Professional Documents
Culture Documents
Preface
Dear Friends,
Crazy Hope u all enjoyed writing the
AIIMS May 2010 Paper! It was
Complete really an exhilarating experience
for all of us. This paper can
Compendium undoubtedly be termed as the
“craziest” of the AIIMS Paper till
of now…so many repeats were there
that we had to literally hunt for
AIIMS May the new questions! But then
again, those Profs at AIIMS know
2010 very well how to fool the students.
Some questions had their
“EXCEPT” omitted, and whether
they did it intentionally or it was
the printer’s devil…we can at best
speculate. Some questions though
looked easy, had some twists in
them. And last but not the least, to
add to the confusion, some repeat
questions were there whose
answers as given in the Great
Grandfathers’ books (AA & MK)
are still controversial. To sum up,
it was really a crazy paper which
only AIIMS can set!
ANATOMY
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PHYSIOLOGY
BIOCHEMISTRY
16. Appetite is stimulated by A/E
a) Agouti related peptide 24. Splicing activity seen in
b) Melanocyte concentrating a) mRNA
hormone b) snRNA
c) Melanocyte stimulating c) tRNA
hormone d) rRNA
d) Neuropeptide Y
25. After digestion by restriction
17. Capacitation occurs in endonucleases DNA strands can be
a) Uterus joined again by
b) Seminal vesicle a) DNA polymerase
c) Epididymis b) DNA ligase
d) Vas deferens c) DNA topoisomerase
d) DNA gyrase
18. The main cause of increased blood flow
to exercising muscles 26. Acetyl coA can be directly converted to
a) Raised blood pressure all except
b) Vasodilatation due to local a) Glucose
metabolites b) Fatty acids
c) Increased sympathetic c) Cholesterol
discharge to peripheral vessels d) Ketone bodies
d) Increased heart rate
27. After overnite fasing,levels of glucose
19. Intrinsic factor of Castle is secreted by tranporters reduced in
a) Chief cells a) Brain
b) Parietal cells b) Muscle
c) Mucus cells c) Adipocytes
d) B cells d) Hepatocyte
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51. STEPS done for 59. All of the following statements about
a) Surveillance of risk factors of purification of water are true except
non-communicable disease a) Presence of Clostridial spores
b) Surveillance of incidence of indicates recent contamination
non-communicable disease of water
c) Surveillance of evaluation of b) Coliforms must not be
treatment of non- detectable in any 100 ml
communicable disease sample of drinking water
d) Surveillance of mortality from c) Sodium thiosulphate is used to
non-communicable disease neutralize certain contaminants
5
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64. Which is NOT an alkylating agent? 73. Drug of choice for Zollinger-Ellison
a) 5-FU syndrome
b) Chlorambucil a) Antihistaminics
c) Melphalan b) Proton pump inhibitors
d) Cyclophosphamide c) Dopamine agonists
d) Antacids
65. Which one of the following drugs cause
hypomagnesemia by increased 74. Pharmacovigilance is done for
excretion? monitoring
a) Frusemide therapy a) Drug price
b) Cisplatin b) Unethical practices
c) Digitalis c) Drug safety
d) Aminoglycosides d) Pharmacology students
66. Which is NOT used in treatment of 75. All of the following drug is CYP3A
heroin dependence? inhibitor except
a) Disulfiram a) Erythromycin
b) Buprenorphine b) Itraconazole
c) Clonidine c) Ritonavir
d) Lofexidine d) Saquinavir
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99. Psammoma bodies seen in A/E 107. Hyperextensibility with normal elastic
a) Follicular CA of thyroid recoil is a feature of
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108. Which of the following about 115. Rapid infusion of insulin causes
atherosclerosis is true? a) Hyperkalemia
a) Intake of PUFA associated with b) Hypokalemia
decreased risk c) Hypernatremia
b) Thoracic aorta involvement is d) Hyponatremia
more severe than abdominal
aorta involvement 116. Digitalis toxicity enhanced by A/E
c) Extent of lesion in veins is a) Renal failure
same as that in arteries b) Hyperkalemia
d) Hypercholesterolemia does not c) Hypercalcemia
always increase the risk of d) Hypomagnesemia
atherosclerosis per se
117. True about hemochromatosis
109. Not a cardiovascular complication of a) Is genetically heterogenous
HIV/AIDS b) Cannot be treated by
a) Cardiac tamponade phlebotomy
b) Recurrent arterial embolism c) Completely penetrant
c) CHF d) More common in female than
d) Aortic aneurysm male
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151. A 68 yr old man came with pain and 158. Pain of ovarian carcinoma is referred to
swelling of right knee. Ahlbeck grade 2 a) Back of thigh
osteoarthritic changes were found on b) Gluteal region
investigation. What is the further c) Anterior surface of thigh
management? d) Medial surface of thigh
a) Conservative
b) Arthroscopic washout 159. A woman with primary infertility with CA-
c) High tibial osteotomy 125 level 90 iu. She has bilateral
d) Total knee replacement palpable mass. USG shows mass in
pelvis. Diagnosis may be
152. Which of the following is a pulsatile a) Ovarian CA
tumor? b) TB
a) Osteosarcoma c) Endometrioma
b) Chondrosarcoma d) Borderline ovarian tumor
c) Osteoclastoma
d) Ewing’s sarcoma 160. Causes of primary amenorrhea are A/E
a) Rokitansky syndrome
153. Posterior glenohumeral instability is b) Sheehan syndrome
tested by c) Kallman syndrome
a) Jerk test d) Turner syndrome
b) Crank test
c) Sulcus test 161. Test for ovarian reserve
d) Fulcrum test a) LH
b) LH/FSH ratio
154. Mineral of the bone is c) FSH
a) Calcite d) Estradiol
b) Hydroxyapatite
c) Calcium oxide 162. Clomiphene citrate – True statement is
d) Calcium carbonate a) Euclomiphene is anti-
estrogenic
155. 65 yrs old man with H/o of back pain b) Pregnancy rate is 3 times as
since 3 months. ESR is raised. Marked compared to placebo
stiffness on examination. Mild restriction c) Incidence of twins is 5-6%
of chest movements. On X-ray, d) It has been shown to increase
syndesmophytes are present. Diagnosis fertility in oligospermic males
is
a) Ankylosing spondylitis 163. At what gestational age should a
b) Degenerative osteoarthritis of pregnancy with cholestasis of
spine pregnancy be terminated?
c) Ankylosing hyperosteosis a) 34 weeks
d) Lumbar canal stenosis b) 36 weeks
c) 38 weeks
156. A lady presents with right knee swelling. d) 40 weeks
Aspiration was done in which CPPD
crystals were obtained. Next best 164. A lady with placenta previa delivered a
investigation is baby. She had excessive bleeding. After
a) ANA resuscitation most likely complication is
b) RF a) Galactorrhoea
c) CPK b) Diabetes insipidus
d) TSH c) Loss of menstruation
d) Cushing’s syndrome
157. Synovial fluid – True statements are
A/E
a) Secreted by Type A cells
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172. The presence of increased levels of 179. Which of the following ocular conditions
which of the following in amniotic fluid is is autosomal dominant in inheritance?
an indicator of open neural tube defect a) Best disease
in the fetus? b) Gyrate atrophy
a) Phosphatidylesterase c) Lawrence-Moon-Biedel
b) Acetylcholinesterase syndrome
c) Pseudocholinesterase d) Bassen Kornzweig disease
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d) Microcalcification
PSYCHIATRY
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Please Note: For the controversial questions, Maxillary nerve traverses the infraorbital
the BEST POSSIBLE answer has been groove and canal in the floor of the orbit,
provided after going through standard and appears upon the face at the
references. However, these are not absolute & infraorbital foramen. Here is it referred
are open for discussion. Repeat questions to as the infraorbital nerve, a terminal
have NOT been explained for obvious branch. At its termination, the nerve lies
reasons. beneath the quadratus labii superioris,
and divides into a leash of branches
ANATOMY which spread out upon the side of the
nose, the lower eyelid, and the upper lip,
1. C (Anterior nasal division of maxillary joining with filaments of the facial nerve.
nerve)
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4. A (Repeat from AIIMS Nov 09, AI 2010) The anterior ethmoidal nerve travels with
the anterior ethmoidal artery and leaves
5. B the orbit through a canal between the
ethmoidal labyrinth and the frontal bone. It
6. C (Repeat from AI 2010) passes through and supplies the adjacent
ethmoidal cells and frontal sinus, and then
7. A (Anterolateral & around the aorta) enters the cranial cavity immediately
lateral and superior to the cribriform plate.
Celiac plexus is the large accumulation
of nerve fibers & ganglia associated with The anterior ethmoidal nerve travels
the roots of the celiac trunk & superior forward in a groove on the cribriform plate
mesenteric artery immediately below the and then enters the nasal cavity by
aortic hiatus of the diaphragm. descending through a slit-like foramen
immediately lateral to the crista galli. It has
branches to the medial and lateral wall of
the nasal cavity and then continues
forward on the undersurface of the nasal
bone. It passes onto the external surface
of the nose by traveling between the nasal
bone and lateral nasal cartilage, and then
terminates as the external nasal nerve,
which supplies skin around the naris, in
the nasal vestibule, and on the tip of the
nose.
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intervertebral disc spaces. Please go through it early symptom. Older untreated children become
once, it will help to clear your concepts. hyperactive, with purposeless movements,
rhythmic rocking, and athetosis.
Ref: http://medind.nic.in/iaf/t07/i2/iaft07i2p158.pdf
On physical examination, these infants are
lighter in their complexion than unaffected
siblings. Some may have a seborrheic or
eczematoid rash, which is usually mild and
disappears as the child grows older. These
children have an unpleasant odor of
phenylacetic acid, which has been described as
musty or mousey. There are no consistent
findings on neurologic examination. Most infants
are hypertonic with hyperactive deep tendon
reflexes. About 25% of children have seizures,
and more than 50% have
electroencephalographic abnormalities.
Microcephaly, prominent maxilla with widely
spaced teeth, enamel hypoplasia, and growth
retardation are other common findings in
untreated children. The clinical manifestations of
classic PKU are rarely seen in those countries in
which neonatal screening programs for the
detection of PKU are in effect.
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55. C
FORENSIC 56. B
33. A 57. B
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http://pt.wkhealth.com/pt/re/eira/abstract.00002018-
Some of the most commonly used drugs 200124030-
prescribed to treat pulmonary hypertension
00005.htm;jsessionid=Lp8fT2gx2MfqnlMyLJkSHKphygq
include:
epoprostenol (Flolan), 3HGGvG4qP1x8zlP3vS7MNDTtL!1947086508!1811956
bosentan (Tracleer), 29!8091!-1?nav=reference
intravenous treprostinil (Remodulin), MICRO
inhaled iloprost (Ventavis),
sildenafil (Viagra, Revatio), 76. C
calcium channel blockers (such as VDRL, RPR & Kahn test are screening
nifedipine), tests. Kahn test is rarely used today.
sitaxsentan (Thelin) - not FDA approved
in the U.S., and Fluorescent Treponemal Antibody
ambrisentan (Letairis). Absorption Test is the most specific test
for syphilis. If this is positive it confirms the
Ref:http://www.medicinenet.com/pulmonar diagnosis
y_hypertension/page5.htm Ref:
http://en.wikipedia.org/wiki/Rapid_plasma_
70. A reagin
71. A 77. B
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81. D 85. D
I am quoting the exact lines from Nelson Options A & B are true (see Harrison).
for each of the 4 options & the answer will Confusion lies betn options C & D.
be clear to you.
About option C
Although CSF cultures are positive in less
Option D - The avidity test can be helpful than 10% of patients with apparent
to time infection. A high-avidity test result meningitis, intrathecal antibodies and a
indicates that infection began >16 wk lymphocytic pleocytosis (approximately
earlier, which is especially useful in 100 cells/µL) are present in more than
determining time of acquisition of infection 80%. Patients with meningitis typically
in the 1st or final 16 wk of gestation. A have elevated protein concentrations (>50
low-avidity test result may be present for mg/dL) but normal glucose levels (45-80
many months and is not diagnostic of mg/dL). Oligoclonal bands specific for B
recent acquisition of infection. burgdorferi may be present.
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About option B – Some CD 4+ cells have been media as it approaches the neck. At the neck of
shown to have cytotoxicity.However, perforin- the aneurysm, the muscular wall and intimal
+
positive cytotoxic CD4 T cells have been elastic lamina stop short and are absent from the
described in human immunodeficiency virus- aneurysm sac itself. The sac is made up of
positive patients suggesting a role not only of thickened hyalinized intima. The adventitia
+ +
CD8 but also of CD4 T cells for killing virus- covering the sac is continuous with that of the
th
infected cells. parent artery. – Robbins 7 /1367
Ref:http://www.medscape.com/viewarticle/543527
94. B
90. C
Option A - With increasing age, tendons, skin,
The amount of precipitate formed is greatly
and even blood vessels lose elasticity. This is
influenced by the relative proportions of
due to the formation of cross-links between or
antigens & antibodies. If increasing quantities
within the molecules of collagen (a fibrous
of antigens are added to the same amount of
protein) that give elasticity to these tissues.
antiserum in different tubes, precipitation will
The “cross-linking” theory of aging assumes
be found to occur most rapidly & abundantly in
that with increasing age, the number of cross-
one of the middle tubes in which the antigen &
linkages within and between collagen
antibody are present in optimal or equivalent
molecules increases, leading to crystallinity
proprtions. In the preceeding tubes in which
and rigidity. – Encyclopedia Britannica
the antibody is in excess, and in the later tubes
in which the antigen is in excess, the
Option B - According to the Free-radical theory,
precipitation will be weak or even absent.
oxidative damage initiated by reactive oxygen
species is a major contributor to the functional
Ref: Textbook of Microbiology –
th decline that is characteristic of aging. While
Ananthanarayan, Paniker 6 / 89
studies in invertebrate models indicate that
animals genetically engineered to lack specific
PATHO antioxidant enzymes (such as SOD) generally
show a shortened lifespan.
91. A http://en.wikipedia.org/wiki/Reactive_oxygen_s
pecies#Cause_of_aging
Controversial question. Both TB & Gangrene
may be the answer. I prefer TB. Even Amit Option D – From the above para, it isclear that
Ashish & MK has preferred TB over gangrene decreased SOD levels cause aging (not
(AA in an old AIIMS Paper & MK in AI09 increased SOD levels?. So option D is wrong.
Paper).
Option C – Somatic mutation theory of aging -
92. C This theory states that an important part of
aging is determined by what happens to our
93. B genes after we inherit them. From the time of
conception, our body's cells are continually
reproducing. Each time a cell divides, there is a
An unruptured saccular aneurysm is a thin- chance that some of the genes will be copied
walled outpouching at an arterial branch incorrectly, this is called a mutation.
point along the circle of Willis or a major vessel Additionally, exposures to toxins, radiation or
just beyond. Saccular aneurysms measure a few ultraviolet light can causes mutations in your
millimeters to 2 or 3 cm in diameter and have a body's genes. The body can correct or destroy
bright red, shiny surface and a thin, translucent most of the mutations, but not all of them.
wall. Demonstration of the site of rupture requires Eventually the mutated cells accumulate, copy
careful dissection and removal of blood in the themselves and cause problems in the body's
unfixed brain. Atheromatous plaques, functioning related to aging.
calcification, or thromobotic occlusion of the sac
may be found in the wall or lumen of the My opinion is that the Free Radical Theory is
aneurysm. Brownish discoloration of the adjacent more appropriate as damage due to free
brain and meninges is evidence of prior radicals may produce somatic mutations also.
hemorrhage. The neck of the aneurysm may be So I will go with option B.
either wide or narrow. Rupture usually occurs at
the apex of the sac with extravasation of blood The major theories of aging as a consequence of
into the subarachnoid space, the substance of random events are:
the brain, or both. The arterial wall adjacent to
the neck of the aneurysm often shows some
intimal thickening and gradual attenuation of the
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112. A 118. C
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125. B
Laryngeal edema is the most feared
complication of hereditary angioedema "Medulloblastoma, accounting for 90% of
(HAE) and can cause an immediate life- embryonal tumors, is a cerebellar tumor
threatening emergency. Case series indicate occurring predominantly in males and at a
that more than half the patients with HAE median age of 5–7 yr....The Chang staging
develop involvement in this area at some system, originally based on surgical
time during their lives. information, has been modified to incorporate
information from neuroimaging to identify risk
Ref: categories."
http://emedicine.medscape.com/article/135604 Ref: Nelson's Pediatrics, 18e, Chapter-497
-overview
Medulloblastoma is the most common
120. A malignant brain tumor in children, accounting
for 10-20% of primary CNS neoplasms and
121. C approximately 40% of all posterior fossa
tumors. It is a highly invasive embryonal
122. D neuroepithelial tumor that arises in the
cerebellum and has a tendency to disseminate
Surgical repair of diseased valves by incising throughout the CNS early in its course.
the fused mitral valve commissures and
replacement with prosthetic devices has For medulloblastoma, a modified version of the
greatly improved the outlook for patients with Chang staging system is commonly used. The
RHD. original Chang system was devised in the late
th th
Ref: Robbins 7 /594; Ghai 6 / 382 1960's, before the widespread use of radiology
Also see the “Addendum” on P.37. scans, and so it relies primarily on information
about tumor size and spread that is obtained
PEDIATRICS during actual surgery, with the naked eye.
Based on what the surgeon sees at the time of
123. A the surgery, the actual tumor is placed in one
of the following categories (T referring to
“The physical findings are altered when an tumor):
increase in the pulmonary vascular resistance
results in diminution of the left-to-right shunt. T1 Tumor <3 cm in diameter
Both the pulmonary outflow and tricuspid T2 Tumor >3 cm in diameter
inflow murmurs decrease in intensity, the T3a Tumor >3 cm in diameter with
pulmonic component of the second heart sound spread
and a systolic ejection sound are accentuated, T3b Tumor >3 cm in diameter with
the two components of the second heart sound definite spread into the brain stem
may fuse, and a diastolic murmur of pulmonic (part of brain that controls breathing,
regurgitation appears. Cyanosis and clubbing hearing, seeing, and other important
functions)
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T4 Tumor >3 cm in diameter with and has a tendency to metastasize via CSF
extension up past the aqueduct of pathways.
Sylvius and/or down past the foramen
magnum Medulloblastomas are notorious for spreading
from the cerebellum down to the spine, or
In addition to "T" staging, medulloblastoma "metastasizing". They typically invade the
staging has been modified by including "M" surrounding lining tissues (meninges) before
staging, where the "M" stands for metastasis. gaining access to the cerebrospinal fluid (CSF)
Remember, this is a word that describes how which bathes both the brain and the spine.
far the tumor cells have spread from the Once there, tumor cells can travel through the
original location, if at all. The M stage is CSF and deposit themselves, or "seed", in any
determined not only by the surgeon's part of the spine, resulting in "metastatic
observations, but also in combination with MRI disease". Rarely, these tumor cells can gain
scans and lumbar cytology, and consists of 5 access outside of the CNS and metastasize to
possible groups: distant bone or bone marrow.
Ref:
http://es.oncolink.org/types/article.cfm?c=22&s
M0 No evidence of metastasis =78&ss=783&id=9484&p=2
M1 Tumor cells found in cerebrospinal
fluid (by lumbar puncture and cytology 127. A
study)
M2 Tumor beyond primary site but still 128. A
in brain
M3 Tumor deposits ("seeds") in spine 129. B
area that are easily seen on MRI
M4 Tumor spread to areas outside the 130. C
CNS (outside both brain and spine)
131. B
Each patient is assigned a combination of one
T stage and one M stage. As mentioned in the 132. B
introduction, one of the reasons staging is
important is that it helps predict how a patient 133. C
might do in the long run, or how "curable" their
cancer is, in a way. For medulloblastomas, the Compensated versus decompensated
M stage is considered far more important in shock
determining ultimate patient outcome and
survival than the T stage. In other words,
regardless of what the T stage may be, To begin to categorize and prioritize the
children who are in the M0 group do far better management of a child in shock, first determine
than those in M1, who tend to fare better than the central blood pressure. Blood pressure
M2 kids, who in turn do better than M3 or M4 measurements determine the central driving
children. Ref: pressure responsible for perfusing the most
http://es.oncolink.org/types/article.cfm?c=22&s critical organs, namely the brain and the heart.
=78&ss=783&id=9484&p=2
Minimum blood pressure requirements can be
determined by establishing the fifth percentile
for normal systolic blood pressure in a healthy,
126. A
well-perfused child. The American Heart
“Although Glioblastoma multiforme is the Association, in the course on pediatric
tumor most prone to extraneural metastasis in advanced life support (PALS), defines infants
the adult population, medulloblastoma with fifth–percentile systolic blood pressure as
metastasizes more commonly in children.” – follows:
• Newborn - 60 mm Hg
Tumors of the pediatric central nervous system
By Robert F. Keating, James T. Goodrich, • Infant (1 mo to 1 y) - 70 mm Hg
Roger J. Packer, P.369 • Child (>1 y) - 70 + 2 X age (in y)
Also know:
Thus, children with poor perfusion and blood
Medulloblastoma (WHO grade IV) is a
pressure below the parameters listed above
malignant, invasive embryonal tumor of the
cerebellum that occurs primarily in children, may be said to have decompensated shock.
has a predominantly neuronal differentiation, Such children, if not quickly and
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141. B
Because CO depends on both SV and HR,
the body typically tries to maintain CO when 142. A (Mattox maneuver)
SV decreases by increasing the HR. Unless
the HR cannot increase for some reason 143. C
(eg, pharmacologic blockade; neurologic
damage, such as cervical cord injury; 144. B
operative insults that may be sustained
during open-heart surgery), a patient in the Complications of ileostomy – Stoma
early stages of shock is typically tachycardic. necrosis may occur in the early
However, such a sign is certainly not very postoperative period and is usually caused
sensitive in children because children may by skeletonizing the distal small bowel
be tachycardic from a wide variety of stimuli, and/or creating an overly tight fascial
including fever, pain, and agitation. defect. Limited mucosal necrosis above
Nevertheless, with the exceptions mentioned the fascia may be treated expectantly, but
above, tachycardia is generally a fairly early necrosis below the level of the fascia
and specific finding in both compensated requires surgical revision. – Schwartz
th
8 /1073
and decompensated shock.
145. A
Here the infant is 6 months old & having
SBP 85 mm Hg, which is above 70 mm Hg. 146. D
So it is a compensated shock. Also, the
infant is not tachypneic (so not early). Hence 147. A
it is a case of late decompensated
hypovolemic shock. 148. D
149. A
SURGERY
150. A
134.C
ORTHO
135. B
151. A
136. A
In 1980, the so-called Ahlbäck classification
137. D was described as follows (Ahlbäck and
Rydberg 1980).
The distribution of polyps in patients is reported
as follows: stomach, 25%; colon, 30%; and Grade 1: narrowing of the articular space;
small bowel, 100%. While these Grade 2: obliteration or almost obliteration of
hamartomatous polyps themselves do not have the articular space;
malignant potential, patients with the syndrome Grade 3: bone attrition less than 5 mm;
have an increased risk of developing Grade 4: bone attrition between 5 and 15 mm,
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Grade 5: bone attrition greater than 15 mm. advanced age of onset of symptoms rendered
AS an unlikely diagnosis.
This grading is based on radiographic
appearance of the joint. Why not Lumbar Canal Stenosis?
From this grading, it is clear that Grade 2 Neurological signs would have been present.
means no bone attrition has yet occurred. Patients with significant lumbar spinal canal
Hence I think the best mode of treatment narrowing report pain, weakness, numbness
here is conservative. Open for discussion. in the legs while walking, or a combination
thereof.
152. A
153. A
154. B
155. C
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th Epidemiology
Ref: Robbins 7 /1314
Incidence: 2-10% of pregnancies
Symptoms
157. A
Severe Pruritus in third trimester of
pregnancy
GYNAE & OBS Pruritus localized to trunk and extremities
Signs
No rash
158. B This ques is open for discussion. No Jaundice in mild form (Prurigo
Causes of coccydynia (coccyx pain) include gravidarum)
History of cancer - Especially colon, prostate, Labs
ovarian, cervical, testicular, or other intrapelvic Serum bile acids >4 (>16 confers adverse
malignancies. fetal outcome)
Ref:http://emedicine.medscape.com/article/309 Management
486-diagnosis Oral Antihistamines
Ursodeoxycholic Acid (Ursodiol)
Increased antepartum observation
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181. B
Potential candidates for GDM are those
having a previous birth of an oversized 182. B
baby of 4 kg or more.
The endolymph is produced from perilymph as
th
Ref: Dutta Obstetrics 6 / 284-285 a result of selective ion transport through the
epithelial cells of Reissner’s membrane and not
directly from the blood. The secretory tissue
170. C Mtx can’t be used during pregnancy. called the stria vascularis, in the lateral wall of
the cochlear duct, is thought to play an
171. D important role in maintaining the high ratio of
potassium ions to sodium ions in the
172. B endolymph.
173. A Ref:
http://www.britannica.com/EBchecked/topic/56
9006/stria-vascularis
OPHTHAL
“It has generally been accepted that
174. A endolymph of the cochlea is produced by stria
vascularis.” – Dr. T. Balasubramanian MS,
175. D DLO
http://www.drtbalu.co.in/endolymph.html
176. B
177. B
178. B
179. A
ENT
180. B
Ref:
http://emedicine.medscape.com/article/861126-
overview
183. A (Repeat from All India 2010)
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Erythema Nodosum
History
The eruptive phase of erythema nodosum begins
with flulike symptoms of fever and generalized
aching. Arthralgia may occur and precedes the
eruption or appears during the eruptive phase. Classic presentation of erythema
Most lesions in infection-induced erythema nodosum with nodular red swellings
nodosum heal within 7 weeks, but active disease over the shins
may last up to 18 weeks. In contrast, 30% of
idiopathic erythema nodosum cases may last Ref:http://emedicine.medscape.com/article/10816
more than 6 months. Febrile illness with 33-overview
dermatologic findings includes abrupt onset of
illness with initial fever, followed by a painful rash Weber Christian Disease
within 1-2 days.
Weber-Christian disease is a skin condition that
Primary skin lesions - Lesions begin as red features recurring inflammation in the fat layer of
tender nodules (see the image below). Lesion the skin. The involved areas of skin manifest as
borders are poorly defined, and lesions vary from recurrent crops of erythematous, sometimes
2-6 cm. During the first week, lesions become tender, edematous subcutaneous nodules. The
tense, hard, and painful; during the second week, lesions are symmetric in distribution, and the
they may become fluctuant, as in an abscess, but thighs and lower legs are affected most
do not suppurate or ulcerate. Individual lesions frequently. Malaise, fever, and arthralgias
last approximately 2 weeks, but occasionally, frequently occur. Nausea, vomiting, abdominal
34
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th
pain, weight loss, and hepatomegaly may also Robbins 7 /1265 says:
occur. Because its etiology is unknown, Weber- “Panniculitis often involves the lower legs.
Christian disease is often referred to as idiopathic Erythema nodosum presents as poorly defined,
lobular panniculitis. exquisitely tender, erythematous plaques and
nodules that may be better felt than seen. Fever
Age - Weber-Christian disease may occur in and malaise may accompany the cutaneous
young children but has been reported most signs. Over the course of weeks, lesions usually
frequently in people in the fourth to seventh flatten and become bruise-like, leaving no
decades of life. residual clinical scars, while new lesions develop.
Biopsy of a deep wedge of tissue is usually
History required to establish a definitive diagnosis.
Patients with Weber-Christian disease typically
have cutaneous and, less frequently, systemic Erythema nodosum and erythema induratum are
symptoms. but two examples among the many types of
• Patients affected with Weber-Christian panniculitis. Weber-Christian disease (relapsing
disease describe crops of lesions that febrile nodular panniculitis) is a rare form of
appear and resolve during a period of lobular, nonvasculitic panniculitis seen in children
weeks to months. The lesions are often and adults. It is marked by crops of erythematous
symmetric in distribution, and the thighs plaques or nodules, predominantly on the lower
and legs are involved most commonly. extremities, created by deep-seated foci of
Individual nodules regress during the inflammation with aggregates of foamy
course of a few weeks. histiocytes admixed with lymphocytes,
• Systemic symptoms of Weber-Christian neutrophils, and giant cells.”
disease include malaise, fever, nausea,
vomiting, abdominal pain, weight loss, ANESTHESIA
bone pain, myalgia, and arthralgia.
187. B
• The etiology of Weber-Christian disease
is unknown, and patients do not report a
history of thermal, mechanical, or Halothane impairs liver blood flow and
chemical trauma. oxygenation the most, perhaps explaining
increased incidence with its use.
Physical
Physical examination reveals erythematous, Enflurane was shown to reduce hepatic
edematous, and tender subcutaneous nodules. blood flow less than halothane.
• The nodules are usually symmetric and
measure approximately 1-2 cm;
Ref: Hepatotoxicity of inhalational agents –
however, the nodules may be much
Dept of Anesthesia, University of Sydney
larger. The lesions commonly occur on http://www.anaes.med.usyd.edu.au/lecture
the thighs and lower legs but may also s/hepatotox_clt/hepatotoxicity.html
involve the arms, trunk, and face.
• The individual nodules resolve during a
couple of weeks, leaving an atrophic Ajay Yadav has mentioned in his book that
depressed scar. Enflurane depresses hepatic functions due
to decreased hepatic blood flow (Ajay
• Occasionally, the epidermis overlying nd
Yadav 2 /63). However he has never said
the nodules breaks down, and the lesion
that Enflurane causes maximum reduction
discharges a brown liquid oil (ie,
in hepatic blood flow. So answer hee is
liquefying panniculitis).
Halothane.
• In individuals with Weber-Christian
disease with visceral involvement,
hepatomegaly or splenomegaly may be Also see the following reference:
present.
Ref:http://emedicine.medscape.com/article/10084 Enflurane (Ethrane), Isoflurane
11-overview (Forane), and Desflurane (Suprane)
Mild postoperative hepatic dysfunction--
due to altered hepatic blood flow.
These anesthetics can promote formation
of acetylator liver proteins which may
cause hepatotoxicity (type II) similar to that
caused by halothane (Fluothane);
frequency < halothane (Fluothane).
Weber Christian disease
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RADIO
190. B
191. B
192. A
193. A
194. A
195. C
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Addendum
122. A patient presents with acute rheumatic References which indicate valve replacement is
carditis with fever. True statement is: done (of course after medical therapy has failed
a) Increased Troponin T in acute rheumatic carditis r as follows:
b) Reduced myocardial contractility
c) Signs of inflammation & necrosis
d) Valve replacement will ameliorate Heart Failure May Require Specific Treatment
CCF
Heart failure in rheumatic fever generally
Explanation: responds to bed rest and corticosteroids;
diuretics and then digoxin may be necessary in
This question has been framed on a single para [1]
in Braunwald. Read it below & you can easily rule patients with more severe disease. Digoxin
out options a,b & c. should be used with caution because of its
lowered therapeutic index in active myocarditis
and the possibility of exacerbation of heart block.
"The severity of left ventricular dysfunction, even
Surgical therapy, e.g. valve replacement, is
in the acute setting, appears to correlate with the
extent of valvulitis rather than with any occasionally required.
myocardial injury. Rheumatic myocarditis, in the
setting of preserved LV function, is not http://www.medscape.com/viewarticle/406404_5
associated with the troponin level elevation seen
[11]
in viral myocarditides. Both echocardiographic
data and postmortem pathology findings are Surgical Care
consistent with severe heart failure in acute RF,
being secondary to altered myocardial mechanics When heart failure persists or worsens after
caused by MR rather than secondary to aggressive medical therapy for acute rheumatic
myocarditis. Traditionally, the diagnosis has been heart disease, surgery to decrease valve
made on the basis of auscultation of mitral or,
less commonly, aortic insufficiency in the setting insufficiency may be life-saving.
of heart failure, with cardiomegaly in the most
severe cases. Severe MR is most commonly http://emedicine.medscape.com/article/891897-
associated with the worst prognosis—acute and treatment
sometimes refractory and fatal heart failure. This
subgroup is most likely to develop significant What is the prognosis (predicted outcome
chronic RHD, with an incidence as high as 90 and course) of the disease?
percent. There is a linear relationship between
the severity of MR during the first episode of RF
and subsequent RHD." - Braunwald's Heart
th
Disease 8 /Chapter 83 Flares tend to be unpredictable as far as how
long they will last and their severity. Having
carditis in the first attack is potentially a higher
risk for heart damage, however, complete healing
may follows carditis in some cases. The most
"Unless valvular regurgitation and severe severe heart damage may require heart surgery
congestive heart failure are refractory to drug for valve replacement.
therapy, valve surgery is avoided for acute RF
patients. Surgical morbidity and mortality have http://www.printo.it/pediatric-
been significant and failed repair leading to valve rheumatology/information/Australia/9.htm
replacement frequent, although postoperative
ventricular function generally improves
significantly, consistent with regurgitation rather There r also many case reports available which
than myocardial dysfunction being the primary show promising results with valve replacement.
mechanism leading to heart failure.” -
th
Braunwald's Heart Disease 8 /Chapter 83
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