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    Dr. Paresh Koli
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    AIPGMEE 2005 Rapid Review Cover

    Anatomy

    1. Carpal tunnel syndrome contains median nerve, flexor pollicis longus and flexor digitorum superficialis.

    2. Femoral ring is bounded by femoral vein, inguinal ligament and lacunar ligament.

    3. While doing thoracocentesis it is advisable to introduce needle along upper border of the rib.

    4. BPH is associated with enlargement of median lobe.

    5. Prostatic urethra is characterised by features that it is widest and most dilatable part, lies closer to anterior surface of prostate and receives prostatic ductules along its posterior wall.

    6. Vas deferens has it’s terminal part dilated to form ampulla, crosses ureter in region of ischial spine and passes lateral to inferior epigastric artery at deep inguinal ring.

    7. Lymph Nodes receiving lymphatics from uterus includes external iliac, internal iliac and superficial inguinal.

    8. On per rectal examination of adult man structures felt includes bulb of penis, prostate and seminal vesicle when enlarged.

    9. Branches of external carotid artery includes superficial thyroid artery, occipital artery and posterior auricular artery.

    10. Paralysis of 3rd, 4th and 5th nerves with involvement of ophthalmic division of 5th nerve, localizes lesion to Cavernous sinus.

    11. Superior oblique muscle is supplied by 4th cranial nerve.

    12. Chorda tympani nerve carries secretomotor fibers to submandibular gland, joins lingual nerve in infratemporal fossa and is a branch of facial nerve.

    13. Type of joint between sacrum and coccyx is Symphysis.

    14. Physiological processes during growth of epiphyseal plate includes proliferation, hypertrophy, calcification, ossification, vasculogenesis and erosion.

    15. Barr body is found in Interphase of cellular cycle.

    Physiology

    1. Pulmonary surfactant is secreted by Type II pneumocyte.

    2. In hypoventilation there is reduction in arterial oxygen tension.

    3. CO2 is primarily transported in arterial blood as Bicarbonate.

    4. Vasodilation in produced by carbon dioxide is maximum in Brain.

    5. Distribution of blood flow in mainly regulated by Arteries.

    6. Factors which normally increase length of ventricular cardiac muscles includes increased venous tone, increased total blood volume and increased negative intrathoracic pressure.

    7. SA node acts as a pacemaker of heart because of fact that it generates impulses at the highest rate.

    8. Main site of bicarbonate reabsorption is Proximal convoluted tubule.

    9. Bulk of water reabsorption occurs secondary to Na+ reabsorption.

    10. Urinary concentration ability of kidney is increased by ECF volume concentration.

    11. NO is also used for cell signaling.

    12. Fibers from contralateral nasal hemiretina projects to Layers 1,4 and 6 of lateral geniculate nucleus.

    13. Parvocellular pathway from lateral geniculate nucleus to visual cortex is most sensitive for stimulus of Color contrast.

    14. Hg F has least affinity for 2,3 biphosphoglycerate.

    15. Heme is converted to bilirubin mainly in Spleen.

    16. Osteoclasts are inhibited by Calcitonin.

    17. Hypercalcemia associated with malignancy is most often mediated by Parathyroid hormone related protein (PTHrP).

    18. Primary action of inhibin is to inhibit secretion of FSH.

    19. 1st physiological response of high environmental temperature is Vasodilation.

    20. Neuronal degeneration is seen in Crush nerve injury, fetal development and Senescence.

    Biochemistry

    1. Amino acid residue having an amino side chain is Proline.

    2. Enzymes that move a molecular group from one molecule to another are known as Transferases.

    3. Fluoride used in collection of blood samples for glucose estimation inhibits enzyme Enolase.

    4. Predominant isozyme of LDH in cardiac muscle is LD-1.

    5. Both Vitamin K and C are involved in Post translational modification.

    Pathology

    1. In reversible cell injury there is diminished generation of adenosine triphosphate (ATP), formation of blebs in plasma membrane and detachment of ribosomes from granular endoplasmic reticulum.

    2. Vascular changes observed in acute inflammation includes vasodilation, stasis of  blood and increased vascular permeability.

    3. Fibrinoid necrosis may be observed in malignant hypertension, polyarteritis nodosa and aschoff’s nodule.

    4. In apoptosis, Apaf- is activated by release of Cytochrome C from mitochondria.

    5. In situ DNA nick end labeling can quantitate fraction of cells in apoptotic pathways.

    6. All endothelial cells produce thrombomodulin are found in hepatic circulation, cutaneous circulation and renal circulation.

    7. Rb is a tumor suppressor gene.

    8. Feature of malignant transformation by cultured cells includes increased cell density, alterations of cytoskeletal structures and loss of anchorage.

    9. A simple bacterial test for mutagenic carcinogens is Ames test.

    10. Tumor markers for testicular tumor includes AFP, LDH and HCG.

    11. Congo red stain is specific for amyloid.

    12. Familial amyloidotic polyneuropathy is caused by mutation of transthyretin protein.

    13. In familial mediterranean fever, gene encoding Pyrin protein undergoes  mutation.

    14. Classification proposed by International lymphoma study group for non-Hodgkin’s lymphoma is known as REAL classification.

    15. Subtype of Hodgkin’s disease Histologically distinct from other subtypes is Lymphocytes predominant.

    16. Tartrate resistant acid phosphatase positivity is typically seen in hairy cell leukemia.

    17. 48  year old woman with weakness for 2 months , cervical lymph nodes enlarged,  spleen palpable  cm below costal margin, Hb  g/dL, platelet count 2.7 x 109/L, TLC 40 x 109/L, 80% mature lymphoid cells with coarse clumped chromatin, lymphoid infiltrate on bone marrow, peripheral blood lymphoid cells were positive ion of lymph node in this patient will most likely exhibit effacement of lymph node architecture by a diffuse proliferation of medium to large lymphoid cells with high mitotic rate.

    18. Patient with IgD myeloma may present with no evident M-spike on serum electrophoresis.

    19. In smoldering myeloma plasma cells constitute 10-30% of total bone marrow cellularity.

    20. In a patient with multiple myeloma, a monoclonal light chain may be detected in both serum and urine.

    21. Aschoff’s nodules are seen in Rheumatic carditis.

    22. In viral pneumonia there is presence of interstitial inflammation, bronchiolitis and multinucleate giant cells in bronchiolar wall.

    23. Atypical pneumonia can be caused by Mycoplasma pneumoniae, Legionella pneumophila and Human Coronavirus.

    24. In Benign nephrosclerosis bilateral contracted kidneys are characteristically seen.

    25. Kidney biopsy from a child with hemolytic uremic syndrome characteristically most likely presents features of Thrombotic microangiopathy.

    26. Chronic alcoholism characteristically causes fatty change in liver.

    27. Features of liver histology in Non cirrhotic portal fibrosis (NCPF) includes fibrosis in and around portal tracts, thrombosis of medium and small portal vein branches and non specific inflammatory cell infiltration in portal tracts.

    28. Chances of having an unaffected baby, when both parents have achondroplasia are 25%.

    29. Differential expression of same gene depending on parent of origin is referred to as Genomic imprinting.

    30. Membrane Protein clathrin is involved in Receptor mediated endocytosis.

    31. Cellular and flagellar movement is carried out by actin, tubulin and myosin.

    Microbiology

    1. In small intestine, cholera toxin acts by ADP ribosylation of the G regulatory protein.

    2. Halophilic Vibrio species includes V. parahaemolyticus, V. alginolyticus and V. fluvialis.

    3. Clostridium perfringens is commonest cause of gas gangrene, is normally present in human faeces and principal toxin of C. perfringens is alpha toxin.

    4. Enteroaggregative E. coli is associated with Persistent diarrhoea, Enterohemorrhagic E. coli can cause haemolytic uraemic syndrome and Enterotoxigenic E. coli is a common cause of traveller’s diarrhoea.

    5. Bacterial disease associated with 3 R’s i.e. rats, ricefields and rainfall is Leptospirosis.

    6. Plates of stool sample suspected of having Campylobacter jejuni should be incubated at 42o C and microaerophilic environment.

    7. Melioidosis is caused by agent which is gram negative aerobic bacteria, bipolar staining of aetiological agent is seen with methylene blue stain and most common form of melioidosis is pulmonary infection.

    8. Organism known to survive intracellularly includes Neisseria meningitidis, Salmonella typhi and Legionella pneumophila.

    9. One of the most common organism causing acute meningitis in an AIDS patient is Cryptococcus neoformans.

    10. Most common pathogen responsible for nosocomial pneumonia in ICU are Gram negative organisms.

    11. Normal microbial flora on skin and mucous membranes cannot be eradicated by antimicrobial agents.

    12. Chlamydia trachomatis is associated with Endemic trachoma, inclusion conjunctivitis and lymphogranuloma venereum.

    13. In Chlamydia pneumoniae a group of specific antigen is responsible for production of complement fixing antibodies.

    14. Viruses can be isolated from clinical samples by cultivation in tissue culture, embryonated eggs and animals.

    15. Virus mediated transfer of host DNA from one cell to another is known as Transduction.

    16. HIV can be detected and confirmed by Reverse transcriptase-PCR.

    17. Neuro Parasites includes Taenia solium, Acanthamoeba and Naegleria.

    18. Giardia lamblia infestation leads to malabsorption.

    19. Capsule of Cryptococcus neoformans in CSF is best seen by India ink preparation.

    20. Serum concentration of IgG1 is maximum among all IgG subclass.

    21. Type I hypersensitivity is mediated by IgE.

    22. Graft from identical twin is Isograft.

    23. Adenosine deaminase deficiency are associated with Severe combined immunodeficiency (SCID).

    Pharmacology

    1. Highly ionized drug is excreted mainly by kidney.

    2. Hormones having cell surface receptors includes Adrenaline, GH and Insulin.

    3. Adrenal suppression should be expected in anyone receiving >5 mg, Prednisolone daily.

    4. Theophylline has an antagonistic interaction with Adenosine receptor.

    5. Neostigmine increased gastrointestinal motility.

    6. Metoclopramide has been shown to offer protection from gastric aspiration syndrome in a patient with symptoms of flux.

    7. Drugs having significant drug interaction with digoxin includes Cholestyramine, Thiazide diuretics and Quinidine.

    8. Nesiritide is a brain natriuretic peptide analogue, it is used in actually decompensated heart failure and it has a short half-life.

    9. Dry mouth during antidepressant therapy is caused by blockade of Muscarinic acetylcholine receptors.

    10. Major difference between typical and atypical antipsychotics is that the former causes tardive dyskinesia.

    11. Antipsychotic drug induced Parkinsonism is treated by Antipsychotics.

    12. Oculogyric crisis is known to be produced by Trifluoperazine, Prochlorperazine and Perphenazine.

    13. Inverse agonist of benzodiazepine receptor is Beta-carboline.

    14. LSD, Phencyclidine and mescaline are hallucinogens.

    15. Topically used sulphonamides includes Sulphacetamide, Silver sulphadiazine and Mafenide.

    16. Amoxicillin, PEnicillin G and Piperacillin are penicillinase susceptible.

    17. Lumefantrine is Antimalarial.

    18. Pyrimethamine is used in therapy of Toxoplasmosis.

    19. Nevirapine is a non-nucleoside reverse transcriptase inhibitor.

    20. Irinotecan is Topoisomerase I inhibitor.

    21. Etanercept acts by blocking tumor necrosis factors.

    Forensic Medicine

    1. In India magistrate inquest is done in Exhumation cases, Dowry deaths within 5 years of marriage and death of person in police custody.

    2. Minimum age at which an individual is responsible for his criminal act is 7 years.

    3. Most reliable method of identification of an individual is Dactylography.

    4. Most common pattern of fingerprint is Loop.

    5. Most reliable criteria in GUstafson’s method of identification is Transparency of root.

    6. Diatoms are aquatic unicellular plant, acid digestion technique is used to extract diatoms and presence of diatoms in femoral bone marrow is an indication of antemortem inhalation of water.

    7. If in a firearm injury, there is burning, blackening, tattooing around wound, along with cherry red colour of surrounding tissues and is cruciate in  shape injury is Close shot entry.

    8. In methyl alcohol poisoning there is CNS depression cardiac depression and optic nerve atrophy. These effects are produced due to Formaldehyde and formic acid.

    9. In chronic arsenic poisoning nail clippings, hair samples and bone biopsy can be sent for laboratory examination.

    10. At autopsy cyanide poisoning case will show congested organs, skin may be pinkish on cherry red in colour and erosion and haemorrhages in oesophagus and stomach.

    Preventive and Social Medicine

    1. Infant mortality includes early neonatal mortality, post neonatal mortality and late neonatal mortality.

    2. Case fatality rate is a good index of severity of an acute disease.

    3. Endemic disease means that a disease is constantly present in a given population group.

    4. Herd immunity of infectious diseases refers to group protection beyond what is afforded by protection of immunized individuals, is affected by presence and distribution of alternative animal hosts and in case of tetanus is does not protect the individual.

    5. 2 ye.

    6. ar old female child to PHC presents with cough, fever for 4 days with inability to drink or last 12 hours, weight 5 kg, RR 45/min. Child is classified as having very severe disease.

    7. For treatment of case III dog bite immediately wash wound with soap and water, give immunoglobulin for passive immunity and give ARV.

    8. Antibiotic treatment of choice for treating cholera in adult is a single dose of Doxycycline.

    9. Congenital rubella is diagnosed when infant has IgM  antibodies at birth, is diagnosed when IgG antibodies persist from more than 6 months and most common congenital defects are deafness, cardiac malformations and cataract.

    10. Most common cancer affecting indian urban women is Breast cancer.

    11. Weight 89 kg and height 172 cm then BMI is 30.

    12. Influence of smoking is independent of their risk factors for CHD, is synergistic to other risk factors for CHD and is directly related to number of cigarettes smoked per day.

    13. Kyasanur forest disease (KFD) is a viral infection transmitted by ticks.

    14. Anti Larval measures include Intermittent irrigation, paris green and gambusia affinis.

    15. Tests used to check efficiency of pasteurization of milk is phosphatase test, standard plate count and coliform count.

    16. Recommended daily energy intake of an adult woman with heavy work is 2900.

    17. Yellow bag is used in hospitals to dispose off human anatomical wastes such as body parts.

    18. Standard normal distribution has variance of 1.

    19. Hb level in healthy woman has mean 13.5 g/dL and standard deviation of 1.5 g/dL, so Z score for women with Hb level 15 g/dL is 1.

    20. Events A and B are mutually exclusive so Probability (A or B) = Probability (A) + Probability (B).

    21. Diagnostic power of a test to correctly exclude disease is reflected by Negative predictivity.

    22. Total cholesterol level = a + b (caloric intake) + c (physical activity) + d (body mass index), is an example of Multiple linear regression.

    23. Best indicator for monitoring impact of iodine deficiency disorder control programme is Neonatal hypothyroidism.

    24. Under WHO ‘Vision 2020’ programme, ‘SAFE’ strategy is adopted for Trachoma.

    25. WHO defines adolescent age  10-19 years of age.

    26. Transplantation of human organs act was passed by Government of India in 1994.

    27. IT act was passed by Government of India in year 2000.

    28. Sources of manager’s powers includes reward, coercive and legitimate.

    Medicine

    1. Splenectomy is useful in Hereditary spherocytosis, Thalassemia and sickle cell disease with large spleen.

    2. Causes of relative polycythemia are dehydration, dengue haemorrhagic fever and Gaisbock syndrome.

    3. Palpable purpura could occur in small vessel vasculitis, disseminated gonococcal infection and acute meningococcemia.

    4. Causes of ST segment elevation on ECG includes early repolarization variant, ventricular aneurysm and prinzmetal angina.

    5. 59 year old man with severe myxomatous mitral regurgitation is asymptomatic , with left ventricular ejection fraction of 45% and end systolic diameter index of 2.9 cm/m2. Most appropriate treatment is Mitral valve repair or replacement.

    6. Abnormal preoperative pulmonary function test in a patient with severe kyphoscoliosis includes increased RV/TLC.

    7. Serum angiotensin converting enzyme may be raised in Sarcoidosis, silicosis and berylliosis.

    8. Ulcerative colitis is commonly predisposes to colonic carcinoma.

    9. 5′-Nucleotidase activity is increased in Bone diseases.

    10. Serum albumin levels help in distinguishing an acute liver disease from chronic liver disease.

    11. 30 year old male with complaints of weakness in right upper and both lower limbs since 4 months, developed digital infarcts involving 2nd and 3rd fingers on right side  and 5th finger on left side, BP 160/140 mm Hg, all peripheral pulses normal and there was asymmetric neuropathy, Hb 12 gm, TLC 12000 cu mm, platelets 4,30,000, ESR 49 mm, proteinuria and  RBC 10-15/hpf with no casts on urine examination. Most likely diagnosis is Polyarteritis nodosa.

    12. Causes of osteoporosis includes Hyperparathyroidism, steroid use and thyrotoxicosis.

    13. Pancreatitis, pituitary tumor and pheochromocytoma may be associated with Medullary carcinoma of thyroid.

    14. Causes of diabetes insipidus includes head injury, histiocytosis and viral encephalitis.

    15. Cluster headache is characterized by unilateral headache, onset typically in 20-50 years of life and associated with conjunctival congestion.

    16. Propranolol is used in prophylaxis of migraine.

    17. Lower motor neuron lesions are associated with flaccid paralysis.

    18. Putamen/ internal capsule is most common location of hypertension bleed in brain.

    19. Normal CSF glucose level in normoglycemic adult is 40-70 mg/dL.

    20. CSF findings in Tuberculous meningitis includes raised protein levels, low chloride levels and cob sugar levels.

    21. Subacute combined degeneration causes reversible dementia.

    22. 40 year old chronic alcoholic, has acute onset onset of seeing snakes all around him in room, not recognising family members, violent behaviour and tremulousness for few hours, missed alcohol drink since 2 days, increased BP, tremors, increased psychomotor activity, fearful affect, hallucinatory behaviour, disorientation, impaired judgement and insight. Most likely diagnosis is Delirium tremens.

    23. 45 year old male with alcohol dependence presents with confusion, nystagmus, ataxia, 6th nerve weakness. Most likely diagnosis is Wernicke encephalopathy.

    24. EEG is usually abnormal in Subacute sclerosing panencephalitis, creutzfeldt Jakob disease and hepatic encephalitis.

    25. Neurological channelopathies includes hypokalemic periodic paralysis, episodic ataxia type I and familial hemiplegic migraine.

    26. Vitamin B deficiency can give rise to Myelopathy, optic atrophy and peripheral neuropathy.

    27. Manifestations of vitamin E deficiency includes hemolytic anemia, posterior column abnormalities and cerebellar ataxia.

    28. Most sensitive test for diagnosis of myasthenia gravis is positive edrophonium test.

    Surgery

    1. Blood stained discharge from nipple indicates Duct papilloma.

    2. Lumbar sympathectomy is of value in management of Distal ischaemia affecting skin of toes.

    3. In adenoid cystic carcinoma, perineural invasion in head and neck cancer is most commonly seen.

    4. Sialography is contraindicated in Acute parotitis.

    5. Abbe-Estlander flap is used in reconstruction of Lip.

    6. Most common complication seen in hiatus hernia is Oesophagitis.

    7. A newborn presented with bloated abdomen shortly after birth with passing of less meconium. Full thickness biopsy of rectum will most likely show Lack of ganglion cells.

    8. Gardner’s syndrome is a rare hereditary disorder involving the colon. It is characterized by polyposis colon, osteomas, epidermal inclusion cysts and fibrous tumors in skin.

    9. Carcinoid tumor is most common in small bowel.

    10. In colon cancer, overall survival is increased by screening procedure.

    11. Patients with ulcerative colitis associated with primary sclerosing cholangitis (PSC) may develop biliary cirrhosis, may have raised alkaline phosphatase and increased risk of hilar cholangiocarcinoma.

    12. Injection of sclerosing agent is ideal treatment for Internal hemorrhoids.

    13. Silicone catheter is most suited for long term use.

    14. Dorsal venous complex is most troublesome source of bleeding during a radical retropubic prostatectomy.

    15. Finasteride is used in medical treatment of benign prostatic hyperplasia (BPH), impotence is well documented after its use and i is a 5 alpha reductase inhibitor.

    16. According to Glasgow coma scale (GCS), a verbal score of 1 indicated no response.

    17. Earliest manifestation of increased intracranial pressure following head injury is altered mental status.

    18. Embryonal rhabdomyosarcoma frequently metastasizes to lymph nodes.

    Obstetrics

    1. Best period of gestation to carry out chorionic villous biopsy for prenatal diagnosis is 10-12 weeks.

    2. Amniotic fluid acetylcholinesterase is most sensitive to detect open spina bifida.

    3. Smallest diameter of true pelvis is Interspinous diameter.

    4. Causes of IUGR includes anemia, PIH and maternal heart disease.

    5. Risk factors associated with macrosomia includes maternal obesity, prolonged pregnancy and previous large infant.

    6. Infant of diabetic mother are likely to have Transposition of great arteries.

    7. In pregnant women with epilepsy rate of congenital malformation is increased in offspring, breast feeding is safe with most anticonvulsants and folic acid supplementations may reduce risk of neural tube defects.

    8. Yellow fever vaccine is absolutely contraindicated in pregnancy.

    9. Risk of preterm delivery is increased if cervical length is 2.5 cm.

    10. Misoprostol has been found to be effective in missed abortions, induction of labour and prevention of postpartum hemorrhage (PPH).

    11. Diaphragm is ideal contraceptive in patient with heart disease.

    12. Most common side effect of IUD insertion is bleeding.

    Gynaecology

    1. Aspermia is term used to describe absence of semen.

    2. Androgens, isoflavones and tibolone decrease hot flashes in menopausal women.

    3. Drugs helpful in treatment of ectopic pregnancy includes methotrexate, actinomycin D and RU 486.

    4. Highest incidence of Gestational trophoblastic disease is in Asia.

    5. Most common cause of secondary amenorrhoea in India is endometrial tuberculosis.

    6. Patient of Rectovaginal fistula should be initially treated with Colostomy.

    7. Most common pure germ tumor of ovary is Dysgerminoma.

    8. In a case of Dysgerminoma of ovary Serum lactic dehydrogenase is likely to be raised.

    Paediatrics

    1. Bart’s hydrops fetalis is lethal because Hb bart’s cannot release oxygen to fetal tissues.

    2. Coagulation profile in 13 year old girl with Menorrhagia having von Willebrands disease is Isolated prolonged PTT with normal PT.

    3. Most common leukocytoclastic vasculitis affecting children is Henoch Schonlein purpura.

    4. Diagnosis of beta Thalassemia is established by Hb electrophoresis.

    5. Eisenmenger syndrome is characterized by pulmonary veins not distended, pruning of peripheral pulmonary arteries and dilatation of central pulmonary arteries.

    6. Most common type of total anomalous pulmonary venous connection is Supracardiac.

    7. Intestinal enzyme Lactase is generally deficient in children following an attack of severe infectious enteritis.

    8. Most common renal cystic disease in infants is Unilateral renal dysplasia.

    9. A child with recurrent urinary tract infections is most likely to show Vesicoureteric reflux.

    10. Most common cause of renal scarring in 3 year old child is Vesicoureteral reflux induced pyelonephritis.

    11. Non-functioning kidney in a child is best diagnos by DTPA renogram.

    12. Most common presentation of a child with Wilms tumor is as an asymptomatic abdominal mass.

    13. Most common malignant neoplasm of infancy is Neuroblastoma.

    14. Common cause of congenital hydrocephalus is Aqueductal stenosis.

    15. Escherichia coli, Streptococcus agalactiae and Listeria monocytogenes are most often associated with acute neonatal meningitis.

    16. In unconjugated hyperbilirubinemia, risk of kernicterus increases with use of Sulfonamide.

    17. Appropriate approach to a neonate presenting with vaginal bleeding on day 4 of life is no specific therapy.

    18. Blood specimen for neonatal thyroid screening is obtained on Cord blood.

    19. Therapies which may be required in 1 hour old infant with severe birth asphyxia includes glucose, calcium gluconate and normal saline.

    20. Dexamethasone is used in fetal therapy of congenital adrenal hyperplasia.

    21. Karyotype of patient with androgen insensitivity syndrome is 46 XY.

    22. Protective effects of breast milk  are known to be associated with antibodies.

    Orthopaedics

    1. 30 year old with road traffic accident sustained fracture of femur, 2 days later developed sudden breathlessness. Most probable cause can be Fat embolism.

    2. 45 year old was given steroids after renal transplant. After 2 years he had difficulty in walking and pain in both hips. Most likely cause is Avascular necrosis.

    3. MRI is investigation of choice for evaluation of suspected Perthes disease.

    4. Subtrochanteric fracture of femur can be treated by Skeletal traction on Thomas splint, Condylar blade plate and Ender’s nail.

    5. Sites commonly involved in pelvic fracture includes pubic rami, alae of ileum and acetabulum.

    6. For fracture of atlas vertebra Jefferson fracture is most common type, Quadriplegia is seen in 80% cases and atlanto occipital fusion may sometimes be needed.

    7. Young woman with accident had quadriparesis, lateral X-ray cervical spine revealed C5-C6 fracture dislocation. Best line of management is cervical traction followed by instrument fixation.

    8. Most common sequelae of TB spondylitis in an adolescent is Bony ankylosis.

    9. Heberden’s arthropathy affects distal interphalangeal joints.

    10. In Klippel-Feil syndrome there is low hairline, bilateral neck webbing and gross limitations of neck movements.

    Ophthalmology

    1. Horner’s syndrome is characterised by miosis, enophthalmos and ptosis.

    2. 30 year old man has 6/5 vision in each eye, unaided. Cycloplegic retinoscopy is +1 D sph at 1 m distance, complains of new sprint at 30 cm that clears up in about 2 minutes. Most probable diagnosis is Accommodative inertia.

    3. 25 year old has sudden painless loss of vision of trauma, anterior segment is normal but with no fundal glow. Most likely cause is Vitreous haemorrhage.

    4. Acanthamoeba does not depend on human host for completion of its life cycle.

    5. In contact lens usage there is a reduction in hemidesmosomes density, increased production of CO2 in epithelium and reduction in glucose utilization by corneal epithelium.

    6. Enlarged corneal nerves may be seen in Keratoconus, leprosy and neurofibromatosis.

    7. 1 1/2 year old child has white reflex from one eye for past month, CT of orbit shows calcification seen within globe. Most likely diagnosis is Retinoblastoma.

    8. In Von Hippel Lindau syndrome retinal vascular tumors are often associated with intracranial hemangioblastoma. Cerebellum is associated with such vascular abnormalities in this syndrome.

    9. 18 year old boy has h/o injury to eye with tennis ball, no perforation, hyphema. Most likely source of blood is Circulus iridis major.

    ENT

    1. Use of Siegel’s speculum during examination of ear provides magnification, assessment of movement of tympanic membrane and as applicator for powdered antibiotic of ear.

    2. Most common site of leak in CSF rhinorrhoea is Cribriform plate.

    3. Most common and earliest manifestation of carcinoma o glottis is Hoarseness.

    4. Androphonia can be corrected by doing Type thyroplasty.

    Skin

    1. 16 year old boy with asymptomatic multiple, erythematous,annular lesions with collarette of scales at periphery of lesions present on trunk. Most likely diagnosis is Pityriasis rosea.

    2. Drugs useful in treatment of Pityriasis versicolor are Selenium sulphide, ketoconazole and clotrimazole.

    3. 8 years old boy from Bihar presents with 6 months history of an ill defined hypopigmented slightly atrophic macule on face. Most likely diagnosis is Indeterminate leprosy.

    4. 40 year old woman with 2 year h/o erythematous papulopustular lesions on convexities of face, background erythema and telangiectasia is seen. Most likely diagnosis is Rosacea.

    5. 36 year old with itchy, annular scaly plaques in both groins. Application o corticosteroid ointment led to extend at periphery. Most likely diagnosis is Tinea cruris.

    6. 27 year old sexually active male develops a vesiculobullous lesion on glans soon after taking tablet paracetamol for fever, lesion healed with hyperpigmentation. Most likely diagnosis is Fixed drug eruptions.

    7. Only definite indication for giving systemic corticosteroids in pustular psoriasis is Extensive lesions.

    Anaesthesia

    1. Sevoflurane is fastest acting inhalational agent.

    2. Disadvantages of anaesthetic ether includes induction is slow, irritant nature of ether increases salivary and bronchial secretions and cautery cannot be used.

    3. Sevoflurane causes rise in intracranial pressure.

    4. Drugs used for treatment of postoperative nausea and vomiting following squint surgery in children are ondansetron, propofol and dexamethasone.

    5. Laryngeal mask airway is used for securing airway of patient in a difficult intubation, in cardiopulmonary resuscitation and in a child undergoing an elective/routine eye surgery.

    6. Most appropriate circuit for ventilating a spontaneously breathing infant during anaesthesia is Jackson Rees modification of Ayres T Piece.

    7. Modes of ventilation  which could be used for weaning off patients from mechanical ventilation includes Synchronized intermittent ventilation (SIMV), pressure support ventilation (PSV) and assist control ventilation (ACV).

    8. LSCS can be carried out with general, spinal and combined spinal epidural anaesthesia.

    Radiology

    1. Gamma camera in nuclear medicine is used for Measuring radioactivity.

    2. In radionuclide imaging most useful radiopharmaceutical for skeletal imaging is Technetium-99m linked to Methylene diphosphonate (Tc-99m MDP).

    3. Radioisotopes used for permanent implants includes Iodine-125, palladium-103 and Gold-198.

    4. Technique employed in radiotherapy to counteract the effect of tumor motion due to breathing is known as Gating.

    5. At t=0 there are 6 x 10^23 radioactive atoms of substance, which decay with disintegration constant = 0.01/sec. Initial decay rate would be 6 x 10^21.

    6. Gold standard for diagnosis of osteoporosis is dual energy x-ray absorptiometry.

    7. Most sensitive imaging modality for diagnosis of ureteric stones in a patient with acute colic is non contrast CT of abdomen.

    8. Nuchal edema is associated with greatest increased risk for Trisomy 21 in fetus.

    9. Transfemoral route is most preferred route to perform cerebral angiography.

    10. Meningioma shows calcification on CT.

    Psychiatry

    1. Preservation is Persistent and inappropriate repetition of same thoughts.

    2. Symptoms do not normally reflect understandable physiological or pathological mechanism differentiates hysterical symptoms from hypochondriacal symptoms.

    3. 18 year old with feeling of changes from inside, feeling of strange as if he is different from his normal self, he is tense and anxious yet could not point out precise change in him. Phenomenon is best called as Depersonalization.

    4. 25 year old with 2 years h/o repetitive, irresistible thoughts of contamination with disassociated with repetitive hand washing, thoughts to be distressing but not able to overcome them along with medication. She will most likely benefit from Exposure and response prevention.

    5. 18 year old with lack of interest in studies for last 6 months. He has frequent quarrels with  his parents and had frequent headaches. Most appropriate clinical approach would be to rule out depression.

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