopy includes all is found. What should be done
except Take the blood sample, urgent CT scan, measure the
Increased pH. blood glucose, if less than 70, start dextrose
C Most commonly performed shunt in hydrocephalus infusion.
Ventriculo-peritoneal shunt. C True about functional division of liver
C Best incision preferred for surgery in diaphragm- Divided into 8 segments, 4 sectors and there are
Circumferential. three major and minor fissures.
(Note: Most commonly used incision is radial).
C Prognosis of esophageal cancer depends on one of AIIMS NOVEMBER 2014
the following option
C You are a qualified general surgeon in a community
T stage. health centre and receive a patient with severe head
C Treatment of choice for hydrocele of hernia sac in 3 injury, rapidly deteriorating GCS, hemiparesis, and
years old children pupils becoming dilated and fixed. CT scan and a
Herniotomy. neurosurgeon are unavailable. You decide to go for
C A patient undergoes right sided laparoscopic exploratory burr hole. Most appropriate statement
hernia surgery and a tack is accidentally placed if no localizing signs are present, place the burr hole
below and lateral to the iliopubic tract and develops on the left temporal side.
pain in the right thigh. Most like nerve injured is C False about traumatic brain injury
Lateral cutaneous nerve of thigh. Lactate increase is associated with good prognosis.
Oncotype Dx test is for
Cushing’s triad include
C
C
Chemotherapy for hormone receptor positive Rise in BP, bradycardia and irregular respiration.
breast cancer.
C On examination of a patient with RTA respiratory
(Note: Other similar genomic tests are Mamma Print, distress and reduced SpO2 was found. Stratosphere
Mammostrat and Prosigna. These tests help determine sign was seen on M mode USG of right anterior
the risk benefit ratio of chemotherapy in early stage chest. Most likely diagnosis
hormone receptor positive breast cancer patients. It
Pneumothorax
helps determine whether patient also needs chemo-
The immediate management for tension pneumo-
therapy along with surgery and hormone therapy.)
C
thorax is
C A female patient undergoes splenectomy for
resistant ITP. He presents with fever and chills on Needle insertion in the second intercostals space in
3rd postoperative day. Most likely cause the midclavicular line.
Left lower zone consolidation. C Panniculus adiposus is found at
C A pregnant woman presents with stab injury in the Orbit
right side of chest. She is shouting for the help. On C The best time for repair of cleft palate is
examination she has pulse 110/minutes and BP 90/ 9 to 12 months
60 mm Hg. Her breath sound is decreased on the C A 15 years old girl presents with pain and swelling
right side. First done over posterior aspect of left thigh that is soft on
Needle decompression on the right side. examination. Color Doppler ultrasonography
C A 2 months pregnant woman presents with a breast showed multiple dilated veins without any major
lump in the upper outer quadrant. Lump is not arterial feeder, indicating a venous malformation.
visible in USG. Next to be done Sclerosing agent that can be used in this patient
Palpation guided core biopsy. Sodium tetradecyl sulphate.
C A woman presents with bloody nipple discharge C A 12 years old girl presents with a nodule in the
from a single duct with family history of breast right lobe of thyroid. Resection revealed a small
cancer. Initial investigation of choice nodule of 2 × 2 cm. Histopathology showed Orphan
MRI Annie eye nuclei. Most likely diagnosis
(Note: Mammogram was not in the choice.) Papillary carcinoma
168 AIIMS and All India PGMEE—Review Questions
C Contaminated wound with necrotic material is best C The mortality rate of emergency operation for
managed with abdominal aortic aneurysm is
Debridement > 50%
C Color of triage given highest priority C True about celiac plexus block is
Red Diarrhea and hypotension are the common side
C False about endemic bladder stones effects.
Always associated with recurrence. C True about damage control surgery
C In GCS, withdrawal to pain stimulus comes under Minimal intervention done to stabilize the patient
M4 and do the definitive surgery later.
C Tumor marker for seminoma C In acute pyelonephritis, USG findings are
PLAP Renal enlargement, compression of the renal
C Time interval in a 60 years old patient of RTA sinuses and increased echogenicity.
presenting in unconscious state but becoming C Most common cause of fresh bleeding per rectum in
conscious and then again unconscious is called a 5 years old child is
Lucid interval Juvenile rectal polyp
C A young male patient previously healthy presented C Osteoblastic secondaries are most commonly seen
with abdominal pain and history of altered bowel from which primary malignancy
habits for last 6 months. On CT scan, there was Prostate
distal dilated ileum, thickened ileocecal junction C The most serious complication of a pelvic fracture is
with thickened cecum with presence of sacculations Hypovolemic shock
on the antimesenteric border. The vascularity of C Structures pierced during pleural tapping are
adjoining mesentery is also increased and there is Endothoracic fascia, skin and intercostal muscle.
surrounding mesentery fat. Differential diagnosis
C A 49 years old male patient with a 35 pack year
includes
history of smoking presents with a painless left
Ulcerative colitis, Crohn’s disease and tuberculosis. scrotal mass. Examination revealed microscopic
C Neo adjuvant chemotherapy is used in hematuria, absence of AFP and LDH. The most
Osteosarcoma, chest wall PNET, ovarian cancer probable cause
stage 3. Renal cell carcinoma.
C A patient underwent sentinel node biopsy for
AIIMS MAY 2013 treatment of breast carcinoma. Nerves likely to be
C A 45 years old patient presents with a 4 × 5 cm mass injured during this procedure
in the neck. Histopathology showed metastasis of Intercostobranchial nerve.
squamous cell origin. Diagnosis of carcinoma of C Innovation of refrigeration leading to better food
unknown primary (CUP) was made after no preservation has lead to decreased prevalence of
primary was found despite thoroughly examining Stomach cancer
laryngoscope, whole body CT and PET CT. TNM C Done in investigation for malabsorption
staging as per AJCC is 13-C triclosan assay
T0N2MO C Parotid gland tumor showing hot spot on Tc 99
C A 5 years old girl spills boiling water accidentally pertechnate scan
over her face and trunk. Methods most accurate to Adenolymphoma
estimate the body surface area involved in burns C An elderly male patient with a history 60 pack year
Lund and Browder chart of smoking is diagnosed with carcinoma lung.
C A 3 years old child suffers from burn injury with the Histology shows small highly mitotic cells, scant
following body parts involved: face including cytoplasm with hyperchromatic nuclei. Clinical
scalp, both buttocks and circumferentially around presentation that might occur in the patient during
both thighs. How much is TBSA involved the course of his illness
0.35 Thin extremities and central obesity.
170 AIIMS and All India PGMEE—Review Questions
AIIMS NOVEMBER 2012 incompetence and dilatation of GSV but deep veins
normal. Management includes
C A 70 years old man diagnosed with prostate cancer Endovascular stripping, stab avulsion and saphe-
was treated with radiotherapy. The recurrence of nofemoral flush ligation with stripping.
the cancer is monitored clinically by
C True about Buerger’s disease
Prostate specific antigen only
Neural involvement
C True regarding nerve injury
C True about peripheral vascular disease
In all cases of open wound with clinical signs of
Buerger’s disease also involves nerves.
nerve injury, nerve exploration should always be
done.
C BIRADS stands for AIIMS MAY 2012
Breast imaging reporting and data system. C Most important physiological cause of GERD is
C Organism associated with fish consumption and Transient LES relaxation.
also causing carcinoma gallbladder C After parotidectomy, patient sweats on cheeks
Clonorchis sinensis while eating, because auriculotemporal nerve
C A child was operated for intussusceptions by resec- (containing parasympathetic secretomotor fibres to
tion of the affected ileal segment revealing tumor parotid gland) is fused with
Villous adenoma Great auricular nerve.
C Causes of acute anal pain C True about epigastric hernia
Perianal abscess, thrombosed hemorrhoids and Located above the umbilicus and on either side.
acute anal fissure. C Pre-malignant jaw cyst
C A 30 years old lactating mother presented with a Odontogenic keratocyst
painful, palpable lump in her left breast. The most C Female patient of meningioma with inflammatory
appropriate investigation to diagnose her condition edematous lesion undergoing surgery, not done
would be Stop steroids
USG C Toddler presenting with few drops of blood coming
C True about inguinal hernia surgery out of rectum. Diagnosis
Hernia in children treated with herniotomy, Juvenile rectal polyp
absorbable mesh should not be used for surgery C Endoscopy of a female patient presenting with dys-
and surgery can be done using laparoscopy. phagia and intermittent epigastric pain shows
C True about radiological features of the intestinal dilated above and narrow at the bottom. Treatment is
obstruction Heller’s cardiomyotomy
The small intestines are said to be dilated if the (Note: Achalasia cardia–Bird’s beak appearance–AB)
loops of bowel have a diameter of > 3 cm, the large C Prognosis of which cancer has become better due to
bowels are said to be dilated if they are > 5 cm for advances in cancer treatment
distal bowel and > 9 cm for proximal bowel and the
ALL in children
absence of air-fluid level on plane supine X-ray does
not rule out obstruction. C Barrett’s esophagus is diagnosed by
C All of the following can be detected on USG in a Intestinal metaplasia
patient with surgical cause of jaundice (Note: Columner metaplasia)
Biliary tree obstruction, gallbladder stones and C Carcinoma breast stage T4b involves
ascites. Skin ulcer over the swelling, dermal edema and
C On the basis of anatomical knowledge of the pelvis, satellite nodule.
a rupture of the urethra above the deep perineal C Postoperative patient of Crohn’s disease with
pouch will lead to extravasation of urine in resection anastomosis presents on 7th post-
Deep pelvis operative day with anastomotic site leak from a
C A patient presents with varicose vein with color fistula with every day leakage adding up to 150–200 ml.
Doppler showing saphenofemoral junction There is no intra-abdominal collection and the
Surgery 171
patient is stable without any complaints. Next line C Complications of ileoanal patch anastomosis in an
of management ulcerative colitis patient most likey leads to
Do conservative treatment and leave him and wait Small bowel obstruction
for spontaneous resolution. C Following RTA, a patient with vague abdominal
C A 42 years old male patient presents with pain was undertaken for emergency laparotomy.
hematemesis. On examination—BP–90/60, HR– On examination- large, contained, stable, non-
120/min splenomegaly present. Most probable pulsatile retroperitoneal hematoma on right side.
cause of bleeding One shot IVU shows a barely discernable nephrogram
Portal hypertension on right side and prompt uptake and excretion on
C External hemorrhoids below the dentate line are left. Next step
Painful Isolate proximal renal vessels , open Gerota’s fascia
and explore kidney.
C Early complication of ileostomy in the postopera-
tive period C Part of capsular plate system of liver
Cystic plate, hilar plate and umbilical plate.
Necrosis
C Enzymes elevated in a child presenting with
C A patient presents with pain and tenderness in left
jaundice, icterus and clay colored stools
iliac fossa. USG shows a 3 cm stone in the renal
Gammaglutamyl transferase, alkaline phosphatase
pelvis without any hydronephrosis. Most appropriate
and 5’ nucleotidase.
treatment
C Correlating with severity of acute pancreatitis
PCNL
AST, serum calcium and serum glucose.
C Drug used in estrogen dependent breast cancer
C A 20 years old man presenting with proptosis and
Tamoxifen
pain in the right eye 2 days after trauma to the eye.
C After doing a graft repair of a thoracoabdominal On examination-bruise on the right eye and
aneurysm, the patient developed weaknesses in forehead. Diagnosis
both legs. Most probable cause Cortico cavernous fistula.
Discontinuation of arteria radicularis magna. C A surgeon while performing a laparoscopic chole-
C Due to decelerations, aorta can be ruptured at cystectomy finds a stone in CBD but is not experienced
places where it is fixed in laparoscopic CBD exploration. Next done
At ligamentum arteriosum, behind the crura of Convert to open cholecystectomy and CBD stone
diaphragm and aortic valve. extraction.
C A 40 years old male patient presented with mild C A patient presents to the emergency with history of
abdominal pain, mild constipation with a feeling of fall from a tree within 2 hours of injury. On
incomplete evacuation and mucus in the stools for examination-he is unable to move both his lower
the past 4 years on examination, tenderness is limbs, has absent sensations at umbilicus and bowel
present in left iliac fossa. Most likely diagnosis and bladder involvement. Spinal tenderness is
Irritable bowel syndrome elicited at the level of D10- L2. The loading dose of
C Characteristic of basal cell carcinoma is IV methylprednisolone given
Nuclear palisading 30 mg/kg within 3 hours
C To expose the celiac axis, left renal artery, SMA and C True about flail chest
abdominal aorta in case of trauma abdomen, Fracture of at least 3 ribs. if overlapping fractured
procedure done is ribs with severe displacement is seen then patients
Left medial visceral rotation. are treated surgically with open reduction and
C Wilm’s tumor associated with fixation and paO2 < 40 and FiO2 > 60 treated with
Aniridia, HTN and hemihypertrophy. intubation and PEEP.
C Early postoperative complication of ileostomy in C Full thickness grafts can be obtained from
postoperative period Elbow, groin and supraclavicular area.
Necrosis C A patient, hemodynamically stable, presents with
blunt injury abdomen. Next investigation
C Smoking associated with
FAST
Carcinoma larynx, carcinoma bladder and carcinoma
esophagus. C AFP increased in
C A 60 years old chronic smoker presents with Hepatoblastoma
painless gross hematuria of 1 day duration. C Treatment of desmoid tumor
Investigation of choice Wide excision
Urine microscopy for malignant cytology cells. C A male patient with azoospermia have normal FSH
C A man with blunt abdominal trauma with history of and testosterone levels and normal sized testes
pelvic fracture has passed only few drops of blood cause
per meatus and no urine in the past 8 hours. His Vas obstruction
bladder is palpable per abdomen. True is C Presence of nephroblastomatosis in biopsy of
Urethral injury Wilm’s tumor of left kidney is indicative of
Increased risk of tumor in right kidney.
C Tumors associated with infective etiology
AIIMS NOVEMBER 2009 Gastric carcinoma, hepatocellular carcinoma, and
C Most important prognostic factor in congenital nasopharyngeal carcinoma.
diaphragmatic hernia C True about cryptorchidism
Pulmonary HTN Cryptorchidism is a risk factor for testicular tumor,
C Risk factor for cholangiocarcinoma seminoma is most common tumor, contralateral
testis is also at risk.
Chronic typhoid carrier, chronic ulcerative colitis
and parasitic infestation (Clonorchis sinensis). C Laparoscopic cholecystectomy was done in a
patient with cholelithiasis with biopsy report of
C Hirschsprung’s disease is due to
adenocarcinoma with invasion of muscular layer,
Failure of migration of neural crest cells from CT normal. Further treatment is
cranial to caudal direction.
Wedge hepatic resection with lymph node dissec-
C A robust male baby, with vigorous feeding and tion.
immediate vomiting at 2 months of age. Diagnosis
Congenital hypertrophic pyloric stenosis. AIIMS MAY 2009
A 65 years old patient of coronary artery disease on
A 45 years old male patient presents with abrupt
C
C
aspirin for 24 years complains of black stools,
onset pain, weakness, loss of contour of shoulder
abdominal examination normal. Diagnosis
and muscle wasting on 5th day of tetanus toxoid
Duodenal ulder immunization. Likely cause is
C Ileocaecal TB is associated with Brachial plexus neuritis.
Megaloblastic anemia. C Double bubble sign is seen with
(Note: Vitamin B12 is absorbed from ileum) Duodenal atresia
C Lynch syndrome is associated with C Indications for penile angiography
Colon carcinoma, endometrial carcinoma and Peyronie’s disease, erectile dysfunction and arterio
carcinoma ovary. (Mn: CEO) venous malformation.
Surgery 175
C True about gastric lymphoma painless mobile, cystic and just below hyoid bone.
Stomach is most common site, associated with Ultrasound showed a thick walled cystic lesion.
H.pylori infection and 5 years survival rate after Management includes
treatment is 60%. Surgical removal
C A 6 years old girl presents with constipation,
urinary retention and on examination- presacral AIIMS MAY 2007
mass. Diagnosis
C A 18 years old girl presenting with thyrotoxic
Anterior sacral meningocele. symptoms and 9 months history of neck swelling.
C True about treatment of early breast carcinoma On investigation, increased T4, decreased TSH and
Postmastectomy radiation therapy is given when 4 palpable 2 cm nodule was found. Next done
or more lymph nodes are positive. Thyroid scan
C Most probable diagnosis of altered sensorium and
AIIMS NOVEMBER 2007 drowsiness after 3 days after TURP in a old age
C Most common location of spinal tumors patient
Extradural Hyponatremia
C Movement aggrevating pain in a case of retrocecal C Most common complication after ERCP
appendicitis Acute pancreatitis
Extension C A 32 years old lady, presenting with unilateral
C In couinaud classification, segment IV of liver is breast cancer with axillary lymphadenopathy. Post
Quadrate lobe modified radical mastectomy is done
C Shoulder pain post-laparoscopy is due to Adriamycin based chemotherapy followed by
CO2 retention tamoxifen depending on estrogen/progesterone
C True about Ogilive’s syndrome receptor status.
Involves entire/part of the large colon, occurs after C Colonic diverticulosis best diagnosed by
previous surgery and occurs commonly after Barium enema
narcotic use. C Complications of surgery for thoracic outlet
C FNAC needle size syndrome
22–26 Pneumothorax, brachial plexus injury and long
C Congenital urogenital abnormality associated with thoracic nerve injury
increased risk of bladder carcinoma C Stone resistant to lithotripsy
Bladder exostrophy Cystine stone
C A 24 years old male, otherwise normal, compains of C A patient, presenting with hematemesis and
mild pain in right iliac fossa in a waveform pattern malena, under goes upper GI endoscopy but there
which increases during the night and he becomes is no significant finding. The patient rebleeds after
exhausted and is admitted to the hospital. On 2 days. Next done
examination-Mild hematuria. Urine- Plenty of RBC, Laparotomy
50 WBC/hpf and pH-5.5 . Diagnosis C True about solitary rectal ulcer syndrome
Ureteral calculus Increased muscle layer proliferation, crypt distortion
C Persistent fetal lobulation of adult kidney is due to and subepithelial fibrosis
Is a normal variant C CEA increased in
C Meiosis occurs in Lung cancer, breast cancer, colon cancer
Primary to secondary spermatocyte
C Transhiatal esophagectomy was planned for
AIIMS NOVEMBER 2006
adenocarcinoma of lower end of esophagus.
Appropriate approach C True about congenital torticollis
Abdomen neck Spontaneous resolution in most cases, 2/3rd cases
C A central midline neck swelling is noted in a 4 years have palpable neck mass at birth and uncorrected
old girl posted for tonsillectomy. The swelling is cases develop plagiocephaly.
Surgery 177
C Adjuvant chemotherapy is of definite value in C A 40 years old woman presents with dysphagia to
Carcinoma colon both liquids and solids and regurgitation for 3
C Lowest risk of carcinoma breast is seen in months. The dysphagia is non-progressive. Diagnosis
Ataxia telangiectasia Achalasia cardia.
(Note: Achalasia cardia may be slowly progressive
After genetic counselling in a family for familial
and may present as non-progressive).
C
polyposis coli, next screening test is
C A 45 years old male patient presents with long
APC gene history of cigarette smoking, gangrene of left foot,
C A patient with carcinoma tongue in right lateral amputation of left foot was done. Biopsy specimen
aspect with lymph node of 4 cm size in level 3 on left showing presence of arterial thrombus with
side of neck. Stage is neutrophilic infiltration in the arterial wall with
N2 inflammation also extending into the neighbouring
C Fruit juice preventing UTI veins and nerves. Diagnosis is
Cranberry Thromboangiitis obliterans.
C Enzymes elevated in a child presenting with C RET proto-oncogene mutation is a hall mark of
jaundice icterus, pruritus and clay colored stools are Medullery carcinoma thyroid.
Gamma glutamyl transpeptidase, alkaline phos- C A 65 years old miner has last 7 kg weight within 2
photase and 5’ nuclestidase. months, presenting with cough, blood streaked
C A 50 years old male presenting with history of sputum, treated for pulmonary TB 10 years ago,
hematomesis-500 ml of blood and on examination- drooping of left eyelid for one month, on
BP-90/60, pulse rate 110/min and splenomegaly 5 examination-Ptosis of left eye and pupillary miosis
cm below lower costal margin. Diagnosis chest X-ray revealing-round opacification in the left
upper apical lobe. Diagnosis
Portal HTN
Squamous cell carcinoma
C A 45 years old female patient complains of
progressive lower limb weakness, spasticity, (Hint: Pancoast tumor).
urinary hesitancy. MRI-Intradural enhancing mass C Acquired/secondary megacolon is seen in
lesion. Diagnosis Rectal malignancy
Meningioma C True about papillary carcinoma of thyroid
C Prognostic factors for acute pancreatitis Can be reliably diagnosed using FNAC, typically
Hypocalcemia, hyperglycemia and AST elevation. spreads to the cervical lymph nodes and requires
total thyroidectomy for large tumors.
C Hypotension in acute spinal injury is due to
C True statements about stones in gallbladder
Loss of sympathetic tone
Pigment stones are due to increased excretion of
conjugated bilirubin, are considered a risk factor for
AIIMS MAY 2006 development of gallbladder carcinoma and 10%
gallstones are radio-opaque.
True about radiological evaluation of a patient with
A 45 years old gentleman has undergone truncal
C
C
Cushing’s syndrome
vagotomy and pyloroplasty for bleeding duodenal
Petrous sinus sampling is the best way to ulcer seven years ago, now presenting with intra-
distinguish a pituitary tumor from ectopic ACTH ctable recurrent symptoms of peptic ulcer. Features
producing tumor, MRI of adrenals may distinguish suggesting Zollinger-Ellison syndrome are
adrenal adenoma from carcinoma and adrenal CT Basal acid out put of 15 meq/hour, serum gastrin
scan distinguished adrenal cortical hyperplasia value of 500 pg/ml and ulcers in proximal jejunum
from an adrenal tumor. and lower end of esophagus.
C Barrett’s esophagus commonly associated with C Defect in migration of neural crest cells result in
Adenocarcinoma Albinism and congenital megacolon.
C Brain tumor highly vascular in nature C True about primary grade IV-V VUR in young children
Glioblastoma > meningioma. Postnatal scarring may occur even in absence of UTI.
178 AIIMS and All India PGMEE—Review Questions
C Head injury with lucid interval, most likely it is a C True about GI bleeding
case of brain hemorrhage of The sensitivity of angiography for detecting GI
Extradural bleeding is about 10–20% as compared to nuclear
C AFP is elevated in imaging, 99 mTc-RBC scan will image bleeding at
Hepatocellular carcinoma rates as low as 0.05–0.1 ml/min and angiography
C Acalculous cholecystitis can be seen in will detect bleeding only if extravasation has
DHF, Enteric fever and leptospirosis. occurred during contrast injection.
C Most beneficial technique of using chemotherapy
AIIMS MAY 2005 with a course of radiotherapy in head and neck
C A warthin’s tumor is malignancies
An adenolymphoma of parotid gland. (Mn: WAL) Concurrent chemotherapy.
C Features seen more in seminoma than non- C Hypoparathyroidism following thyroid surgery
seminomatous germ cell tumors of the testis are occurs within
Tumors remain localized to testis for a long time, 2–5 days
they are radiosensitive and they metastasize C A 55 years male patient presents with features of
predominantly by lymphatics. obstructive jaundice, loss of 7 kg weight in last 2
C Complications of total thyroidectomy include months, CT scan-CBD dilated till the lower end and
Airway obstruction, hemorrhage and hoarseness. main pancreatic duct is also dilated. Pancreas is
C The initial investigation of choice for a post- normal. Diagnosis
cholecystectomy biliary stricture is Periampullary carcinoma
CT scan (Hint: Double duct sign).
C Treatment of choice for an 8 mm retained CBD stone is C Investigation of choice for assessment of depth of
Endoscopic stone extraction. penetration and perirectal nodes in rectal cancer
C Treatment of choice for medullary carcinoma thyroid Transrectal ultrasound.
Total thyroidectomy. C Following resuscitation, a patient with bleeding
C Indications for cholecystectomy are: esophageal varices should be treated initially with
70/M with symptomatic gallstones. Sclerotherapy
20/M with sickel cell anemia and symptomatic C A 20 years female patient presented with a thyroid
gallstones and swelling. FNAC will not diagnose
60/F with large gallbladder polyp. Follicular carcinoma of thyroid
C True about Ludwig’s angina C A 13 years old boy presents with acute onset right
An infection of the cellular tissues around submandi- scrotal pain. The pain is not relieved on elevation of
bular salivary gland. scrotum and he has no fever or dysuria. The testis is
enlarged and tender. Routine urine examination is
AIIMS NOVEMBER 2004 normal. No history of trauma. Most appropriate
management
A 25 years female patient presents with spontaneous
Immediate exploration.
C
nipple discharge of 3 months duration, on examina-
C A 40 years female patient has undergone cholecys-
tion-discharge is bloody and from a single duct.
tectomy. Histopathology reveals that she has a 3 cm
True about management
adenocarcinoma in the body of gallbladder
Ultrasound can be a useful investigation, galacto-
infiltrating up to the serosa. Further management
gram is not essential and most of the blood stained
nipple discharges are due to papilloma or other Radical cholecystectomy
bengin condition. C Migratory thrombophlebitis is associated with
C A 25 years male patient presents with history of Lung carcinoma, pancreas carcinoma, and GI carci-
RTA two hours ago, hemodynamically stable, noma.
abdomen-soft and hematuria noted on catheteri- C During bilateral adrenolactomy, intraoperative
zation of the bladder. Next step dose of hydrocortisone should be given after
CECT abdomen Excision of both adrenal glands.
180 AIIMS and All India PGMEE—Review Questions
and radiated to back and in interscapular region. ultrasound abdomen showing-stone in the CBD.
He is a known hypertensive. On examination-cold Best treatment option
and clammy, HR—130/min, BP—80/40 mm Hg, JVP ERCP and bile duct stone extraction.
normal, peripheral pulses present and equal. Breath C A 14 years female patient of normal height and
sounds decreased at the left lung base and chest weight for age, complains of right breast size twice
X-ray showing left pleural effusion. Diagnosis that of left breast since onset of puberty 2 years ago.
Acute aortic dissection. On examination-both breasts have a similar
C Breast conservation surgery for breast cancer in consistency on palpation with normal nipples and
indicated in areola. Diagnosis
T1 breast cancer and extensive in situ cancer. Virginal hypertrophy
Treatment of acute upper GI bleed possibly avoided
A 65 years male patient diagnosed with prostate
C
C
cancer three years back was treated by surgery and Intravenous β blockers.
hormone therapy. Presently he has developed C True about varicose veins
urinary symptoms and progressive backache. 5% oily phenol is an appropriate sclerosant for
Tumor marker indicative of disease relapse venous sclerotherapy.
Dysphagia lusoria is due to
PSA
C
Compression by aberrant blood vessel.
C Malignant disease of childhood with best progno-
C Least malignant thyroid cancer
sis
Papillary carcinoma.
Wilm’s tumor. C Blood stained discharge from the nipple indicates
C A 3 years male child presents with history of Duct papilloma.
constipation and abdominal distension for last 2 C Most common site of carcinoma esophagus in India
years, plain radiograph of abdomen revealing, Middle 1/3rd.
faecal matter containing distended bowel loops. A C Substance not used as an irrigant during TURP
barium enema study done subsequently shows a
Normal saline.
transition zone at the rectosigmoid junction with
reversal of rectosigmoid ratio. Diagnosis AIIMS MAY 2003
Hirschprung’s disease
C Most likely cause of a 3 years old boy presenting
The tendency of colonic carcinoma to metastasize is
with poor urinary stream
C
best assessed by
Posterior urethral valve.
Depth of penetration of bowel wall.
C There is a high risk of renal dysplasia in
C A 40 years female patient has undergone an open Posterior urethral valve.
cholecystectomy, procedure uneventful. She has
C Post dural puncture is typically
100 ml of bile output from the drain kepts in the
Bifrontal or occipital
gallbladder bed on first postoperative day. On
examination afebrile and an icteric. The abdomen is C A young patient presents with history of dysphagia
soft and bowel sounds are normal. Advice more to liquid than to solids. First investigation
Clinical observation Barium swallow
C True about hepatocellular carcinoma C True of gas gangrene
High incidence in East Africa and South-East Asia, Caused by Clostridium perfringens, gas gangrene is
worldwide incidence parallels the prevalence of characterized by severe local pain, crepitus and sign
Hepatitis B and liver transplantation offer the of toxemia and high dose penicillin and aggressive
only chance of cure in those with irresectable debridement of affected tissue is treatment of
disease. established infection.
C A 50 years female patient presents with history of C In blast injury, organs vulnerable to blast wave
recurrent episodes of right upper abdominal pain Ear drum, GIT and lung.
for last one year, history of jaundice and fever C Contraindication for ESWL for renal calculi
for 4 days, on examination- patient is toxic, BP 90/ Uncorrected bleeding diasthesis, pregnancy and
60 mm Hg, started on intravenous- antibiotics, ureteric strictures.
182 AIIMS and All India PGMEE—Review Questions
C Investigations done for anterior urethral stricture C Indications for surgery in gastric lymphoma
Retrograde urethrogram, micturating cystoure- Bleeding, perforation and residual disease following
throgram and high frequency USG. radiotherapy.
C Treatment of choice for prepucial adhesions pro- C A middle age male patient presents with stab injury
ducing ballooning of prepuce during micturition in to chest, on examination-hemodynamically stable,
a 2 years old boy neck veins engorged and heart sound muffled. True
Circumcision. statements are
(Hint: Phimosis) Diagnosis is cardiac tamponade, echocardiogram
C Cells from the neural crest are involved in is done to confirm pericardial blood and the entry
Hirschprung’s disease, neuroblastoma and PNET. wound should be sealed with an occlusive
C A warthin’s tumor is dressing.
An adenolymphoma of parotid gland. (Mn: WAL) C A young adult male patient presents with pain on
C True about testicular tumors the right flank and hematuria, CECT abdomen-
Seminomas are radio sensitive. Large 8 × 8 cm solid mass in right kidney and 3 × 3 cm
C Upper GI endoscopy and biopsy from lower solid mass occupying upper pole of left kidney.
esphagus in a 48 years old woman with chronic Surgery of choice
heart burn shows presence of columner epithelium Right radical nephrectomy and left partial
with goblet cells. It is consistent with nephrectomy.
Metaplasia C True about germ cell tumors of testis
(Note: Normally squamous). They constitute 90–95% of all primary testicular
C Oncological emergencies are tumors, seminoma is most common tumor
Spinal cord compression, SVC syndrome and developing in the patients with cryptorchid testis
tumor lysis syndrome. and high inguinal orchidectomy is the initial
C Side effect of tamoxifen in carcinoma of breast patients surgical procedure.
Cataract, endometrial carcinoma and thromboem- C A 25 years male patient presents after road traffic
bolic events. accident, on examination-pelvic fracture and blood
C Common causes of respiratory difficulty in the at urethral meatus. True about this patient
immediate postoperative period are Retrograde urethrography should be done after the
Mycardial infarction, overdose of narcotic analgesic patient is stabilized, Foley’s catheter may be
and residual effect of muscle relaxant. carefully passed if the RGU is normal and rectal
C A patient undergoing surgery suddenly develops examination may reveal a large pelvic hematoma
hypotension with et CO2 decreasing by 15 mm Hg with the prostate displaced superiorly.
suddenly. Diagnosis C True about peyronie’s disease
Pulmonary embolism Painful erection, associated with Dupuytren’s
contracture of the tendon of the hand and sponta-
AIIMS NOVEMBER 2002 neous regresssion occurs in 50% of the cases.
C The Gold standard investigation for extrahepatic C Post traumatic epilepsy refers to
biliary atresia Seizure occurring within several weeks to months
Preoperative cholangiography. after injury.
C True about malignant potential of colorectal polyps C Fetal hydronephrosis is diagnosis in a mother at 34
Polyps of FPC invariably undergoes malignant weeks gestation. The aminotic fluid is normal most
change, villous adenoma is associated with high appropriate management
risk of malignancy and juvenile polyps have little or Delivery at term followed by radiological evaluation.
no risk. C The length of the feeding tube for transpyloric
C Treatment of squamous cell carcinoma of anal canal feeding is measured
Chemoradiation From tip of ear lobe to the umbilicus.
(Note: Cisplatin based chemotherapy and radical C Preservative for packing catgut suture
radiotherapy). Isopropyl alcohol.
Surgery 183
C A 9 years male patient underwent near total C A patient of abdominal injury presents with signs of
thyroidectomy followed by radical neck dissection peritonitis and shock. Airway and breathing were
for cervical lymphadenopathy (needle biopsy of lymph secured and IV fluid started with 2 large bore
node- secondaries from papillary carcinoma thyroid) cannulas. Next line of management
and biopsy confirming the diagnosis. Next done Exploratory laparotomy under GA.
Start thyroxine suppression therapy C Surgeon excises a portion of liver to the left of the
C Left varicocele in old aged male patient arises suspi- attachment of the falciform ligament. Segments
cion of resected are
Left renal tumor Segment 2 and 3.
C Renal stone associated with Proteus infection
Triple phosphate
ALL INDIA 2011
C Most common cause of delayed urinary tract
C True about ranula obstructive symptoms after TURP
Cystic swelling in floor of mouth. Bladder neck stenosis
C Follicular carcinoma of thyroid can be best C During TURP, surgeon takes care to dissect above
differentiated from a follicular adenoma by the verumontanum to prevent injury to
Vascular invasion External urethral sphincter.
C Multiple cutaneous sebaceous adenoma are seen in C A 55 years old smoker presents with history of five
Muir-Torry syndrome. episodes of macroscopic hematuria each lasting for
C A 30 years old male patient presents with about 4–5 days in past 5 years. Investigation
symptoms of epigastric pain, radiating to back that performed to evaluate the suspected diagnosis
makes him wake-up at night and is relieved by Urine microscopy and cytology.
consuming food. There is history of similar pain in C Best recommended management option for a 40
the past diagnosed as perforated duodenal ulcer years old patient with a single kidney presenting
and treated with omental patch surgery on two with a solitary exophytic mass of 4 cm localized at
occasions. Pain before and after surgery has been its lower pole
controlled with PPI and analysis. Diagnosis Partial nephrectomy
Duodenal ulcer C A woman presented with hematuria was found to
C True about gastric carcinoma have stage II transitional cell carcinoma of bladder.
Often associated with hypochlorhydria/achlorhy- True is
dria. 70% chance of recurrence 5 years after TURP.
C A woman presents with 3 day history of epigastric C Surgery for undescended testis performed at 6
pain radiating to back, normal serum amylase months.
levels and gallbladder stones and enlarged C A 5 years old child presenting with balloning of
pancreas on USG abdomen. Diagnosis is prepuce after micturition. O/E prepucial adhesions
Acute pancreatitis in penis. Best management
C Middle aged woman presents with 2 years history Circumcision
of recurrent abdominal pain with radiation to her C Nutrient not included in TPN
back, pain severe in intensity and refractory to Fibres
simple analgesics, USG and CECT confirming C A patient with head injury opens eyes to painful
diagnosis and showing dilated pancreatic duct. stimulus uses inappropriate words and localizes
Operation of choice pain. GCS score
Longitudinal pancreaticojejunostomy. 10
C A patient with stab injury to anterior abdomen
ALL INDIA 2010
presents with a tag of omentum providing through
the abdominal wall near the umbilicus. He is C Lord’s plication is done for
hemodynamically stable and shows no signs of Hydrocele
peritonitis Next done C Stones hard to break by ESWL
CECT abdomen Calcium oxalate monohydrate.
Surgery 185
C A 50 years old woman presented with abdominal C In orthotropic liver transplantation, best way to get
pain, anuria, radiological finding of bilateral bile drainage in donor liver
impacted ureteric stones with hydronephrosis, Donor bile duct with recipient bile duct or Roux en
urinalysis showing RBC with pus cells in urine, Y choledochojejunostomy.
serum creatine 16 mg/dl serum urea 200 mmol/dl. C Most common cyst and other spleen are
Immediately required Hydatid cyst
J stent drainage C A male patient presents with fever for 3 weeks,
C Complication of PCNL done through 11th splenomegaly hypoechoic shadow in spleen near
intercostals space the hilum on USG, and gram-negative bacili isolated
Hydrothorax on blood culture. Most likely caustive organism is
C Most common renal vascular anomaly Salmonella
Supernumeray renal artery. C A patient with ITP has a platelet count of 50,000
C First autologous renal transplant was done by being planned for splenectomy. Best time for
Hardy platelet infusion in this patient
C Most common site of urethral carcinoma in men is After ligating the splenic artery.
Bulbomembranous urethra. C Most common cause of abdominal aortic aneurysm
C The Grayhack shunt is established between Atherosclerosis
Corpora cavernosa and saphenous vein. C Primarily restrictive operations for morbid obesity
C An adult presented with hemetemesis, and upper are
abdominal pain, endoscopy showed growth at Vertical band gastroplasty, laparoscopic adjustable
pyloric antrum of stomach, CT scan-growth gastric banding and Roux en Y operation.
involving pyloric antrum without infiltration or C TRISS includes
invasion into surrounding structures and no RTS + ISS +Age (Mn: MIRA–M is mechanism of
evidence of distant metastasis. At laparotomy injury)
neoplastic growth was observed to involve the C A 30 years old patient presents with left sided abdo-
posterior wall of stomach and pancreas extending minal pain, 6 hours after RTA, hemodynamically
6 cm up to tail of pancreas. Most appropriate surgery. stable, FAST positive, CECT showing grade II
Partial gastrectomy + distal pancreatectomy. splenic laceration. Most appropriate management
C True about Gastrointestinal carcinoid tumors Conservative management
Small intestine and appendix account for almost (Note: If on CECT contrast blush with grade III is
60% of all GI carcinoid, 5 years survival for seen splenic artery embolization is most
carcinoid tumors is 76% and appendicial carcinoids appropriate treatment).
are more common in females than males. C A woman presented with stab injury to left side of
C Surgery of choice in a young male patient the abdomen, hemodynamically stable. CECT
presenting with complete rectal prolapse revealing laceration in spleen. Laparoscopy was
Abdominal rectopexy. planned but patient’s pO2 suddenly dropped as
C Treatment of choice for annular pancreas soon as pneumoperitoneum was created. Most
Duodenojejunostomy likely cause is
Gaseous embolism through splenic vessels.
C A lady presents with recurrent attacks of giddiness
and abdominal pain since 3 months, normal C Scale to evaluate prognosis after subarachnoid
endoscopy, fasting blood glucose level 40 mg% and hemorrhage
elevated insulin levels, CT abdomen showing well Hess and Hunt Scale
defined 8 mm enhancing lesion in the head of pan-
creas with no other abnormal findings. Treatment ALL INDIA 2009
Enucleation C A man with blunt injury abdomen after RTA has BP
C According to Bismuth/Strasberg classification, 100/80 mm Hg, PR 120/mn, airway established
cystic blowout is classified as and respiration stabilized. Next step
Type A Blood for cross matching and IV fluids.
186 AIIMS and All India PGMEE—Review Questions
C True about necrotizing fascitis C Parastromal hernia is most frequently seen with
Infection of fascia and subcutaneous tissue, most End colostomy
commonly caused by group A beta hemolytic C The advantage of bladder drainage over enteric
Streptococcus and surgical debridement is manda- drainage after pancreatic transplantation
tory. Better monitoring of amylase levels.
C True about lymphoepithelioma of the parotid gland C Post-chemotherapy based staging system in Wilm’s
Associated with EBV infection, highly radiosen- tumor
sitive and type of squamous cell carcinoma SIOP (International Society of Paediatric Oncology)
C Triple assessment for carcinoma breast includes
Clinical examination, mammogram and FNAC. ALL INDIA 2008
(Mn: FMC)
C Moderately increased risk of invasive breast C Non-absorbable sature
carcinoma is associated with Polypropylene
Atypical lobular hyperplasia C Decision about surgery in case of hemothorax due
C Thoracic outlet syndrome is primarily diagnosed by to blunt trauma chest is based on
Clinical evaluation. Hemodynamic status > nature of chest tube output.
C Popliteal artery pulsation are difficult to feel C A male patient with blunt trauma abdomen is
beacause hemodynamically stable. Next done
Further imaging of abdomen.
It is not superficial and does not cross prominent
bone. C A young patient presents with a massive injury to
proximal duodenum, head of pancreas and distal
C Intermittent claudication is defined as
common bile duct. Surgery of choice
Pain in muscle on excercise only.
Pancreaticoduodenectomy (Whipple’s operation).
A patient with critical lower limb ischemia presents
Landmark for facial nerve during parotid surgery
C
C
with
Digastric muscle, tragal pointer and retrograde
Rest pain and ischemic, ulcers. dissection of distal branch.
C Lumbar sympathectomy is of value in the manage- C Abbe-Estlander flap is used for
ment of Lip
Distal ischemia affecting the skin of the toes. C Most common histological type of thyroid carcinoma
(Note: Sympathectomy is not indicated in anhydro- Papillary carcinoma thyroid.
sis). C Complications of hemithyroidectomy includes
C Pseudoclaudication is caused by External branch of superior laryngeal nerve palsy,
Lumbar canal stenosis recurrent laryngeal nerve palsy and wound
C Best material for below inguinal arterial graft is hematoma.
Saphenous vein graft (upside-down). C A 25 years old women complains of discharge of
C Most common part of subclavian artery affected by blood from a single duct in her breast. Most appro-
stenosis priate treatment is
First part Microdochectomy
C The most common site of rupture of abdominal C Most common tumor in the posterior mediastinum
aortic aneurysm Neurofibroma
Laterally into the left peritoneum. C A 45 years old woman presents with symptoms of
C Most common cause of superficial thrombophlebitis acute cholecystitis. On USG, there is solitary gall-
Intravenous catheters/infusion. stone of size 1.5 cm. Symptoms are controlled with
C SEPS is a procedure used for medical management. Next most appropriate test
Veins Laparoscopic cholecystectomy immediately.
C True about Zenker’s diverticulum C An otherwise normal woman presents with
Acquired diverticulum, false diverticulum and symptoms of flatulent dyspepsia. She was started
lateral X-rays on barium swallow are often diag- on PPI which controlled her symptoms. The next step
nostic. Wait and watch
Surgery 187
of the midline and the swelling moves upward on C Allen’s test is useful in evaluating
protrusion of tongue. Integrity of palmar arch.
C Mixed tumors of the salivary glands C Most common cause of AV fistula
Most common in parotid gland. Penetrating trauma.
C The most important prognostic factor in breast C Dacron vascular graft
carcinoma Textile synthetic (Mn: STD).
Stage of tumor at the time of diagnosis. C Preferred sites for planning vascular access for
C Biopsy of opposite breast is indicated in type of maintenance hemodialysis
breast carcinoma Non-dominant extremity, upper limb and radio-
Lobular carcinoma cephalic AV fistula.
C The tumor that may occur in the residual breast C Most preferred approach for pituitary surgery is
overlying skin following wide local excision and Trans-sphenoidal
radiotherapy for mammany carcinoma is C Components of Glasgow Coma Scale
Angiosarcoma Eye opening, Verbal response and motor response.
C Referred pain is felt along the inner side of right (Mn: EVM)
thigh C Total score in GCS
In inflamed pelvic appendix inflamed ovaries and 15
stone in pelvic ureter. C Blood stained discharge from nipple indicates
After E.coli, next most common organism impli-
Duct papilloma
C
cated in acute suppurative bacterial peritonitis is
C Perineural invasion in head and neck cancer is seen
Bacteriodes
in
C A patient of post-cholecystectomy biliary structure
Adenoid cystic carcinoma
has undergone ERCP three days ago. Following this
she has developed acute cholangitis. The most C Sialography is contraindicated in
likely organism Acute parotitis
E. coli. C Most common complication of hiatus hernia
C True about stones in CBD Esophagitis
Can present with charcoat’s triad, suggested by a C Full thickness biopsy of rectum of a neonate
bile duct diameter > 6 mm of USG and ERCP, presenting with bloated abdomen shortly after
sphincterotomy and balloon clearance is now the birth with passing of less meconium is most likely
standard treatment. to show
C Biliary stricture after laparoscopic cholecystectomy Lack of ganglion cells
usual occurs at (Note: Hirschsprung disease)
Upper part of CBD C Gardener’s syndrome (a rare hereditary disorder of
C Modalities used for in situ ablation of liver colon) is characterized by
secondaries Polyposis colon, osteoma, epidermal cysts and
Alcohol, cryotherapy and radiofrequency. (Mn: CAR) fibroma.
C The most common cause of gastric outlet obstruction C Carcinoid tumor is most common in
in India Small bowel > Lung
Stomach carcinoma C Overall survival increases by screening in
C Treatment for anal canal carcinoma Colon cancer
Chemoradiotherapy C True about patients of ulcerative colitis associated
C Part of triple therapy immunosuppression for post- with primary sclerosing cholangitis (PSC)
renal transplant patients May develop biliary cirrhosis, may have raised
Cyclosporine, azathioprine and prednisolone (Mn: alkaline phosphatase and increased risks of
CAP). cholangiocarcinoma.
C True about testicular tumors C Ideal for treatment with sclerosing agent injection
Bilateral in up to 10% cases. Internal hemorrhoids.
Surgery 189
C Catheter material most suitable for long term use C A 20 years old male patient presents with chronic
is constipation, headache, palpitation, on examination
Silicone Marfanoid habitus, neuromas of tongue, medullated
C Most trouble some source of bleeding during a corneal nerve fibres and nodule of 2 × 2 cm size in
radical retropubic prostatectomy left lobe of thyroid gland. Diagnosis is
Dorsal venous complex MEN IIB
C True about finasteride C Most common site of oral cancer among Indian
Used in medical treatment of BPH, impotence is population
well documented side effect and it is a 5 alpha Alveolobuccal complex
reductase inhibitor. C Most common malignant tumor of adult males in
C According to GCS, score of 1 indicates India is
No response Oropharyngeal carcinoma.
C Earliest sign/symptom of increased intracranial C Most common site of intestinal obstruction in gall-
pressure following head injury is stone illeus is
Altered mental status Ileum
C Soft tissue sarcoma frequently metastasing to the C Type of pancreatitis with best prognosis
lymph nodes Gallstone pancreatitis.
Embryonal rhabdomyosarcoma C Surgery of choice for a rectal carcinoma at 5 cm from
the anal verge is
ALL INDIA 2004 Abdominoperineal resection.
Significant risk factors for colonic carcinoma in an
Biopsy from a mole on foot shows cytologic atypia
C
C
adenomatous polyp are
of melanocytes and diffuse epidermal infiltration
by anaplastic cells, also present in the papillary and Villous histology size > 2 cm and atypia.
reticular dermis C A 50 years old male patient presents with painless
Melanoma Clark level IV terminal hematuria. Cystoscopic examination
revealed a solitary papillary tumor. Histopatho-
C Chronically lymphadenopathy limb is predisposed
logy of completely resected tumor is suggestive of
to
grade III transitional cell carcinoma with no muscle
Thickening of the skin, recurrent soft tissue infec-
invasion. Management
tions and sarcoma.
Intravesical BCG
C Initial treatment of rupture of varicose veins at the
C Unilateral undescended testis ideally operated
ankle should be
around
Direct pressure and elevation.
6 months
A 20 years old man suffering from pulmonary TB
Important causes of hyponatremia
C
C
presents with massive recurrent hemoptysis—
Gastric fistula, excessive vomiting and prolonged.
Vascular structure first evaluated for angiographic
Ryle’s tube aspiration.
treatment is
C Preservative used while packing catgut suture
Bronchial artery
Isopropyl alcohol
C CECT chest of an elderly male with carcinoma right
C Indication of radiotherapy in pleomorphic adenoma
lung shows a tumor of 5 × 5 cm in upper lobe and
of parotid
3 × 3 cm in middle lobe. Primary treatment
Second histological benign recurrence.
Surgery
C Thoracic extension of cervical goitre is usually
ALL INDIA 2003
approached through
Neck C Most characteristic of congenital hypertrophic
C Pancreatitis, pituitary tumor and Pheochromocy- pyloric stenosis
toma may be associated with The pyloric tumor is best felt during feeding.
Medullary carcinoma thyroid. C Marjolin’s ulcer is
(Hint: MEN syndrome) Malignant ulcer found on the scar of burn.
190 AIIMS and All India PGMEE—Review Questions
C In an adult patient with pleural effusion, most C Most common tumor of salivary gland
appropriate site for pleurocentesis done by Pleomorphic adenoma.
inserting a needle in C Premalignant condition with highest probability of
7th intercostal space in mid-axillary line. progression to malignancy is
C Measurement of intravascular pressure by a Erythroplakia
pulmonary artery catheter should be done C An edentulous old man develops squamous cell
At end expiration. carcinoma in buccal mucosa that has infiltrated to
C A 24 years old man falls on the ground when struck the alveolus. Following may be indicated in
in the right temple by a base ball. On way to treatment
hospital, lapses into coma. He is unresponsive with Radiotherapy, segmental mandibulectomy and
dilated right pupil at hospital emergency. Most marginal mandibulectomy involving removal of
important step in initial management upper half of mandible.
Cranitomy C Cork screw esophagus is seen in
C A 75 years old woman presents with post-myocardial Diffuse esophageal spasm.(Mn: CD)
infaction after 6 weeks with mild CHF. There is past C Achalasia cardia treatment associated with high
history of neck surgery for parathyroid adenoma rate of recurrence
5 years ago. EKG showing slow atrial fibrillation. Botulinum toxin
Serum Ca2+ 13 mg/dl and urinary Ca2+ 300 mg/24 h. C Barrett’s esophagus is
On examination-small mass in the paratracheal Lower esophagus lined by columner epithelium.
position behind the right clavicle. Appropriate C The adenocarcinoma of esophagus developed in
management
Barrett’s esophagus.
Ultrasound guided alcohol injection of the mass.
C The lowest recurrence of peptic ulcer is associated
C Feature of de Quervain’s disease with
Increased ESR, tends to regress spontaneously and Vagotomy + antrectomy.
painful and associated with enlargement of
C Risk factor for development of gastric carcinoma
thyroid.
Intestinal metaplasia III.
C A 35 years old woman with recurrent episodes of
headache and sweating, on examination-thyroid C Early gastric cancer indicates
nodule and ipsilateral large cervical lymph node Involvement of mucosa, submucosa with/without
and family history of renal calculi and thyroid lymph node.
cancer to mother. Investigations necessary before C Site of obstruction in gastric outlet obstruction in a
thyroid surgery peptic ulcer patient
Estimation of urinary metanephrines, VMA and Duodenum
catecholamines (Mn: CMV). (Hint: Misnomer).
C Associated with thyroid storm C The most suitable route for protein and calorie
Surgery for thyrotoxicosis, stressful illness in administration in a patient in coma for last 15 days
thyrotoxicosis and I131 therapy for thyrotoxicosis. following RTA
C Needle biopsy of solitary thyroid nodule in a young Jejunostomy tube feeding
woman with palpable cervical lymph node on the C An infant presents with acute intestinal obstruction,
same side demonstrating amyloid in stroma. contrast enema showing intussceptions. Likely
Diagnosis is cause is
Medullary carcinoma of thyroid. Payer’s patch hypertrophy.
C Treatment of choice of 25 years old woman C A patient develops single liver metastasis of 2 cm
presenting with palpable thyroid nodule, ipsilateral after undergoing operation for carcinoma colon.
palpable cervical lymph node and needle biopsy Next done
demonstrating amyloid in stroma Resection
Total thyroidectomy and modified radical neck C Sentinel lymph node is important in
dissection on the side of enlarged lymph node. Breast carcinoma
192 AIIMS and All India PGMEE—Review Questions
13
193
194 AIIMS and All India PGMEE—Review Questions
C A young lady presents with nausea and vomiting. C Fistula test is conducted in a woman who underwent
She is 6 weeks amenorrhea and urine test for hysterectomy for carcinoma cervix by introducing
pregnancy is positive. BP is 100/60 and heart rate is a catheter into the bladder through the urethra and
120/min. USG shows adnexa of size 5 × 5 cm. Next vaginal cavity is packed with 3 sterile swabs. Dye is
best done injected and it is noticed that dye stains uppermost
Laparoscopy immediately swab. Most likely diagnosis
C A woman presents with bilateral ovarian mass with Ureteovaginal fistula
smooth surface. On histopathology, mucin secreting C A woman presents with BP–100/60, pulse–120/
cells are found with signet ring appearance min, 6 week amenorrhea, urinary pregnancy test
Krukenberg tumor positive. Next done
C Dose of dexamethasone given for fetal lung maturity Laparoscopy.
6 mg, 4 dose, 12 hours apart (Note: Suspected ruptured ectopic pregnancy)
C Dose of carbetocin in PPH C Level of proteinuria to diagnose severe pre-eclampsia
100 μg IV 2000 mg
(Note: Carbetocin is the long acting analogue oxytocin (Note: Old diagnostic criteria. According to new
introduced recently for prevention of uterine atony diagnostic criteria, proteinuria is not needed for
after cesarean section and to control PPH.) diagnosis of severe pre-eclampsia)
C A 10 years old girl presents with huge mobile mass C A 32 years old lady presents 4 days after unprotected
in pelvis that is present in hypogastric region also. sexual intercourse. Contraceptive advised
On examination, doctor is unable to insinuate the Copper IUCD
fingers between mass and pelvis. Most likely
diagnosis in her case is
Ovarian mass AIIMS NOVEMBER 2014
C Galactorrhea-amenorrhea syndrome-hormone that C A woman with antiphospholipid syndrome should
is tested in addition to prolactin is be treated with to prevent miscarriage
TSH. Aspirin and low dose heparin.
C A 16 years old girl, who plays football daily, presents C Expected date of delivery is arbitrary. True about
with primary amenorrhea and was treated with EDD
OCP in the past. On examination she has breast Less than 5% of woman deliver on the exact date
Tanner stage 5 and pubic hair Tanner stage 1. She which is 40 weeks of gestation, 50% of females
may have deliver within 1 week of EDD and 80% of females
Androgen insensitivity syndrome. deliver within 2 weeks of EDD.
C Two hour oral glucose tolerance test is done in a C True about augmentation of labor
pregnant woman. What are the cut off values Amniotomy enhances the progress of labor in the
Fasting 95 mg/dl, 1 hour 180 mg/dl and 2 hours 155 first stage and negates the need for oxytocin
mg/dl. administration, there is no increased risk of
C Drugs given in PCOS unfavourable maternal and neonatal adverse
OCP, metformin and clomiphene outcomes and intermittent auscultation is equivalent
C Dose of folic acid in a lady for prevention of neural to continuous electrical fetal monitoring when done
tube defects in subsequent babies when she has in a 1:1 doctor/nurse to patient ratio.
history of a baby with neural tube defects C Elective cesarean section even at term can lead to an
4000 μg increased incidence of medical complications and
C A lady presents with history of recurrent abortions adverse outcomes. The universal recommendation
(5 times) around 14–18 weeks. Investigations done for elective C.S. is at how many weeks
in current pregnancy are 39
Fetal karyotyping, anticardiolipin antibody and C Methods of abdominal tubal ligation
lupus anticoagulant. Irwing’s method, Pomeroy technique and Parkland
(Note: Syphilis does not cause recurrent abortion.) method.
Obstetrics and Gynecology 195
C If lifestyle factors are identified, the changes leading C Basis for sex chromatin testing
to improved chances of fertility are Barr body
Lose weight, gain weight and less or more exer- C Hysteroscopic myomectomy scores over open
cise. myomectomty in the following except
C A 40 years old male patient presents with primary Less bleeding
infertility, testes normal in shape but vas not
palpable, semen analysis showing azoospermia, AIIMS NOVEMBER 2013
low volume, low pH, high viscosity and high
liquefaction time. Most likely diagnosis C Seen in pregnancy with heart disease but not in
CFTR mutation. normal pregnancy
C Normal stature with minimal or absent pubertal Distended neck veins.
development is seen in C Complications more common in ventouse delivery
Kallmann syndrome than forceps
C First line treatment in the management of a 13 years Subgaleal hemorrhage, cephalohematoma and
old girl with abnormal uterine bleeding (anovulatory) intracranial hemorrhage.
are C Risk factors of cervical cancer
Mefenamic acid, tranexamic acid and estrogen + Multiple partners, early sexual partners and
progesterone pill. smoking.
C A 12 years old girl presents with history of child C Fertilized ovum reaches the uterine cavity by
abuse. She is bleeding profusely from the genitalia, 4–5 days
with severe perineal injuries and fractured pelvis. C A 16 years old girl presents with primary amenorr-
The most appropriate management hea, hirsutism, irregular bleeding and infertility
Urgent blood transfusion. and diagnosed as PCOS. Drugs that can be given
C The screening tests for breast and genital cancer in Spironolactone, OCPs and clomiphene citrate.
females include C Maximum cardic output seen in which week of
CA 125 for ovarian cancer, pap smear for cervical pregnancy among the following
smear and mammography for breast cancer. 32 weeks > 28 weeks.
C A pregnant woman presents with bleeding per
vaginum at 20 weeks of pregnancy. On examination
AIIMS MAY 2014 the os is open but no product has come out. Most
C Following indicate superimposed pre-eclampsia in likely diagnosis
a pregnant female of chronic hypertension Inevitable abortion.
New onset proteinuria, platelet count < 75,000 and C A 26 years old lady got pregnant for the first time,
fresh retinal hypertensive changes. LSCS was done for fetal distress. During preg-
C Antihypertensive drug not to be given in pregnancy nancy, mild headache was reported. 2 days after
Enalapril delivery, she presents with headache and seizure
but proteinuria is absent. CT scan is done and
C Administered in acute hypertension during labor
shows 2 × 3 cm parasagittal hematoma. Most likely
IV labetalol, IV nitroprusside and IV hydralazine. diagnosis
C Part of HELLP syndrome Sagittal sinus thrombosis.
Hemolysis, elevated liver enzymes and thrombocy- C If untreated, percentage of mother to child
topenia. transmission of HIV during delivery without
C Indications for elective cesarean section in a patient intervention in a non-breastfed child is
with past history of ceserean section 15–30%
Breech, macrosomia and post-term. C Radiation dose for early and locally advanced
C Responsible for pubertal growth in females cancer cervix at point A during brachytherapy
Pulsatile release of GnRH during sleep. 80–85 gray and 85–90 gray.
196 AIIMS and All India PGMEE—Review Questions
C True about latent phase of labor C Following constitutes the active management of
According to ACOG, it starts after 3–4 cm cervical third stage of labor for the prevention of post-
dilatation but they are planning to increase it to partum hemorrhage
5 cm, begins at the end of active phase and is a part Direct injection of oxytocin when the baby’s
of 1st stage of labor and starts with contraction of shoulders are delivered, constant controlled cord
labor. traction and misoprost.
C A 16 years old girl presents with primary amenorrhea C Perinatal transmission of HIV can be prevented by
and raised FSH level. Her height is 58 inches. Histo- Zidovudine administration to both the mother and
pathology of ovary shows baby, avoidance of breastfeeding and administra-
Absence of oocytes in the ovaries (streak ovaries). tion of vitamin A.
C Most accurate and safest method to diagnose viable C A young girl presents with short stature, widely
pregnancy at 6 weeks spaced nipples and amenorrhea. Genetic constitution
USG for fetal cardiac activity. 45 XO
C Most common site of primary for intraocular (Note: Turner syndrome)
metastasis is from
C The most accurate and safe method to diagnose
Breast
viable pregnancy at 6 weeks of gestation is
C Correct order of lochia
Ultrasound visualization of fetal cardiac activity.
Rubra, serosa and alba.
C True about fetal breathing in utero
C Tests used for screening of cancers in females-CA-
125- ovarian cancer, mammography Increases risk of amniotic fluid aspiration, causes
Breast cancer and pap smear-cervical cancer. conditioning of respiratory muscles and has a
higher risk of respiratory distress syndrome.
C Type of abnormality in sexual development with
best prognosis among the following C A 30 years old woman from poor background from
Congenital adrenal hyperplasia. hilly area presents with complaints of frequency,
dysuria, hematuria, loss of appetite, mild fever and
amenorrhea. The most likely cause
AIIMS MAY 2013
Genitourinary tuberculosis.
C True regarding time of ovulation
It occurs after ripening of follicles by FSH. AIIMS NOVEMBER 2012
C Patient develops shock just after a normal delivery.
C Feature seen in pregnancy with heart disease which
Most probable cause
is not seen in normal pregnancy
Uterine inversion
Distended neck veins.
C The test used to differentiate between maternal and
fetal blood in a given sample is C A 36 years old multigravida at 34 weeks, with
previous 2 normal vaginal delivery now presented
Apt test
with unstable lie. The most likely diagnosis in this
C A 19 years old patient presents with primary case is
amenorrhea, well developed breast and pubic hair
Placenta previa
but absence of vagina and on USG her uterus was
absent. Diagnosis C A young lady presents with complaints of copious
vaginal discharge, but there is no cervical discharge on
Müllerian agenesis
per speculum examination. Drugs for the treatment
C HRT can be used to provide benefit in post-
menopausal females for all of the conditions except Metronidazole and fluconazole.
Cardiovascular disease C Shock index (HR/SBP) is used to know the severity
C True about Duncan’s method of placental separation of the bleeding in cases of hemorrhage. Value most
indicative for significant PPH
There is peripheral separation of placenta, maternal
surface of placenta presents at the vulva and blood 0.9–1.1
collects between the placenta and fetal membranes C Treatment of carcinoma cervix stage 3b include
and escapes from the vagina. Concurrent chemoradiation.
Obstetrics and Gynecology 197
Eclampsia, HELLP syndrome and renal failure. C Ideal contraceptive for a couple living in different
C Oral glucose tolerance test is performed to diagnose cities meeting occasionaly
gestational diabetes mellitus in cases of Barrier method
Congenital anomalies in fetus, polyhydramnios C A 36 weeks pregnant diabetic female with NST non-
and unexplained fetal loss. reactive Next done
C True for an elective forcep delivery Proceed to biophysical profile.
The fetal head should be at station ‘0’. C Drug used in pregnancy
Prophylthiouracil
AIIMS MAY 2011
AIIMS NOVEMBER 2010
C Seen in ovulatory phase
Stimulation of continuation of reduction division of C Treatment of carcinoma cervix III-B include
oocytes. Intracavitatory brachytherapy followed by external
C True about prolactinoma in pregnancy beam radiotherapy.
Most common pituitary tumor but rarely sympto- C Risk factors for vaginal candidiasis are
matic, regular visual check up and macroadenoma DM, HIV and pregnancy.
> 1 cm associated with bad prognosis. C The regimen used for expectant management of
C Best treatment for a 30 years old woman presenting placenta previa
with hypertension and menorrhagia Mac Afee and Johnson regimen.
MIRENA (LNG IUCD) C Sugar present normally in the urine of a pregnant
C Diagnosis of 35 years old woman presenting with woman in the third trimester
primary infertility and palpable pelvic mass, Ca- Glucose
125 level-90 u/ml diagnosis is C Classification for abruptio placenta
Endometrioma Pages and Sher classification.
C Ideal contraceptive for lactating mothers C Best regimen for eclampsia
Lactational amenorrhoea. MgSO4.
Test for ovarian reserve
Seen in corpus cancer syndrome
C
C
FSH
HTN, Obesity and DM, (Mn: HOD).
C True about clomiphene citrate
C Endometrial cancer involving 50% of endome-
Enclomiphere is antiestrogenic.
trium, extending to vagina, lymph nodes negative
C Seen in gestational diabetes with positive peritoneal cytology. Stage
Previous macrosomic baby, obesity and polyhy-
3b
dramnios.
A 30 years old mother has a boy with Down’s
Vaginal delivery can be allowed in
C
C
syndrome from previous pregnancy. She is now
Mentoanterior, extended breech and dichorionic
9 weeks pregnant. What would you advise to
twins with first vertex and second breech.
her
C Pregnant lady acquires chickenpox 3 days prior to
Chorionic villous biopsy at this stage will confirm
delivery. She delivers by normal vaginal route. True is
presence or absence of Down’s syndrome.
Baby will develop neonatal varicella syndrome.
C A 30 years old pregnant mother presents with C A 20 years old patient presents with primary
obstructed labor, febrile, dehydrated with IUFD amenorrhoea, well developed breasts and pubic
and cephalic presentation. Best management option hair, but absence of vagina and uterus. Diagnosis
Caesarean section. Müllerian agenesis
C Antiphospholipid antibody syndrome is associated C Test differentiating maternal and fetal blood cells
with Apt test
Antibody to lupus, recurrent abortion and venons C A 20 years old average weight girl presents with
thrombosis. oligomenorrhoea, facial hair, raised free testosterone
C Ideal contraceptive for newly married couple levels, USG- ovary normal. Diagnosis
Combined OCP. Adrenal hyperplasia.
Obstetrics and Gynecology 199
C Parameters in the Manning scoring system of C The most important indication for surgical repair of
biophysical profile for fetal monitoring are a bicornuate uterus is
Fetal tone, fetal gross body movements and Habitual abortion
nonstress test C Treatment recommended to reduce the hereditary
C A 27 years old primigravida presents with PIH with risk for ovarian cancer in woman with BRCA I and
BP 150/100 mm Hg at 32 weeks of gestation with no BRCA II mutation
other complication. If BP is controlled on treatment Prophylactic oophorectomy
and no other complication developed, pregnancy C Antihypertensive safe in pregnancy
should be best terminated at
α methyldopa, amlodipine and clonidine.
37 completed weeks
C A 13 years old girl presents with acute pain in the
lower abdomen with history of cycical pain for last AIIMS MAY 2005
6 months and not attaining menarche yet. On local C Biochemical markers of triple tests are
genital examination, a tense bulge in the region of β hCG, unconjugated estriol and AFP.
hymen was seen. Diagnosis C Causes of DIC during pregnancy
Imperforate hymen Abruptio placenta, amniotic fluid embolism and
C The shortest diameter in fetal head Intrauterine death.
Bitemporal diameter C At 28 weeks gestation, amniocentesis reveals a delta
C Embryo implantation occurs after how many days OD of 0.20 that is at the top of third zone of liley
of ovulation curve. The most appropriate management
7–9 days Repeat amniocentesis after 1 week.
C hCG is secreted by C Characteristics of an ideal candidate for copper-T
Trophoblast cells insertion includes
C Appropriate material for antenatal diagnosis of Has normal menstrual periods, has borne at least
genetic disorders includes one child and is willing to check IUD tail.
Fetal blood, amniotic fluid and chorionic villi. C During laparoscopy the preferred site for obtaining
C Estrogen administration in a menopausal woman cultures in a patient with acute PID is
increases the Fallopian tubes
Bone mass C Absolute contraindication of OCP in a young
C The sensitivity of uterine masculature is female of reproductive age group
Enhanced by estrogen and inhibited by progeste- Impaired liver function
rone. (Mn: e for e). C In a young female of reproductive age with regular
C In those mammals, seasonal breader, females are cycles of 28 days, ovulation occurs around 14th day
receptive only once a year. The cycle is of cycle. First polar body is extruded
Estrous Accompanied by ovulation.
C In the perspective of the busy life schedule in the
AIIMS NOVEMBER 2005 modern society, the accepted minimum period of
sexual cohabitation resulting in no offspring for a
C Markers for malignant germ cell tumors of ovary couple to be declared infertile is
AFP, β-hCG and LDH. One year
C Highest level of MSAFP is found in C The best time to do chorionic villous sampling
Gastroschisis 11–13 weeks
C Measurement of fetal maturity not affected by a C Indications for postoperative radiotherapy in
bloody tap during amniocentesis carcinoma endometrium
Phosphatidylglycerol Endocervical involvement, myometrial invasion
C DOC of typhoid fever in pregnancy of more than half thickness and positive lymph
Ceftriaxone nodes.
Obstetrics and Gynecology 203
C Most common cause of breech presentation C A 20 years old woman presents with BP 70/40 mm
Prematurity Hg, PR 120/min and positive urine pregnancy test.
C According to WHO criterian, minimum normal Managed by
sperm count Immediate laparotomy
15 millions/ml (Hint: Ruptured ectopic pregnancy).
(Note: According to WHO 2010 criteria) C The production of cervical mucus is stimulated by
C Known side effects of tocolytic therapy Estradiol
Hypotension, hyperglycemia and tachycardia. C Risk factors for postoperative infection after hyste-
C Drugs used for medical abortion rectomy
Mifepristone, misoprostol and methotrexate. Surgery for malignancy, urinary catheterization > 7
C True about ventouse (Vaccum extractor) days and use of blood transfusion.
Minor scalp abrasions and subgaleal hematomas in C Investigation required in a case of recurrent
newborn are more frequent than forceps. spontaneous abortion
C A 20 years old primigravida presents with painless Thyroid function tests, hysteroscopy and tests for
APH at 38 weeks of gestation. O/E-uterus soft and APLA.
non-tender, head engaged. Appropriate management C High risk factors for development of choriocarci-
is noma in a case of vesicular mole
Pelvic examination in OT Serum hCG levels> 100000 miu/ml, features of
C The most common cause of occipitoposterior thyrotoxicosis and presence of bilateral theca lutin
position of fetal head during labor cysts of ovary.
Android pelvis
C Most common congenital anomaly seen in preg-
nancy with DM is AIIMS MAY 2002
Neural tube defects C A pregnant lady develops chickenpox. Highest
C A drop in fetal heart rate typically lasting less than chance of neonatal infection is in
2 minutes and usually associated with umbilical Last 5 days
cord compression is called C Twin discordance is defined as difference in two
Variable declaration twins
C Renal disorder associated with worst pregnancy 25% with the larger twin as index.
outcome
C CVS done before 10 weeks may result in
Scleroderma
C A perimenopausal woman with well differentiated Oromandibular limb defects.
adenocarcinoma of uterus has more than half of C True about red degeneration of fibroid
myometrial invasion, vaginal metastasis and Occurs commonly during pregnancy, due to
inguinal lymph nodes metastasis. Staging is interference with blood supply and treated with
IV B analgesics.
C A woman has 2 children and presents with galac-
AIIMS NOVEMBER 2002 torrhoea and amenorrhoea for 1 year. Diagnosis
C Use of LNG releasing IUCD in helpful/preventive in Sheehan’s syndrome.
Dysmenorrhoea, menorrhagia and PID. C Pap smear is useful in diagnosis of
C Use of OCP are known to protect against HPV, inflammatory changes and Trichomonas
Ovarian carcinoma, endometrial carcinoma and vaginalis.
uterine sarcoma. C A woman presenting with 2nd stage of labor with
C Best parameter for fetal age estimation by USG in PV finding is anterior fontanelle and supraorbital
third trimester is ridge felt. The presentation is
Femur length Brow presentation.
C Most common causes of VVF in India is C Used as post coital contraception
Obstructed labor. Danazol, ethinyl estradiol and LNG.
Obstetrics and Gynecology 205
C Sterilization procedure with maximum chance of C A 55 years old female patient presents with
reversal abdominal pain, distension, ascites and dyspnea,
Laparoscopic tubal ligation with clips. CA 125 levels elevated. Diagnosis
C Used in treament of PPH Carcinoma ovary
Misoprostol, carboprost and methyl ergometrine. C True about mother to child transmission of HIV
C Estrogen replacement for postmenopausal sympton Risk of infection decreases if elective caesarean
causes an increase in section is done, HIV may be transmitted to fetus
Triglycerides during gestation and risk of infection in fetus
increases as duration of infection in mother
C Danazol is used in treatment of
increases.
Cyclical mastalgia
C A pregnant mother presents with fever, Hb 7
C Acetic acid staining of cervix shows
gm%, TLC normal, platelet decreased and frag-
Squamous meteplasia, cervical carcinoma in situ
mented RBC (shistocytes). Differential diagnosis
and cervical dysplasia.
are
(Note: Acetic acid staining is done in colposcopsy).
DIC, TTP and HELLP syndrome.
C Associated with gynaecomastia
ALL INDIA 2012
Estrogen secreting tumor, hCG secreting tumor and
C Seen in a normal pregnancy TSH secreting adenoma.
Increase in blood volume, increase in cardiac C True about twins delivery with preterm labor
output and increase in heart rate. Second has more chance of polycythemia.
C A woman has just given birth to a normal baby. The C True about GFR in pre- eclampsia
most appropriate time for starting Kegel’s exercises is It decreases
She should have started in 3rd trimester itself.
IUCD not requiring to be changed after 3–5 years is
ALL INDIA 2011
C
CuT 380A.
(Note: 10 years) C Factors leading to weight gain in pregnancy
C True about HBsAg positive pregnant woman- Ethnicity, pre-pregnancy weight and socio-
HBsAg Ig should be given to baby within 12 economic status.
hours. C Congenital malformation of fetus diagnosed
C A young male patient presents with delayed earliest in a first trimester ultrasound
puberty with decreased LH, FSH and testosterone. Anencephaly
Differential diagnosis are C Most specific marker for neural tube defects
Kallman syndrome, constitutional delay and Dax 1 Acetylcholinesterase
gene defect. C Gold standard test for assessing β-hCG in maternal
C Pregnant woman G3P1A1 on full term pregnancy serum
presents. On examination- Uterine contractions 2 Radioimmunoassay
per 10 minutes, lasting 30–35 seconds, cervix 4 cm C Included in expectant management of placenta
dilated, membranes intact and 3/5th of head previa
palpable per abdomen. On repeat examinations 4 Blood transfusion, corticosteroids and anti-D
hours later, cervix 5 cm dilated and cervicograph administration.
remain to the right of alert line. True is C A lady presents at 37 weeks of gestation with
On repeat examination, her cervicograph should uterine contraction and pain suggestive of labor for
have touched the action line. 10 hrs. O/E-cervix is persistently 1 cm dilated and
C LH surge occurs due to uneffaced. Next line of treatment
Markedly increased estrogen level. Sedation and wait
C Germ cell tumor of the ovary are C Maneuvers used in shoulder dystocia
Choriocarcinoma, dysgerminoma and endodermal Macroberts maneuver, suprapubic pressure and
sinus tumor. woods corkscrew maneuver.
206 AIIMS and All India PGMEE—Review Questions
C Treatment showing best treatment for premens- C Dietary supplement recommended for a pregnant
trual syndrome lady on Heparin
SSRI Calcium
C TOC of a fluctuant non-tender swelling of the C True about breast infection during lactation
introitus of a woman is Can lead to abscess formation for which I and D
Marsupialisation may be required.
(Hint: Bartholin’s cyst). C Congenital infection associated with minimal
C Salpingitis or endosalpingitis is best confirmed by teratogenic risk to the fetus is
Hysteroscopy + laparoscopy HIV
C True about androgen insensitivity syndrome C A pregnant mother presents with history of
XY genotype, short vagina present and absent delivery of a previous child with CAH. The best
ovaries. management protocol for current pregnancy is
C Virus associated with cervical Ca-HPV. To start dexamethasone as soon as pregnancy is
C True about squamous cell carcinoma of cervix confirmed.
Common at squamocolumnar junction, post coital
bleeding is a common symptom and HPV 16 and 18 ALL INDIA 2007
are associated with high risk of carcinogenesis. C Shape of Nulli parous cervix is
C Ideal treatment for 55 years old woman with simple Circular
hyperplasia of endometrium with atypia C Fibroid uterus may present with
Simple hysterectomy Pelvic mass, infertility and polymenorrhoea.
C Condition diagnosed by chorionic villous biopsy C Most common gestational trophoblastic disease
Down’s syndrome, phenylketonuria and sickle cell following hydatidiform mole is
anemia. Invasive mole
C True regarding Doppler studies of the umbilical C Most common ovarian cyst to undergo torsion is
circulation Bengin cystic teratoma
Maternal smoking leads to increase in S/D ratio, C Non-contraceptive benefits of OCP seen in
normal pregnancy shows a characteristic decrease RA, endometriosis and endometrial carcinoma.
in S/D ratio with advancing gestational age and C True about IUD
changes in flow velocity wave forms of the
LNG releasing IUD has effective life of 5 years, IUD
umbilical artery may be important in clinical
can be used for emergency contraception within
management of high risk pregnancies.
5 days and the pregnancy rate of lippes loop and
C Known causes of recurrent abortions are CuT 200 are similar.
SLE, Rh incompatability and syphilis.
C IUCD with life span of 10 years
Induction at term is indicated in
CuT 380A
C
HTN, DM and renal disease
C An antihormonal substance used to induce
C Contraindication of vaginal delivery after previous ovulation
CS
Clomiphene citrate
Previous classical CS, no vaginal delivery in the
C Aspiration of sperms from testis done in
past and puerperal infection in previous pregnancy.
TESA
C Risk factors for placenta accreta includes
Maximum cardiac output during pregnancy is seen
Previous LSCS scar, previous curettage and previous
C
in
myomectomy.
C Tocolytic agents are Immediate postpartum period
Salbutamol, isoxsuprine and ritodrine. C Dexamethasone injection is given in a lady of 32
C Drugs useful in management of PPH weeks pregnancy to prevent
Ergometrine, misoprostol and oxytocin. RDS
C DOC for severe pre-eclampsia C Bishops score includes
Labetalol Dilatation, effacement and station of presenting part.
Obstetrics and Gynecology 209
C On TVS, shape of cervix indicating imminent C Most common cause of tubal block in India
preterm labor Tuberculosis
U C MOA of OCP are
C Doppler finding in IUGR associated with worst Inhibition of ovulation, prevention of fertilization
prognosis and interference with implantation of fertilized
Reversal of diastolic flow ovum.
C External cephalic version is C/I in C True about LNG releasing intrauterine system
PIH Can be used as hormone replacement therapy,
C Caudal regression syndrome is seen in babies of useful for treatment of endometrial hyperplasia
mothers having and irregular uterine bleeding can be problem
Gestational diabetes initially.
C Large baby is born. Likely complication in preg- C Mechanisms accounting for reduced risk of upper
nancy associated with it is genital fact infections in users of progestin releasing
Gestational diabetes IUDs
C Hypothyroidism in pregnancy is associated with Reduced retrograde menstruation, thickened cervical
PIH, prematurity and recurrent abortions. mucus and decidual changes in the endometrium.
C Antiepileptic associated with congenital malforma- C Emergency contraception prevents pregnancy by
tion when used in pregnant woman are Inhibition of ovulation, prevention of fertilization
Phenytion, carbamazepine and valproate. and interference with implantation of fertilized
C TOC for ovarian cyst in a postpartum period ovum.
Immediate removal C Prenatal diagnosis of 16 weeks of pregnancy can be
C Highest transmission of hepatitis B from mother to performed using
fetus occurs if the mother is infected during Amniotic fluid, chorionic villi and maternal blood.
IIIrd trimester C The best way of diagnosing Trisomy 21 during 2nd
trimester of pregnancy
ALL INDIA 2006 Amniocentesis
(Note: IOC)
C Hormone raised in PCOD
Tuberculosis flares up most commonly in a
Luteinizing hormone
C
pregnant woman in
C True about PCOD
Puerperium
Increased LH, can cause infertility and may be
associated with abnormal glucose tolerance test. C Tumors commonly known to increase in pregnancy
C Treatment for virilizing adrenal hyperplasia Pituitary adenoma, meningioma and neurofibroma.
Cortisone C Vitamin deficiency most commonly seen in a
C Among genital tract malignancy, risk of metastasis pregnant mother on phenytion therapy for epilepsy
for ovary is least in Folic acid
Carcinoma cervix. C A primigravida presents to casuality at 32 weeks
C IOC in a 55 years postmenopausal woman presenting gestation with acute pain abdomen for 2 hours,
with postmemopausal bleeding vaginal bleeding and decreased fetal movements
Fractional curettage should be managed by
C Surgery with highest incidence of ureteric injury Immediate cesarean section
Wertheim’s hysterectomy C Complications during pregnancy increasing the
C Microscopic findings in a case of bacterial vaginosis risk of PPH
in 40 years old woman presenting with complaints Hydramnios, macrosomia and twin pregnancy.
of profuse vaginal discharge but no discharge from C Indicators of impending uterine rupture during
cervix on the speculum examination are labor includes
Presence of clue cells, abundance of gram variable Fetal distress, fresh bleeding per vaginum and
coccobacilli and absence of lactobacilli. passage of meconium.
210 AIIMS and All India PGMEE—Review Questions
C Most common pure germ cell tumor of the ovary is Early onset severe pre-eclampsia, unexplained
cerebrovascular accidents and three or more
Dysgerminoma
consecutive first trimester pregnancy losses.
C In a case of dysgerminoma of ovary, tumor markers
Risk factors for UTI in pregnancy
likely to be raised
C
C A 50 years old woman presents with bilateral solid C Cut-off value of cervical length of 24 weeks of
ovarian tumors, ascites and upper GI endoscopy- gestation for prediction of preterm delivery
ulcerative growth in pyloric region of stomach. 2.5 cm
Diagnosis C Pure gonadal dysgenesis is diagnosed by presence of
Carcinoma stomach with Krukenberg’s tumor. Bilateral streak gonads
C Choice of adjuvant treatment for endometrial C Most common cause of first trimester abortion
carcinoma stage IA, grade I is Chromosomal abnormalities.
No treatment C A hypertensive pregnant woman of 34 weeks
comes with history of abdominal pain, bleeding per
vaginum, and loss of fetal movements. O/E-Uterus
ALL INDIA 2003 is contracted with increased uterine tone. FHS
C Risk factors known for development of endometrial absent. Diagnosis
carcinoma Abruptio placenta.
Use of HRT, family history and obesity. C A 20 years old woman presents with history of
C A case of GTN belongs to high risk group if disease sharp pain in the lower abdomen for 2–3 days every
develops after months approximately 2 weeks before the menses.
Full term pregnancy. Diagnosis
C A primigravida at 37 weeks of gestation reported to Mittelschmerz
labor room with central placenta previa with heavy C A 55 years old woman has recurrent urinary
bleeding per vaginum. O/E -fetal heart rate normal. retention after hysterectomy done for a huge
Best managed by fibroid. Cause
Cesarean section Injury to the hypogastric plexi.
C Hemodynamically stable nulliparous patient with C A 45 years old woman presents with bilateral
ectopic pregnancy has adnexal mass of 2.5 × 3 cm ovarian mass, ascites and omental caking on CT
and β-hCG-1500 mIu/ml. TOC scan. Diagnosis
Medical management. Malignant epithelial ovarian tumor.
C A 55 years old woman presenting with post-
ALL INDIA 2002
menopausal bleeding for 3 months has a 1 × 1 cm
nodule on the anterior lip of cervix. Next best C Character of vagina in normal pregnancy
investigation Increased number of lactobacilli.
Punch biopsy. C Associated with increased risk of thromboembolism
C Drugs used for management of PPH in normal pregnancy
Misoprostol, oxytocin and prostaglandin. Increased production of clotting factors by liver.
C Laparotomy performed in a case of ovarian tumor C Cephal-hematoma
revealed unilateral ovarian tumor with ascites Does not vary in tension with crying.
positive for malignant cells and positive pelvic C A pregnant woman developed idiopathic choles-
lymph nodes. Stage is tatic jaundice. Conditions associated
IIc Intense itching, markedly increased levels of alkaline
C Observed in normal pregnancy phosphatase and SGOT, SGPT less than 60 IU.
C A 30 years old woman presents with bilateral deep
Fall in serum iron concentration, increase in serum
vein thrombosis of legs, past history of recurrent
iron binding capacity and increase in blood oxygen
fetal loss and one attack of pulmonary embolism
carrying capacity.
and prolonged APT on coagulation testing
C B lynch suture is applied on Anti-phospholipid antibody syndrome.
Uterus. (Mn:But) C Contraindication in management during labor in a
C Pyometra is a complication associated with 20 years old pregnant woman with mitral stenosis
Carcinoma cervix, carcinoma endometrium and class II and rheumatic heart disease
pelvic radiotherapy. Methergin at delivery of anterior shoulder.
212 AIIMS and All India PGMEE—Review Questions
C Absolute contraindication for treatment of C Semen analysis of a 25 years old infertile male-
thyrotoxicosis in pregnancy of 6 months duration sperm count 12 million/ml, pH 7.5, volume 2 ml, no
I131 therapy agglutination seen. Morphology 60% normal and
C Associated with breech presentation at normal full 60% motile sperms. Diagnosis
term pregnancy Oligospermia
Fetal malformation, uterine anomaly and cornual C Sample for testing LH and FSH in a case of PCOD are
implantation of placenta. best taken on the following days of menstrual cycle
C Seen in the infant of a diabetic mother 8–10 days
Polycythemia C A 20 years old young girl presents with history of
C Always an indication of cesarean section rapidly developing hirsutism, amenorrhoea with
Untreated stage of Ib carcinoma cervix, active change in voice. Hormone tested in blood
primary genital herpes and Type IV placenta previa Testosterone
(major previa). C A 30 years old mother of two children is suffering
C True for episiotomies from amenorrhoea for last 12 months with history
Can be either midline or mediolateral, involvement of failure of lactation following 2nd delivery but
of anal sphincter is classified as 3rd, 4th degree. asymptomatic thereafter, skull X-ray showing
Perineal tear and midline episiotomies bleed less, empty sella. Diagnosis is
are easier to repair and heal more quickly. Sheehan’s syndrome
C In instrumental vaginal delivery C A 35 years old woman with children aged 5 and 6
Forceps may be used if ventouse fails. years has history of amenorrhoea and galactorrhoea.
C Karyotype of a 2 years old girl with Down’s Blood tests- Increased prolaction. The CT of head
syndrome has 21/21 translocation in karyotyping. may reveal
If father is a balanced translocation carrier, risk of Pituitary adenoma.
recurrence in subsequent pregnancies C A 45 years old woman presents with history of
100% polymenorrhoea for last 6 months. First line of
C The short retroviral regime administration in the management
peripartum period decreases the risk of vertical Oral contraceptives for 3 cycles.
transmission by C Indicated in menorrhagia
50% NSAIDS, tranexamic acid and norethisterone.
C Complete failure of Müllerian duct fusion results in C Most common genital proplapse
Uterus didelphys Cystocele
C Most common cause of female pseudohermaphro- C A 30 years old patient examined for infertility by
ditism is hysterosalpingography, reveals bead like fallopion
CAH tube and clubbing of ampulla. Most likely cause is
C A woman presents with hot flush after stopping of Mycobacterium tuberculosis.
menstruation. It can be relieved by C TOC for Chlamydial infection in a 25 years old
Ethinyl estradiol patient presenting with vaginal discharge
C Contraceptive LNG-IUD has cumulative pregnancy Azithromycin and contact tracing.
rate of 5 years of C May predispose to endometrial carcinoma
0.5 Unopposed estrogen, radiation and tamoxifen therapy.
14
Pediatrics
213
214 AIIMS and All India PGMEE—Review Questions
upper lobe and right mediastinal shift. The most hours later the baby showed hypotonia, lethargy,
likely diagnosis constricted pupils and two episodes of seizures.
Congenital lobar emphysema. The staging of HIE is
C Most likely cause of fluid discharge from umbilicus 2
on straining/crying C Asymmetric Moro’s reflex at birth is indicative of
Urachal fistula Erb’s palsy
C A newborn has not passed meconeum for the first C A very preterm baby on 30 ml/kg of enteral feeding
48 hours. Next investigation done developed sudden severe abdominal distension
Lower GI contrast study. with visible bowel loops on day 6 of life. The baby
C Ominous sign in a 10 days old newborn also showed temperature instability and lethargy.
Conjugated hyperbilirubinemia. X-ray of the abdomen showed portal venous gas.
The staging of NEC is
C A 4 years old child presents with persistent cough
following trachoesophageal fistula repair. The 2b
cough is dry, barky and occasionally associated C Babies with least risk of developing hypoglycemia-
with expiratory wheezing. The most likely diagnosis Appropriate for gestational age babies.
Tracheomalacia C The most common fungal infection in the neonates
C A 10 months old child weighing 5 kg and 68 cm in transmitted by caregiver’s hands is
height presents with cough. Her respiratory rate is Candida parapsilosis
48/min. There is no chest indrawing and grunt. C A child presents with deficient bone mineralization,
Most likely diagnosis low serum calcium, high serum phosphorus,
No pneumonia-only cough and cold. decreased urinary excretion of calcium and
phosphorus and elevated levels of alkaline
C An 8 years old child treated for nephrotic syndrome
phosphatase. The most likely diagnosis
developed diarrhea and acute kidney injury with
serum creatinine 4.5 mg/dl. His baseline creatinine Renal glomerular rickets.
was 0.9 mg/dl. Causes for elevation in serum C Bull neck is seen in severe cases of
creatinine Diphtheria
Renal vein thrombosis, furosemide induced C In a rural clinic, a 3 years old girl child who is
hypovolemia and diarrhea induced oliguria. emaciated is brought by her mother. Her Hb level
was 5 gm/dl. The girl has edema over her knees and
C Vasculitis not occurring in adults
ankles with discrete rash on her knees, ankles and
Kawasaki disease elbows. Most likely worm infested
C A 4 years old girl presents with severe headache, Hook worm
with fever and vomiting. Gram stain of the CSF
C A 10 years old child presents with edema, oliguria
showed Gram-positive rods. The most likely etiology
and frothy urine for the first time. Urine examina-
Listeria monocytogenes. tion showed +++ proteinuria, no RBC/WBC and no
casts. Serum albumin was 2.5 gm/dl and serum
AIIMS MAY 2014 creatinine was 0.5 mg/dl. The most likely diagnosis is
C A 32 weeks, 1400 gram neonate is born to a primigra- Minimal change disease
vida. The baby did not require resuscitation and C A 6 years old girl presents with fever for the past 5
showed stable vitals and shifted to NICU. Feeding days, generalized erythematous rash, strawberry
of the neonate by tongue and cervical lymphadenopathy. The most
Start IV feeding with minimal enteral feeding. likely diagnosis is
C Components of Kangaroo mother care Kawasaki disease
Skin to skin contact, exclusive breastfeeding and C Enzyme replacement therapy is available for
early discharge and follow-up. Gaucher’s disease
C A 32 weeks baby is born to a mother with eclampsia, C A child presents with albinism. He should be
who was given IV magnesium sulphate. The baby evaluated for
was resuscitated and transferred to the NICU. 12 Eye consultation
Pediatrics 215
C A 7 years old boy presents with a right sided C To establish the diagnosis of H type tracheo-
hemangioma and left sided focal seizures. The most esophageal fistula, what is required
likely diagnosis Tracheo-bronchoscopy.
Sturge Weber syndrome. C A 3 days old baby is admitted with intraventricular
C A 1.5 years old girl is brought with complaints of hemorrhage. Baby develops abdominal distension.
excessive enlargement of head, intolerance to feeds The X-ray abdomen showed pneumatosis portalis.
and severe malnourishment. MRI imaging was Stage of necrotizing enterocolitis
suggestive of a medulloblastoma causing obstruc- 2b
tive hydrocephalus. Example of irrational manage- C Children with germline retinoblastoma are more
ment likely to develop other primary malignancy
Radiotherapy 35–40 gray was given to the whole Osteosarcoma of lower limbs.
craniospinal axis. C A 4 years old girl presents with abdominal lump.
Bone scan is needed in
AIIMS NOVEMBER 2013 Neuroblastoma
C An 8 years old boy presents with increasing muscle AIIMS MAY 2013
weakness, bulky calves, muscle tightening and
serum creatine kinase levels increasing with the C Major Jones’ criteria for the diagnosis of rheumatic
age. Most likely diagnosis fever
Dystrophin deficiency Chorea, carditis and subcutaneous nodules.
(Note: Duchenne muscular dystrophy) (Note: Other major criteria are migratory polyarth-
C A 2 days old premature neonate develops GTCS. ritis and erythemia marginatum)
Investigation done to diagnose the pathology C A 2 days old neonate in the NICU develops seizures.
Next best investigation
Transcranial ultrasound.
C A pediatrician in a district hospital with specialized Transcranial ultrasound
neonatal care unit calls an ophthalmologist for C Characteristics of Rett syndrome
consultation for Increased incidence of mental retardation, seizures
A baby born at 28 weeks of gestation. and abnormal dendritic morphology in cortical
pyramidal cells.
C An Afroamerican kid of 6 years of age presented with
A case of meningomyelocele was posted for surgery.
abdominal pain, chronic hemolysis and abnormal
C
Till the patient is waiting for the surgery, covering
RBC shape on peripheral smear. Most likely cause
of the sac is protected by a gauze soaked in
Point mutation
Normal saline
(Hint: Sickle cell anemia)
C A 4 years old child presents to the emergency with
Drugs given in treatment of cyanotic spells in a
respiratory difficulty and noisy breathing. On
C
patient of TOF
examination, X-ray shows thumbs sign. The most
Phenylephrine, propranolol and sodium bicarbonate. probable diagnosis is
C Syndromes associated with uniparental disomy are Epiglottitis
Angelman’s syndrome, Prader-Willi syndrome and C A child presents with fever and sore throat, on
Russell-Silver syndrome. examination-respiratory rate was 36/min, tempe-
C A newborn has frothing of mouth. Cyanosis is rature 39°C, saturation on pulse oximetry 96%. The
present on day one. Most likely diagnosis child had barking cough and stridor only on crying.
Esophageal atresia Otherwise, the child was hydrated, able to drink
C A 6 weeks old baby presents with cough and cold and consolable. Next step
for the last 3 days, RR is 48/min, febrile, wheezing Single dose dexamethasone.
but no chest retraction. True statements are C A 6 years old child with steroid dependent nephrotic
Treat wheeze, treat fever and antibiotics not required. syndrome has developed corticosteroid toxicity
C Efficacy of phototherapy is affected by and posterior subscapular cataracts. Best alterna-
Type of light used, spectral irradiation by incident tive for the treatment
light and initial concentration of bilirubin. Levamisole
216 AIIMS and All India PGMEE—Review Questions
C A slow growing highly vascular tumor in adults C A pre-term 32 weeks newborn baby with respira-
affecting cerebellum, brain stem and spinal cord tory rate of 86/min, with grunting. On examination
Hemangioblastoma No nasal flaring, chest behind in movement than
C A 3 years old child has hepatosplenomegaly, on abdomen, minimal intercostal retraction and no
examination of the bone marrow, large cells are xiphisternal retraction. The Silverman score for the
seen with crumpled paper appearance. Which of neonate-4.
the following must have accumulated in these cells C A child presents with seizure, oval hypopigmented,
Glucocerebrosidose macules on the trunk and sub-normal IQ. Diagnosis is
C Following suggest a developmental delay in Tuberous sclerosis
milestones C A child presents with seborrheic dermatitis, sinusitis
Absence of pincer grasp at 9 months, not climbing and chronically draining ears. On examination
stairs up and down at 2 ½ years and not able to sit at child has failure to thrive, hepatosplenomegaly and
9 months. exophthalmos. Diagnosis is
C Babies can breathe while suckling due to Histiocytosis X
Higher position of larynx. C In a child CSF examination is not used in the
C A 2 years old boy presents with a lump in right diagnosis of
side of the abdomen. Ultrasound showed it to be Hodgkin’s lymphoma.
solid mass. On examination, his right arm and leg C The developmental age of a child who knows her
were found to be longer. The most likely diagnosis full name and gender, can eat without spilling and
is can dress herself without supervision is
Wilm’s tumor 4 years
C Most common organism causing neonatal sepsis C Most common organism causing neonatal sepsis
Klebsiella Klebsiella
AIIMS NOVEMBER 2011 C A 5 years old tall boy present with pubic hair
development, increased pigmentation of genitalia,
C NESTROFT test is a screening test for phallic enlargement and BP 130/90 mm Hg.
β thalassemia Measurement of hormone diagnostic is
C A 5 years old male child presenting with episodic Increased 11 deoxycorticol
anemia and jaundice since birth. Differential C Feature of juvenile idiopathic arthritis
diagnosis includes Rheumatoid nodule, uveitis and spikes of high
G6PD deficiency, PNH, hereditary spherocytosis. fever (Mn: FUN).
C True about newborn assessment C A 4 weeks old female child presents with severe dehy-
APGAR at 1 minute indicates respiratory resusci- dration, hyperkalemia, hyponatremia and normal
tation, fetus can rapidly washout CO 2 through genitalia. Measurement of hormone diagnostic
placenta and anaerobic metabolism causes acidosis.
Aldosterone
C Diagnosis of a 5 years old child presenting with peri-
C Hypoplasia of limbs and scarring is caused due to
vascular IgA deposition, neutrophilic collection,
Varicella
erythematous rash on the lower limbs and non-
blanching purpura is C A pregnant lady (non-compliant to spiramycin)
HSP had no other complaints than mild cervical lympha-
denopathy in first trimester. Child was born with
C Condition worsened by prostaglandin E infusion
hydrocephalus and intracerebral calcification
Obstructed TAPVC
Toxoplasmosis
C A 3.5 kg male infant born at term after uncomplica-
AIIMS MAY 2011
ted pregnancy and delivery developed respiratory
C True about a variant of dent disease in a male child distress shortly after birth and requires mechanical
with Fanconi syndrome with nephrocalcinosis ventilation. Chest-X-ray-normal cardiac silhouette
Hypercalciuria, proteinuria and rickets. but diffuse ground glass appearance to the lung
C Most common microorganisms associated with fields. Surfactant therapy fails and hypoxemia
cystic fibrosis worsens. Routine culture and echo finding are
Pseudomonas aeruginosa (non-mucoid). negative. Similar history in a term female sibling
C True about cystic fibrosis dying at 1 month of age. Diagnosis
AR, mutation in cystic fibrosis transport regulator Neonatal pulmonary alveolar proteinosis.
C A child presents with steroid resistant nephrotic C A child presents with respiratory distress, failure to
syndrome secondary to FSGS, not responsive to thrive, sweat chloride levels 35 and 40 mEq/L. Next
methylprednisolone. Next given best test for diagnosis of cystic fibrosis
Oral cyclosporine Nasal transmembrane potential difference.
C A previously healthy 6 weeks old female is found C True regarding a study under Australian collabo-
unresponsive in her crib. On examination- well rative trial on steroids use in neonates
developed and well nourished with normal blood Corticosteriods to children caused behavioural
pressure and appearance of the genitalia but with worsening.
increased pigmentation of her skin. Blood glucose C Prognostic factors in international prognostic index
level is 30 mg/dl. Diagnosis for lymphomas
Familial glucocorticoid deficiency. LDH, number of extra-lymphatic sites involved and
C Diagnosis of a 2 months old infant presenting with stage of disease
failure to thrive, recurrent emesis, hepatospleno- C A neonate discharged 2 days back healthy
megaly, adrenal insufficiency and adrenal calcifi- presented with severe respiratory distress and
cation noted radiologically shock on 7 days of life. Diagnosis
Wolman’s disease Hypoplastic left heart syndrome.
C True about congenital rubella C Ductus dependent blood flow is required in
IgG persists for more than 6 months, IgM antibody congental heart diseases
present at birth and most common anomalies are Hypoplastic left heart syndrome, pulmonary
hearing and cardiac defects. stenosis and TGA with intact ventricular septum.
218 AIIMS and All India PGMEE—Review Questions
C Diagnosis of a 3 years old boy with normal develop- AIIMS NOVEMBER 2005
mental milestones with delayed speech and
difficulty in communication and concentration and C Recurrent respiratory tract infections may occur
not making friends also in
Autism TGA, VSD and total anomalous venous return.
C Most common cause of renal artery stenosis in C A female child has recently learned to eat with
children in India spoon without spilling, to dress and undress herself
with supervision and to understand that she is a
Takayasu aortoarteritis
girl. These skills are first mastered between the ages
Newborn baby presenting with profuse blee-
of 2 and 3 years.
C
ding from unbilical stump after birth. Diagnosis
C A 30 years old lady delivered a healthy baby at 37
is
weeks of gestation. She was a known case of chronic
Factor XIII deficiency HepB infection. She was positive for HBsAg but
C Most common cause of neonatal sepsis is hospital in negative for HBeAg. Most appropriate treatment
India Both active and passive immunization soon after birth.
Klebsiella C Switch over from fetal to adult hemoglobin synthesis
C A term neonate with unconjugated hyperbilirubi- begins at what gestation
nemia of 18 mg/dl on 20th day. Common causes 36 weeks
are C A 6 months old 3.2 kg weight boy presents with
Hypothyroidism, breast milk jaundice and G6PD recurrent vomiting , polyuria, S. urea–60 mg/dl,
def. creatinine 0.7 mg/dl, calcium–12.8 mg/dl,
C DOC for rheumatric fever prophylaxis is penicillin phosphate 3 mg/dl, pH–7.45, bicarbonate 25 mEq/
allergic patient L and PTH 140 pg/ml (Normal <60 pg/ml), daily
Erythromycin urinary calcium excretion reduced, U/S-bilateral
C Common to both acute and chronic malnutrition nephrocalcinosis. Diagnosis
Weight for age Mutation of the calcium sensing receptor.
C A 5 years old boy presents with overnight petechial C Most appropriate treatment of a child presenting
spots 2 weeks back he had h/o abdominal pain and with diarrhea, peripheral circulatory failure,
no hepatosplenomegaly. Diagnosis arterial pH 7.0, PCO2 15 mm Hg, PO2 76 mm Hg
Idiopathic thrombocytopenic purpura. Bolus of ringers lactate.
C A 5 years old boy gets electrocuted while playing in
C A 6 years old child with IQ 50 can do
a park. The child is apnoeic, ventilated with bag and
Identify colors mask. There are burns on each hand. Next step
Check pulses
AIIMS NOVEMBER 2006
C Mechanism of heat production in a neonate are AIIMS MAY 2005
Cutaneous vasoconstriction, universal flexion like a
C True about TOF
fetus and breakdown of brown fat with adrenaline
Ejection systolic murmur in second intercostal
secretion.
space, single second heart sound, and normal
C Single gene defect causing multiple unrelated
jugular venous pressure.
problems
C Earliest manifestation of Cushing’s syndrome
Pleiotropism
Loss of diurnal variation.
(Note: Opposite is Epistasis).
C FA present in breast milk important for growth C Conditions observed in marasmus
Docosahexaenoic acid. Extreme weakness, low insulin levels and muscle
C Constant in Schwartz formula for calculation of wasting.
creatinine clearance in a child depends upon C Characteristic radiological feature of transient
Mass, age and method of estimation of creatinine tachypnea of newborn is
(Mn: MAC). Prominent horizontal fissure
Pediatrics 221
C Deficiency of-keto acid decarboxylase leading to C Drug avoided in an infant 6 months old with TOF
block in metabolism of branched chain amino acid presenting with cyanotic spell initiated by crying
is observed in Isoprenaline
Maple syrup urine disease (Note: it causes peripheral pooling of blood).
C Dengue shock syndrome is characterized by C Liver biopsy of a neonate presenting with jaundice
Hepatomegaly, pleural effusion and thrombocyto- shows giant cell/neonatal hepatitis. Diagnosis
penia. Alpha-1 antitrypsin deficiency.
C Epiglottitis in a 24 years old child most commonly C Dietry management of a 3 years old boy with bilateral
due to infection with renal calculi secondary to idiopathic hypercalciuria
H. influenzae type b Increased water intake, low sodium diet and
C Cardiac defects characterized by ductus dependent avoidance of meat proteins.
blood flow C A 2 months old infant presenting with failure to
TGA with intact septum, interrupted aortic arch thrive, polyuria, medullary nephrocalcinosis
and hypoplastic left heart syndrome. affecting both kidneys and investigation showing-
C Principal mechanism in phototherapy reducing blood pH-7.48, bicarbonate 25 mEq/L, potassium 2
serum bilirubin mEq/L, sodium 126 mEq/L and chloride 88 mEq/
Structural isomerization (Mn: SI > PI > PO). L. Diagnosis
Structural isomerization > photoisomerisation > Bartter’s syndrome
photo-oxidation. C A 10 years old boy with nephrotic syndrome and
C Syndrome best associated with congenital heart steroid dependent for last 5 years now develops
disease markedly cushingoid with BP of 120/86 mmHg and
Holt-Oram syndrome small sub-capsular cataracts. TOC
C Formula for plasma osmolality is Cyclophosphamide
2[Na+] + glucose/18 + BUN/2.8 C A 12 years old boy has bilateral gynaecomastia,
height 148 cm, weight 58 kg, sexual maturity rating
C Leading cause of death in U-5 children in developing
stage 2. Cause
countries
Pubertal gynaecomastia.
Acute lower respiratory tract infections.
C A 9 years old child presents with growth retarda-
AIIMS NOVEMBER 2004 tion, propensity to hypoglycemia, short stature,
micropenis, increased fat and high pitched voice
C TOC for primary grade V VUR involving both and bone age of 6 years on skeletal survey. Diagnosis
kidneys in a 6 months old boy Growth hormone deficiency
Antibiotic prophylaxis C Oral rehydration mixture contains glucose and
C A 7 years old boy with left renal mass had bone pain sodium because both of them
due to bone metastatic deposits. The most likely Facilitate the transport of each other from the
renal tumor is clear cell sarocoma. intestinal mucosa to the blood.
C An 8 days old breastfed baby presents with C Features of TTP
vomiting poor feeding and loose stools, O/E—HR More common in females, petechiae, ecchymosis
190/min, BP 50/30 mm Hg, RR-72/min, capilary and bleeding and increased megakaryocytes in
refill time 4 sec, Hb-15 gm/dl, Na+ –120 Meq/L, K– bone marrow.
6.8 mEq/L, bicarbonate 15 mEq/L, urea–30mg/dl C Lead pipe appearance of colon on barium anema is
and creatinine 0.6 mg/dl. Diagnosis seen in
Acute tubular necrosis. Crohn’s involvement of the colon.
C A male infant presents with distension of abdomen C A 2 years old boy presents with vitamin D resistant
shortly after birth and less meconinm passed. Full rickets, S. calcium–9 mg/dl, phosphate-2.4 mg/dl,
thickness rectal biopsy is likely to show alkaline phosphatase–104/IU, normal intact PTH
Lack of ganglion cells and bicarbonate 2 mEq/L. Diagnosis
(Note: Hirschsprung disease) Hypophosphatemic rickets.
222 AIIMS and All India PGMEE—Review Questions
C IOC for one year old infant presenting with poor C Retrolental fibroplasia is associated with
urinary stream since birth Low birth weight (ROP).
Voiding cystourethrography. C A full term baby, exclusively breast fed with ade-
C First clinical intervention in a neonate with quate hydration, normal systemic examination and
congenital diaphragmatic hernia weight same as birth weight at the end of 1 week was
Insert a nasogastric tube. passing golden yellow stools. Advice to the mother
C Investigations for diagnosis of HIV infection in a Reassure her that nothing is abnormal.
2 months old child C Features seen in child after birth whose mother is
DNA-PCR, P24 antigen assay and viral culture. exposed to Diethylstilbestrol during pregnancy
C In pediatric advanced life support, intraosseous Clear cell Ca, malformation of vagina and uterus
access for drug/fluid administration is recommended and vaginal adenosis.
for pediatric age of C A child died soon after birth. O/E-Hepatospleno-
< 6 years age megaly and edema all over the body. Diagnosis
C Newborns at increased risk of hypoglycemia are α thalassemia
Birth asphyxia, maternal diabetes and RDS. C TOC of a child presenting with fever for 2 days,
C A 10 years old child presenting with headache, altered sensorium and purpuric rashes and BP
vomiting, gait instability, diplopia, O/E-papillo- 90/60 mm Hg-IV pencillin
edema and gait ataxia. Diagnosis (Hint: Meningococcal meningitis).
Midline posterior fossa tumor
C A neonate presents with encephalitis without any
(Hint: ICT is increased). skin lesions most probable causative organism is
C A 3 years old child presents with history of bronchial HSV II
asthma, progressive shortness of breath for 1 day,
C An infant presents with hypotonia and hyporeflexia.
O/E-blue, gasping and unresponsive. First done is
During his intrauterine period there was polyhy-
Administer 100% oxygen by mask.
dramnios and decreased fetal movements. Diagnosis
C The metabolic disturbance in CHPS
Spinal muscular atrophy.
Hypochloremic alkalosis.
C Associated with proximal muscle weakness
(Note: Hirschprung disease)
Duchenne muscular dystrophy, polymyositis and
C Failure to pass meconium within 48 hours of birth
spinomuscular atrophy.
in a newborn with no obvious external abnormality
Congenital aganglionosis.
C Ductus dependent blood flow is necessary in ALL INDIA 2012
congenital diseases C A 1 year old girl is brought with the fever for 24 hours
Hypoplasia of left heart, obliterated aortic arch and and on and off coughing, passing foul smelling
transposition of great vessels with intact ventricular bulky stools and 4 attacks of bronchitis in the past.
septum. Diagnosis suggested
Transient tachypnea of newborn is commonly seen in
Cystic fibrosis
C
Elective cesarean section.
Regarding parenteral nutrition of newborns, 20%
Posterior iliac horns are seen in
C
C
intralipid has following advantages over 10%
Nail patella syndrome
intralipid solution
C A 10 years old boy presents with polyuria, poly-
dypsia, Na+–154, K–4.5, HCO–3–22, S. osmolality–295 Reduced phospholipids, increased calorie density/ml
and blood urea-50, urine specific gravity–1.005. of fluid and better triglyceride clearance.
Diagnosis C Most commonly identified fetal tumor
Diabetes insipidus Sacrococcygeal teratoma.
C Treatment of a child with pauci-immune crescentic GN C A patient of meningomyelocele posted for surgery
Prednisolone + cyclophosphamide. and the covering of sac is protected by a gauze piece
C Poor prognostic indicator of ALL is soaked in
Hypodiploidy Normal saline
224 AIIMS and All India PGMEE—Review Questions
C Least chance of infective endocarditis is seen with C Decreased hormone level of LH, FSH and testoste-
(among the options) rone in a child presenting with pubertal delay is
Small ASD suggestive of
C True about jaundice in neonates- Kallmann’s syndrome
Can be seen after ventouse delivery. C Most common tumor of fetus is
C A term infant born to a diabetic mother is lethargic Sacrococcygeal teratoma
few hours after birth and blood glucose 30 mg%. C Most common bacterial cause of diarrhea in children
done next in India
10% dextrose IV ETEC
A mentally challenged child presents with dysphagia,
Wide neural forminea is seen in
C
C
ophisthotonic spasms, choreoathetoid movements
Neurofibromatosis
and self mutilative behavior with positive family
history. Investigation suggested C True regarding jaundice in newborn
Serum uric acid Physiological jaundice starts after 48 hrs, Ventouse
C Fever for 24 hours, history of 3 episodes of chest delivery may be associated, breast milk jaundice
infection and constipation with passage of large peaks on day 7.
foul smelling bulky stools in a one-year-old child is C A 7 years old child presenting with ambiguous
suggestive of genitalia, normal height, weight and BP, bifid labia
Cystic fibrosis. with 2 separate perineal openings, 2.5 cm long
C Neonate borne out of non-consanguineous marriage phallus and no palpable gonads in the inguinal
had erosion and blisters in the area of contact with region and present Müllerian structures. Diagnosis
history of similar disease in elder slibling dying after Simple virilisation of primary CAH.
2 weeks. It is suggestive of epidemolysis bullosa. C In parentral nutrition 10% intralipid infusion, as
C Developmental age of a child using 4–6 words compared to 20% intralipid influsion will have
including proper nouns but communication is Less energy, less hypertriglyceridemia.
mainly nonverbal
15 months
ALL INDIA 2011
C Blood sugar of a gestational age neonate with birth
weight 4.0 kg, gestational age of delivery 40 weeks C Initial feeding method of choice in a premature
and lethargy is 30 mg/dl. Treatment is baby, born at 33 weeks of gestation with birth
Intravenous dextrose 10%. weight 1500 gm and stable vitals
C Hormone increased in Prader-Willi syndrome Orogastric tube feeding
Ghrelin C Most important prognostic factor in neonatal
C Mediastinal lymphadenopathy in a young boy congenital diaphragmatic hernia
presenting with dyspnea suggests Pulmonary HTN
T cell lymphoblastic ALL (Note: Least important prognostic factor - Delay in
C Long term sequelae associated with radiotherapy in emergent surgery).
children for treatment of CNS tumors are C A 38 weeks, 2.2 kg birth weight neonate presents
Endocrine deficits, musculoskeletal hypoplasia and with intolerance to feed/abdominal distension on
reduced IQ, learning and behavior difficulties. second day, negative sepsis screening and 72%
C Child presenting with skin infections, reduced platelets PCV. Best management
and reduced IgM is most probably suffering from
Partial exchange transfusion.
Wiskott-Aldrich syndrome.
C Earliest indicator of pathological GERD in infants
C Cause of seizure of a 5 years old child of nephrotic
syndrome on treatment with tacrolimus and Respiratory symptoms
prednisolone presenting with edema and seizure, C Most likely cause of infant of diabetic mother with
urea–98 mg/dl, Na+–135mEq/L albumin –1.5 mg/ weight 3.8 kg presenting with seizures after 16
dL, Ca+–7.5 mg/dl hours of birth
Tacrolimus toxicity Hypoglycemia
Pediatrics 225
C Additional component in pentalogy of Fallot phosphate 9 mg/dl and serum intact PTH of 30 pg/
ASD ml. Diagnosis
C X-ray chest feature differentiating between ASD Hypoparathyroidism
and VSD C A non-immunized child presents with recurrent
Enlarged left atrium bouts of severe cough followed by audible whoop.
C A previously healthy infant presents with recurrent Best specimen to isolate the organism and confirm
episode of abdominal pain, history of passing diagnosis
altered stool after episodes of pain but no history of Nasopharyngeal swab.
of vomiting or bleeding per recturm. Diagnosis C A previously healthy eight years old boy after
Intussuception completing 8 days out of 10 days course of cefaclor
C A 10 years old child presents with hemetemesis, for upper respiratory tract infection now presents
malena, mild splenomegaly but no obvious jaundice with high grade fever, arthralgia, pruritic erythe-
or ascites. Diagnosis matous lesion and lymphadenopathy. Diagnosis
Serum sickness like ilness (SSLI) > type II HS
EHPVO
reaction.
C A child presents with fever, mild respiratory
C Right sided isomerism is associated with
distress, started on oral antibiotics, showing initial
improvement but deteriorating again with fever, Asplenia
wheeze and exaggerated breathlessness. X-ray C A 5 years old child presents with burn, burn area
chest-Hyperlucency and PFT- obstructive pattern. equal to the size of his palm is equal to 1% body
Diagnosis surface area.
Bronchiolitis obliterans
C Most common tumor associated with NF-1 in a child ALL INDIA 2010
Juvenile myelomonocytic leukemia. C Health status of a child under 5 years of age is
C Most common cause of meningoencephalitis in affected by
children Infections, low birth weight and malnutrition.
Enterovirus C Investigation of choice for a neonate presenting
C Complete surgical removal of craniopharyngioma with fever, lethargy, abdominal distension, vomi-
leads to multiple endocrinopathies in a six years old ting, constipation and provisionally diagnosed as
child. Hormone replaced first volvulus neonatarum with suspected perforation
Plain X-ray.
Hydrocortisone
C A 10 years old boy presenting with seizure has BP
C One year old female child presents with short
in upper extremity 200/140 mm Hg and non-
stature, leathargy, constipation, palpaple goitre,
palpable femoral pulses. Diagnosis
low T4 and elevated TSH. Diagnosis
Coarctation of aorta.
Thyroid dyshormonogenesis.
C A 6 years old asymptomatic girl have persistent
C A 8 days male infant presents with vomiting, hypertension, no significant history, normal
lethargy, dehydration, features of shock, hyperpig- urinary examination. Diagnosis is
mentation of genital skin, normal external genitalia, Renal parenchymal disease.
unremarkable abdominal examination, blood
C Best management of a child presenting with
sodium 123 mEq/L, blood potassium 7 meq/L and
intermittent episodes of left sided flank pain, USG -
hypoglycemia. Diagnosis
large hydronephrosis with dilated renal pelvis and
Congenital adrenal hyperplasia. cortical thinning with normal ureter and kidney
C Common causes of ambiguous genitalia in a female differential function 19%
child Pyeloplasty
Fetal placental aromatase def., congenital adrenal C Diagnosis of a child presenting with hepatomegaly
hyperplasia and WNT-4 gene mutation. and hypoglycemia and no improvement in blood
C A 2 weeks old male baby presents with history of sugar even after epinephrine administration
seizures, serum calcium 5.5 mg/dl, serum von Gierke’s disease.
226 AIIMS and All India PGMEE—Review Questions
C Major risk factors associated with a greater risk of C True about childhood polycystic kidney disease
developing epilepsy after febrile seizures Pulmomany hypoplasia may be seen, renal cysts
Complex febrile seizure, developmental abnormali- are present at birth and congenital hepatic fibrosis
ties and positive family history of epilepsy (Mn: CDEF). may be seen.
C A child presents with short episodes of vacant stare C A 7 years old girl is brought with complaints of
several times a day. The vacant episode begins generalized swelling of the body. Urinary
abruptly and child remains unresponsive during examination reveals grade 3 proteinuria and
the episode. There is no associated history of aura or presence of hyaline and fatty casts. History of
pastical confusion. Diagnosis hematuria absent. True is
Absence seizures No IgG or C3 deposits on renal biopsy.
C Indicated in juvenile myoclonic epilepsy (JME) C True about neuroblastoma
Topiramate, Valproate and Zonisamide. Most common extracranial solid tumor in childhood
C A child presents with history of seizures and mental > 50% present with metastasis at time of diagnosis
retardation and multiple hypopigmented macules and often encase aorta and its branches at time of
on clinical examination. Diagnosis diagnosis.
Tuberous sclerosis. C Marker for neural tube defects
C Most common microbial agent associated with Increased acetylcholinesterase.
recurrent meningitis due to CSF leaks
Pneumococci ALL INDIA 2008
C A two years old child with a long history of
purulent nasal discharge and fever, now presents C True about Gomez classification
with conjunctival congestion, edema, fever 102°F/ Prognostic value for hospitalized children, based
103°F, WBC 12,000/mm3, negative culture for eye on 50th centile Boston standards and between 75
discharge, and opacification of ethmoidal sinus on and 89 % implies mild malnutrition.
X-ray. Next investigation C The most common cause of short stature
CT scan Constitutional
C A boy presents with weakness in lower limbs, calf C A very low birth weight preterm baby is on
hypertrophy, positive Gower’s sign and elevated ventilator for respiratory distress. Baby presents
CPK value of 10,000. Diagnosis is with clinical features of necrotizing enterocolitis
Duchenne muscular dystrophy. with perforation. Appropriate management is
C Primary metabolic bone disorder is scurvy is Peritoneal drainage
Decreased osteoid matrix formation. C Prebiotics is beneficial in
Necrotizing enterocolitis
ALL INDIA 2009 C Most commonly associated with coarctation of
C The most common fetal response to acute hypoxia aorta
Bradycardia Bicuspid aortic valve
C Vaccine with maximum efficacy after single dose C Right sided aortic arch is most strongly associated
Measles with
C Nutritional assessment methods indicating inade- Truncus arteriosus
quate nutrition are C True statement about PDA
Increased 1–4 years mortality rate, low birth weight It is a common heart lesion in rubella, hypoxia and
and decreased weight for height. immaturity are important in maintaining the
C Treatment options of hyperleukocytosis in a child patency and treatment is closure of defect by
with acute myeloid leukemia ligation and division of ductus.
Allopurinol, alkalinization and IV fluids. C A child presents with severe respiratory distress 2
C Prophylaxis of a neonate born to HBsAg positive days after birth. On examination- scaphloid
mother includes abdomen, decreased breath sound on left side. He
Both vaccines and immunoglobulin. was managed by prompt endotracheal intubation.
Pediatrics 227
After ET tube placement maximal cardiac impulse C Syndromes associated with NHL
shifted further to right. Next step in management Down’s syndrome, Patau syndrome and Klinefelter’s
Confirm position of endotracheal tube (not by syndrome (Mn: DPK).
X-ray) > Remove tube and reattempt intubation > C Good prognostic factors for childhood ALL
nasogastric tube insertion and bowel decompression. Female sex, hyperdiploidy and t(12, 21) translocation.
C A 6 years old child presenting with recurrent episodes C Minor criteria for diagnosis of RF according to
of gross haematuria for 2 years is suffering from modified Jone’s criteria
IgA nephropathy Fever
C True about Kawasaki disease (Note: Other minor criteria are arthralgia, increased
Associated with coronary artery aneurysm in up to ESR, increased creative protein, prolonged PR
25% of untreated cases. interval in ECG)
C True about 21 hydroxylase deficiency C Cardiomyopathy is a feature of
Most common cause of CAH in children, affected Duchenne’s muscular dystrophy, Friedrich’s ataxia
females present with ambiguous genitalia, and and Pompe disease.
affected males present with precocious puberty. C Most common mode of treatment for 1 year old
C Most common type of seizure in neonate child with asthma
Subtle Inhaled short acting β-2 agonist.
C Most common CNS involvement in group of intra- C Leukotrine receptor antagonist indicated in
uterine congenital infections-CMV and Toxoplamosis bronchial asthma
(most common symptomatic CNS involvement in Zafirlukast
HSV and Rubella) C Diagnosis of a child presenting with 3 days history
C True about cerebellar astrocytoma in pediatric age of upper respiratory tract infection with stridor
group Laryngotracheobronchitis.
Usually low grade tumors, have a good prognosis and C A newborn presents with treatment resistant CHF,
more commonly seen in first and second decades. bulging anterior fontanelles with bruit on
C Cyst in a child located and associated with vertebral auscultation and transfontanella USG finding of
defects hypoechoic midline mass with dilated lateral
Neuroenteric cyst ventricles. Diagnosis
C Treatment for nocturnal enuresis with least relapse Vein of Galen malformation.
rate C Most common microorganism causing meningitis
Bell alarm systems in a 1 year old child
C Resistant Plasmodium falciparum malaria in pediatric Pneumococcus
age group treated by C Jitteriness can be distinguished from seizures by
Clindamycin Abnormality of gaze, autonomic disturbance and
sensitivity to stimulus.
ALL INDIA 2007 C Diagnosis of a child presenting with microcephaly,
blue eyes, fair skins mental retardation and positive
C Age of a baby who has developed mouthing but has ferric chloride test
not developed stranger anxiety, likes and dislikes Phenyl ketonuria
for food
(Note: Melanin is synthesized from tyrosine is
5 months synthesized from phenylalanine. Phenylalanine
C Milestone developing first hydroxylase deficiency in phenylketonuria affects
Mirror play 6 months, crawling…., creeping…., this reactions).
Pincer graps. C Darkening of urine on standing is associated with
C Best indicator of long term nutritional status Alkaptonuria.
Height for age C Investigation for a premature baby of 34 weeks deve-
C Most common tumor in children is loping bullons lesion on skin and periostitis on X-ray
Leukemia VDRL for mother and baby.
228 AIIMS and All India PGMEE—Review Questions
C Drug treatment for a child presenting with drowsi- C The earliest indicator of response after starting iron
ness, decreased deep tendon reflexes, seizures, in young girl with iron deficiency
history of constipation and lines on gums Increased reticulocyte count.
EDTA C Late onset hemorrhagic disease of newborn is
C Cat eye syndrome characterized by
Partial trisomy 22 Onset at 4–12 weeks of age, intracranial hemorrhage
C Autosomal dominant conditions are can occur and IM vitamin K prophylaxis at birth has
Marfan’s syndrome, osteogenesis imperfecta and a protective role.
Ehlers-Danlos syndrome. C True for TOF
C In an AR disorder, one parent is normal, other is RVH, VSD and PS
carrier and child is also affected (Note: Overriding of aorta also occurs in TOF)
Uniparental disomy C Blalock and Taussing shunt is done between
C Father to none and mother to all, inheritance is Aorta to pulmonary artery.
Mitochondrial inheritance. C Left atrium in enlarged in
Aortopulmonary window, PDA and VSD.
C 1 months old boy presents with failure to thrive,
ALL INDIA 2006
features of congestive failure and femoral pulses
C A normally developing 10 months old child should feable as compared to branchial pulses. Diagnosis
be able to do Coarctation of aorta
Stand alone, play pick a boo and pick up a pellet C The most important determinant of prognosis in
with thumb and index finger. Wilm’s tumor
C Features of prematurity in a neonate Histology
No creases on sole, abundant lanugo and empty C Malignant tumor of childhood metastasizing to
scrotum. bones most often is
C Principal mode of heat exchange in an infant Neuroblastoma
incubator C A child with a small head, minor anomalies of the
Conduction, evaporation and radiation. face including thin upper lip, growth delay and
C Characteristics of Autism developmental disability can have
Delayed language development, repetitive behavior Chromosomal syndrome, Mendelian syndrome
and severe deficit in social interaction. and teratogenic syndrome.
C Features of Down’s syndrome C An affected male infant born to normal parents
Hypothyroidism, Brushfield’s spots and VSD. could be an example of
C Specific neonate malformation in maternal insulin AR disorder, polygenic disorder and vertically
dependent DM transmitted disorder.
In a family, the father has widely spaced eyes,
Caudal regression
C
increased facial hair and deafness. One of three
Potassium requirement of child
children has similar feature. The mother is normal.
C
1–2 mEq/kg Pattern of inheritance
C Sodium content of ReSoMal Autosomal dominant
45 mmol/L
(Note: ReSoMal is rehydrated solution for malnouri-
shed child) ALL INDIA 2005
C The most common etiology for acute bronchiolitis C Bart’s hydrops fetalis is lethal because
in infancy Hb Bart’s cannot release oxygen to fetal tissues.
Respiratory syncytial virus. C The coagulation profile in a 13 years old girl with
C True about Mumps menorrhagia having von Willebrands disease is
Meningoencephalitis can precede parotitis. Isolated prolonged aPTT and normal PT.
Pediatrics 229
C Neural tube defects are C Therapy of 5 years old boy passing 18 loose stools in
Encephalocele, myelomeningocele and anencephaly. 24 hours and vomiting twice in last 4 hours when he
C Features of absence seizure is irritable but drinking fluid is
Usually seen in childhood, 3 Hz spike wave in EEG Oral rehydration therapy
and precipitation by hyperventilation. C A 12 years old boy with no major medical illness
C A 1 year old child presenting with 2 week history of complains of breaking out with blocky area of
fever, vomiting and altered sensorium with cranial erythema that are pruritic over skin of his arm, leg
CT scan revealing basal exudates and hydrocephalus. and trunk everytime within an hour of eating sea
Etiological agent responsible foods. Diagnosis
Mycobacterium tuberculosis. Localised anaphylaxis
C Enzyme replacement therapy is available for C A 45 days old infant presents with icterus, followed
Gaucher’s disease 2 days after with symptoms and signs of acute liver
C Duchenne’s muscular dystrophy is a disease of failure, HBsAg positive. The mother is HBsAg
Sarcolemmal proteins. carrier. The mother’s hepatitis B serological profile
(Note: Dystrophin) is
C Bacterial meningitis is children (2 months–12 years HBsAg and HBeAg positive.
of age) is usually due to C A 5 years old asymptomatic boy, immunized with
Pneumococcus, Meningococcus and H. influenza 3 doses of recombinant Hep B vaccine at age of 1
type b. year, is detected to be HBsAg positive on 2 separate
C Essential features of ADHD occasions during a screening programme for
hepatitis B. His mother was treated for chronic
Hyperactivity, impulsivity and lack of concentration.
hepatitis B infection around the same time. Next
C A 20 years old woman had premature rupture of done
membrane and delivered a male child who became
Obtain anti-HBsAg antibody levels.
lethargic and apnoeic on the first day of birth and
went into shock. The mother had a previous history C A 18 years old boy presents with abdominal pain,
of abortion 1 year back on vaginal swab culture fever and bloody diarrhea for 18 months, 100 cm
growth of β-hemolytic colonies on blood agar was height, 14.5 kg weight, stool culture negative for
found. Gram staining shows Gram-positive. known enteropathogens, sigmoidoscopy finding
Organism is normal, mantoux test negative. During the same
period, child had an episode of renal colic and
Streptococcus agalactiae
passed urinary gravel. Diagnosis
C The most common agent associated with neonatal
Crohn’s disease
bacterial meningitis
C Young girl from Bihar presents with three episodes
Streptococcus agalactiae.
of massive hematemesis and malena, no history of
C β-lactamase producing ampicillin resistant strain of jaundice, O/E-large spleen, mild ascites, non-
H. influenzae has been isolated from CSF of a 2 years palpable liver, USG-portal vein not visualized, LFT
old boy suffering from meningitis. Appropriate normal and endoscopy revealing esophageal
antimicrobial of choice here is varices. Diagnosis
3rd generation cephalosporin > trimethoprim- Portal HTN due to extrahepatic obstruction.
sulphamethaxazole combination.
C True about pyuria in children
Infection can occur without pyuria, pyuria may be
ALL INDIA 2003 present without UTI, and isolated pyria is neither
C Transient myeloproliferative disorder of newborn confirmatory nor diagnostic for UTI.
is associated with C Most common cause of abdominal mass in neonates
Down’s syndrome Multicystic dysplastic kidneys.
C Features of Noonan syndrome C A 10 years old girl presents with swelling of one
AD, crypto-orchidism and hypertrophic cardiomyo- knee joint. Differential diagnosis are
pathy. JRA, TB and vilonodular synovitis.
Pediatrics 231
C A 1 month old baby presents with frequent C Six months old girl presents with recurrent UTI,
vomiting, failure to thrives moderate dehydration, USG- bilateral hydronephrosis, MCU-bilateral
blood Na+–122 mEq/L and blood K+–6.1 mEq/L. grade IV VUR. TOC
Diagnosis Ureteric reimplantation
21 hydroxylase deficiency. C The most common cause of ambiguous genitalia in
C A 2 months old baby presents with history of a newborn
jaundice, turmeric colored urine, pale stool since 21 hydroxylase deficiency
birth, O/E-liver span of 10 cm, firm in consistency, C Primary site of hematopoiesis in the fetus before
spleen of 3 cm. Most specific investigation for mid pregnancy
establishing diagnosis
Liver
Peroperative cholangiogram.
C Complications in the newborn of a diabetic
mother
ALL INDIA 2002 Hyperbilirubinemia, hypocalcemia and hypomag-
C Sign warranting further evaluation of develop- nesemia.
mental status in a healthy 12 weeks old infant C Administration of glucose solution is prescribed for
Doest not vocalize Child of a diabetic mother, history of hypoglycemia
C 6.7 kg weight 2 years old boy present with history and neonates.
of vomiting and diarrhea for last 8 days. O/E skin C Closure of PDA in a premature infant can be
pinch over anterior abdominal wall goes back stimulated by
quickly to its original position. Interpretation Prostaglandin inhibitors
Skin pinch cannot be evaluated in this child. C A 3 years old boy presents with fever, dysuria, gross
(Note: because child is severely malnourished) hematuria, O/E-Prominent suprapubic area dull
C An infant presents with history of seizures and skin on percussion, urinalysis-red blood cells but no
rashes, metabolic acidosis and increased blood proteinuria. Diagnosis
ketone levels. Diagnosis Posterior urethral valves
Multiple carboxylase deficiency. C True about β-thalassemia major
C True about RDS Microcytic hypochromic anemia, splenomegaly
Usually occurs in neonates born before 34 weeks of and target cells on peripheral smear.
gestation, is more common in babies born to C Diagnosis of congenital CMV infection in a neonate
diabetic mothers and leads to cyanosis. established by
C Common manifestations of congenital rubella Urine culture of CMV, intranuclear inclusion bodies
Deafness, mental retardation and PDA. in hepatocytes and CMV viral DNA in blood by PCR.
C A 10 years old boy presents with fever, bilateral C Type of Hb used in diagnosis of β-thalassemia trait
cervical lymphadenopathy, prior history of HbA2
sore throat, no hepatomegely, peripheral blood C Characteristic feature of juvenile myoclonic epilepsy
smear showing >20% lymphoplamacytoid cells. Myoclonic seizures frequently occur in morning.
Diagnosis
C A 15 years old girl presents with history of recurrent
Infectious mononucleosis. epistaxis, hematuria, hematochezia history of
C Most common genetic cause of liver disease in profuse bleeding from the umbilicat stump at
children birth. Inv. Normal PT, aPTT, TT and fibrinogen
α 1 antitrypsin deficiency. levels. Platelet count as well as platelet function test
C Childhood tumors most frequently metastasizing normal. Urea clot lysis test positive. Clotting factor
to the bone likely to be deficient
Neuroblastoma Factor XIII
232 AIIMS and All India PGMEE—Review Questions
15
Dermatology
232
Dermatology 233
flushing and burning sensation on exposure to sun C A patient presented with thinning of nails
and on any emotional disturbance. The most likely and onycholysis. Other findings observed in
diagnosis him
Rosacea Basal degeneration > Violaceous papules
C Not a variant of lichen planus (Note: Lichen planus).
Lichen scrofulosorum C A patient presents with focal alopecia areata.
C Nikolsky’s sign is seen in Associated with
Pemphigus vulgaris Nail pitting, atopy and exclamatory mark.
An elderly patient presents with itchy tense blisters
A man presents with rashes on face and also
C
C
on normal looking skin as well as on urticarial
complains of decreased mental function. He is also
plaques. The most likely diagnosis
having few macular lesions on his skin. On CT scan,
Bullous pemphigoid
intracranial calcification was seen. His wife is
C A male patient presents with recurrent erythema- normal. His 10 years old daughter is also normal
tous plaque at the same site on glans penis, which but his 6 years old son is also having similar skin
sometimes forms a bulla and heals with hyperpig-
lesions. Most likely diagnosis
mentation. The most likely diagnosis
Autosomal dominant inheritance
Fixed drug reaction
(Note: Tuberous sclerosis)
AIIMS MAY 2014
AIIMS MAY 2013
C Olympian brow and rhagades are seen in
C A middle aged man presents with multiple painful
Congenital syphilis
blisters on a erythematous base along the T3
C A 60 years old gentleman presents with painful, dermatome on the trunk. Most likely etiological
grouped vesicles over erythematous plaques in T3 agent
dermatome region of trunk. Likely causative Varicella Zoster virus.
organism
C A young 8 years old boy presents with multiple
Varicella zoster discrete, shiny, pin head papules on dorsal aspect
C A 19 years old boy presents with several comedones, of hand, forearms and penis. Most likely diagno-
papules and pustules on face and trunk. Drug of sis
choice Lichen nitidus
Topical retinoic acid + oral doxycycline. C A 20 years old girl presents with a relatively
C A 37 years woman presents with multiple, linear, painless ulcer of 3 cm on the labia majora with
itchy wheals, with itching for 30 minutes at the site. raised margins. Most likely organism
The most likely diagnosis Treponema pallidum infection.
Dermatographic urticaria. C The Ridley- Jopling classification for leprosy is
C A young 8 years old boy presents with multiple based on
discrete, shiny, pin head papules on dorsal aspect of Histopathological, clinical, bacteriological and
hand, forearm and shaft of penis. Most likely immunological.
diagnosis C A male patient presents with sudden onset painful
Lichen nitidus. tense blisters with urticarial plaque. Best investiga-
C A 30 years old man presents with flaccid bullae on tion
an erythematous base and erosions over the oral Direct immunofluorescence.
mucous membrane. The blisters developed painful C A young male patient presents with painful ulcers
erosions on rupture. The immunofluorescent on the mouth and glans penis with blurred vision
examination of skin biopsy shows and history of recurrent epididymitis. Most
Fishnet IgG deposition in epidermis probable diagnosis
(Note: Pemphigus vulgaris) Behçet syndrome.
234 AIIMS and All India PGMEE—Review Questions
AIIMS NOVEMBER 2012 coalesced to form large sheet. The surface of the
macule showed fine scaling. Similar episode one
C A patient presents with oral ulcer and flaccid skin year ago subsiding with treatment. Investigation
bullae that are slow to heal. The lesion is that will confirm the diagnosis
Suprabasal KOH mount
C A young man presents with asymptomatic macules C Associated with sun exposure
and erythematous painless lesion over glans with
Actinic keratosis
generalized lymphadenopathy. Treatment of
choice
Benzathine penicillin. AIIMS NOVEMBER 2011
C A man has recurrent urticaria following exercise
and coming out in sun, diagnosis is C Diagnosis of a patient presenting with history of
Cholinergic urticaria recurrent oral ulcers (ulcers are small with a
yellow floor surrounded by an erythematous halo
on the lips) and multiple tender nodules on the
AIIMS MAY 2012 shin
C An infant has papulovesicular lesions on palms, Behçet’s syndrome
soles, face and trunk. The diagnosis would be C The only definitive indication of systemic corticoste-
Scabies roids in psoriasis
C A young boy had itchy, excoriated papules on the Impetigo herpatiformis
forehead and the exposed parts of the arms and legs (Note: It is pustular psoriasis in pregnancy)
for three years. The disease was most severe in the C Intercellular IgG deposition in epidermis in
rainy season improved completely in the winter. Pemphigus
The most likely diagnosis is C Granular IgA deposition at dermal papilla in
Insect bite hypersensitivity. Dermatitis herpetiformis
C A 25 years old sexually active wife of a long distance
truck driver presented with copious vaginal
discharge of 2 days duration. Syndromic manage- AIIMS MAY 2011
ment is
C Neonatal fat necrosis resembles
Azithromycin + metronidazole + fluconazole.
Poststeroidal panniculitis.
A lady developed pigmentation on the bridge of the
Fine reticular pigmentation with palmar pit are
C
C
nose and cheeks on exposure to sunlight. The most
seen in
likely diagnosis is
Dowling degos disease
Chloasma
C Child with erythematous non-blanching bosselated
C Characteristic feature of borderline leprosy
lesion on right side of face. Treatment is
Inverted saucer shaped lesions.
Flash light pumped dye laser.
C Multiple hypoaesthetic, hypopigmented macules
on right lateral forearm with numerous acid fast C True about incontinent pigmenti
bacilli is indicative of X linked dominant, primary skin abnormality and
Borderline leprosy avascularity of peripheral retina.
C A 60 years old male patient presents with discolora- C Child presents with linear verrucous plaques on the
tion, thickening and tunneling of 2 fingernails and trunk with vacuolization of keratinocytes in
1 toe nail. Investigation done stratum spinosum and stratum granulosum.
KOH mount Diagnosis is
C A 26 years old man presented with multiple, small Verrucous epidermal nevus.
hypopigmented macules on the upper chest and C True about acrodermatitis enteropathica
back for last three months. The macules were Low serum zinc levels, symptoms improve with
circular, arranged around follicles and many had zinc supplementation and autosomal recessive.
Dermatology 235
C A 20 years old girl develops small itchy wheals after C Erythematous scaly lesions on external aspect of
physical exertions, walking in the sun, eating hot elbows and knee of a patient can be clinically
spicy food and when angry. She is suffering from diagnosis by
Cholinergic urticaria. Auspitz sign
C Multiple hypoesthetic erythematous large plaques C Actinic keratosis is seen in
with elevated margins on trunk and extremities in Squamous cell carcinoma
a 40 years old male with bilateral enlargement of C Wood’s lamp light is used in diagnosis of
both ulnar and lateral popliteal nerves Tinea capitis
Borderline lepromatous leprosy. C Drug of choice for multiple nodulocystic lesions on
the face of patient
AIIMS MAY 2003 Retinoid
16
Anesthesia
240
Anesthesia 241
C Drug not affecting absorption and secretion of C A patient is posted for the surgery but has raised
cerebrospinal fluid intracranial tension. Anesthetics preferred
Nitrous oxide Sevoflurane
C Intravenous anesthetic agent contraindicated in C Suxamethonium is available as a clear, colorless
epileptic patients posted for general anesthesia liquid. The shelf life of suxamethonium is
Ketamine 2 years
C Midazolam causes
Anterograde amnesia, tachyphylaxis during high AIIMS NOVEMBER 2012
dose infusion and decreased cardiovascular effects C An infant with respiratory distress was intubated.
as compared to propofol. The fastest and accurate method to confirm intubation
Capnography
AIIMS NOVEMBER 2013 C EEG in anesthesia is useful in
C Contraindicated in an epileptic patient posted for Depth of general anesthesia.
general anesthesia C Kinemyography is used for
Ketamine Monitoring of neuromuscular function.
C Drug causing malignant hyperthermia C True about lidocaine
Suxamethonium It acts on sodium channels in both active and
C Tubocurare affects which muscle first inactive state, it is given IV in cardiac arrhythmias
Head and neck and extensive first pass metabolism.
C According to AHA 2010 guidelines, drug not used C Most potent agent among the following
in CPR Nitrous oxide
Atropine C Modified Allen’s test is used for checking the
C On doing laparoscopic cholecystectomy patient proper arterial supply at the
developed wheezing. Used in the treatment Wrist
Deepen the plane of anesthesia. C A patient with hypertension, under control by
C Sensory block for lower segment cesarean section is medication falls under which grade
given at the level of ASA 2
T4 C Dose of which muscle relaxant is calculated on the
C Contraindications for neuraxial block basis of total body weight of an obese person rather
Platelet count < 50,000, patient on clopidogrel and than its ideal body weight
local infection. Atracurium
C Effective strategies to decrease the risk of post- C After endotracheal intubation in a 2 years old child
puncture dural headache are posted for craniotomy, after 2 minutes, the bellows
Use of small bore needle, use of atraumatic needle of the anesthesia machine were found to be
and supplementation of fluids. collapsing. Next best thing to do next
C Induction of inhalational agent is faster with Increase the rate of flows.
Combination with nitrous oxide.
AIIMS MAY 2012
AIIMS MAY 2013
C In a pregnant patient, there is decreased requirement
C A woman is posted for elective cholecystectomy. Her of the spinal anesthetic agent because of the
preoperative evaluation and airway was normal. In Decreased volume of subarachnoid space,
the operating room, monitors were attached and engorgement of epidural veins and increased
antibiotics was given. Suddenly she became pulseless sensitivity of the nerves to anesthetic agent.
and unresponsive. Next step in the management C Seen in Scholine apnea
Start chest compressions. It is due to succinylcholine, can be inherited and
C True about hypothermia in anesthesia patients usually do not die of scholine apnea if
Can be prevented by administration of warm fluids. properly managed.
242 AIIMS and All India PGMEE—Review Questions
C A 40 years old lady undergoes incisional hernia C A patient complains of severe pain after thoracotomy.
surgery under general anesthesia and complains of Treatment
awareness during her surgery. Monitoring technique IV fentanyl
to prevent such awareness C A 70 kg weighted old athlete posted for surgery.
Bispectral index monitoring He was given succinylcholine due to unavailability
C A patient presented with blunt trauma to the of vecuronium, in intermittent dosing (640 mg
emergency with heart rate of 150/min, BP 80/50 total). During recovery patient was not able to
and is posted for emergency laparotomy. Anesthetic respire spontaneously and move limbs. It is due to
agent of choice Phase 2 blockade produced by succinylcholine.
Ketamine C Middle aged man had severe maxillofacial trauma
C A 30 years old man with no past medical history is due to road traffic accident. After 1 hour, pulse is
injured in a bomb blast, is suspected of splenic 120/minute, BP–100/70 mm Hg, SpO2–80% with
injury. Ideal anesthetic agent of choice for emergency oxygen. Immediate management is
laparotomy Orotracheal intubation
Etomidate C Inhalational agent preferred in patient with liver
C The most important constituent in soda lime for compromise for surgery for mitral stenosis
reabsorption of CO2 in a closed circuit is Xenon
Calcium hydroxide
C Maximum dose of lignocaine with adrenaline for
AIIMS MAY 2010
local blocks in ophthalmic surgeries is
7 mg/kg C Volatility of anesthetic agent is directly proportional
C A 10 years old child undergoing squint surgery to lowering the flow in portal vein. Portal vein flow
suddenly developed increased heart rate, is maximally reduced by
arrhythmia, high fever, metabolic and respiratory Halothane
acidosis on arterial blood gases and elevation of end C Local anesthesic causing methemoglobinemia
tidal CO2. First agent of choice Prilocaine > Benzocaine
Dantrolene
AIIMS NOVEMBER 2009
AIIMS NOVEMBER 2011
C Anesthesia of choice in a child with bladder
C With reference to the optimal management of exostrophy and chronic renal failure
patients with sepsis in ICU, all of the following Atracurium
interventions are evidence based except C Local anesthetic first used clinically was
Intensive blood glucose monitoring and prevention Cocaine
of hyperglycemia improves survival in critically ill C A 55 years old lady a known patient of thyrotoxicosis
patients. in control posted for APR. There was sudden drop
in BP and end tidal CO2 decreased from 40 to 10 mm
AIIMS MAY 2011 Hg during surgery. There was mill wheel murmur.
Diagnosis is
C Cisatracurium is preferred over atracurium because
Air embolism.
of
No histamine release.
AIIMS MAY 2009
C Laudonosine is a metabolite of
Atracurium C Dead space is increased by
Anticholinergic drugs, standing and hyperextension
of neck.
AIIMS NOVEMBER 2010 C Most common complication of coeliac plexus block
C Anesthetic agent causing adrenal suppression Hypotension
Etomidate (Note: Lower limb vasodilatation)
Anesthesia 243
C Induction agent producing cardiac stability C Most common nerve used for monitoring during
Etomidate anesthesia
C True about CPAP Ulnar nerve.
Initiate early in preterm with respiratory distress, (Note: and muscle is adductor pollicis)
initiate with > 50–60% FiO 2 and improved lung C Merit of nasotracheal intubation is
compliance and oxygenation. Good oral hygiene
C Flat capnogram seen with
Accidental extubation, dissociation of anesthetic AIIMS NOVEMBER 2005
tube and mechanical ventilation facling.
(Note: also seen in esophageal intubation and C Bradycardia is common after injection of
severe bronchospasm) Succinylcholine
C True about ketamine
Direct myocardial depressant, may induce cardiac
AIIMS MAY 2008 dysarrhythmias in patients receiving TCA and
C Technique used to maintain proper oxygen flow to emergence phenomena are more likely if anticholi-
patient—Proportionater between N2 and O2 control nergic premedication is used.
valve, different pin index for nitrogen and oxygen C Cardiovascular monitoring techniques are
and calibrated oxygen concentration analysis. Central venous pressure monitoring, pulmonany
C Most common cause of postoperative renal failure artery catheterization and transesophageal echo-
Decreased renal perfusion. cardiography.
C Shortest acting ND muscle relaxant C Confirmation of placement of double lumen tube
for pulmonary surgery by
Gentacurium > Mivacurium > Rapacuronium
Bronchoscopy
C During perioperative period, myocardial ischemia
AIIMS NOVEMBER 2007 can be detected by most sensitive and practical
C True about thiopentone investigation
2D transesophageal echocardiography.
Sodium carbonate is added to improve its
solubility, cerebroprotective and contraindicatd in C Most common cause of hypoxia during one lung
porphyria. ventilation
C Cerebral oxygen consumption is increased by- Increased shunt fraction.
Ketamine. C Anesthesia of technique of choice in LSCS in a
C Mivacurium, true are women with coarctation of aorta
Increasing the dose produces rapid onset of action, General anesthesia
bronchospasm and flushing. C Induction agent of choice for corrective surgery for
cyanotic heart disease in 5 years old child
Ketamine
AIIMS MAY 2007 C Pressure tracing that identifies placement of Swan-
Ganz catheter in the pulmonary artery
C Muscle relaxant of choice in hepatic and renal
Pulmonary artery pressure tracing has dicrotic
failure
notch from closure of pulmonary valve.
Cisatracurium > Atracurium
C The outcome following resuscitation of a cardiac
C Side effect of oxygen therapy are arrest is worsened if during resuscitation patient is
Absorption atelectasis, decreased vital capacity and given
endothelial damage. 5% Dextrose
C Seen in malignant hyperthermia C A 6 months old child is suffering from PDA with
Hypertension, hyperkalemia and metabolic congestive cardiac failure. Inhalational induction
acidosis. agent of choice for ligation of ductus arteriosus
(Note: and respiratory acidosis) Sevoflurane
244 AIIMS and All India PGMEE—Review Questions
C Following cannulation of right subclavian vein, C Fire breaks out during laser vocal cord surgery.
patient developed respiratory distress, BP dropped What should be done?
to 100/55 and heart rate increased to 140/min, Pouring sterile water, removing endotracheal tube
diminished air entry towards right side of chest and and treatment with steroid and antibiotics.
hyperresonant note on percussion. Diagnosis is
Tension pneumothorax. ALL INDIA 2010
C Most potent cerebral vasodilator
Hypercarbia C A patient with bilirubin value of 8 mg/dl and
serum creatinine 1.9 mg/dl is planned for surgery.
C A 45 years old male patient with history of smoking
Muscle relaxant of choice
is scheduled for surgery. True are
Atracurium
Nicotine has effects on carotid and aortic bodies and
can increase sympathetic tone, dose requirement of C True about neuromuscular blockade produced by
muscle relaxants are increased in smokers and succinylcholine
smoking causes decreased surfactant levels. No fade on train of four stimulation, no post-tetanic
C True about anesthetic machine facilitation and train of four ratio > 0.7.
Temperature of desflurane vaporizer chamber is 39°C. C A 25 years old overweight female patient given
fentanyl-pancuronium anesthesia for surgery.
After surgery and extubation she was observed to
ALL INDIA 2011
have limited movement of upper body and chest
C Definite airways are wall in recovery room. She was conscious and alert
Nasotracheal tube, orotracheal tube and cricothy- but limited voluntary respiratory effort. HR and BP
roidotomy. normal. Cause is
C Anesthetic agents contraindicated in patients with Incomplete reversal of pancuronium.
hypertension C A speedy intubation was performed in a 27 years
Ketamine old female patient with acute abdominal pain and
C Epileptogenic anesthetic agent is posted for laparotomy, but after the intubation,
Enflurane > Sevoflurane breath sounds were observed to be decreased on left
C Anesthetic agent with vasoconstrictor is contrain- side and a high end tidal CO2 was recorded. Likely
dicated in diagnosis is
Finger block Endobronchial intubation.
(Note: i.e. end artery block)
C Anesthetic agent to be avoided in sickle cell disease ALL INDIA 2009
IV regional anesthesia. C Sodium bicarbonate when given with local
(Note: also avoided in Raynaud‘s disease and anesthesia has following effect
scleroderma) Increases speed and quality of anesthesia.
C Spinal anesthesia given at the level (Note: also increases duration)
L2-4 C Anesthetic drug injected for paravertebral block is
C Anesthesia resident was giving spinal anesthesia likely to diffuse to
with patient suddenly undergoing aphonia and Epidural space, intercostal space and superior and
loss of consciousness. Cause inferior paravertebral spaces.
Vasovagal attack C Sign of successful stellate ganglionic block
C Index evaluating intraoperative awareness of Nasal stuffiness, Guttman’s sign and Horner’s
patient is syndrome.
Bispectral index
C Rise in end tidal CO2 due to thyroid surgery can be
AIIMS NOVEMBER 2008
due to
Malignant hyperthermia, thyroid storm and C Absortion of local anesthetic is maximum in route
neuroleptic malignant syndrome. IV > Tracheal > Intrapleural > Intercostal
Anesthesia 247
C Anesthetic agent increasing intracranial pressure C Induction agent causing adrenal cortex suppression
Sevoflurane Etomidate
C Drugs used in postoperative nausea and vomiting C During rapid sequence induction of anesthesia
following squint surgery in children Pre-oxygenation is mandatory.
Dexamethasone, ondansetron and propofol. C Patient recovers spontaneously and no reversal is
C The laryngeal mask airway of a patient in conditions required in depolarizing muscle relaxant in
In difficult intubation, in cardiopulmonary resusci- balanced anesthesia
tation and in child undergoing routine eye surgery. Atracurium
C The circuit used most commonly for ventilating a C The most appropriate anesthetic among the
spontaneously breathing infant during anesthesia following options for tendon lengthening operation
Jackson Rees modification. of 5 years old boy patient of Duchenne muscular
C Modes of ventilation that can be used for weaning dystrophy
off patients from mechanical ventilation Induction with IV suxamethonium and N 2O and
Assist control ventilation, pressure support venti- oxyen for maintenance.
lation and synchronized intermittent mandatory
C A 25 years old male patient undergoing incision
ventilation
and drainage of abscess and GA with spontaneous
C LSCS can be carried out under technique of anesthe- respiration. Most appropriate anesthetic circuit
sia is
General anesthesia, spinal anesthesia and combined
Mapleson A
spinal epidural anesthesia.
17
Radiology
AIIMS MAY 2015 C A middle aged lady presents with severe bone
pains at multiple sites. Plain radiograph reveals
C Investigation of choice in a child presenting with multiple lytic lesions in pelvis, ribs and femur,
features suggestive of biliary atresia fracture of the clavicles and subperiosteal reabsorp-
Hepatic scintography. tion of metacarpals over the radial aspect. The most
C Investigation of choice for acute appendicitis in likely diagnosis
children is Hyperparathyroidism
USG C The investigation of choice for acute appendicitis in
C A patient presented with tachyarrhythmia and was children is
implanted inflatable cardioverter defibrillator. Ultrasonography
Now he presents with shock. Investigation of C The investigation of choice in a patient with acute
choice to exclude displacement of ICD is head injury
Plain radiograph NCCT head
C Investigation of choice for stress fracture is C The gold standard for diagnosis of bronchiectasis is
MRI HRCT chest
C Expansion of subarachnoid space occurs on myelo- C The neuroimaging signs of tuberous sclerosis
graphy in includes
Indradural extramedullary tumours. Giant cell astrocytoma, subependymal nodules and
C Investigation of choice for fetal heart activity at white matter lesions.
6 weeks
USG AIIMS MAY 2014
C Non-invasive investigation of choice for myocardial C Puff of smoke appearance on cerebral angiography
viability is seen in
FDG PET scan Moyamoya disease.
C Most sensitive test for detecting fetal cardiac activity C A 7 years old patient presents with severe headache,
in 6 week pregnancy paralysis of upward gaze, loss of light perception
USG for fetal cardiac activity. and accommodation, nystagmus and failure of
convergence. CT scan showed homogenous hyper-
dense lesion above the sella and in the posterior part
AIIMS NOVEMBER 2014
of the third ventricle. MRI showed that the lesions
C A child presents with a history of injury to left fore- were homogenous and isointense on T1 weighted
finger tip with a glass piece. On examination, the imaging, and isointense on T2 weighted imaging
finger is swollen and tender. Best investigation to deter- with intense contrast enhancement. The most likely
mine the glass foreign body in the patient’s finger diagnosis
Plain radiograph Germinoma
249
250 AIIMS and All India PGMEE—Review Questions
conjunctival congestion, and extraocular muscle C USG feature of thyroid nodule suggestive of
palsy after 4 days of trauma to the eye malignancy
Intracranial digital subtraction angiography. Hypoechogenicity, non-homogenous and microcal-
cification.
AIIMS MAY 2011 C Investigation of choice for a lesion of temporal bone
CT scan
C Most commonly dissected artery following arterio-
graphy by femoral route
Inferior mesenteric artery AIIMS NOVEMBER 2009
C Used in diagnosis of protein losing enteropathy C Structure causing posterior impression on barium
Tc albumin, Tc dextran and In transferrin. swallow is
C Pure β emitters are Aberrant right subclavian artery.
Yttrium 90, strontium 90 and phosphorous 32. C Rib notching is seen in
C Central dot sign is seen in Aortic disruption, Blalock Taussig shunt and
Caroli’s disease (Mn: C for C) pulmonary atresia with large VSD.
C Radiological features of LVHF are C A child presents with respiratory distress. Investi-
Increased flow in upper lobe veins, Kerley B lines gation of choice for suspected vascular ring
and cardiomegaly. MRI
C Radiation induced necrosis can be diagnosed by
AIIMS NOVEMBER 2010 PET
C Element absolete in radiotherapy
C Radiation exposure is least among the options
Radium 226
Micturating cystourethrogram.
C Most sensitive imaging for breast carcinoma-DCIS is
MRI AIIMS MAY 2009
C A 20 years female patient with 6th cranial nerve C True regarding scurvy
palsy on T2 weighted MRI shows hyperintense Bowing of legs
lesion in cavernous sinus showing homogenous
C Stereotactic radiosurgery uses
contrast enhancement
Proton, linear accelerator and gamma knife.
Schwannoma
C C1 and C2 can be best visualized by
Odontoid view
AIIMS MAY 2010 C CT or Hounsefield number depends upon
C A male patient was brought unconscious to the Mass density
hospital with external injuries. CT brain shows no C Radiological finding of renal papillary necrosis on
midline shift, but basal cistern were compressed excretory urogram are
with multiple small hemorrhages. Diagnosis is Tracks and horns from calyces, ring shadow and
Diffuse axonal injuries egg in cup appearance.
C A newborn presents with CHF with bulging anterior C Cerebral blood flow in an asphyxiated child is best
fontanellae and brui on auscultation. Transfontanellar measured by
USG shows a hypoechoic midline mass with dilated NIRS
lateral ventricles. Most likely it is a case of
Vein of Galen malformation.
AIIMS NOVEMBER 2008
C A 48 years old woman comes with bilateral pro-
gressive weakness of both lower limbs, spasticity C Gold standard investigation for recurrent GIST is
and mild impairment of respiratory movements. PET CT
MRI shows an intradural mid-dorsal midline C Earliest detectable congenital malformation by
enhancing lesion. Diagnosis is USG is
Meningioma Anencephaly
252 AIIMS and All India PGMEE—Review Questions
AIIMS MAY 2008 C Bone scan of a patient with multiple myeloma shows
Cold spots.
C Absolute contraindication of MRI C Most sensitive radiological indicator for aneuploidy
Pacemaker is
C Most chemoresistant tumors among the following is Nuchal translucency.
Malignant fibrous histiocytoma.
C PACS in medical imaging stands for AIIMS MAY 2006
Picture archiving and communication system.
C Snowman appearance on X-ray is seen in C Differential diagnosis of spinal cord edema on MRI
TAPVC. Myelomalacia
C If the right cardiac silhoute is obliterated, it means C Mammography feature suggestive of malignancy
the pathology involves- Right middle lobe. Areas of spiculated microcalcification.
C Egg on side appearance is seen in C Extra axial dural based enhancing tumour on MRI
Uncorrected TGA. in a female patient of 40 yrs age presenting with
C Investigation of choice for acoustic neuroma recurrent headaches. Diagnosis is
MR with contrast. Meningioma
C Sign of increased ICT C Plethoric lung fields are seen in
Erosion of dorsum sella, sutural diastasis and ASD, VSD and TAPVC.
copper beaten appearance (Mn: CDE)
C Hair on end appearance is seen in AIIMS NOVEMBER 2005
Thallasemia C Investigation of choice for posterior urethra is
Voiding cystogram.
AIIMS NOVEMBER 2007 C Intensity modulated radiotherapy is used in
C Floating water lily sign is seen in Prostate cancer.
Hydatid cyst C Radioactive isotopes used for brachytherapy
C Hamptom’s hump is seen in chest X-ray in Cobalt 60, iodine 125 and iridium 192.
Pulmonary embolism. C Solitary hypoechoic lesion of the liver without
septate or debris is most likely to be
AIIMS MAY 2007 Simple cyst.
C Most common cause of mixed cystic and solid supra- C Therapeutic mode commonly employed in intra-
sellar mass seen on cranial MR scan of 8 years old child operative radiotherapy
Craniopharyngioma Electron
C Most common cause of sclerotic skeletal metastasis C Radiation therapy to hypoxic tissue may be poten-
in a female tiated by
Breast carcinorna Metronidazoole
C Most radiosensitive tumor among following C Stereotactic radiosurgery is a form of
Ewing’s tumour (Melt like snow) Radiotherapy
C Investigation of choice for differentiating recurrence C Investigation of choice for extra-adrenal pheochro-
of brain tumor from radiation induced necrosis mocytoma
PET Scan MRI
C Radioluscent stones are
Allopurinol, orotic acid and xanthine.
AIIMS NOVEMBER 2004
C Rays used for treatment of deep seated tumors
C Earliest X-ray feature of childhood leukemia X-rays and gamma rays.
Radiolucent transverse metaphysical bands. C Vessel evaluated first in angiography for massive
C Continuous sheet of wire mesh of copper to shield recurrent hemoptysis in a patient of tuberculosis
the EEG cabins to avoid picking of noise from Bronchial artery
external electromagnetic disturbances is called as C Single 2 cm space occupying lesion of mixed
Faraday cage echogenicity in right lobe of liver on USG is found
C Attenuation value of zero HU (Hounsfield units) in in a 20 years old man. Next investigation is
CT scan corresponds to Hepatic scintigraphy (SPECT)
Water C X-ray is produced when
C Piezoelectric crystal technique is used in Electron beam strikes the anode.
Ultrasonography C HRCT, a special CT technique greater details
C Most common organ involved in bronchogenic utilizes
carcinoma Bone algorithm for image reinstruction.
Adrenals C Differential diagnosis of anterior mediastinal mass
Lymphoma, teratoma and thymoma.
AIIMS MAY 2004 C Most radiosensitive phase of cell cycle
C Investigation of choice for evaluation of blunt G2
abdominal trauma C Investigation (non-invasive) for definitive diagnosis
CT scan before preparing for epilepsy surgery of a boy
presenting with 10–12 partial complex seizure
C Features of malignant gastric ulcer on barium meal are
episodes per day despite 4 drug antiepileptic
Location on the greater curvature, Carman’s
regime with history of repeated high grade fever in
meniscus sign and radiating folds which do not
childhood and MRI normal
reach the edge of the ulcer.
Video EEG with ictal 99mTc-HMPAO Brain SPECT.
C The investigation of choice for imaging of urinary
C Dense persistent nephrogram may be seen in
tract tuberculosis
Acute ureteral obstruction, dehydration and
CT scan
systemic hypertension.
C Radiation dose for pain relief in bone metastasis
C The most recent advance in non-invasive cardiac
30 Gy in 10 fractions.
out put monitoring is use of
Electrical impedance cardiograph technology.
AIIMS NOVEMBER 2003
C Radiopaque shadow with air fluid level in chest
C Maximum permissible dose for radiotherapy in along with hemivertebra of 6th thoracic vertebra on
pregnancy plain X-ray in a newborn most likely cause is
0.5 rad Congenital diaphragmatic hernia.
254 AIIMS and All India PGMEE—Review Questions
C Best investigation for bone metastasis is C Prunning of pulmonary artery is seen in-
Bone scan. Pulmonary hypertension.
C CT scan is least accurate in diagnosis of C True regarding ossified posterior longitudinal
Gallstones ligament (OPLL)
C Dose of radiation during whole body exposure that MRI best for diagnosis, low signal intensity on all
leads to hematological syndrome is MR sequences and gradient echo MR sequence may
2 Grey overestimate the canal stenosis.
C Test of choice for reversible myocardial ischemia
ALL INDIA 2010 Thallium scan.
C Walls of CT scanner room are coated with C Preoperative test necessary in Down’s syndrome
patient before surgery
Lead
C The major difference between X-ray and light is Echocardiography
Energy C Amifostine protects
C Most ionizing radiation is Salivary glands, kidney and GIT
Alpha
C Background radiation is
ALL INDIA 2008
Radiation present constantly from natural sources.
C Which best estimates the amount of radiation C Photoelectric effect can be best described as an
delivered to an organ in the radiation field Interaction between low energy incident photons
Absorbed dose. inner shell electron.
C True about stochastic effects of radiation C Allergic reaction to radiologic contrast agents
Probability of effect is a function of dose. are
C Egg on side appearance is seen in Anaphylactic reaction
TGA C Most radiosensitive phase of cell cycle is
C True about CT scan features of adrenal adenoma G2M
Calcification is rare, low attenuation and regular C Used to measure GFR
margins. 99m
Tc DTPA
C A patient presents with acute renal failure and
C Flaring of anterior ends of ribs is characteristically
anuria with normal USG. Investigation regarding
seen in
renal function that gives best information is
DTPA scan. Rickets
C A dense renogram is obtained by C Inferior rib notching is seen in
Rapid bolus injection of dye. Coarctation of aorta
C Earliest radiological sign of pulmonary hypertension
in chest X-ray is
ALL INDIA 2009
Cephalization of pulmonary vascularity.
C Focal and diffuse thickening of gallbladder wall C Earliest sign of left atrial enlargement is
with high amplitude reflections and comet tail
Posterior displacement of esophagus.
artefacts on USG suggests the diagnosis of
Most common feature of aortitis on chest X-ray
Adenomyositis
C
18
Psychiatry
258
Psychiatry 259
C A cigarette smoker thinks that smoking will not C A child is not eating vegetables. His mother starts
cause him cancer as he smokes less number of ciga- giving a chocolate each time he finishes vegetables
rettes and eats well and exercises regularly. This is in the diet. The condition is called
Self exemption Operant conditioning
C A 16 years old girl presents with recurrent abdomi-
AIIMS NOVEMBER 2014 nal pain but biochemical assays and ultrasound
C Loss of memory caused by neuronal degeneration abdomen is normal. After waking up from sleep,
and not associated with normal aging process she suddenly complains of loss of vision of bilateral
Amnestic syndrome. eyes. Ophthalmologist finds nothing on examination.
Most likely diagnosis
C A patient with a history of alcohol consumption of
250 ml everyday for the past 12 years comes to the Malingering
hospital and is diagnosed as alcohol dependent C Cognitive remediation is used for
syndrome. Drug avoided in the patient Cognitive restructuring
Disulfiram
C A 20 years old man with schizophrenia was given AIIMS MAY 2013
10 mg haloperidol. 3 days later, he was brought back
by the father complaining of the patient looking C In Paget’s theory of cognitive development,
upwards and the eyeballs rolling up. Clinical exami- concepts like out of sight is out of the following
nation was otherwise normal. Most likely cause stage
Acute dystonic reaction. Sensorimotor stage.
C The treatment of choice for PTSD is C An alcoholic brought to the emergency after 2
Cognitive behavior therapy. days of abstinence complained of nausea,
C True about autism vomiting and dizziness and developing seizures
Poor eye contact, language delay and dermatoglyphic on 2nd day progressing to the GTCS. Drug of
abnormality. choice
Chlordiazepoxide > Diazepam
AIIMS MAY 2014 C Drug used as an anticraving agent in patients of
alcohol dependence
C True about blackouts
Acamprosate
Remote memory is relatively intact during the
A child was assessed with wechsler intelligence
blackout, it is a discrete episode of anterograde
C
scale and his intelligence was found to be in the
amnesia and associated with alcohol intoxication.
average range. His IQ is most likely to be
C According to ICD 10 revision, for establishing a
diagnosis of mania, the symptoms should persist 90
for at least C While performing a mental status examination
1 week (MSE), the awareness or understanding of a patient
of his/her illness is called
C The evidence based psychological therapy of choice
for depression is Insight
Cognitive behavior therapy.
AIIMS NOVEMBER 2012
AIIMS NOVEMBER 2013 C A man started taking alcohol at 20 years, presently
C A chronic alcoholic patient, who has not consumed taking 3 quarters daily over 30 years, now complains
alcohol for last 2 days, is brought to the emergency that he gets kick in 1 quarter, diagnosis is
by his wife with complaints of nausea, vomiting Reverse tolerance.
and dizziness. On second day he develops seizures C A child does not eat vegetables. His mother starts
that progressed to GTCS. Drug of choice for this giving him a chocolate every time he finishes
condition vegetables in the diet. The condition is
Chlordiazepoxide Operant conditioning
260 AIIMS and All India PGMEE—Review Questions
C A young girl presenting with repeated episodes of memoty deficit, headache, convulsions, abnormal
excessive eating followed by purging by laxatives. movements, forgetfulness, 4 attacks during day and
Diagnosis is 2 attacks at night but CT scan is normal. It is a case of
Bulimia nervosa Epilepsy
C Increased suicidal tendency is associated with
AIIMS NOVEMBER 2009 Serotonin
C Stimulation of cranial nerve leading to elevation of
mood AIIMS NOVEMBER 2007
Vagus nerve C Perceptual interpretation of a real object is
A 20 years old girl presents with complaints of
Illusion
C
nausea, vomiting and pain in the legs. Physical
C Type A personality is characterized by
examination and laboratory finding normal.
Hostility, time pressure and competitiveness.
Probably it is a case of
Somatoform pain disorder. C Schizophrenia, true are
C Substance dependence is due to 3rd person auditory hallucination, inappropriate
Personality, peer pressure and family history of emotions and formal thought disorder.
substance abuse. C Psychodynamic model of disease explains the
C Included in personality trait psychopathologic cause of all mental illness to be
Sensation seeking, neuroticism and openness to Unconscious conflict
experience. C Learning involves
Modeling, exposure and response prevention.
AIIMS MAY 2009
AIIMS NOVEMBER 2006
C Anticraving agents for alcohol dependence are
Acamprosate, naltrexone and topiramate. C The drug for long term maintenance in opoid
C True about hallucination addiction
It occurs in the absence of perceptual stimulus. Methadone (Mn: M for M)
C A man taking 20 cigarettes per day, started
coughing, his family suggesting quitting cigarettes. AIIMS MAY 2006
He is ready to quit but thinks quitting will make him C A patient on haloperidol develops hyperpyrexia,
irritable. The best health planning model followed is rigidity, mutism, akinesia, sweating , tachycardia
Precontemplation and preparation. and increased BP and increased WBC count and
increased creatine phosphokinase with no history
AIIMS NOVEMBER 2008 of any other drug intake or any signs of infection
C Chemical increasing on electroconvulsive therapy Neuroleptic malignant syndrome .
Brain derived neurotrophic factor. C A patient on haloperidol develops tongue protrusion,
C Type 2 schizophrenia is characterized by stiffness, abnormal posture of limbs and trunk,
Negative symptoms, poor response to treatment oculogyric crisis with no loss of consciousness which
and CT scan abnormal. improved within a few minute of diphenyldramine
C According to Disability Act 1995, seventh disability HCI injection. He suffered from
Acute dystonia.
is usually referred to as
Mental illness C An adult person complaints of fear of leaving home,
fear of travelling alone and fear of being in a crowd
and develops anxiety and palpitation in these
AIIMS MAY 2008
situations and avoids public transport. He is
C Atypical antipsychotics are suffering from
Clozapine, olanzapine and risperidone. Agoraphobia.
C A 25 years old girl presents with 6 months history of (Note: Fear of open space, public space and crowded
altered sensorium, involuntary movements, space from where there is no easy escape)
262 AIIMS and All India PGMEE—Review Questions
surgeries. He seems to maintain sick role and seeks C Differential diagnosis of premenstrual tension
attention from the nurses. Extensive examinations includes
and investigations reveal no physical or psycho- Psychiatric depressive disorder, panic disorder and
pathological illness. He is suffering from generalized anxiety disorder.
Factitious disorder.
AIIMS MAY 2002
AIIMS MAY 2003 C An old man for last 10 years suspects his neighbours
and feels that whenever he passes, they plan against
C Drug of choice in ADHD
him behind his back. He also feels his wife has been
Methylphenidate
replaced by a double and calls police for help. He is
C Yawning is a feature of well groomed and alert. He is suffering from
Opioid withdrawal Paranoid schizophrenia.
C False perception without any external stimulus is C A patient is brought with 6 months history of odd
called behavior and he talks to self and sometimes mutters
Hallucination to himself loudly. There is family history of a
C Schneider’s first rank symptom relative disappearing some years back. He is
Voice commenting on actions. suffering from
C Elderly housewife lost her husband (by myocardial Schizophrenia
infarction) with home she stayed alone for decade. C Three years after an encounter with earthquake, a
A week after, she heard his voice talking to her but woman has nightmare about the episode and she
say nothing. Then she often heard his voice conver- also gets up in the night and feels terrified. She is
sing with her and also discussed her daily matters most likely suffering from
with him. But this provoked sadness and anxiety Post-traumatic stress disorder.
when preoccupied with his thought. Drug prescri-
bed ALL INDIA 2012
Haloperidol
C True about clozapine
If WBC < 3000/mm3, clozapine should be disconti-
AIIMS NOVEMBER 2002 nued, action of clozapine is more on D1 receptors
C Lack of insight is a feature of than D2 and combination of clozapine and
Mania, reactive psychosis and schizophrenia. carbamazepine should be better avoided.
C A 16 years old girl with marked fluctuations in her (Note: Clozapine induced agranulocytosis is
mood and pervasive pattern of unstable idiosyncratic and not dose dependent)
interpersonal relationship presents with several C Criteria for substance dependence
attempts of wrist slashing in the past in response to Repeated unsuccessful attempts to quit the
trivial fights at home. She is suffering substance, characteristic withdrawal symptoms;
Border line personality disorder. substance taken for relieving withdrawal and
C A 65 years old male present with marked substance taken in larger amount and for longer
forgetfullness, visual hallucination, deterioration in period than intended.
condition for last one year and mini-mental status C Serotonin dopamine antagonists are
examination score of 10. Diagnosis Zotepine, risperidone and sertindole.
Dementia C Paranoid psychosis observed with cocaine abuse
C A woman at 40 years of age presents with can be explained by
complaints of ache and pain from all over her body Intoxication
for 4 years. She has insomnia and has lost her C Best cognitive behavior therapy technique for
appetite she has lack of interest in work and poor treatment of 35 years old female patient diagnosed
socialization. She denies feeling of sadness. with OCD and she washing her hands several times
Diagnosis a day
Major depression Response prevention
264 AIIMS and All India PGMEE—Review Questions
C Poor scholastic performance is associated with C A chronic smoker taking 20 cigarettes per day has
Anxiety, ADHD and specific learning disability. developed chronic cough. His family suggested
C Delusion seen in quitting cigarettes. He is ready to quit but thinks
Dementia, depression and schizophrenia. quitting will make him irritable. His stage of
C Repetitive transcranial magnetic stimulation behavior change
(rTMS) is USFDA approved for the treatment of Contemplation and cost analysis.
Depressive disorder. C True about imbecile
C True about narcotic drugs and psychotropic Impaired self care, condition usually congenital or
substances (NDPS) act acquired at an early age and intellectual capacity
equivalent to a child of 3–7 years of age.
It provides for severe punishment for drug users
and peddlars alike.
ALL INDIA 2010
C Bizarre interpretation of an object is most appro-
priately known as C Autistic disorder is characterized by
Illusion Lack of social interaction, stereotypic movements
C General adaptation syndrome (GAS) is seen in and delayed development of speech.
Stressful situations. C Cognitive errors are
C A 16 years male patient suffering from drug abuse Catastrophic thinking, arbitrary inference and
has his perception of sensory modalities crossed overgeneralization.
over (he complains of sound can be seen and sights C In behavior therapy, behavior is increased by
can be heard). Drug responsible Reward, operant conditioning and negative
LSD reinforcement.
C Parts of cognitive behavior change technique
ALL INDIA 2011 Pre-contemplation, contemplation and action.
C A 60 years old man had undergone cardiac bypass
C A 40 years old patient presents with history of surgery 2 days back. Now he has started forgetting
depressed mood, loss of appetite, insomnia and no things and not able to recall names and phone
interest in surrounding for past 1 year. These numbers of relatives. It is a case of
symptoms followed soon after a business loss 1 year Cognitive dysfunction.
back. True about her management
(Note: Impaired memory and intellect)
Antidepressant treatment based on the side effect C Alcoholic paranoia is associated with
profile of the drugs.
Fixed delusions
C Antidepressant drug used in nocturnal enuresis
(Note: Alcohol induced psyclotic disorder)
Imipramine
C An old man is brought by his wife. He thinks that he
(Note: TOC-Bell and alarm, DOC-Desmopressin) has has committed sins all through his life. He is
C Most common cause of premature death in very much depressed and has considered
schizophrenia committing suicide. He had also attached sessions
Suicide with a spiritual guru. He does not want to hear
C A patient with acute psychosis who is on anything on the contrary. Treatment
haloperidol 20 mg/day for last 3 days, has an Antipsychotic and antidepressant.
episode characterized by tongue protrusion, C A 30 years old man for 2 months suspects his wife is
oculogyric crisis, torticollis, and abnormal posture having an affair with his boss. He thinks his friend
of limbs and trunk without loss of consciousness for is also involved from abroad and provides
20 minutes before presenting to the emergency. But technology support. He thinks people talk ill about
improved soon after diphenylhydramine. Diagnosis him. His friends tried to convince but he is not
is convinced at all. Otherwise he is normal, does not
Acute dystonia. have any thought disorder or any inappropriate
C Drugs used in treatment of alcohol dependence behavior
Acamprosate, naltrexone and disulfiram. Persitent delusional disorder.
Psychiatry 265
C A 28 years old girl presented with sadness, C Conditions included in diagnosis of bipolar
palpitation, loss of appetite and insomnia. But there disorder
is no complaint of hopelessness, suicidal thoughts Mania alone, mania and depression and mania and
and there is no past history of any precipitating anxiety.
event. She is doing her office job normally and her C Most common symptom of alcohol withdrawal is
social life is normal and she is doing well in other Tremor
areas of life
Generalized anxiety disorder.
ALL INDIA 2006
C A patient presents with self harm with suicidal
intent. Conditions requiring an immediate C Loosening of association is an example of
specialist assessment Formal thought disorder.
Formal thought disorder, social isolation and C Good prognosis for schizophrenia
chronic severe physical illness. Acute onset, late onset and married.
C Intense nihilism, somatization and agitation in old
age are the hallmark symptom of
ALL INDIA 2009
Involutional melancholia.
C As per ICD/DSM criteria, patients of which disease (Note: Form of severe depression)
are eligible for disability benefit as per national trust C Mutism and akinesis in a person appearing awake
act and alert is a condition known as
Mental retardation. Stupor
C Lithium is used in treatment of C Bright light treatment is most effective for
Major depression, vascular headache and Seasonal affective disorder.
neutropenia. (Note: Mood disorders with seasonal pattern)
C FDA approved indications of modafinil are C Rivastigmine and donepezil are used in manage-
Obstructive sleep apnoea syndrome, shift work ment of
syndrome and narcolepsy. Dementia
C Pavlov’s experiment is an example of
ALL INDIA 2008 Classical conditioning.
C Dementia precox term was given by
Kraeplin ALL INDIA 2005
C Clinical features of post-traumatic stress disorder C Preservation is
Flashback, hyperarousal and emotional num- Persistent and inappropriate repetition of the same
bing. thoughts
C A 40 years old father of son suffering from leukemia C Difference between hysteria and hypochondriasis
diagnosed 2 months back presents with lethargy, Symptoms do not normally reflect understandable
headache, low mood and sleep deprivation. Social physiological or pathological mechanism in
interaction is good but has absented himself from hysteria.
work. It is most probably C A 20 years old boy complains of feeling changed
Adjustment disorder from inside. He describes himself as feeling strange
C A 30 years man presents to OPD with erectile as if he is different from self. He is tense and anxious
dysfunction. Basic screening tests are normal. Next but unable to locate the change in himself. It is a case
step of
Oral sildenafil citrate. Depersonalization
C A lady has history of repetitive, irresistible thoughts
of contamination with dirt associated with
ALL INDIA 2007
repetitive hand washing. She reports these thoughts
C Delusion is a disorder of to be her own and dispersing. Treatment of choice
Thought Exposure and response prevention.
266 AIIMS and All India PGMEE—Review Questions
19
Orthopedics
268
Orthopedics 269
C A 10 years old child presents with a cortex based C Causes of clubfoot in neonates
lesion surrounded by reactive sclerosis in the CTEV, spina bifida and arthrogryposis multiplex
middle of shaft of tibia. The most likely diagnosis congenita.
Fibrous cortical defect. C A 40 years old man presented with acute onset pain
C For pronation to occur, which 2 joints must have and swelling of left great toe. On X-ray, punched
their axis of rotation in parallel out lytic lesion seen on phalanx with sclerotic
Talonavicular and calcaneocuboid joints. margins and overhanging bony edges. Most likely
C The H-reflex is important for assessing which of the diagnosis
following Gout
S1 radiculopathy. C Both bone and disc spaces are destroyed in
C Sunray appearance in osteosarcoma is due to Tuberculosis
Periosteal reaction. C True about osteoporosis
C An elderly post-menopausal lady presented with Calcitonin decreases pain, bisphosphonates are
swelling in her right great toe. X-ray of the foot work horse for treatment and PTU is used in severe
showed punched out erosions of the great toe, with osteoporosis.
overhanging margins and adjacent soft tissue
masses. Most likely diagnosis AIIMS MAY 2013
Gouty arthritis.
C An elderly lady is on treatment with alendronate
for 7 years. She now presents with complaints of
AIIMS MAY 2014 pain in the thigh. The best investigation for her
C The earliest sign of cord compression in tuberculosis X-ray
of thoracic spine C An elderly lady falls and is diagnosed with Colle’s
Extensor plantar fracture. After proper treatment, she now
C A 5 years old boy presents with pain and swelling complains of stiffness and severe pain in the wrist
in diaphysis of tibia along with fever and raised ESR. with cold sensation and cyanosis of the fingers.
Most likely diagnosis X-ray of the hand shows spotty deossification. Most
Ewing sarcoma likely diagnosis
C The signs of malignant transformation in osteochon- Sudeck’s dystrophy.
droma are C A 22 years old man suffered a left knee injury while
Pain, increase in size and increase in thickness of playing football. On examination, there was
cartilage cap. anterior laxity in full extension but it was normal at
90° flexion. Most likely injured part is
Posterolateral bundle of ACL.
AIIMS NOVEMBER 2013
C After trauma, lower limb is noted to be shortened
C A 24 years old college student injures his right knee with abduction and internal rotation. Type of hip
while playing hockey. The patient presents with dislocation present
instability of knee joint in full extension without Central
instability at 90° of flexion. The structure most C A person was found lying in the right lateral position
commonly damaged by the police. He had injuries on his right face, hand
Posterolateral bundle of anterior cruciate ligament. and on the right knee. Which nerve injury can
C True about supracondylar fracture of humerus explain the injuries caused in the patient
Nerve injury related manifestations are transitory. Femoral nerve
C Gallow’s traction is applied in C A child presents with a fracture in his leg. He was
Fracture shaft of femur. given Gallow’s traction after being admitted. He is
C A 7 years old child presents with fever and tibial suffering from
swelling exhibits periosteal reaction on X-ray and Fracture shaft femur.
raised ESR and TLC. Next done C True about supracondylar fracture in children
MRI The neurological complications are transitory.
270 AIIMS and All India PGMEE—Review Questions
C The first centre of ossification appear during C A person is able to abduct his arm, internally rotate
At the end of 2nd month of pregnancy. it, place the back of hand on lumbosacral joint, but
C A middle aged lady presenting with complaints of is not able to lift it from back. Etiology is
lower back pain. On examination Subscapularis tendon tear.
Weakness of extension of great toe with no sensory
impairment. MRI reveals prolapsed IV disc at level- AIIMS MAY 2010
L4–L5. C Posterior glenohumeral instability can be tested by
(Note: Extensor hallucis longus is supplied by L5) Jerk test
C Meralgia paresthetica is due to involvement of
AIIMS MAY 2011 Lateral cutaneous nerve of thigh (Mn: Mera is late)
C Characteristic radiological feature of fibrous
C Non-neoplastic lesions stimulating bone tumor are dysplasia is
Fibrous dysplasia, bone island and bone infarct. Ground glass appearance.
C In bounce home test of knee joint, end feel is descri- C A 66 years old man presents with pain and swelling
bed as of right knee. Ahlback grade 2 osteoarthritic
Bony, spongy and firm. changes were found on investigation. Further
C According to Enneking system, true regarding management is
active benign tumor is Conservative
Intracapsular, thick rim of reactive bone and C A 65 years old man with back pain since 3 months,
extended curettage is treatment. raised ESR, marked stiffness and mild restriction of
C Variant of giant cell tumour is chest movements and syndesmophytes in
vertebrae on X-ray. Diagnosis is
Chondroblastoma
Ankylosing spondylitis.
C Percutaneous vertebroplasty is indicated in C Synovial fluid-true are
Metastasis, osteoporosis and hemangioma. Follows non-Newtonian fluid kinetics, contains
C True about high tibial osteotomy hyaluronic acid and variable viscosity.
Deformity recurs after a long time, done through C A lady presents with right knee swelling with
cancellous bone and done in case of unicompart- CPPD crystals on aspiration. Next investigation
mental disease. among the choice is
TSH
AIIMS NOVEMBER 2010 C Major mineral of bone is
Hydroxyapatite
C A patient presents with injury to left knee after road
C Pulsatile tumor is
traffic accident. Dial test was positive. Cause is
Osteoclastoma > osteosarcoma.
Posterolateral coroner ligament injury.
C Gallow’s traction is used for fracture AIIMS NOVEMBER 2009
Shaft femur
C Commonest site in bone involvement in hematoge- C Seen in pseudogout
nous osteomyelitis Large joints affected, chondrocalcinosis and
deposition of calcium pyrophosphate.
Metaphysis
C Young girl presenting with swelling of right thigh
Associated with poor prognosis in Ewing’s sarcoma
with history of trauma 2 months back. Now she
C
Fever presents with swelling of midshaft of femur and
C A 35 years old lady with chronic backache with D12 low grade fever. ESR is mildly raised. Laminated
collapse but intervertebral disc space maintained. periosteal reaction on X-ray. Next investigation is
Differential diagnosis are MRI
Multiple myeloma, osteoporosis and metastasis. C Treatment of choice for non-united fracture of lower
C A newborn child presents with inverted foot and 1/4th tibia with multiple discharging sinuses and
dorsum of foot cannot touch the tibia. Probably it is various puckered scar with 4 cm shortening of leg
CTEV Ilizarov’s fixation.
272 AIIMS and All India PGMEE—Review Questions
C Associated with CV junction anomalies C Pain and tenderness over lateral condyle of
Basilar invagination, odontoid dysgenesis and humerus with painful dorsiflexion of wrist indi-
ankyosing spondylitis. (Mn: ABO) cates
C Bankart’s lesion involves part of glenoid labrum Tennis elbow
Antreior part (Mn: Bankart’s has an) C Diagnosis of one year old child presenting with
multiple fractures seen in various stages of healing
is
AIIMS MAY 2006
Batterred baby syndrome.
C Transient synovitis/toxic synovitis of hip is charac-
terized by
AIIMS MAY 2005
May follow upper respiratory infection, ESR and
WBC counts are usually normal and USG hip shows C Pathognomonic feature of rheumatoid arthritis
widening of joint space. Extensor pollicis brevis and abductor pollicis
C The malunion of supracondylar fracture of longus.
humerus leads most commonly to C Bone tumor of epiphysis of long bone
Cubitus varus Chondroblastoma
C Skeletal traction can be given by C Level of tendon sheath contraction in trigger finger
Bohler’s stirrup, Kirschner’s wire and Steinman’s is at
pin. MCP joint
C Recurrent dislocation of shoulder occurs with
Bankart’s lesion, capsular laxity and Hill- Sach’s AIIMS NOVEMBER 2004
lesion.
C Sudden increase in pain in osteochondroma caused C Middle aged alcoholic male patient presents with
due to pain in dorsal spine tenderness at dorsolumbar
Bursitis, fracture and sarcomatous change. junction and destruction of 12th dorsal vertebra
with loss of disc space between D12-L1 vertebra in
C Complications of supracondylar fracture of humerus
X-ray. Diagnosis
in children are
Pott’s spine
Malunion, myositis ossificans and compartment
C Painful swelling over the left shoulder in a 15 years
syndrome.
old boy with osteolytic area and stippled calcifica-
C The differential diagnosis of giant cell tumor in tion over proximal humeral epiphysis on X-ray and
small bones of the hands or feet includes immature fibrous matrix with scattered giant cells
Aneurysmal bone cyst, hyperparathyroidism and on biopsy may be diagnosed as
osteosarcoma. Chondroblastoma
C X-ray of leg of a 15 years old boy reveals evidence of C Slight flexion of DIP joint in middle finger injury
aggressive bone tumor with both bone destruction during fist cuff with normal X-ray finding in a 25
and soft tissue mass and biopsy further revealing years old male patient can be best managed by
bone cancer with neural differentiation. Most likely Splint the finger in hyperextension.
diagnosis is C A 2 years old child holding her father’s hand
Ewing’s sarcoma. slipped and fell but did not let go of her father’s
hand, continued to cry and holding the forearm in
pronated position refused to move the affected
AIIMS NOVEMBER 2005 extremity. Appropriate management
C Lab finding of 50 years old patient presenting Supinate the forearm.
with multiple pathological fractures are serum C A 50 years old man sustained posterior dislocation
Ca-11.5, phosphate 2.5 mg/dl and alkaline phos- of left hip in an accident, reduced after 3 days. He
phates 940 IU/dl. The most probable diagnosis complains of pain in hip (left) after 6 months but X-
is ray of pelvis normal. Next investigation
Hyperparathyroidism MRI of hip
274 AIIMS and All India PGMEE—Review Questions
elbow and also that hammer was becoming heavier C After lifting something heavy from ground, a
and heavier. Muscles affected are patient complains of back pain radiating to lateral
ECRL and ECRB leg and great toe of lower limb. Diagnosis
C In jaw dislocation displacement of articular disc L4–L5 disc prolapse.
beyond articular tubercle of TM joint resulting from C Complications of fracture neck of femur
spasm of excessive contraction of Avascular necrosis, non-union and shortening (Mn:
Lateral pterygoid ANS)
C The classical flexion and rotation deformity at hip C Following an accident a person is not able to abduct
and knee joints in poliomyelitis are due to his shoulder and flexion movement of elbow joint is
contracture of also not possible. Other movements are normal. Site
Tensor fascia lata. of injury
C Most sensitive test in an acutely injured knee of an Upper trunk.
athlete is C A patient presents with recurrent posterior
Lachmann test dislocation of shoulder. On radiography, most
C A 10 years old boy presents with pain in right arm probable site for Hill Sach’s lesion
near the shoulder with X-ray finding showing Anteromedial
expansile lytic lesion in upper third of humerus. C Avascular necrosis in fractured proximal fragment
Diagnosis is may be of scaphoid bone is due to
Simple bone cyst. Retrograde blood flow in scaphoid.
Activity difficult for a patient with anterior cruciate
A young girl with rapid increase in height for last
C
C
deficient knee joint
one year is having difficulty in sitting cross legged
Walk down hill and squatting and complains of knee going into
axilla every time she squats. Diagnosis
AIIMS MAY 2002 Slipped capital femoral epiphysis.
C Most common site of adamantinoma of long bone C A patient after RTA presents with flexion and exter-
nal deformity of the left hip, shortening of affected
Tibia
limb by 7 cm, mass noted in left gluteal region moving
C Chondroblastoma occurs in with the movement of the femur. X-ray finding
Epiphysis Acetabular roof fracture with central dislocation.
C X-ray finding of a 10 years old boy with pain in
C A 30 years old female patient presents with pain
upper end of humerus reveals lesion of metaphysis
and tenderness in index finger just under the nail,
with breech of overlying cortex. Most likely it is a
inability to wash her hands with cold water but no
case of
history of trauma or injury. Further finding
Aneurysmal bone cyst.
Ridging of nail, discoloration and pin head tenderness
C Twisting injury of knee in flexed position results in
(Hint: Glomus tumour).
injury to
Tubercular osteomyelitis may be
Anterior cruciate ligament, capsular tear and
C
C A 40 years old male patient presents with weakness C Structure first fixed during reimplantaion of an
and pain in lower limbs, history of paralysis of both amputated digit is
lower limbs during childhood. Diagnosis Bone
Post polio syndrome.
C True about SACH foot
Shoes can be worn out, central wooden keel present ALL INDIA 2010
and base of lower limb prosthesis C Lift off test
(Note: Solid ankle cushion heel foot). Subscapularis
C True about menisci
ALL INDIA 2011 Lateral menisci covers more tibial articular surface,
medial meniscus is more commonly injured and
C Main blood supply to head and neck of femur
menisci are predominantly made up of
comes from
Type 1 collagen
Medial circumflex femoral artery.
C Sixty years old lady is presenting with long C Median nerve lesion at the wrist causes
standing history of pain and swelling in her right Thenar atrophy, weakness of 1st and 2nd lumbricals
knee and pain is significantly interfering with her and weakness of FPB.
activities of daiy living. Radiological evaluation C True about articular changes in aging
shows grade 3 changes of osteoarthritis. Manage- Synthesis of proteoglycans is decreased, total
ment of such a patient is proteoglycan content is decreased and total water
Total knee replacement. content of cartilage is decreased.
C Atheletic teenage girl complaining of anterior knee C Metal on metal articulation should be avoided in
pain on climbing stairs and on getting up after Young female.
prolonged sitting. Most likely diagnosis is C Breathlessness and chest pain on second post-
Chondromalacia patellae. operative day of hip replacement with right ventri-
C A 50 years old lady sprained her ankle 2 moths back cular dilatation and tricuspid regurgitation on
from which she made a steady recovery. 2 months echocardiography. Diagnosis is
after the injury she gradually developed severe Pulmonary embolism.
pain in her right ankle with significant limitation of
C Characteristic triad of Klippel-Feil syndrome
ankle movement. Clinical examination reveals
includes
edema and shiny skin. Likely diagnosis is
Short neck, low hairline and restricted neck move-
CRPS 1
ment.
C Most common nerve involved in supracondylar
fracture of humerus is C Progression of congenital scoliosis is least likely in
vertebral anomaly
Anterior interosseous nerve.
C A six years old boy presents with painful limp, Block vertebra
tenderness in femoral triangle and some limitation C A patient involved in road traffic accident presents
of hip movements with normal X-ray. Next course with quadriparesis, sphincter disturbance,
of action is sensory level up to the upper border of sternum
MRI scan and respiratory rate of 35/minute. Level of lesion
C Blount’s disease is characterized by is
Genu valgum, genu recurvatum and internal tibial C4–C5
torsion. C True about synovial cell sarcoma
C True about radial nerve palsy Occurs more often at extra articular sites, usually
Loss of nerve supply to ECRB, EPB and loss of seen in patients less than 50 years of age and knee
sensation over first dorsal web space. and foot are common sites involved.
C Agent decreasing bone resorption in osteoporosis C Brown tumor is seen in
Alendronate, etidronate and strontium. Hyperparathyroidism
Orthopedics 277
C Right lower limb of a male patient following RTA C Inversion injury at ankle can cause
was flexed, adducted, internally rotated and short. Fracture tip of lateral malleolus, fracture base of 5th
Diagnosis metatarsal and fracture of sustentaculum tali.
Posterior dislocation of hip. C A 40 years old laborer suddenly develops acute
C Sciatic nerve injury may occur in lower back pain with right leg pain and weakness of
Posterior dislocation of hip joint. dorsiflexion of right great toe. True is
C Osteomalacia is associated with The appearance of foot drop indicates early surgical
Increase in osteoid maturation time. intervention.
C Most sensitive test in suspected old tear of anterior C Most common cause of acute osteomyelitis
cruciate ligament is Staphylococcus aureus.
Lachman test C Endosteal scalloping and punctate calcification in
C In actinomycosis of spine, abscess usually erodes expansile lesion in the centre of femoral metaphysis
Towards the skin. in a 45 years old male patient favours the diagnosis
of
Chondrosarcoma
ALL INDIA 2002
C A child presents with predisposition to fracture,
C Carpal tunnel syndrome is due to compression of anemia and hepatosplenomegaly despite diffusely
Median nerve increased radiographic density of bones
C Most common nerve involved in fracture of surgical Osteopetrosis.
neck of humerus C A 10 years old child presents with scoliosis, hairy
Axillary nerve tuft in skin of back and neurological deficit with X-
C Associated with supracondylar fracture of ray AP view showing multiple vertebral anomalies
humerus and vertical bony spur overlying lumbar spine
Rare after 15 years of age, cubitus varus deformity Diagnosis is
commonly results following malunion and Diastematomyelia
extension type fracture is more common than the C Unexplained hypotension in head injury patient
flexion type. warrants evaluation of
C Deformity produced due to malunion developed in Thoracic spine
fracture of lateral condyle of femur C Complete transaction of spinal cord at C7 level
Genu valgum. produces
C Patellar tendon bearing POP cast is indicated in Hypotension, anesthesia below level of lesion and
Fracture tibia. areflexia below level of lesion.