Home Forums General Books & Resources AIIMS PG November 2013 Rapid Review

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    Dr. Paresh Koli
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    AIIMS PG Nov 2013 Rapid Review cover

    Anatomy

    1. Parts of Mesorectal fascia includes Superior rectal vein, pararectal nodes and inferior mesenteric plexus and doesn’t include Inferior rectal vein.

    2. Derivatives of neural ectoderm in eye includes Retina, Constrictor and dilator pupillae but not Ciliary muscle (derived from mesoderm).

    3. Parts of ethmoid bone includes Agger nasi, Crista galli and Uncinate process and does not include inferior turbinate.

    4. Anal sphincter is supplied by S2,3,4 nerve roots.

    5. Predominant arterial blood supply of stomach is through Left gastric artery.

    6. Muscle which is anatomically located in back but functionally thoracic is Latissimus dorsi.

    7. Thumb and index finger are supplied by C6 , C7 nerve roots.

    8. Blood testis barrier is formed by sertoli cells (Sertoli cell barrier).

    9. During Spermatogenesis division of chromosomes from diploid to haploid state first occurs in Spermatogonia to primary spermatocyte division.

    10. Blood supply to medulla includes Anterior spinal artery, Posterior inferior cerebellar artery but does not include Superior cerebellar.

    11. Intercostal space which doesn’t follow VAN (Vein, Artery and Nerve) structure is 1st intercostal space.

    12. Long space between collagen fibres is found in Cornea.

    13. Anatomical sphincter for fallopian tube is located in its intramural part.

    14. Vaginal epithelium is embryologically solely derived from Mullerian duct (paramesonephric duct) epithelium i.e Mesodermal origin. (Taken from internet- Actual paper answer was Endoderm of urogenital sinus.

    15. Chromosomes are visualized through light microscope with resolution of 10 Mb.

    Physiology

    1. Alleviation of pain by repeated stimulation (Transcutaneous electrical nerve stimulation -TENS) is by Gate control theory.

    2. Regarding muscle contraction false is that calcium binding to tropomyosin.

    3. Platelet’s attachment to collagen is through vWF.

    4. Progesterone excreted in urine as Pregnanediol (metabolite of progesterone).

    5. Sympathetic control of blood supply is least to Brain (mainly by metabolic control).

    6. During excitation contraction coupling, T tubules on excitation releases calcium from sarcoplasmic reticulum, for initiation of relaxation calcium enters sarcoplasmic reticulum and Acetylcholine acts on motor end plate.

     

    Biochemistry

    1. Cyclooxygenase is a Suicidal enzyme.

    2. ATP production in RBC is not a use of NADPH.

    3. Best method to detect known genetic loci is FISH.

    4. PCR is used for DNA amplification.

    5. Decrease in Insulin/Glucagon ratio increases activity of glucose 6 phosphatase.

    6. Ketosis is seen in Von Gierke’s disease is due to facts that it causes hypoglycemia and oxaloacetate is needed for gluconeogenesis but not due to low fat immobilization.

    7. Peptidyl transferase is an amino acyltransferase as well as the primary enzymatic function of the ribosome, which forms peptide bonds between adjacent amino acids using tRNAs during the translation process of protein biosynthesis

    8. Enzymes which are part of Fatty acid synthetase complex includes Acyltransferase, Enoyl reductase and Thioesterase and does not include Acetyl CoA carboxylase.

     

    Pharmacology

    1. Fasudil is a Rho kinase inhibitor.

    2. DOC for JME in pregnancy is levetiracetam.

    3. Newly approved drug for Lennox gastaut syndrome is Rufinamide.

    4. Carbamazepine is commonest cause of toxic epidermal necrolysis and Stevens-Johnson syndrome.

    5. Cholinomimetic are contraindicated in partial heart block

    6. Sudden stoppage of antidepressant which doesn’t cause any side effects is fluoxetine.

    7. Isoprenoid alcohol induce apoptosis (in various malignant cells and inhibit tumorigenesis in several in-vivo models).

    8. Corticosteroid is indicated in severe typhoid fever.

    9. LMWH differs from unfractionated heparin in that it is less bound to plasma proteins.

    10. Hyoscine butylbromide (Scopolamine butylbromide) does not cross BBB.

    11. Rate at which the active drug is removed from the body is called Clearance.

    12. Iodine is not contraindicated  in hyperthyroidism

    13. Duration of action of Flumazenil is 20 min (15-140 min).

    14. Drug used for primary pulmonary hypertension (PAH) is Bosentan (dual endothelin receptor antagonist).

    15. Drug with both alpha and beta agonistic action is Epinephrine.

    16. Snowfield vision is seen in Methyl alcohol poisoning and major metabolite causing the complications in methyl alcohol poisoning is Formic acid.

     

    Pathology

    1. Tumor marker for Seminoma is PLAP (Placental alkaline phosphatase).

    2. In Vitamin B12 deficiency there is no increase in reticulocyte count.

    3. In Iron deficiency anemia transferrin saturation is reduced <16%, it is detected by serum ferritin levels even in earlier states and is mostly presented without any symptoms.

    4. Uniparental disomy is seen in Angelman’s syndrome, Silver Russell syndrome and Prader Willi syndrome but not seen in Bloom syndrome.

    5. African-American kid with, abdominal pain, chronic hemolytic anemia and abnormal RBC shape. Most common mechanism is point mutation (sickle cell anaemia).

    6. Tensile strength of the wound is due to cross linkage of tropocollagen.

    7. A 70-year-old man who was working in asbestosis factory and h/o smoking. On routine X-ray a mass was seen in right apical region. The histopathology of this should examine desmosomes to distinguish epithelial malignant mesotheliomas (EMM) rom adenocarcinoma.

    8. A 32-year-old female with Virchow node enlargement on biopsy shows owl eye nuclei and CD 30 and CD15 positive diagnosis. Most probable diagnosis is Nodular lymphocyte predominant Hodgkin’s lymphoma.

    Forensic Medicine

    1. In autopsy curling ulcer should be examined in – 1st part of duodenum.

    2. Disclosure of identity of a rape victim is punishable under section 228A IPC.

    3. Conducting criminal abortion victim is punishable under section 312 IPC.

    4. Embalming before autopsy is punishable under section 201 of IPC.

    5. According to Delhi Anatomy Act, a body is declared unclaimed after 48 hours for the purpose of conducting anatomical examination and dissection or other similar purpose.

    6. Lateral buttock traction test is done to detect habitual passive agent.

    7. False regarding methyl alcohol poisoning is that fomepizole is a competitive inhibitor of dehydrogenase.

    8. Rigor mortis not seen in fetus of less than 7 months of gestational age.

    9. In RTA patient lost consciousness, later he gained consciousness and again after sometime he lost consciousness. This is an example of Lucid interval.

     

    Microbiology

    1. Main function of MHC class I and II is to present the antigen to T cells.

    2. Not a common cause for neonatal sepsis in India is Acetobacter.

    3. After a disaster, Leptospirosis, Leishmaniasis and Acute respiratory infections epidemics are seen but Rickettsia epidemic is not seen.

     

    Ophthalmology

    1. Topiramate concentration used for diagnostic and therapeutic procedures in ophthalmology is 0.01 i.e. 1%.

    2. Band shaped keratopathy is due to deposition of Calcium.

    3. Intraocular solid tumor causing bilateral proptosis is Neuroblastoma.

    4. In pterygium, recurrence rate after surgery with bare sclera resection technique is 30% (25-89%).

    5. Optic atrophy is not seen in retinitis pigmentosa.

    6. In Indirect ophthalmoscopy there is magnification of 4-5 times, convex lens in used in it and it can be used in hazy cornea.

    7. In cataract there is increase in insoluble proteins and decrease in soluble proteins.

    8. A new-born baby is referred from CHC to an ophthalmologist at 28 weeks of gestational age for any ophthalmological problems.

    9. Glaucomatous atrophy causes damage to ganglion cells of retina and their axons.

    10. A patient with eye pain and blurring of vision. Drug which is contraindicated in this patient is homatropine (narrow angle glaucoma).

    11. Corneal change in Vitamin A deficiency is actinic degeneration.

    12. According to NPCB post-cataract surgery surveillance is done by Sentinel surveillance.

    13. Degenerative myopia leads to retinal tear and Retinal detachment.

    14. Brimonidine is an alpha 2 adrenergic agonist which decreases aqueous production.

    15. Most common source of intraocular metastasis is from breast (breast & lungs in women and Liver & lung in men).

    16. Conjunctiva in Vitamin A deficiency shows Squamous hyperplasia.

    17. Most common malignancy associated with retinoblastoma is osteosarcoma.

    ENT

    1. Tympanogram in otosclerosis shows Type As (s-stiffness curve).

    2. Topical steroid is contraindicated after sinus surgery for Antrochoanal polyp.

    3. Part of cochlear implant that is implanted in inner ear during surgery is Transmitter coil.

    4. A person who consumed peanut developed edema of tongue, stridor, dyspnea, rash, urticaria and swelling of neck and lips. Most likely cause of this is angioneurotic oedema.

    5. Indication of tonsillectomy in a child with enlarged tonsils includes Sleep apnea.

    6. A patient with OSA (obstructive sleep apnea) with hypertension on treatment and apnea-hypopnea index of 5. Next step in management should be weight reduction and diet (index of 5 is mild disease, CPAP is effective for moderate and severe disease).

    PSM

    1. Under ESI Act, State Government’s share of expenditure on medical care is 1/8 and ESI Corporation’s share of expenditure on medical care is 7/8 of total cost.

    2. In assessing the literacy rate only people with age above 7 years are considered.

    3. Screw feed technology is a non-burning thermal treatment in which there is weight reduction by 20-30% and volume reduction by 80%. (not used for pathological, cytotoxic and radioactive waste)

    4. Percentage of GDP allocated to health in India is 4.1% i.e. 0.041.

    5. Burden of under 5 mortality in the India in 2012 was 6 million.

    6. Measles vaccination in all 9-14 years old children at one-time is called as Catch up.

    7. Q test is used to determine outliers.

    8. Indoor air pollution can cause Chronic lung disease, adverse pregnancy outcome and pneumonia in children but does not cause Neurological complications.

    9. Roll back malaria initiative includes strengthening of health system, training of health workers and use of insecticide treated mosquito nets and does not include developing new insecticides.

    10. Rashtriya Swasthya Bima Yojana (RSBY) is applicable only for BPL families.

    11. In India last case of polio (wild poliovirus) was detected on 13th January 2011.

    12. If mean Hb value of a population is 13.2 g/dL then 50% of population will have Hb value above 13.2 g/dL.

    13. Population between mean and +1 standard deviation is 0.34.

    14. In disaster triage, 1st importance is given to Red.

    15. RDA of iodine in pregnancy is 220 mcg/day.

    16. Folic acid fortification is done with flour and is indicated in women who intend to become pregnant.

    17. In Normal distribution, 68.3% of population is covered with mean +1 SD.

    18. Highly poisonous insecticides (Category 10) are labelled with black colour code in biomedical waste management.

    Medicine

    1. Coarse tremors of are seen in Parkinsonism, Alcohol and General anaesthesia. Fine tremors are seen in Thyrotoxicosis.

    2. Acquired causes of Aplastic anemia includes transplantation of ABO incompatible stem cells, toxins and radiation.

    3. A diabetic patient comes with loss of vision. Next investigation to be done in this patient is serum homocysteine.

    4. For contrast nephropathy abnormality seen is greater than 25% increase of serum creatinine or an absolute increase in serum creatinine.

    5. Biomarkers of acute kidney injury includes NGAL, KIM1 and Cystatin C and does not includes micro RNA.

    6. In critical illness myoneuropathy there could be diaphragm atrophy due to mechanical ventilation.

    7. A 32 years old Bengali woman with fever since 3 days and had 2 episode of seizure and is awaiting investigation. Initial management should include i.v Mannitol.

    8. A woman on antihypertensives came with hemiparesis and speech difficulty since past 2.5 hrs. BP was 180/100. Next step in management should be immediate NCCT scan.

    9. A patient with hemiparesis and a native aortic valve disease had recovered after a week. Treatment of choice to prevent recurrent stroke is antiplatelet drugs only.

    10. TB meningitis patient develops confusion and altered sensorium. Investigation which could be done includes CT and MRI and investigation which is not required is CSF examination.

    11. A female patient who eats mainly junk foods presents with bleeding around hair follicles, bleeding in mucosal areas and joints. The defect in this patient is with hydroxylation of proline.

    12. Criterias for severe malaria includes LDH levels raised >45, raised serum creatinine and reduced blood sugar <40 mg/dL.

    13. A patient on Amphotericin B had potassium level of 2.3 mEq/dL. For correction for its level, 40 mEq over 24 hours.

    14. A patient had an anaphylactic shock with BP 80/65 mm Hg. Treatment includes epinephrine (main), antihistaminics, steroids and oxygen.

    15. A male didn’t have alcohol for 2 days and then presented with nausea vomiting on day 1 and seizures on day 2. Treatment of choice is diazepam.

    16. Post surgically patient developed diastolic hypertension. Treatment should be sodium restriction.

    17. Most common type of Non-hodgkins lymphoma in India is Diffuse large granular B cell lymphoma.

    18. Features of megaloblastic anemia includes Segmental erythrocytes and jaundice.

    19. In Aspiration pneumonia posterior segments of upper lobe and apical segments of lower lobes are most commonly involved when aspiration occurs in supine position.

    20. Involvement of corpus striatum and lesions in thalamus, midbrain, pons and medulla is seen in leigh syndrome.

    21. No focal neurological deficits, ptosis and severe headache are features of Subarachnoid haemorrhage.

    22. Patient of age 60 yrs presents with sudden severe headache becomes unconscious. After waking up there is blurring of vision, Photophobia and neck rigidity. Investigation of choice for this patient is NCCT (for SAH).

    23. A patient with 6 months history of altered bowel habits. Investigation shows increased mesenteric fat, dilatation of proximal and distal ileum and thickening of the walls. Probable diagnosis includes Ulcerative colitis, Crohns disease and Ileocolic TB and does not include ischemic bowel disease.

    Surgery

    1. Investigation of choice in Anorchia is USG or MRI.

    2. For h shaped oesophageal fistula investigation of choice is oesophagoscopy.

    3. Treatment for contaminated necrotic wound is debridement.

    4. Lactating woman comes with breast pain. Investigation of choice is ultrasound.

    5. A newborn baby presents with respiratory distress, cyanosis and froth in the mouth. Most probable diagnosis is oesophageal atresia

    6. Mortality rate for surgery of ruptured Aortic aneurysm surgery is 50% (26% in symptomatic, 5% in asymptomatic and 35% in ruptured aneurysms).

    7. Primary idiopathic Endemic bladder stones have peak incidence in children <3 years, it is predominantly associated with cereal based diet and treatment includes Ammonium nitrate and calcium but they are not recurrent after surgery.

    8. 60-year-old man with fever with chills, dysuria and diffuse back pain and shows Increased PSA with tender prostate. Next step in management is to admit the patient and give antibiotics.

    9. 1st line of treatment for Tension pneumothorax is insertion of needle into the 2nd intercostal space.

    10. Bradycardia in a patient with RTA could be due to neurogenic shock.

    11. In Glasgow coma scale withdrawal of limb on painful stimulus comes under M4.

    12. A 50-year-old female with progressive painless jaundice, Alkaline phosphatase 550, SGOT 75, Total bilirubin 6.5 and Conjugated bilirubin is 4.3. Most common diagnosis is Obstructive jaundice from malignant biliary jaundice.

    13. Neoadjuvant chemotherapy is useful in Osteosarcoma, breast ca stage 2 and Ovarian cancer Stage 3 but not useful in PNET chest wall.

    14. A 60-year-old man with Alcoholic liver disease came with hematemesis. Regarding management, somatostatin infusion is indicated, negative NGT aspirate does not exclude variceal bleed, rigid bronchoscopy can be done and NGT insertion does not provoke variceal bleed.

    15. For hemoptysis investigation of choice is chest X-ray and massive hemoptysis is defined as 300-600 ml.

    16. Patient with necrotizing enterocolitis has right flank pain, 10 days h/o ventilation and gas in portal vein. Stage of NE in this patient is Stage 2b.

    17. In a burns case doctors was looking for curling’s ulcer. part that he should examine is 1st part of duodenum.

    Pediatrics

    1. Drugs used in cyanotic spell includes Na bicarbonate, propranolol and Adrenaline and does not include CaCl2.

    2. Immunisation of 5-year-old by National immunisation schedule is giving DT booster.

    3. Effectiveness of phototherapy doesn’t depend on Skin pigmentation.

    4. A 10 yr old boy with leg muscles hypertrophy and decreasing CK. Most probable diagnosis is DMD (Duchenne muscular dystrophy).

    5. In neonatal resuscitation step which is not followed is finger sweeping of mouth to remove foreign body

    6. For Childhood CML drug of choice is protein tyrosine kinase inhibitor.

    7. A bone scan necessary for metastasis in a 4-year-old child is done in case of neuroblastoma.

    8. Neonate comes with seizures. Next investigation to be done is transcranial USG.

    9. For bag-mask ventilation of a newborn, the bag size is usually >450 ml.

    10. Bilateral swelling of the calf and decrease in CPK with increasing age in a child is seen in Dystrophin deficiency.

    11. 6 weeks old boy with fever and cough for 3 days, now has RR 48/min and ronchi on chest. No chest indrawing is seen. For this patient no antibiotics are needed and bronchodilators can be given. (Child does not have pneumonia according to WHO guidelines).

    12. Juvenile CML (Juvenile myelomonocytic leukemia – JMML) is the 2nd most common form of cancer in infants and most common form of cancer in older children.

    Obstetrics and Gynaecology

    1. Order in lochia after birth is Lochia rubra, Lochia serosa and Lochia Alba.

    2. Fertilised ovum reaches uterus by 4-5 days after fertilization.

    3. Maximum cardiac output during pregnancy seen at 32 weeks of pregnancy.

    4. Risk factors for cervical cancer includes multiple partners, early sexual intercourse and Smokin and does not include low parity.

    5. Best prognosis among sex ambiguity diseases is found in congenital adrenal hyperplasia

    6. Patient with less than 20 weeks gestation, bleeding PV, cervical os dilated and placenta and fetus in the uterus. Most probable diagnosis is inevitable abortion.

    7. Complications more commonly seen in vacuüm cup assisted delivery compared to forceps delivery includes Subgaleal hemorrhage, Cephalhematoma and IC hemorrhage and does not include lateral rectus palsy which is more common in forceps delivery.

    8. Sign of heart disease in pregnancy which is not seen in normal pregnancy distended neck veins.

    9. A couple coming to infertility clinic with 4 yrs of unprotected intercourse, female is normal, male ejaculate volume 0.8ml, fructose negative and no sperms on high power field. Next investigation should be transrectal ultrasound to rule out ejaculatory duct obstruction.

    10. Drug which is not used in PCOD is Tamoxifen.

    11. Radiation dose for cervical cancer at point A for early and late stage cancer is 70-75 Gy and 75-80.

    12. Risk of transmission of HIV from mother to baby if no intervention is done is 25%.

    13. Latent phase of labour is a part of 1st stage of labour.

    14. A pregnant patient underwent LSCS for fetal distress. She had mild hypertension during pregnancy. She developed headache and episode of seizure. Ct shows a mass seen in parasagittal area of size 2*3 cm (parasagittal hematoma) and no proteinuria. Most probable diagnosis is sagittal sinus thrombosis.

    15. Office endometrial aspiration for endometrial carcinoma is not a screening method in women.

    16. Most accurate and safe method of diagnosis of pregnancy in patient with 6 weeks of amenorrhea is USG showing fetal activity.

    17. Woman with primary amenorrhea had webbing of neck, height 141 cms and FSH was increased. Ovarian microscopy in this patient will reveal loss of oocyte.

    18. 30-year-old woman with hirsutism and infertility is diagnosed to have PCOS. Treatment of choice is Clomiphene.

    19. Gender identity disorder with good prognosis is Testicular feminization syndrome.

    20. At 6 weeks of gestation best test for viability is usg for fetal cardiac activity.

    Orthopaedics

    1. Gallows traction is applied for fracture of shaft of femur.

    2. In Supracondylar fractures there is transient nerve injury.

    3. A 14-year-old boy with 14 days of fever and swelling around the tibia showing periosteal reaction on X-ray. Next investigation should be bone biopsy.

    4. Clubfoot is found in CTEV.

    5. A hockey player sustained injury and presented with instability of knee o/e anterior drawer test is positive and lachman test negative.Most probable diagnosis is injury to posterolateral part of anterior cruciate ligament.

    6. Both vertebral body and intervertebral disc space is involved in Tuberculosis.

    7. 10-year-old obese child is referred from endocrinology department to emergency for painful limp. Investigations which could be done includes MRI, USG and NCECT and no need to do X-ray pelvis and hip.

    8. In osteoporosis, calcitonin ameliorates bone pain, in severe osteoporosis PTH is used and bisphosphonates are workhorse of its treatment.

    9. Rotator cuff is a Dynamic shoulder cuff stabilizer.

    10. Male patient with h/o weakness of left upper limb, is able to hold pen, normal hand grip and all movements are preserved except dorsiflexion of wrist. There is no sensory loss. Most likely diagnosis is Posterior interosseous nerve injury.

    Psychiatry

    1. Mother gives her child a chocolate whenever the boy eats vegetables (normally he doesn’t). This is an example of operant conditioning.

    2. A 20 yr old female had abdominal pain last week with loss of vision but USG and clinically normal. She again presented with loss of vision reflexes are normal. Most probable diagnosis is Malingering.

    3. Features of Kluver bucy syndrome includes Hypersexuality, Hyperorality and placidity and doesn’t include Hypermetamorphosis.

    4. Cognitive remediation is used for correcting cognitive distortion.

    Anaesthesia

    1. During laparoscopic cholecystectomy patient develop wheeze. Treatment of choice is to Deepen plane of anaesthesia.

    2. Anaesthetic agent contraindicated during neurosurgery in epileptic patient is I.V propofol.

    3. Malignant hyperthermia caused by Suxamethonium.

    4. According to AHA 2010 guidelines Adrenaline, Vasopressin and Amiodarone can be used for CPR but drug not used for CPR is Atropine.

    5. Induction is quicker when N2O is given along with inhalational agent (due to second gas effect).

    6. For d-tubocurarine highly sensitive muscle is thos of head and neck and least is diaphragm which is also fastest to recover.

    7. For neuraxial block (anaesthesia) contraindication includes Platelet count <50,000, patient on clopidogrel and in local infection and is not contraindicated in patients on antihypertensive medication.

    8. Preventive techniques for post lumbar puncture (spinal anaesthesia) headache includes Close stylet, Atraumatic needle and Using needle with small diameter and does not include prophylactic crystalloid diameter.

    9. Dermatomal level of anesthesia for LSCS is up to T4.

     

    Radiology

    1. Patient with respiratory distress and decreased pO2 and Stratosphere sign on M mode USG. Most likely diagnosis is pneumothorax.

    2. Full form of FAST is Focused assessment with sonography in trauma.

    3. Spinal cord injury without radiological abnormality is seen in children.

    4. Painful and swollen great toe with radiologically punched out lesions and overhanging erosions with involvement of adjacent soft tissue. Most probable diagnosis is gouty arthritis.

    5. Increased pulmonary blood flow is radiologically indicated by Kerley B lines, descending pulmonary artery diameter> 16 mm and peripheral arteries more than 6.

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