Home Forums General Books & Resources AIPGMEE 2012 Rapid Review

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    Dr. Paresh Koli

    AIPGMEE 2012 Rapid Review cover


    1. Structures passing through the inguinal canal in women includes Ilioinguinal nerve, round ligament of uterus and lymphatics from the uterus.

    2. Valves of Houston disappear after mobilization of Rectum.

    3. Predominant blood supply to the supraduodenal bile duct is derived from vessels that run upward along the bile duct from the duodenal end of the duct such as the retroduodenal and the gastroduodenal end.

    4. Structures crossing the right ureter anteriorly includes terminal ileum, vas deferens and right colic and ileo colic vessels.

    5. Little finger of hand corresponds to C8 dermatome.

    6. In spinal cord efferents leave from the anterior horn, spinal cord ends at the lower border of L1 in adults and denticulate ligaments suspend spinal medulla in the subarachnoid space.

    7. Sensory supply to pinna includes auriculotemporal nerve, great auricular nerve and lesser occipital nerve.

    8. Dilator pupillae iridis is supplied by postganglionic sympathetic fibers from superior cervical ganglion.

    9. Muscles derived from Pharyngeal arches includes Tensor tympani, tensor palatini and orbicularis oculi.


    1. Antithrombin III prevents clotting of blood in the normal vascular system.

    2. Discharge from Baroreceptors causes inhibition of Rostral ventrolateral medulla.

    3. Clamping of the carotid arteries below (proximal) carotid sinus is likely to produce increase in blood pressure and increase in heart rate.

    4. Cardiac output decreases during standing from lying position.Electromechanical systole is best defined as the interval between Q wave and S2 (Q-S2 interval).

    5. Genotype of a person with blood group ‘A’ should be AO.

    6. Negative intrapleural pressure is maintained by lymphatic drainage of pleural cavity.

    7. Normal intrapleural pressure is negative because chest wall and lungs recoil in opposite directions.

    8. Amount of dissolved oxygen transported in 100 ml of plasma in a subject breathing 100% oxygen at 4 ATA (atmospheric pressure) will be 9 ml.Additional amount of oxygen transported in 100 ml of blood in a subject breathing 100% oxygen under hyperbaric conditions of 4 ATA compared to normobaric conditions (1 ATA) will be 6 ml.

    9. Maximal cerebral vasodilatation is caused by Hypercarbia.

    10. In carbon monoxide poisoning carboxyhemoglobin (COHb) causes left shift of oxyhaemoglobin dissociation curve, partial pressure as low as 0.6 mm Hg can be lethal in it and hyperbaric oxygen is used for treatment of it.

    11. Events that happens when a nerve impulse arrives at the Neuromuscular junction includes release of calcium from the sarcoplasmic reticulum, initiation of formation of cross bridges to allow muscle contraction and efflux of calcium through synaptic vesicles into the synaptic cleft.

    12. ‘Sham Rage’ is caused by hypothalamic stimulation, it is a pathological rage reaction and is associated with synaptic stimulation.

    13. Nucleus of hypothalamus most closely related to sexual activity in men is Preoptic nucleus.

    14. ‘Sleep wake cycle’ will be prolonged to greater than hours if all environmental /external cues are removed.

    15. Basal ganglia nucleus which is primarily glutaminergic is Subthalamic nucleus.

    16. Types of islets cells which secrete amylin are Beta cells.

    17. Diurnal variation in Eosinophil count is related of cortisol.


    1. An immunoglobulin molecule represents the Quaternary structure of organized protein structure.

    2. Metabolic functions occurring in the mitochondria includes Beta-oxidation of fatty acids, protein synthesis and citric acid cycle.

    3. Events occurring when concentration of glucose in the liver decreases includes inactivation of phosphofructokinase-2 (PFK-2), activation of fructose 2, 6 BPG and increased levels of glucagon.

    4. Metabolic changes occurring during prolonged fasting when compared with fasting for 12-24 hours includes increased usage of ketone bodies by brain, decreased degradation of muscle proteins and decreased usage of glucose by brain.

    5. Metabolic events occurring during 12-24 hours of fasting includes increase in free fatty acids, increase in ketone bodies and decrease in glycogen.

    6. Enzymes common to the synthesis of cholesterol and ketone bodies includes HMG CoA synthase.

    7. Serine, Threonine and Tyrosine undergoes phosphorylation by protein kinases in Eukaryotes.

    8. Serine in a protein commonly acts as a potential O-Glycosylation site for attachment of an oligosaccharide unit.

    9. Mature cytoplasmic mRNA is transcribed from nuclear DNA.

    10. Most characteristic function o Type II restriction enzymes is to cut DNA at palindromic sites.

    11. Methods most suited to assess function of a gene includes transgenic animals and gene knockout animals.

    12. Assays used for estimation of total serum protein includes Biuret, Bradford and Lowry’s.

    13. If a protein solution on heating forms a precipitate at about degree C which re-dissolves at higher temperature, solution is likely to contain Bence Jones protein.

    14. Keratin in skin is softer than keratin in nail because keratin in skin has less number of disulphide bonds.

    15. Oxidation, reduction and hydrolysis are Phase I (non synthetic) reaction and Conjugation is Phase II (synthetic) reaction.

    16. For a 12-year-old child with mental retardation and h/o self-mutilation, Serum uric acid levels test will help in determining the diagnosis (Lesch Nyhan syndrome).


    1. CCB which is most potent cerebral vasodilator is Nimodipine.

    2. Indications of Thiazide diuretics include Hypertension, Heart failure and nephrolithiasis from idiopathic hypercalciuria.

    3. Diuretics associated with increased risk of drug induced urinary calculi formation includes Furosemide, Acetazolamide and Triamterene.

    4. Furosemide is contraindicated in a patient with idiopathic hypercalciuria and renal calculi.

    5. Apixaban is a Factor Xa inhibitor.

    6. CYP2C19 enzymes is the common pathway of metabolism of both Clopidogrel and PPI.

    7. Long term use of Metformin is associated with Vitamin B12 deficiency.

    8. Drugs with low therapeutic index whose blood levels need to be monitored includes Lithium, Cyclosporine and Gentamicin.

    9. Overdose of Sodium Nitroprusside may cause features of cyanide toxicity.

    10. Drugs which are Serotonin Dopamine antagonist includes Risperidone, Sertindole and Zotepine.

    11. Clozapine has a relatively lower potency to block D2 receptors in comparison to D1 receptors, it should be discontinued if WBC count is <3000/mm3 and combination of clozapine and carbamazepine should be avoided.

    12. After taking some medication for an acute attack of migraine, a female patient developed nausea, vomiting and tingling/numbness of her hands. Tip of her fingers and nail bed also turned blue. Most likely drug to cause above features is Ergotamine. (Ergotamine toxicity)

    13. Mast cell stabilizers inhibit mast cell degranulation and release of allergic mediators by preventing calcium influx across mast cell membrane.

    14. Bactericidal agents includes INH, Moxifloxacin and Daptomycin.

    15. Drugs effective against Methicillin resistant staphylococcus aureus (MRSA) includes Ciprofloxacin, Cotrimoxazole and Vancomycin. Cefaclor being an 2nd gen oral cephalosporin is ineffective against it.

    16. Sparfloxacin and Moxifloxacin have longest half-life of 18.7 hrs and 12.1 hrs respectively amongst available fluoroquinolones.

    17. Fluoroquinolones not requiring renal dose adjustment are Trovafloxacin, Moxifloxacin, Grepafloxacin and Pefloxacin.

    18. Patient on HAART presents with lipodystrophy, hypertriglyceridemia and hypercholesterolemia. Most likely agent responsible is Ritonavir.

    19. Side effect most likely to occur in slow acetylators on treatment with INH for Pulmonary TB is peripheral neuropathy.

    20. Adverse effects of Thalidomide includes constipation. Sedation and peripheral neuropathy.

    21. A patient with diarrhea was prescribed a drug to inhibit pyruvate errodoxime oxidoreductase. He is most likely to be suffering from Cryptosporidiosis.

    22. Temozolomide is an Alkylating agent.

    23. Drug A is already in use and Drug B needs to be introduced. Value of the new drug in relation to the old drug can be established by Phase III of clinical trial.

    24. Preferred method of drug designing is target structure based.


    1. Cytokeratin is a marker of carcinomas.

    2. Characteristic marker for Langerhans cell Histiocytosis is CD1a.

    3. Il-6, TNF and IFN-alpha are pyrogenic cytokines.

    4. Stem cell population found in bone marrow includes Endothelial progenitor cells, Mesenchymal stem cells and Hematopoietic stem cells.

    5. Most likely mediastinal mass for a patient presenting with dyspnea is Precursor T cell ALL.

    6. Increased Reid index is used to characterise Chronic bronchitis.

    7. Most characteristic feature of ARDS is Diffuse alveolar damage.

    8. Amyloid associated protein is seen in secondary amyloidosis associated with chronic diseases.

    9. Rheumatoid factor is an IgM antibody directed against IgG.

    10. 30-year-old woman has erythematous butterfly rash on her cheeks. Antibody which should be assayed initially for her suspected condition is Anti-Ds-DNA. (Malar rash suggests a possible diagnosis of SLE).

    11. 40-year-old hypertensive male with sudden onset headache and altered sensorium admitted to hospital, BP 220/110 mm Hg and patient died 4 hours later. Likely pathological finding in his kidneys would be small kidney with petechial haemorrhages (Suggests diagnosis of malignant hypertension- malignant nephrosclerosis).

    12. Hereditary angioneurotic edema (HANE) is most commonly caused by C1 esterase deficiency, increased levels of bradykinin and decreased complement substrate C2 and C4.

    13. Immune hypersensitivity reaction responsible for Myasthenia gravis is Type II hypersensitivity.

    14. Autosomal dominant disorders includes Gardner’s syndrome, neurofibromatosis and Peutz-Jeghers syndrome.

    15. Congenital erythropoietic porphyria is autosomal recessive.

    16. Most common mutation in Ewing’s sarcoma is Translocation 11; 22.


    1. Prions are most resistant to antiseptics.

    2. 5-year-old child with pustular lesions on lower legs. Culture from lesions showed gram positive cocci. Provisional diagnosis of Group A streptococcal pyoderma can be done by Bacitracin sensitivity.

    3. Endotoxin of Vibrio cholerae has no part in pathogenesis of disease (cholera is primarily caused by exotoxin-cholera enterotoxin).

    4. Cholera toxin effects are mediated by stimulation of cAMP.

    5. Vibrios most commonly associated with ear infections is V. alginolyticus.

    6. Infective dose of Salmonella typhi is 10^2-10^5 bacilli.

    7. Characteristic infection of Nocardia Asteroides is Brain abscess.

    8. Gram stained periorbital exudative in severe panophthalmitis with cellulitis in an elderly diabetic shows irregular branching septate and broad hyphae. Most likely diagnosis is Apophysomyces sp.

    9. Farmer from sub-himalayan region presents with multiple leg ulcers. Most likely causative agent is Sporothrix schenckii (Itraconazole is DOC).

    10. Features shared between T cells and B cells includes Class I MHC expression and antigen specific receptors. During development T cells undergo both positive selection and negative selection and B cells undergo only negative selection.

    11. EBV causes autoimmunity by Polyclonal B cell activation.

    12. IgG deficiency is the most common subclass disorder associated with recurrent infections by polysaccharides encapsulated bacteria.

    13. Patients with recurrent sinopulmonary infection by polysaccharide encapsulated bacteria should be investigated for concomitant deficiencies of IgA and IgG subclass of immunoglobulins.

    14. Most common mechanism of antibiotic resistance is production of neutralizing enzymes by bacteria, complete elimination of target binding site may be the mechanism of resistance in some enterococci against vancomycin and alteration of target binding site leads to development of resistance to antibiotics in streptococcus pneumoniae.

    15. Vaccination is based on the principle of immunological memory.

    16. In gamma release assay for diagnosis of TB, nd generation quantiFeron TB (Gold) assay used ESAT-6 and CFP-10.

    Forensic Medicine

    1. Anteroposterior diameter of skull is minimum in Brachycephalic.

    2. Method used for demonstrating old washed-up blood stains is Luminol stray.

    3. Person hits another with wooden stick on provocation. This leads to formation of a bruise 3cm x 3cm on the forearm. No other injuries noted. This falls under IPC section 334 (voluntarily causing hurt on provocation) and nature of injuries is simple, weapon used is simple and not dangerous. So punishment is imprisonment for 1 month and/or fine of Rs. 500.

    4. Disclosure of identity of rape victim is protected under section 228A of IPC.

    5. Glaister Keene rods is used in rape victims to determine rupture of hymen and whether rupture is recent or old.

    6. Accused in case of sodomy reveals that he is an active agent and is a regular participant. On examination fecal smell, tear of frenulum and relative constriction of shaft of penis will be seen and smegma will not be seen.

    7. For MTP consent is required only from wife provided she is above 18 years of age.

    8. ‘Japanese detergent suicide technique’ involves mixing of common household chemical to produce H2S and other poisonous gases.

    9. Narcotic drugs and psychotropic substances act (NDPS) provides different punishment for drug users and drug peddlers.

    10. Elimination of Phenobarbitone is commonly enhanced by alkaline diuresis.


    1. In case control and cohort studies, cohorts are chosen based on history of ‘Exposure’, cohort studies requires longer time frame than case control studies and cohort studies yield information about more than one disease.

    2. Period of pathogenesis occurs after agents enters the human host, tertiary prevention is possible at this stage and subclinical phase may be present.

    3. Yoga is best described as a form of Preventive medicine.

    4. State of disease endemicity in which disease transmission has been stopped but the agent persists is Elimination.

    5. Culex, Anopheles and Aedes act as vectors for Filariasis worldwide.

    6. Recommended Larvicides for control of malaria includes Abate, Fenthion and Copper acetoarsenite.

    7. Vaccines recommended for elderly travelers includes Influenza, Pneumococcal and tetanus.

    8. DALY means years lost due to premature death and years lived with disability.

    9. Vision 2020 includes cataract, Refractive errors and Diabetic retinopathy.

    10. Health related millenium development goals in India includes reduction of U5MR rate by 2/3rd between 1990-2015, reduction of maternal mortality ratio by 3/4th between 1990-2015 and halt and begin to reverse the spread of HIV/AIDS by 2015.

    11. Regular reporting of health information is used for planning, administration and effective management of health services, for epidemiological research and for quantifying health problems and assessing health care needs.

    12. Resource person for training of ASHA are AWW and ANM.

    13. Sex ratio of children in the age group of 0-6 years according o 2011 census is 914.

    14. For purpose of intervention trials, the preferred randomization unit is an individual for Vaccine, Drug and Health education.

    15. ‘Design effect’ is associated with Cluster sampling.

    16. Crude mortality rate should be adjusted for age to allow comparisons.

    17. Median is the most appropriate measure of central tendency for Incubation period, Survival time and Health expenditure.

    18. Fasting blood sugar (FBS) of a population is known to be normally distributed with a mean of 105 mg% and standard deviation of 10 mg%. Thus 95% of the population will have FBS within 85 and 125.

    19. Estimated mean Hb of 100 mean women is 10 g%. SD is 1 gm%. Standard error of estimate will be 0.1.

    20. ‘P’ value stands for probability of concluding that a difference exists while in reality such a difference does not exist.

    21. For diagnosis of SLE 6 tests are done of which 4 came positive and 2 negative. To determine the probability of SLE at this point, we need to know prior probability, sensitivity and specificity.

    22. Amount of alcohol consumption amongst a group of alcoholics, before and after intervention was recorded. Most appropriate statistical test to assess ‘significant change’ from intervention programme would be Paired t test.


    1. Vitamin B12 and folic acid deficiency anemia is associated with a raised MCV and normal MCHC.

    2. Fanconi’s anemia is associated with a hypoplastic marrow.

    3. Massive splenomegaly is likely to be associated with CML, polycythemia vera and primary myeloproliferative disorder.

    4. Thalassemia major, Sideroblastic anemia and hereditary spherocytosis are associated with secondary hemochromatosis.

    5. Common features of Multiple myeloma includes Bone pain, Normocytic normochromic anemia and susceptibility to bacterial infection. Hyperviscosity syndrome is least common feature.

    6. In DIVC there is increased FDP, prolonged PT and reduced platelets.

    7. 25-year-old pregnant woman presents with thrombocytopenia (platelet count <50,000) and fragmented RBCs in peripheral smear. Likely DD includes TTp, DIC and HELLP syndrome.

    8. Morphine, Furosemide and positive pressure ventilation are used in the initial management of acute life threatening cardiogenic pulmonary edema.

    9. Preferred marker for detecting Acute STEMI in Athletes is Troponin T/I.

    10. Conditions associated with Infective endocarditis includes small VSD, mild MR, mild MS and small ASD (least likely).

    11. Rofecoxib has been linked with increased incidence of cardiac mortality.

    12. Patient with sudden onset of breathlessness after a subclavian vein cannulation. On examination, breath sounds are absent while the chest is hyper-resonant on percussion on one side. Most likely cause is Iatrogenic pneumothorax.

    13. Non-small cell carcinoma of lung (NSCCL) is most common NSCCL amongst asian population, contralateral mediastinal nodes are a contraindication to surgical resection and single agent chemotherapy is preferred for patient >70 years with advanced disease.

    14. 30-year-old man with generalized edema and hypertension, subnephrotic proteinuria (<2 gm), microscopic hematuria, decreased serum complement levels and positive anti-hepatitis C antibodies. Most likely diagnosis is MPGN and Cryoglobulinemia. If this patient also has skin lesions, most likely diagnosis becomes Mixed cryoglobulinemia.

    15. Patient with bronchiectasis since 5 years presents with edema on legs and proteinuria. Most likely finding in his kidney will be Amyloid nephropathy.

    16. Hemolytic uremic syndrome usually follows haemorrhagic colitis, it is often self-limited, fever is usually mild or absent and serotoxins also known as Shiga like toxins (SLT; SXt) or Verotoxin (VT) are the most commonly implicated toxins in the pathogenesis of hemolytic uremic syndrome.

    17. Patient on ketoconazole for a fungal disease develops GERD should not be prescribed Cisapride as it it increases risk of cardiovascular adverse effects.

    18. Lubiprostone is used for Irritable bowel syndrome of constipating type.

    19. 14-year-old girl with h/o prolonged fever, abdominal discomfort, splenomegaly and leukopenia. In the course of the disease she develops acute abdominal event and died. Likely finding on autopsy is Longitudinal ulcers (Enteric fever).

    20. Deficiency of Vitamin B12 is most commonly seen in short bowel syndrome with ileal resection.

    21. Man with h/o hematemesis of about 500 ml of blood and on examination spleen is palpable 5 cms below the left costal margin. Most likely diagnosis is Portal hypertension.

    22. Microscopic polyangiitis is a ‘Small vessel vasculitis’.

    23. Type I cryoglobulinemia is associated with Hyperviscosity, Monoclonal IgM paraprotein and normal complement levels.

    24. SPECt studies have shown reduced flow to the thalamus in patient with Fibromyalgia.

    25. Occurrence of hyperthyroidism following administration of supplemental iodine to subjects with endemic iodine deficiency goiter is known as Jod-Basedow effect.

    26. Lower detection limit for 3rd generation TSH assays is about 0.01-0.02 mIU/L.

    27. Conditions likely to be associated with gynaecomastia Adrenal tumours, HCG secreting tumours and Estrogen secreting tumors.

    28. Drugs used in the management of chronic hypocalcemia includes Thiazide, elemental calcium and Vitamin D analogues.

    29. 12-year-old boy with h/o progressive increasing difficulty in walking, frequent falls, ataxic gait, nystagmus, deep tendon reflex absent and planters were extensor. Most likely diagnosis is Friedreich’s ataxia.

    30. 45-year-old female comes with pain, fatigue, weakness in both lower limbs and history of paralysis affecting both lower limbs in childhood from which she made good functional recovery. Most likely diagnosis is Post-polio syndrome.

    31. Patient with traumatic paraplegia due to injury of the thoracic cord of T3 level is observed to have a blood pressure of 210/120. Initial management should be Nifedipine.

    32. Ventrolateral cordotomy is performed to produce relief of pain from right leg. This is effective because it interrupts Left lateral spinothalamic tract.

    33. Patient with suspected subarachnoid hemorrhagic presents with blood isolated in the fourth ventricle on CT scan. Aneurysmal rupture is likely to have resulted from Posterior inferior cerebellar artery aneurysm.

    34. Cerebral ischemia occur when cerebral blood flow is less than 20 ml/100g/min.

    35. Basal exudates, infarcts and hydrocephalus are finding observed in brain imaging studies. Most likely diagnosis is Tuberculous meningitis.

    36. Pneumococcal meningitis is associated with pleocytosis with high protein and low sugar on CSF.

    37. Conditions associated with normal pressure spontaneous CSF leaks includes Empty sella syndrome, Encephalocele and Meningocele.

    38. Age related dementia has been associated with increased levels of Homocysteine.

    39. Deep brain stimulation of Subthalamic nucleus has been shown to reduce frequency of symptoms in Parkinsonism.

    40. Stimulation of periaqueductal grey matter is experimentally used to control intractable pain.

    41. Lateral geniculate body is most resistant to Neurofibrillary tangles in Alzheimer’s disease.

    42. Principal sites of involvement in Wernicke Korsakoff syndrome are Mammillary bodies, thalamus and periaqueductal grey matter.

    43. Thalamus is responsible for the amnestic defect in Wernicke korsakoff syndrome.

    44. Conduction velocity of nerve is reduced in Acute inflammatory demyelinating neuropathy (AIDP), Hereditary sensorimotor neuropathy (HMSN) and Multifocal motor neuropathy.

    45. HIV induced, Hansen’s disease and Amyloidosis are classified as ‘Small fiber’ neuropathies.

    46. Young adult presents with proximal weakness of upper limbs, features of facial palsy and winging of scapula. Most likely diagnosis is Facioscapulohumeral dystrophy.

    47. Conditions associated with ‘Episodic’ weakness includes Channelopathy, Lambert Eaton syndrome and Hyperkalemia.

    48. In Von-Hippel-Lindau syndrome cranio spinal hemangioblastoma are common.

    49. Criteria for Brain Stem death includes absent pupillary light reflex and dilated pupils.

    50. Generalized lymphadenopathy is one of the clinical criterion used to define ‘AIDS related complex’.


    1. A person with ‘inappropriate speech’ evaluated by the ‘Glasgow coma scale’ will have a verbal score of 3.

    2. During an emergency thoracotomy, the incision is made >1 cm lateral to sternal margin to preserve internal mammary artery.

    3. 10-year-old boy with cervical lymphadenopathy, needle biopsy from nodes revealed secondaries from papillary carcinoma of thyroid. CHild underwent complete removal of tumor near total thyroidectomy and radical neck dissection. Immediate next line of management is to start thyroxine suppression therapy.

    4. Gastroduodenal artery is most commonly involved in a haemorrhage from duodenal ulcers.

    5. 30-year-old male with massive hematemesis, 2×2 cm ulcer on posterior aspect of 1st part of duodenum, bleeding vessel was visualized but bleeding could not be controlled endoscopically, blood transfusion was administered and patient was planned for surgery, BP 90/70 and pulse rate was 11 with Hb 9 gm% at time of surgery. Best surgical management would be Duodenotomy with ligation of bleeding vessel followed by aggressive acid-suppressive therapy (PPI) along with anti H. pylori therapy as indicated.

    6. In carcinoid tumors extensive involvement of small intestine is associated with higher probability of Lung metastasis, 5 year survival for carcinoid tumor is >60% and appendiceal carcinoids are more common in females.

    7. For a 30-year-old male with complete rectal prolapse Abdominal rectopexy is associated with lowest risk of recurrence.

    8. Diagnostic method of choice for Hirschsprung disease is Rectal biopsy.

    9. 60-year-old female with h/o recurrent abdominal pain, on imaging multiple small cystic lesions likely a bunch of grapes in the head of pancreas with a grossly dilated main pancreatic duct. Most likely diagnosis is Intraductal papillary mucinous neoplasm (IPMN).

    10. Most common cause of a pyogenic liver abscess is biliary tract infection.

    11. Expanded criteria for Liver donation includes Hepatitis B serology positive, Age of donor may be more than 70 years and can be taken from individual with mild hepatic steatosis.

    12. Extended criteria for Liver donation includes Donor age >70 years, Mild hepatic steatosis and donor after cardiac death.

    13. Most common cause of isolated splenic metastasis is Carcinoma ovary.

    14. Patient with a suspected renal tumor/mass is diagnosed by exfoliative urinary cytology. Histological type which is most likely to be diagnosed on urinary exfoliative cytology is Transitional cell carcinoma.

    15. Newborn with meningomyelocele has been posted for surgery. Defect should be immediately covered with Normal saline gauze.

    16. Most common complication of Total parenteral nutrition (TPN) is Catheter related complications.


    1. In a newborn, physiological jaundice usually peaks after 48 hours and breast milk jaundice usually peaks after day 7.

    2. For a child with vocabulary of 4-6 words however main mode of communication and social interaction continues to be non-verbal, most likely developmental age of the child is 15 months.

    3. Child with fever of 24 hours, h/o 3 episodes of chest infection and passage of foul-smelling bulky stools. Most probably diagnosis is Cystic fibrosis.

    4. Child with an obvious rash presents with recurrent infections, decreased count and reduced IgM. Most likely diagnosis is Wiskott Aldrich syndrome.

    5. 7-year-old child presents with ambiguous genitalia increasing with age, her height, weight and blood pressure were normal, labia appeared bifid with 2 separate perineal openings, phallic length was 2.5 cm and no palpable gonads in inguinal region and USG shows mullerian structures. Most probable diagnosis is Simple virilizing congenital adrenal hyperplasia.

    6. Child with decreased levels of LH, FSH and testosterone presents with delayed puberty. Most likely diagnosis is Kallmann’s syndrome.

    7. Hormone Ghrelin is raised in Prader-Willi syndrome.

    8. Most common tumor of fetus and newborn is Sacrococcygeal Teratoma.

    9. Treatment of choice for Stage I Wilms tumor is open nephroureterectomy.

    10. Large for gestational age baby delivered at 40 weeks was observed to be lethargic. Blood sugar was 35 mg/dL. Management is 10% IV dextrose.

    11. 6-year-old admitted to Paediatric ICU for seizures and treated with Tacrolimus and Prednisolone. Blood urea 68 mg/dL, serum sodium 136 meq/L and serum calcium 7.5 mg/dL. Most likely cause of his seizures is Tacrolimus toxicity.

    12. Parenteral nutrition to supply fatty acids in being considered for a neonate. When comparing 10% intralipid solution to 20% solution, 10% solution has higher phospholipid/triglyceride ratio, less energy/caloric content and higher serum phospholipid concentrations.

    Obstetrics & Gynaecology

    1. LH surge principally due to sustained/ marked rise in estrogen.CuT-380A is approved by the USFDA for 10 years of continuous use.

    2. Dysgerminoma, endodermal sinus tumor and choriocarcinoma are germ cell ovarian tumors.

    3. 55-year-old woman with abdominal distension, bloating, pelvic pain, respiratory distress, features of ascites and CA-125 levels are elevated. Most likely diagnosis is CA-ovary.

    4. Features seen in normal pregnancy includes increase in heart rate, cardiac output and volume.

    5. Components of active management of 3rd stage of labor includes controlled cord traction, inj. Methergine and Inj. Syntocinon.

    6. Lady G3P1A1 is admitted to the labour room at term, cervix is 4 cm dilated, membrane are intact and head is palpable 3/5 per abdomen. After 4 hours repeated examination is done and cervix is 5 cm dilated, station is unchanged and cervicograph remain on right side of alert lens. In this patient cervicograph status suggest that intervention is likely to be required.

    7. In vaginal preterm delivery of twins, 2nd twin has higher risk of hyaline membrane disease.

    8. In pre-eclampsia GFR decreases.

    9. 39-year-old G4P3 with LMP 8 weeks ago, no h/o bleeding or pain. VDRL-RPR positive and antibodies to treponema pallidum (MHA-TP) also positive. Best pharmacotherapy in her is penicillin.

    10. In newborn born to HBsAg positive mother, Hepatitis B vaccine and HB Ig should be administered within 12 hours of birth.

    11. For mother to child transmission of HIV, majority of fetuses are not infected even without any intervention, risk of mother to child transmission can be reduced by elective cesarean section and risk is related to the status of infection in mother.

    12. Methotrexate is absolutely contraindicated in pregnancy and lactation.

    13. Maternal use of Diethylstilbestrol has an increased incidence of hypospadias is child.

    14. Mobius syndrome in fetus may be caused by maternal intake of Misoprostol.


    1. Otosclerosis, serous otitis media and suppurative otitis media produce conductive hearing loss.

    2. 60-year-old diabetic patient presents with extremely painful lesion in external ear and otorrhea not responding to antibiotics. Also evidence of granulation type tissue in the external ear and bony erosion with facial nerve palsy is noted. Most likely diagnosis is Malignant otitis externa.

    3. Middle ear infections are known to spread to the brain from Direct bony invasion, oval/round window and hematogenous spread.

    4. Cochlear implants improve speech and sound perception, better chance of acquiring normal or near normal verbal skills and improved sound localization and discrimination is possible.

    5. Tumor arising from olfactory nasal mucosa is Esthesioneuroblastoma.

    6. Elderly male with h/o dysphagia, regurgitation foul breath, cough and bilateral lung creps. Most likely diagnosis is Zenker’s diverticulum.

    7. Laryngomalacia is most common congenital anomaly of the larynx, it is associated with an omega shaped epiglottis and stridor is increased on crying and relieved on lying down in it.

    8. Spasmodic dysphagia is a dystonia of laryngeal muscles, its standard treatment is with multiple injection of botulinum toxin.

    9. Topical application of Mitomycin C is recommended for Laryngotracheal stenosis.


    1. A patient with h/o recurrent posterior dislocation of humerus is evaluated for a Hill-Sach’s lesion. Then anteromedial aspect of head of humerus is likely to shows this lesion.

    2. 20-year-old male involved in single vehicle rollover accident presented with instability to abduct the shoulder and flex the elbow and wasting of the supraspinatus, deltoid and biceps muscles. Most likely diagnosis is Upper trunk injury.

    3. Proximal fragment of scaphoid after fracture is predisposed for avascular necrosis because of retrograde blood flow to the proximal fragment.

    4. 30-year-old woman with pain and tenderness in index finger which worsens on exposure to cold, bluish discolouration of nail bed and no associated h/o trauma. Likely associated finding is pinhead shaped lesion beneath the nail (signs of Glomus tumor).

    5. 12-year-old with rapid increase in weight and height over the past 1 year presents with difficulty in sitting cross legged and squatting. Knee would go into axilla every time she flexes her hip and knee. Most likely diagnosis is Slipped capital femoral epiphysis.

    6. Complication of fracture neck femur includes shortening, non-union, avascular necrosis and malunions (least likely).

    7. SACH (Solid Ankle Cushioned Heel) forms the base of a lower limb prosthesis and it may wear out with time.

    8. Treatment of choice for a painful amputation stump neuroma is Re-excision of Neuroma.

    9. Tuberculosis of Bone is characterized by paucibacillary disease and hematogenous spread.

    10. Patient with lifting heavy weight presents with sudden onset pain in lower back radiating along posterolateral thigh and lateral leg to big toe with numbness. Most likely diagnosis L4-L5 disc prolapse.

    11. Yellow flag sign of lower back pain includes reliance on passive treatment, social isolation and belief that back pain is severely disabling.

    12. Most common cause of bone disease in India is Nutritional deficiency.

    13. Drug induced osteomalacia is known to be associated with the use of Phenytoin.


    1. Biopsy was performed for a patient with recurrent chalazion involving the upper lid. Most likely diagnosis on histopathology is Sebaceous cell carcinoma.

    2. Malnourished poor child comes with nodule around limbus with hyperemia of surrounding conjunctiva in left eye and axillary and cervical lymphadenopathy. Most likely diagnosis is Phlyctenular conjunctivitis.

    3. Regular contact lens user presents with complaints of severe pain, redness, photophobia and blurring of vision for more than 2 weeks not responding to standard treatment. Also paracentral ring shaped lesion with stromal infiltrates and overlying epithelial defects is observed in affected eye. Most likely diagnosis is Acanthamoeba keratitis.

    4. 30-year-old male with rural; background comes with h/o difficulty in vision since 10 days after vegetative material falling into left eye about 15 days ago. On examination ulcerative lesion in cornea with feathery margins and creamy exudates is seen. Few satellite lesions were also noted. Most likely diagnosis is Fusarium sp.

    5. Wavelength of laser for shaping cornea in refractive surgery is 193 nm.

    6. Young patient with gradual blurring of vision in left eye, fine stellate keratic precipitate and aqueous flare and a typical complicated posterior subcapsular cataract. No posterior synechiae were observed. Most likely diagnosis is Heterochromic iridocyclitis of Fuch’s.

    7. 55-year-old male with limbal scar comes with markedly defective vision for near and far, on examination wide and deep anterior chamber, iridodonesis and dark pupillary reflex are noted. Vision of 6/6 is achieved with correcting lens of +11D. Most likely diagnosis is Aphakia.

    8. Patient comes to emergency with uniocular diplopia, oblique illumination show golden crescent while oc-axial illumination shows a dark crescent line. Most likely diagnosis is Ectopia lentis.

    9. Infant with white pupillary reflex, on slit lamp examination a zone of opacity is observed around fetal nucleus with spoke like radial opacities. Most likely diagnosis Lamellar cataract.

    10. 70-year-old man with deterioration of vision 3 weeks after cataract extraction and IOL implantation. Slit lamp examination shows honeycomb maculopathy and fluorescein angiography (FA) shows flower petal hyperfluorescence. most likely diagnosis is Cystoid macular edema.

    11. 60-year-old diabetic patient with uneventful phacoemulsification with IOL implantation presents with pain, diminution of vision, redness, watering and a greyish yellow pupillary reflex on 3rd postoperative day. On examination circumcorneal congestion, aqueous cells 4+, hypopyon in anterior chamber with posterior synechiae and retrolental flare. Most likely diagnosis is Endophthalmitis.

    12. Child with lid lag, enlarged cornea with a diameter of 3 m and double contoured opacities concentric to the limbus (Haab’s striae). Most likely diagnosis is Congenital glaucoma.

    13. 75-year-old patient with deterioration of vision, pupillary reflex is sluggish, IOP normal and optic disc evaluation shows a large and deep cup and primarily shows paracentral scotomas. Most likely diagnosis is Normal tension glaucoma.

    14. Young adult presents with night blindness tubular vision, IOP 18 mm and anterior segment is unremarkable. Fundoscopy showed attenuation of arterioles and waxy pallor of the optic disc with bony corpuscles like spicules of pigmentation in mid peripheral retina and Ring scotomas were observed on perimetry. Most likely diagnosis is Pigmentary retinal dystrophy.

    15. Fundoscopy of a patient shows chalky white optic disc with well defined margins. Retinal vessels and surrounding retina appears normal. Most likely diagnosis is Primary optic atrophy.

    16. Most common mode of spread of Retinoblastoma is Optic nerve.

    17. Central retinal artery occlusion is known to be associated with Orbital Maculopathy.


    1. Young woman with white lacy lesions in oral cavity and annular genital lesions. Likely diagnosis is Lichen Planus.

    2. Erythematous annular lesions with peripheral ‘Collarette of scales’ is a feature of Pityriasis rosea.

    3. 30 year old male has severely itchy papulo-vesicular lesions on extremities, knees, elbows and buttocks for 1 year. Direct immunofluorescence staining of lesions showed IgA deposition at dermoepidermal junction. Most probable diagnosis is Dermatitis herpetiformis.

    4. Newborn baby of non-consanguineous marriage developed erosions and blisters in areas where mother handles the child for feeding and other purposes. Perioral areas are involved and extensive denudation is noted. Associated h/o death of one siblings from a similar presentation. Most likely diagnosis is Epidermolysis bullosa.

    5. In a patient with Claw hand due to leprosy, deformity would be classified as Grade II.

    6. Total skin electron irradiation is used for treatment of Mycosis fungoides.


    1. ACE inhibitors and Angiotensin receptor blockers can be stopped safely with minimal risk of adverse effects before an abdominal surgery.

    2. For chronic smoker for elective surgery, increased nicotine level may increase sympathetic tone, reduced pulmonary capacity may result from poor ciliary function and reduced surfactant and increased risk of infection.

    3. Pethidine is contraindicated in renal failure.

    4. Total intravenous Anaesthesia (TIVA) reduces cerebral metabolic rate.

    5. Thiopentone has cerebroprotective effect because of decreased cerebral metabolism.

    6. Rocuronium is muscle relaxant which causes maximal pain on injection.

    7. Individual intraoperative awareness is evaluated by Bispectral imaging.

    8. BERA is least affected by anaesthesia.

    9. In anaesthetic machines temperature of Desflurane vaporizer chamber is 39o C.


    1. Best view to visualize minimal Pneumoperitoneum is left lateral decubitus with horizontal beam.

    2. Chest x-ray of an industrial worker exposed to asbestos over 20 years shows an ill-defined rounded opacity in the lower lobe with a ‘Comet tail’ appearance on PA view. Most likely diagnosis is round atelectasis.

    3. Liver metastasis from breast cancer appear as hypoechoic on USG.

    4. MRI is useful for localizing small lesions in the brain and evaluating bone marrow and it is contraindicated in patients with pacemakers.

    5. Extra-axial intracranial lesion showing contrast enhancement on MRI is suggestive of Meningioma.

    6. IOC for Renal scarring defect in kidney is DMSA scan.

    7. Bone density is best studied by DEXA scan.

    8. Best investigation for bone metastasis is bone scan.

    9. Widened neural foramina is frequently seen in Neurofibromatosis.

    10. Amifostine is a Radioprotective agent.

    11. Long term sequelae of craniospinal radiotherapy for children with CNS tumors includes Neurocognitive dysfunction, Endocrinological dysfunction and Musculoskeletal hypoplasias.


    1. Delusions are seen in Schizophrenia, Depression and Dementia.

    2. 2-year-old boy with delayed speech and communication skills, not making friends and finds it difficult to concentrate. He is also observed to repeatedly spending time starting at his own hands. Most likely diagnosis is Autism.

    3. Scholastic performance is impaired in ADHD, Specific learning disabilities, anxiety and PICA.

    4. General adaptation syndrome (GAS) is seen in Stressful situations.

    5. Repeated transcranial magnetic stimulation (rTMS) of brain is used in treatment of depression.

    6. Woman washes her hands at least 40 times/day for no apparent reason. Cognitive behaviour therapy for her treatment should include response prevention and exposure.

    7. Features of drug dependence includes Tolerance, Persistent desire to quit drug and Consumption of Large amount of drug over prolonged period.

    8. 60-year-old boy suffering from drug abuse presents with crossover of sensory perceptions such that sounds can be seen and colors can be heard. Most likely agents responsible for drug abuse is LSD.

    9. Paranoid psychosis with cocaine is seen due to Intoxication.

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