ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and
Notes)
ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and
Notes)
(By Dr Varun Singhal MD Std., Top Ranker All India 2003, 4 ,
All Rights reserved AIPPG).
Discuss controversial
questions in Question Forum
Q.1 The parvocellular pathway from lateral geniculate nucleus to visual
cortex is most sensitive for the stimulus of:
Q.14 Aspermia is the term used to describe: 1. Absence of semen. 2. Absence of sperm in ejaculate. 3. Absence of sperm motility. 4. Occurrence of abnormal sperm. Answer is 1 DORLAND DICTIONARY ASPERMIA is absence of semen AZOOSPERMIA mean absence of sperm OLIGOZOOSPERMIA IS less than 20 millon sperm per ml of semen. Q.15 Which of the following statements can be regarded as primary action of Inhibin? 1. It inhibits secretion of prolactin. 2. It stimulates synthesis of estradiol 3. It stimulates secretion of TSH. 4. It inhibits secretion of FSH. Answer is 4 Harrison priciple of internal medicine 15th ed /2157 GANONG REVIEW OF PHYSIOLOGY 19TH EDITION/127 Inhibin inhibits the release of FSH by the hypothalamic-pituitary unit. Activin enhance FSH secretion as well as having local effects on ovarian steroidogenesis. Follistatin attenuates the actions of Activin and other members of the transforming growth factor (TGF) family. Q.16 A 40 year old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onset of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for few hours. There is history of his having missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behavior, disorientation, impaired judgement and insight. He is most likely to be suffering from: 1. Alcoholic hallucinosis. 2. Delirium tremens. 3. Wernicke encephalopathy. 4. Korsakoff’s psychosis. Answer is 2 Harrison priciple of internal medicine 15th ed/2565 All India repeat Q of 2003 When a chronic alcoholic stops taking alcohol then withdrawal symptoms generally begin within 5 to 10 h of decreasing ethanol intake, peak in intensity on day 2 or 3, and improve by day 4 or 5. Features include tremor of the hands (shakes or jitters); agitation and anxiety; autonomic nervous system over activity. The term delirium tremens (DTs) refers to delirium (mental confusion with fluctuating levels of consciousness) along with a tremor, severe agitation, and autonomic over activity). It is to be noted that only 5 to 10% of alcohol-dependent individuals ever experience DTs. Q.17 A 45 year male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from: 1. Korsakoff’s psychosis. 2. Wernicke’s encephalopathy. 3. De Clerambault syndrome. 4. Delirium tremens. Answer is 2 Harrison principle of internal medicine 15th ed /2562 All India repeat Q of 2004 Wernicke's disease is a common and preventable disorder due to a deficiency of thiamine vitamin. Alcoholic’s account for most of the cases of it. The characteristic clinical triad is that of ophthalmoplegia, ataxia, and global confusion. However, only one -third of patients of Wernicke's disease have this classic clinical triad. Ocular motor abnormalities include horizontal nystagmus on lateral gaze, lateral rectus palsy (usually bilateral), conjugate gaze palsies, and rarely ptosis. The pupils are usually spared, but they may become miotic with advanced disease. Atrophy of the Mamillary bodies is seen in most chronic cases. Q.18 A 25year old female presents with 2year history of repetitive, irresistible thoughts of contamination with dirt associated with repetitive hand washing. She reports these thoughts to be her own and distressing; but is not able to overcome them along with medications. She is most likely to benefit from which of the following therapies: 1. Exposure and response prevention. 2. Systematic desensitization. 3. Assertiveness training. 4. Sensate focusing. Answer is 1 New oxford textbook of psychiatry 1st ed/827-828 Although it is a repeat question, many guides has been given the answer systemic desensitizationBut according to oxford “the behavioral therapy is as effective as pharmacotherapy in O.C.D. Recently 2 neuroimaging studies found that patient with O.C.D., who are successfully treated with behavioral therapy shows changes in cerebral metabolism similar to those found by successful treatment with S.S.R.I.” The principle behavioral approach in O.C.D. is exposure for obsession and response prevention for virtual. Desensitization, thought stopping, flooding, implosion therapy and aversion conditioning have also been used in-patient with O.C.D. Q 19 An 18 year old boy came to the Psychiatry OPD with a complaint of feeling changed from inside. He described himself as feeling strange as if he is different from his normal self. He was very tense and anxious yet could not point out the precise change in him. This phenomena is best called as: 1. Delusional mood. 2. Depersonalization. 3. Autochthonous delusion. 4. Over valued idea. Answer is 2 Neeraj ahuja psychiatry 5th ed/113 Charlis G Morris psychology 10th ed/522 Essential feature of depersonalization is that person suddenly feels changed or different in a strange way. This kind of feeling is especially common during adolescence and young adult E.g. A 20 yr old college student sought professional help experiencing episodes of feeling outside of himself for 2 yr. At these times he felt groggy, dizzy, and preoccupied. Delusion mood and autochthonous delusion are the false belief as per definition, but this boy doesn’t have false belief Q.20 The major difference between typical and atypical antipsychotics is that: 1. The latter cause minimal or no increase in prolactin. 2. The former cause tardive dyskinesia. 3. The former area available as parenteral preparation. 4. The latter cause substantial sedation. Answer is 2 K.D.T. Essential of pharmacology p396 Atypical anti psychotic
Q.21 Dry mouth during antidepressant therapy is caused by blockade of: 1. Muscarinic acetylcholine receptors. 2. Serotonergic receptors. 3. Dopaminergic receptors. 4. GABA receptors. Answer is 1 K.D.T. Essential of pharmacology p410 Anticholinergic side effect of antidepressant leads to dry mouth in the patients on these drugs. Dry mouth is due to the Muscarinic acetylcholine receptor antagonism of these drugs. Q.22 All of the following are hallucinogens, except: 1. LSD. 2. Phenylcyclidine. 3. Mescaline 4. Methylphenidate. Answer is 4 Charlis G Morris psychology 10th ed/175 Hallucinogen LSD Mescaline Psilocybin Phenylcyclidine Peyote Phenylcyclidine is also known as angel dust.?Methylphenidate is not a hallucinogen. It is a CNS stimulant and used in treatment of narcolepsy. Q.23 An 18-year-old student complains of lack of interest in studies for last 6 months. He has frequent quarrels with his parents and has frequent headaches. The most appropriate clinical approach would be to: 1. Leave him as normal adolescent problem. 2. Rule out depression. 3. Rule out migraine. 4. Rule out an oppositional defiant disorder. Answer is 1 Charlis G Morris psychology 10th ed/416 Adolescence is a period of storm and stress, fraught with suffering, passion, and rebellion against adult authority (so they may have frequent quarrels with his parents). Between 15-30% of adolescent student dropout of high school, many regularly abuse drugs. So the problem of in this q. is a normal adolescent problem. There is no sadness in mood. So it excludes depression Frequent quarrels and loss of interest in studies only, exclude Migraine. Oppositional defiant disorder- age group is 8-12 yr. Q.24 Preservation is: 1. Persistent and inappropriate repletion of the same thoughts. 2. When a patient feels very distressed about it. 3. Characteristic of schizophrenia. 4. Characteristic of obsessive compulsive disorder (OCD) Answer is 1 New oxford textbook of psychiatry 1st ed/63 Neeraj ahuja psychiatry 5th ed/13 Perservation is found in many organic mental disorders, it is not characteristic of schizophrenia. It is defined as an inability to shift from one theme to another one. A thought is retained long after it has become inappropriate in the given context. For e.g. a patient may give a correct answer to the first question, but repeats the same response to a subsequently completely different question. Q.25 One of the following usually differentiates hysterical symptoms from hypochondriacal symptoms: 1. Symptoms do not normally reflect understandable physiological or pathological mechanisms. 2. Physical symptoms are prominent which are not explained by organic factors. 3. Personality traits are significant. 4. Symptoms run a chronic course. Answer is 1 Q.26 Which one of the following is the investigation of choice for evaluation of suspected Perthe’s disease ? 1) Plain X-ray 2) Ultrasonography (US) 3) Computed Tomography (CT) 4) Magnetic Resonance Imaging. Answer is 4 Dahnert Radiological review manual, 5th Ed, Pg-49 Haaga; CT/MRI of whole body MRI is 90-100 sensitive and 85-90% specific for diagnosis of Perthe’s disease and avascular necrosis (Haaga). MRI can detect the earliest changes in signal intensity of tissues. Edema seen as a high- signal- intensity (bright) on MRI T2 weighted image as earliest sign of inflammation. So it is the investigation of choice in evaluation of suspected Perthe”s disease If Question were – Next step in evaluation of patient, or what will be the first investigation of choice? Then answer will be – Plain X-ray PEARL POINTS about Legg-Calve-Perthe’s disease- Coxa plana -It is idiopathic avascular necrosis of femur head -Only 10% cases are bilateral, -M: F ratio - 5:1, but in bilateral cases M: F is 2:1 -When occur In adults it is called Chandler’s disease -Loss of “asterisk “ sign – seen on CT/MRI -Double line sign (in 80% of cases) seen on MRI Q.27. Eisenmenger syndrome is characterized by all except: 1. Return of left ventricle and right ventricle to normal size. 2. Pulmonary veins not distended. 3. Pruning of peripheral pulmonary arteries. 4. Dilatation of central pulmonary arteries. Answer is 1 Dahnert Radiological review manual, 5th Ed, Pg -627-628 CXR findings of Eisenmenger syndrome - Pronounced dilatation of central pulmonary arteries - Pruning of peripheral pulmonary arteries - Enlarged RV+ RA - Return of LA +LV to normal size - Normal pulmonary vein - No redistribution of pulmonary vein (normal venous pressure). Q.28 In which one of the following conditions the Sialography is contraindicated? 1. Ductal calculus. 2. Chronic parotitis 3. Acute parotitis 4. Recurrent sialadenitis. Answer is 3 LB 24TH/728 Mumps is the most common cause of acute painfull parotid swelling,that predominantly affect the children.acute bacterial parotitis is most commonly caused by staph. Aureus. Sialography is absolutely contraindicated in acute infection. Q.29 The most common site of leak in CSF rhinorrhea is: 1. Sphenoid sinus. 2. Frontal sinus. 3. Cribriform plate. 4. Tegmen tympani. Answer is 3 Snell’s clinical anatomy 7th Ed, Pg-802 Harrison principle of internal medicine 15th Ed Cribriform plate of the ethmoid bone may be damaged in the fractures of ant. cranial fossa. The patient will be having epistaxis and CSF rhinorrhea. CSF may also leak through the adjacent sinus. Persistent rhinorrhea and recurrent meningitis are indications for surgical repair of torn dura and underlying fracture. Pearl points about head injury. (Bailey and love’s 24th ed/596) Glial and macrophage reactions begin within 2 days after brain contusion and result in scarred, hemosiderin-stained depressions on the surface (plaques jaunes) after years. Those are one source of posttraumatic epilepsy that occurs after years of the head injury. Administration of prophylactic antibiotic in fracture base of skull gives no benefit. Even it can increase morbidity and mortality. Dexamethasone having controversial role in treating raised I.C.T. in-patient of head injury. But it has a definite role in raised ICT due to other reason. Fluid leaking from nose and ear should be screened for ?-transferrin (tau protein) to confirm the CSF. Fresh blood clot and coagulopathic proteins gives mixed density on CT called SWIRL sign Blow out fracture is fracture of orbital floor gives TEAR DROP sign on CT. Q.30 Which of the following is the most common renal cystic disease in infants is? 1. Polycystic kidney. 2. Simple renal cyst. 3. Unilateral renal dysplasia. 4. Calyceal cyst. Answer is 3 Current pediatric diagnosis and treatment, 11th Ed, Pg-15; Dahnert Radiological review, 5th Ed, Pg-928-929 -Most abdominal masses in the newborn are associated with the kidneys (multicystic dysplastic kidney, hydronephrosis, etc) -MCDK –is Potter type II cyst -It is second most common cause of an abdominal mass in neonate (after hydronephrosis) -It is most common form of cystic disease in infants - U/L MCDK is the most common form of multicystic dysplastic kidney (80-90%). Lt: Rt ratio 2:1 -Nuclear studies (99m-Tc MAG3) preferred over IVP for evaluation of the function of kidneys, because in first month of life the concentrating ability of even normal neonatal kidneys is suboptimal. Q.31 The most common type of total anomalous pulmonary venous connection is: 1. Supracardiac. 2. Infracardiac 3. Mixed. 4. Cardiac. Answer is 1 Ref- C.P.D.T; 11Ed / 557 Dahnert Radiological review, 5th Ed, Pg-603 TAPVC –It is classified according to the site of entry of pulmonary vein into the right of the heart Type 1 – (55%) entry into left SVC or Rt SVC (Supracardiac) Type 2 - entry into Rt atrium or coronary (cardiac) Type 3 - entry in portal vein (Infracardiac) Type 4 – mixed Q.32 Which one of the following is the most common location of hypertensive bleed in the brain? 1. Putamen/external capsule. 2. Pons. 3. Ventricles. 4. Lobar white matter. Answer is 1 Harrison principle of internal medicine 15th ed/2386 Intraparenchymal hemorrhage is most common type of intracranial hemorrhage. Hypertension, trauma, and cerebral amyloid angiopathy are among the imp. causes. Advanced age and heavy alcohol consumption also increase the risk. Cocaine use is one of the most important causes of it in the young adults. The most common sites of Intraparenchymal bleed are the basal ganglia (Putamen, thalamus, and adjacent deep white matter), deep cerebellum, and Pons. The Putamen is the most common site for hypertensive hemorrhage Q.33 Which one of the following is the most preferred route to perform cerebral angiography? 1) Transfemoral route 2) Transmaxillary route 3) Direct Carotid Puncture 4) Transbranchial route. Grainger and Allison’s Diagnostic Radiology 4th ed./150 Harrison internal medicine 15th ed/. It is possible to opacity arteries in many areas of the body using a direct percutaneous needle puncture. The common carotid and vertebral arteries can be punctured in the neck using an anterior approach to obtain arteriograms of the carotid and vertebrobasilar systems; the subclavian, axillary or brachial arteries can be punctured for upper limb arteriography, the abdominal aorta (high or low) for lumbar, pelvic and leg arteriography; and the femoral artery for single leg studies. But now Percutaneous studies in the head and neck and upper limb have been largely supplanted by the transfemoral catheter method. Grainger and Allinson Diagnostic Radiology 4th ed. Harrison internal medicine 15th ed/. Q.34 Which one of the following soft tissue sarcomas frequently metastasizes to lymph nodes? 1. Fibrosarcoma. 2. Osteosarcoma. 3. Embryonal Rhabdomyosarcoma. 4. Alveolar soft part sarcoma. Answer is 3 Harrison principle of internal medicine 15th ed/626 Sarcomas tend to metastasize through the blood rather than the lymphatic system; lymph node metastases occur in 5% of cases. Exceptions are Synovial and epithelioid sarcomas, Clear-cell sarcoma (melanoma of the soft parts), Angiosarcoma, and Rhabdomyosarcoma Where nodal spread may be seen in 17% The pulmonary parenchyma is the most common site of metastases in sarcomas. Exceptions are
In the treatment of sarcomas Doxorubicin (Adriamycin is trade name) -based chemotherapy is favored (as in Leiomyosarcomas). Q.35 Which one of the following radioisotope is not used as permanent implant? 1. Iodine-125 2. Palladium-103. 3. Gold-198. 4. Caesium-137. Regional therapy of advanced carrier, Michael T. Lutze. Jushua T. Rubin. Ist ed/184. R.C.S. Pointon, The Radiotherapy of malignant Disease 2nd ed/7. Radioisotopes used, as permanent implant is known as brachytherapy. Brachytherapy sources. Some of these radionuclides, e.g. radium-226, are accompanied by an equilibrium amount of one or more radioactive daughter products, which have different half-lives and emit different radiations.
- Caesium 137 source are now more commonly used. - Gold 198 is used for Permanent gold seed implant. - Stronum 90 - Bone Yitrium 90 - Pituitary gland Iodine 125 - CNS metastasis (RUBIN) Q.36 Which one of the following tumors shows calcification on CT scan? 1. Ependymoma 2. Meduloblastoma. 3. Meningioma. 4. CNS lymphoma. Answer is 3 Dahnert; Radiological review manual 5th Ed /299 CT findings of Meningioma— 1.Sharply demarcated well circumcised slowly growing mass 2.Wide attachment to adjacent dura mater 3.Cortical buckling of underlying brain 4. Hyperdense (70-75% due to psammomatous calcification) lesion on NECT 5.Calcification as circular/radial pattern seen on CT in20-25% cases 6. Hyperostosis of adjacent bone (in 18%)
D / D of suprasellar mass with calcification - Craniopharyngioma (90% have calcification) -Meningioma (25 % calcified as seen on CT) -Granuloma -Dermoid / Teratoma -Rarely hypothalamic Glioma or Optic Glioma Q.37 The technique employed in radiotherapy to counteract the effect of tumor motion due to breathing is known as: 1. Arc technique. 2. Modulation. 3. Gating. 4. Shunting. Answer is 3 Grainger and Allison’s, diagnostic radiology 4th ed/143 Gated imaging When any motion of body produces disturbance and motion related artifact in images in Radiology or during radiotherapy, then gating is done to reduce the motion related artifacts. If cardiac motion - ECG gating done If respiratory motion - Diaphragmatic gating done. Q.38 In which of the following diseases, the overall survival is increased by screening procedure? 1 Prostate cancer. 2 Lung cancer. 3 Colon cancer. 4 Ovarian cancer. Answer is 3 Harrison principle of internal medicine 15th ed/501 Widespread screening for breast, cervical, and colon cancer is beneficial for certain age groups
Q.39 Gamma camera in Nuclear Medicine is used for: 1 Organ imaging. 2 Measuring the radioactivity. 3 Monitoring the surface contamination. 4 RIA. Answer is 2 Walter – Miller, Textbook of Radiotherapy; Pg -112 Grainger and Allison diagnostic radiology 4th Ed/141 Gamma camera is the devices used to observe the distribution of an isotope in an organ, or in a part of the body. It receives the gamma ray photons from patient through a grid of thousands of holes drilled parallel to each other. Gamma camera measures the radioactivity in body then forms a image GAMMA CAMERA IS Used for detection of radioactivity IN BODY. The M/C used detector is scintillation detector. Scintillators - when these are struck by a photon of X-ray or gamma ray they scintillate (released as a flash of light). In gamma camera - Scintillator used is made upto NaI crystal. Q.40 At t=0 there are 6x1023 radioactive atoms of a substance, which decay with a disintegration constant () equal to 0.01/sec. What would be the initial decay rate? 1 6x1023 2 6x1022 3 6x1021 4 6x1020 Answer is 3 Grainger and Allison’s. Diagnostic radiology 4th ed/140. Radioactive decay - - dN 1 l = - dt N l = is decay constant dN = is decay rate. It dt = is from starting (dt = T2 - T1) dt it T1 is 0 than dt = t When T1 is 0 - it is called initial decay dN = is called initial decay rate. t So initial decay role dN = - lXN = .001 x 6 x 1023 = 10-2 x 6 x 1023 = 6 x 1021 is the answer - Initial decay rate = radioactive atoms initially x disintegration constant =6 x10 (23) x .01 =6 x 10 (21) Q.41 An 18-year-old boy comes to the eye casualty with history of injury with a tennis ball. On examination there is no perforation but there is hyphaema. The most likely source of the blood is 1 Iris vessels. 2 Circulus iridis major. 3 Circulus iridis minor. 4 Short posterior ciliary vessels. Answer is 2 Parson disease of eye 19th ed/16,407 Circulus Arteriosus major situated along the base of iris in the ciliary body. Circulus arteriosus minor along papillary margin A concussion injury to iris, especially angle resection leads to hemorrhage in the ant. Chamber called hyphaema. Q.42 A 25-year-old male gives history of sudden painless loss of vision in one eye for the past 2 weeks. There is no history of trauma. On examination the anterior segment is normal but there is no fundal glow. Which one of the following is the most likely cause? 1 Vitreous haemorrhage. 2 Optic atrophy. 3 Developmental cataract. 4 Acute attack of angle closure glaucoma. Answer is 1 Parson disease of eye 19th ed/360 A. K. Khurana ophthalmology 2nd ed/11
Q.43 The mother of a one
and a half year old child gives history of a white reflex from one eye
for the past 1 month. On computed tomography scan of the orbit there is
calcification seen within the globe. The most likely diagnosis is:
PEARL POINTS Q.52 Lumbar sympathectomy is of value in the management of:
Recent inversionSuggests a fibrosing underlying lesion such as carcinoma or mammary duct ectasis. ‘ Eczema’ (rash involving nipple or areola, or both)if unilateral, this is the classic sign of Paget’s disease of the nipple, a presentation of breast cancer. Duct papillomas benign hyperplastic lesions rather than neoplasms and are not premalignant. Duct papillomas present with nipple bleeding or a blood-stained discharge. The differential diagnosis thus includes intraduct carcinoma and infiltrating carcinoma which must be excluded. Ductography may confirm the presence of a duct Papilloma (Fig. 39.23). Duct papillomas are usually treated by surgical excision of the affected segment of breast (microdochectomy). The affected segment is identified during operation by passing a probe into the duct from where blood can be expressed. Q.54 The earliest manifestation of increased intracranial pressure following head injury is: a. Ipsilateral papillary dilation. b. Contralateral papillary dilatation. c. Altered mental status. d. Hemiparesis. Answer is 3 Bailey and love’s 24th ed/610 Essential surgery 3RD ED /pg 138 These finding are in serial events of manifestation of raised intracranial tension
Q.55 In which of the following conditions Splenectomy is not useful? 1 Hereditary spherocytosis. 2 Porphyria. 3 Thalassemia. 4 Sickle cell disease with large spleen. Answer is 2 Harrison principle of internal medicine 15th ed/670,672,673 HEREDITARY SPHEROCYTOSIS The major clinical features of hereditary spherocytosis are anemia, splenomegaly, and jaundice. Splenectomy reliably corrects the anemia, although the RBC defect and its consequent morphology persist. The operative risk is low. RBC survival after Splenectomy is normal or nearly It should be noted that Cholecystectomy should not be performed without Splenectomy in any patient of hemolytic anemia, as intrahepatic gallstones may result. Splenectomy in children should be postponed until age 4, if possible, to minimize the risk of severe infections with gram-positive encapsulated organisms. Polyvalent pneumococcal vaccine should be administered at least 2 weeks before splenectomy. THALLESSIMIA In-patient of thallessimia Splenectomy is required if the annual transfusion requirement, volume of RBCs per kilogram body weight per year increases by 50%. SICKLE CELL ANEMIA In sickle cell anemia repeated microinfarction in tissues occur due to sickling. Thus, the spleen is frequently infarcted within the first 18 to 36 months of life called autosplenectomy, causing susceptibility to infection, particularly from pneumococci. Acute venous obstruction of the spleen (splenic sequestration crisis leads to congestive splenomegaly), a rare occurrence in early childhood, may require emergency transfusion and/or splenectomy to prevent trapping of the entire arterial output in the obstructed spleen. Q.56 The following is ideal for the treatment with injection of sclerosing agents. 1 External hemorrhoids. 2 Internal hemorrhoids. 3 Prolapsed hemorrhoids. 4 Strangulated hemorrhoids. Answer is 2 CMDT2004/619, Bailey and Love’s Surgery 24th ed/1257. There is 3 degree of hemorrhoids according to position.
Material commonly used of injection sclerotherapy is – Phenol, Almond
oil,
Q.57 In which of the following locations. Carcinoid tumor is most common? 1 Esophagus. 2 Stomach. 3 Small bowel. 4 Appendix. Answer is 4 According to Harrison the ileum is the most common site of carcinoid.But all other books (Robbins 7th ed, Schwartz surgery, Dahnert radiology, Margulis gastrointestinal radiology, Sabiston surgery, Devita, s cancers, CSDT etc.) still say that Appendix is the most common site for carcinoid. So in my opinion answer will be appendix. Q.58 Pancreatitis, pituitary tumor and phaeochromocytoma may be associated with: 1 Medullary carcinoma of thyroid. 2 Papillary carcinoma of thyroid. 3 Anaplastic carcinoma of thyroid. 4 Follicular carcinoma of thyroid. Answer is 1 Harrison principle of internal medicine 15th ed/2185
MEN1 gene, located on chromosome 11q13, Mutations of the - RET proto-oncogene have been identified in 93 to 95% of patients with MEN 2, but it is located on 10th chromosome. Q.59 ardener’s syndrome is a rare hereditary disorder involving the colon. It is characterized by: 1 Polyposis colon, cancer thyroid, skins tumors. 2 Polyposis in jejunum, pituitary adenoma and skin tumors. 3 Polyposis colon, osteomas, epidermal inclusion cysts and fibrous tumors in the skin. 4 Polyposis of gastrointestinal tract, cholangiocarcinoma and skin tumors. Answer is 3 Harrison principle of internal medicine 15th ed/583
Q.60 The most common cancer, affecting Indian urban women in Delhi, Mumbai
and Chennai, is:
-Main lesion described as an obliterative portal venopathy of liver’ with patchy Segmental sub endothelial thickening of intrahepatic portal veins. -Thrombus formation with variable obliteration or recanalization. -Scarring and fibrosis of portal tract. -Fibrosis prominent in extra hepatic portal vein and its intrahepatic branches. -Liver surface may appears nodular but it is never cirrhotic -Widening and fibrosis of space of disse -Capillarization of sinusoids - Non-specific inflammatory cell in portal tracts leads to fibrotic reaction. - NCPF Common in India + Japan. - Male predominance seen with mean age 25-35 yr - Difference in Japanese and Indian - • All patient has increase portal and splenic pressure. Japanese have elevated hepatovenous portal gradient (HVPG), while Indian may have normal or increase HVPG • Japanese are likely to have 10-20 yr older and shows female predominance. - Imaging modality of choice - splenoportography with help of Doppler (Doppler flowmetry). - Best investigation is - liver biopsy. Q.63 The most common complication seen in hiatus hernia is: 1 Oesophagitis. 2 Aspiration pneumonitis. 3 Volvulus. 4 Esophageal stricture. Answer is 1 Robbins Pathologic basis of disease7ED/802 Dahnert Radiological review manual 5th ed/p 832. Reflux Oesophagitis is frequently seen in association with sliding hernias Association of Hiatus hernia
Q.64 Patients of Rectovaginal fistula should be initially treated with: 1 Colostomy. 2 Primary repair. 3 Colporrhaphy. 4 Anterior resection. Answer is 2 Maggot’s Abdominal Surgery Ed. /p.2147-49 Prior to surgery of Rectovaginal fistula, a complete 3-day mechanical and antibiotic bowel preparation should be performed and colon must be completely emptied, cleansed and sterilized prior to surgery. When all signs of infection have resolved, no evidence of fistulitis is there, and fresh granulation tissue is present, the primary repair can be performed. Even in recurrent fistulas or fistulas after pelvic irradiation, they recommend a Martius graft technique for repair. So even in recurrent condition they does not perform the colostomy initially. Whether or not to perform a diverting colostomy? There Preference is not to perform a colostomy in individuals undergoing their first repair with a Martius graft. - Colporrhaphy done in prolapsed uterus - Anterior resection done in C.A. rectum. Q.65 A young woman met with an accident and had mild quadriparesis. Her lateral X-ray cervical spine revealed C5-C6 fracture dislocation. Which of the following is the best line of management? 1 Immediate anterior decompression. 2 Cervical traction followed by instrument fixation. 3 Hard cervical collar and bed rest. 4 Cervical laminectomy. Answer is 2 Chapman’s Orthopedic Surgery 3rd ed/3699 Apley’s Orthopedics 8th ed/654 Maheshwari Orthopedics TREATMENT of Fracture dislocation at lower cervical spine (below C3 spine) • The displacement must be reduced as a matter of urgency. • Skull traction is used, it is started with 5 kg and increasing it step wise by similar amount up to 30 kg. • If closed treatment with traction up to 2/3 of body weight or 65 pounds (Whichever is less) is unable to achieve adequate reduction, operative intervention is required. • If reduction fails - Posterior open reduction and fusion is done. Q.66 Which of the following catheter materials is most suited for long-term use is? 1 Latex. 2 Silicone. 3 Rubber. 4 Polyurethane. Answer is 2 Essential surgery, problems, diagnosis and management H. George Burkitt/Clive R.G. Quick 3rd ed/393 With either type of catheterization (urethral or suprapubic), the major problems are catheter blockage and infection. Catheter rapidly becomes blocked by epithelial debris or by gradual accretion of calculus. Modern silicone or silicone - coated ‘long term’ catheters are better in this respect but must also be changed regularly (every 3 month’s 10-12 wks). Q.67 The main site of bicarbonate reabsorption is: 1 Proximal convoluted tubule. 2 Distal convoluted tubule. 3 Cortical collecting duct. 4 Medullary collecting duct. Answer is 1 Harrison principle of internal medicine 16th ed/1641 Also see Q 8 Reclamation of filtered HCO3? takes place largely in the proximal tubule (80-90%) and, under normal circumstances, is virtually complete below a critical plasma HCO3? concentration. The threshold concentration, which is normally about 26 m mol/L, in human, is identical to the concentration of HCO3? in plasma. As a consequence, HCO3? wastage is totally prevented normally. Q.68 Which of the following is the most troublesome source of bleeding during a radical retro pubic prostatectomy? 1 Dorsal venous complex. 2 Inferior vesical pedicle. 3 Superior vesical pedicle. 4 Seminal vesicular artery. Answer is 1 Glenn’s Urologic surgery 5th ed/277 Michael J. Drdler, Surgical management of urological disease, An anatomic approach Ist ed/PG 654. There are two dorsal venous plexus around the prostate. Superficial dorsal vein is divided and then sutured directly. But the deep dorsal vein complex runs parallel to the urethra at the apex of prostate and then fans out over the anterior of prostate. We feel that it is important to control these vessels preemptively rather than simply to incise them and place sutures afterward. A Mc- -Dougal clamp is useful for this purpose. Santorini’s plexus provides the major source of venous drainage of the prostate. This plexus lies on the anterior surface of the prostate in the puboprostatic space. The deep dorsal vein of the penis and its tributaries are the major contributors to the plexus. During retropubic prostatectomy this vessel should be controlled separately (1) before capsulotomy in cases of simple retropubic procedures and (2) before opening endopelvic fascia and dividing puboprostatic ligaments in cases of radical prostatectomy. Q.69 The most common cause of renal scarring in a 3 year old child is: 1 Trauma. 2 Tuberculosis. 3 Vesicoureteral reflux induced pyelonephritis. 4 Interstitial nephritis. Answer is 3 Dahnert radiological review manual 5th ed/p 983, 946 VESICOURETERIC REFLUX - (Congenital reflux = Primary reflux) 9-10% of normal Caucasian babies 1.4% of schoolgirls 30% of children with a first episode of UTI Reflux nephropathy also called chronic atrophic pyelonephritis. It leads to the scarring of kidney. Scar formation occurs only up to age 4 years. Vesicoureteral reflux induced Pyelonephritis is most common cause of renal scarring in children. Q.70 The most sensitive imaging modality for diagnosing ureteric stones in a patient with acute colic is: 1 X-ray KUB region 2 Ultra sonogram 3 non-contrasts CT scan of the abdomen. 4 Contrast enhanced CT scan of the abdomen. Answer is 3 Dahnert Radiological review manual 5th ed/P 981-982 M/c type of calculus is Calcium stone
Q.71 Which one of the following is not used as tumor marker in testicular
tumors?
Q.73 In a child, non-functioning kidney is best diagnosed by: 1 Ultrasonography. 2 IVU. 3 DTPA Renogram. 4 Creatinine clearance. Answer is 3 Grainger and Allinson, Diagnostic Radiology 3rd ed/115 Urinary Tract imaging in Pediatrics age group A two-part evaluation of the kidney is now commonplace; renal morphology is assessed with ultrasound and renal function by radionuclide study. Both congenital and acquired conditions may result in reduced renal function, and radionuclide imaging is superior to excretory urography in providing information. In the neonatal period, this conjoint imaging technique is excellent in evaluating cystic dysplastic conditions, obstructive uropathies, and renovascular disturbances. Renal scintigraphy and ultrasonography complement each other. Renal function and the status of the collecting system can be assessed by agents which are filtered by the glomeruli-like radiographic contrast media - 99mTc diethylene-triaminepentaacetic acid (DTPA) - or secreted by the renal tubules - iodine-131 (131I-) labelled ortho-iodohippurate (OIH), 99mTc mercaptoacetyltriglycine (MAG3). An agent which binds in the cortex is used to assess functioning renal parenchyma: 99mTc dimercaptosuccinic acid (DMSA). By combining features of both the above groups, 9mTc glycoheptonate (GH) is partially cleared by filtration (85%) and partially bound to proximal renal tubules (15%). Q.74 The most common malignant neoplasm of infancy is: 1 Malignant Teratoma. 2 Neuroblastoma. 3 Wilms’ tumor. 4 Hepatoblastoma. Answer is 2 Dahnert radiological review manual 5th ed/932-933 Grainger and Allinson, diagnostic radiology, 5th ed/1757 Neuroblastoma is the most common solid abdominal mass of infancy (12.3% of all perinatal neoplasm). It constitutes 3rd M/C malignant tumor of infancy (after leukemia > CNS tumor). But Neuroblastoma is 2nd M/C tumor of childhood (Wilms tumor is first) - Site of metastasis in Neuroblastoma - bone (60%) > L.N. (42%) > orbit > liver (15%) < intracranial. - Syndrome associated with metastasis of neuroblastoma - 1) Hutchinson syndrome 2) Pepper syndrome 3) Blueberry muffin syndrome. Q.75 The most common presentation of a child with Wilm’s tumor is: 1 An asymptomatic abdominal mass. 2 Hematuria. 3 Hypertension. 4 Hemoptysis due to pulmonary secondary. Answer is 1 Grainger and Allinson, diagnostic radiology, 5th ed/1760 Dahnert radiological review manual 5th ed/984-85 -Wilm’s tumor - (Nephroblastoma)
10% tumor is - phaeochromocytoma |