AIPPG Presents
"AIIMS NOV 2003"

• Solutions to AIIMS November 9th 2003 MD / MS entrance examination questions.

• Fully referenced explained and accurate answers

• All relevant material included.

• Published by Paras Publishers, Hyderabad.
• Maximum retail price Rs 75.
• Available at a bookstore near you. In case of difficulty in getting this book email aiimsbook@aippg.com. For preview see below.

Preview Question 1: Subject ENT

58. In complete bilateral palsy of recurrent laryngeal nerves, there is:

1. Complete loss of speech with stridor and dyspnea.
2. Complete loss of speech but no difficulty in breathing.
3. Preservation of speech with severe stridor and dyspnea.
4. Preservation of speech and no difficulty in breathing.
Ans. 1: Complete loss of speech with stridor and dyspnea

This is an emergency requiring tracheostomy.

References: (1) Scott Brown’s otolaryngology volume I, 6th ed Page 1/12/17: “Bilateral paralysis of recurrent laryngeal nerve results in complete loss of vocal power and marked inspiratory stridor often necessitating tracheostomy”

(2) Gray’s anatomy Page 1463, 37th ed. “complete division reduces voice to a whisper”

(3) Snell’s Clinical anatomy page 808 5th Ed: “Bilateral complete section of recurrent laryngeal nerve results in vocal cords assuming midway position between adduction and abduction. Breathing is impaired. Since Rima glotidis is partially closed speech is lost”

(4) BD Chaurasia anatomy page 210 volume 3, 3rd Ed: “ When both recurrent laryngeal nerves are paralyzed vocal cords lie in cadaveric position and phonation is completely lost. Breathing is difficult”

Note: Only Dhingra Page 296 mentions that voice is good in bilateral recurrent laryngeal paralysis. [Keeping in view of above references, 1 is the correct answer!!!]

Preview Question 2: Subject Pediatrics

162. Portal hypertension in children in India is commonly due to:

1. Indian childhood cirrhosis.
2 Extra hepatic portal venous obstruction.
3. Idiopathic portal hypertension.
4. Hepatic out flow tract obstruction.

Ans. 2: Extra hepatic portal venous obstruction

In India causes of portal hypertension are -
- Extra hepatic portal venous obstruction (EHPVO) 68- 76 %
- Intrahepatic causes 24- 28 %
- Non cirrhotic portal fibrosis 4 %
In India portal hypertension has been found more in low socioeconomic group.

In western countries causes of portal hypertension are:

- Intrahepatic causes 68 – 81 %
- Extra hepatic causes 9 – 27 %
- Budd-Chiari syndrome 5 - 10 %
Reference: Ghai-264, “Yaccha surendra kumar: Journal of gastroenterology and hepatology (2002)”

AIIMS NOV 2003 Forum

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