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Quicklinks for Easy Navigation All Exams All Exam Notifications All Prospectus All Results All Counseling Notifications Latest CET NEET : Government of Tamil Nadu strongly protests the move to conduct an All India Common Entrance Test for admission to UG / PG courses in Medical Colleges CET NEET : NEET PG Official Site AIIMS Nov 2012 PGI Dec 2012 NIMHANS 2013-14 AIIMS Nov 2012 Answers, Explanations : From OHC Course and Book : POSITIVE EVIDENCE BASED November 28, 2012 By TargetPG 1 Comment AIIMS Nov 2012 Answers, Explanations : From OHC Course and Book : POSITIVE EVIDENCE BASED

AIIMS Nov 2012 Answers, Explanations : From OHC Course and Book : POSITIVE EVIDENCE BASED Dear Doctor, Greetings from POSITIVE-P.G.Medical Entrance Exam Training Centre-Chennai. POSITIVE did a micro audit of AIIMS NOV 2012 (The gold standard exam to assess any P.G. Medical Entrance Training Programme). Out of the 200 questions from AIIMS NOV 2012 Exam, above 150questions have (75%) been discussed at various academic programmes at POSITIVE/OPERATION HARRI CAPSULE. As you all know, the 1st rank mark in AIIMS NOV 2012 will be somewhere near 70% only!!(140 questions).

On top of the 150 questions discussed at POSITIVE, with your indigenous stuff if you could stretch it by 10-15 more questions, we could reach approximately 155-165 correct answers, which means the top rank list of AIIMS NOV 2012 should be teeming with POSITIVIANS/OHCians!!! This will become a reality if you had utilized POSITIVE/OHC completely. The number of questions covered from 18th edition of HARRISON was around 100!This was the main reason for Conducting OPERATION HARRI CAPSULE-2-Which covered Harrison(18th)completely along with SPM&OPHTHAL,so that it was able to cover around 125-130 questions from AIIMS NOV-2012!!!

POSITIVE EVIDENCE BASED

Concrete evidences from POSITIVE materials for the various questions from AIIMS NOV 2012 Exam.

POSITIVE ACADEMIC PROGRAMMES NUMBER OF QUESTIONS (OVERLAP INCLUDED) AIIMS-N0V-2012 1. OPERATION HARRI TEXT BOOK 50 2. OPERATION HARRI CAPSULE(OHC) 120 3 EXCITING 18TH

5 4. CONSULTANTS 105 5. MODEL EXAMS, PRETESTS 15 6. MKT [MUST KNOW TABLES] 10 7. POSI GOLD 50 * Questions may overlap in various POSITIVE programmes. *The questions from OPERATION HARRI BOOK/POSIGOLD has been provided evidence with the year and the page number fron POSIGOLD BOOK to make it more authentic!!!

OPERATION HARRI CAPSULE-2(OHC)- A CRASH COURSE FROM SEP28-2012 TO 0CT9-2012 Was conducted in Chennai by POSITIVE.IT INCLUDED *12 DAYS OF 18TH EDITION BASED BRAIN STORMING DISCUSSION *OPHTHAL,SPM *STUDY MATERIALS INCLUDED -Operation Harri book -2 medicine Handouts - MKT Book(Must Know Tables)-( A Special note to OHCians(2)-when you go through the discussion you will realize, why we conducted a model exam based exclusively on MKTS on 8-10-2012 at OHC2-MKT has covered some tough questions which will decide the TOPPERS!!!) _Recent Advances -POSIGOLD(Acollection of AIIMS-2007-2012,ALL INDIA-2007-2012) OHC claimed it can cover 120 questions from AIIMS NOV-2012.The proof has been provided.The various programmes in OHC2 Has stood up to its reputation and it has delivered around 115-120 questions in AIIMS NOV-2012!!!

We hope you all had utilized POSITIVE/OHC Completely! Our mission at POSITIVE was to provide study materials beyond routine books,but within the domain of entrance examinations and with GODS grace we delivered what we promised! Happy Christmas&new year year greetings to all of you from POSITIVE FAMILY POSITIVELY yours With warm regards Dr. R.S. Manorajan, M.D., D.M [Nephro] Academic Director-POSITIVE

AIIMS NOVEMBER 2012-complete POSITIVE DISCUSSION Kindly note *Black color-AIIMS-NOV-2012 QUESTIONS *Green color-POSITIVE materials *Red color-questions not discussed in POSITIVE

POSITIVE AIIMS NOV-2012

1. A GIRL WITH PRECOCIOUS PUBERTY WITH Laughter for unknown reasons-MRI [AIIMS NOV 2012] A. HYPOTHALAMIC HAMARTOMA B. PINEAL GERMINOMA C. CRANIOPHARYNGIOMA D.HISTIOCYTOMA Ans A REF-HARRISON Hypothalamic hamartomas and gangliocytomas may arise from astrocytes, oligodendrocytes, and neurons with varying degrees of differentiation.

These tumors may overexpress hypothalamic neuropeptides, including GnRH, GHRH, and CRH. With GnRH-producing tumors, children present with precocious puberty, psychomotor delay, and laughingassociated seizures Rarely, hamartomas also are associated with craniofacial abnormalities; imperforate anus; cardiac, renal, and lung disorders; and pituitary failure as features of Pallister-Hall syndrome, which is caused by mutations in the carboxy terminus of the GLI3 gene. Hypothalamic hamartomas are often contiguous with the pituitary, and preoperative MRI diagnosis may not be possible Pituitary gland height ranges from 6 mm in children to 8 mm in adults; during pregnancy and puberty, the height may reach 1012 mm. Anterior pituitary gland soft tissue consistency is slightly heterogeneous on MRI, and signal intensity resembles that of brain matter on T1-weighted imaging Adenoma density is usually lower than that of surrounding normal tissue on T1-weighted imaging, and the signal intensity increases with T2-weighted images. The high phospholipid content of the posterior pituitary results in a pituitary bright spot. 2. A PT ON AMPHOTERICIN WITH HYPOKALEMIA-2.3-TREATMENT [AIIMS NOV 2012] a. 40 MEQ/24HRS b. 60 MEQ/24HRS c. 80 MEQ/24HRS d. 120 MEQ/24HRS Ans ?D(question is ambiguous) REF OPERATION HARRI BOOK-PAGE 193,OHC If hypokalemia is severe (<2.5 mmol/L) and/or critically symptomatic, intravenous K+-Cl can be administered through a central vein with cardiac monitoring in an intensive care setting at rates of 10 20 mmol/h; higher rates should be reserved for acutely life-threatening complications. The absolute amount of administered K+ should be restricted (e.g., 20 mmol in 100 mL of saline solution) 3. BLINK REFLEX IS USEFULL FOR DIAGNOSIS OF LESION AT[AIIMS NOV 2012] A. NMJ B. MIDPONTINE LESION

C. AXONAL NEUROPATHY D. MND ANS-B REF-OHC2-NEURO BLINK REFLEX Electrical or mechanical stimulation of the supraorbital nerve on one side leads to two separate reflex responses of the orbicularis oculian ipsilateral R1 response having a latency of approximately 10 ms and a bilateral R2 response with a latency in the order of 30 ms. The trigeminal and facial nerves constitute the afferent and efferent arcs of the reflex, respectively. Abnormalities of either nerve or intrinsic lesions of the medulla or pons may lead to uni- or bilateral loss of the response, and the findings may therefore be helpful in identifying or localizing such pathology. 4. MARKER OF GLIOMA [AIIMS NOV 2012] A) CD133 B) CD 24 C) CD 44 D) CD 33 Ans A REF-OHC 5. WHICH IS NOT SEEN IN FTD [AIIMS NOV 2012] A. LESS THAN 65 YEARS B. AFFECTIVE SYMPTOMS C. STEREOTYPE BEHAVIOUR D. INSIGHT Ans-d REF-OHC2- NEUROLOGY *Frontotemporal dementia in the fifth to seventh decades

*Cognitive testing typically reveals spared memory but impaired planning, judgment, or language. Poor business decisions and difficulty organizing work tasks are common, and speech and language deficits often emerge. *Patients with often show an absence of insight into their condition Exciting 18thA major clinical form of FTLD known as the behavioral variant of frontotemporal dementia (bvFTD) causes a progressive frontal lobe syndrome that can start as early as the fifth decade of life. In these patients, the anterior temporal lobe and caudate nucleus are also atrophic. The behavioral changes can include shoplifting, compulsive gambling, sexual indiscretions, and obsessive-compulsive preoccupations. 6. COL4A5 SEEN [AIIMS NOV 2012] A. ALPORT B. THIN BASEMENT DISEASE C.GOOD PASTURE SYNDROME D. NAIL PATELLA ANS A Ref-OHC-2-NEPHRO,CONSULTANT,RECENT ADVANCES BOOK-OHC2 I This is the most abundant collagen of the human body. It is present in scar tissue, the end product when tissue heals by repair. It is found in tendons, skin, artery walls, the endomysium of myofibrils, fibrocartilage, and the organic part of bones and teeth. COL1A1, COL1A2 osteogenesis imperfecta, EhlersDanlos syndrome, Infantile cortical hyperostosis aka Caffeys disease II Hyaline cartilage, makes up 50% of all cartilage protein. Vitreous humour of the eye. Collagenopathy, types II and XI COL2A1

III This is the collagen of granulation tissue, and is produced quickly by young fibroblasts before the tougher type I collagen is synthesized. Reticular fiber. Also found in artery walls, skin, intestines and the uterus COL3A1 EhlersDanlos syndrome, Dupuytrens contracture IV basal lamina; eye lens. Also serves as part of the filtration system in capillaries and the glomeruli of nephron in the kidney. COL4A1, COL4A2, COL4A3, COL4A4, COL4A5, COL4A6 Alport syndrome, Goodpastures syndrome

V most interstitial tissue, assoc. with type I, associated with placenta COL5A3 EhlersDanlos syndrome (Classical) VI most interstitial tissue, assoc. with type I myopathy and Bethlem myopathy

COL5A1, COL5A2,

COL6A1, COL6A2, COL6A3

Ulrich

VII forms anchoring fibrils in dermal epidermal junctions dystrophica VIII some endothelial cells COL8A1, COL8A2

COL7A1 epidermolysis bullosa

Posterior polymorphous corneal dystrophy 2

Hereditary nephritis with sensori Neural hearing loss Predominantly - X. linked dominant Ocular - 15 30% - Lenticonus - Oil drop cataract Ear - Sensori Neural Deafness (Never from birth) COL 4 A5 Chain abnormality in the GBM(COL 4 A3-Good pasture)

7. TYPE 1 RTA ALL EXCEPT [AIIMS NOV 2012] A. HYPOKALEMIA B. RENAL STONES C. Inability to acidify URINE PH LESS THAN 5.5 D. HCO3 MORE THAN 4 Ans D REF-OPERATION HARRI-page 202,OHC,POSIGOLD-AI-2012

DISTAL PROXIMAL * Normal anion gap* Inappropriately high urine pH (pH > 5.5). *FeHCO3 -5% * Hypokalemia *Nephrocalcinosis , Stones. *PositiveUAG, low urine [NH4+] * Normal anion Gap* Urine pH < 5.5 * FeHCO3 > 15 20 % * Hypokalemia * No nephrocalcinosis , Stones. * PositiveUAG, low urine [NH4+] Classic distal RTA (type 1 RTA) * Hypokalemia, hyperchloremic acidosis, low urinary NH4+ excretion (positive UAG, low urine [NH4+]), and inappropriately high urine pH (pH > 5.5). * Such patients are unable to acidify the urine below a pH of 5.5. * Most patients have hypocitraturia and hypercalciuria, so nephrolithiasis, nephrocalcinosis, and bone disease are common. 8. A PATIENT WITH MULTIPLE RENAL STONES ANALYSIS REVEALED CYSTINE CRYSTALS-TREATMENT ALL EXCEPT [AIIMS NOV 2012] a. CYSTEAMINE b. D PENCILLAMINE c. ALKALINISATION OF URINE d. ADEQUATE HYDRATION Ans A REF-EXCITING 18TH-OHC 2 DISCUSSION CYSTINURIA

In type I cystinuria, -autosomal recessive pattern of inheritance. A gene on chromosome 2 -designated SLC3A1 encodes the heavy chain of the transporter -abnormal in type I. Non-type I -dominant trait -mutations in the SLC7A9 gene on chromosome 19, which encodes the light chain of the heteromeric transporter. typical hexagonal, platelike cystine crystals. Cystinuria can also be detected by using the urine sodium nitroprusside test. the test is sensitive, it is positive for cystinuria in many asymptomatic heterozygotes. Treatment-high fluid intake,alkalinising urine,dpencillamine,tiopronin,captopril Diagnosis -hexagonal cystine crystals on urinalysis, and 24-h urinary cystine excretion that exceeds 400 mg (normal less than 30 mg/d). penicillamine, tiopronin, and captopril EXCITING 18TH EDITION CYSTINOSIS multisystem autosomal recessive disease caused by mutations of cystinosin, a hydrogen iondriven transporter responsible for exporting cystine from lysosomes. infantile (nephropathic), adolescent, and adult forms. The nephropathic form -most common,

Fanconi syndrome, salt and water wasting, growth retardation, rickets, . End-stage renal disease occurs by age 10 photophobia and blindness, hypothyroidism, delayed pubertal development, and late-onset neurologic disease. diagnosis -cystine content of peripheral blood leukocytes. Cysteamine provides a direct treatment cystinosis does not recur in transplanted kidneys

9. RENAL CALCULI-WHAT IS NOT REQUIRED [AIIMS NOV 2012] a. PROTEIN RESTRICTION b. CALCIUM RESTRICTION c. SALT RESTRICTION d. PLENTY OF WATER Ans B REF-OHC ,POSIGOLD 10. COGNITIVE DECLINE IN AGING-IS DUE TO INCREASE LEVEL OF WHICH AMINOACID [AIIMS NOV 2012] A. TAURINE B. CYSTINE C. HOMOCYSTINE D. METHIONINE Ans-c Ref-POSIGOLD,OHC 11. POLYMYOSITIS-ALL EXCEPT [AIIMS NOV 2012] A. OPTHALMOPLEGIA B. PROXIMAL MUSCLE WEAKNESS C. PNS D. Ans A REF-POSIGOLD-AI-2006,OHC2-DISCUSSION 12. WILSON DISEASE [AIIMS NOV 2012] A. LOW URINARY COPPER B. HIGH SRUM CERULOPLASMIN C. INCREASED SERUM AND URINARY COPPER

D. DECREASED SERUM COPPER Ans C REF-OHC2 DISCUSSION,CONSULTANT MODIFIED POSIGOLD 154. Which of the following statements about Wilsons disease is true: (AI 2010) A. Low serum ceruloplasmin and low urinary copper B. Low serum ceruloplasmin and high urinary copper C. High serum ceruloplasmin and low urinary copper D. High serum ceruloplasmin and high urinary copper ANS-B Diagnosis (neuro./ psych. WD) (strongly suggested ) based on at least two of the following; Low serum Cerulplasmin High 24 HR urine copper K.F Ring 13. BONE MARROW APIRATE WAS DRY,BM BIOPSY WAS POSSIBLE-ACUTE LEUKEMIA WITH MYELOFIBROSIS [AIIMS NOV 2012] A. UNDIFFERNTIATED AML B. ERYTHOBLASTIC AML C. MEGAKARYOCYTIC AML D. BURKITS LEUKEMIA ANS-C REF-OPERATION HARRI PAGE-487 TABLE,OHC Disorders Causing Myelofibrosis Malignant Nonmalignant Acute leukemia(lymphocytic,

myelogenous, megakaryocytic) Chronic myelogenous leukemia Hairy cell leukemia Hodgkin disease Idiopathic myelofibrosis Lymphoma Multiple myeloma Myelodysplasia Polycythemia vera Systemic mastocytosis HIV infection Hyperparathyroidism Renal osteodystrophy Systemic lupus erythematosus Tuberculosis Vitamin D deficiency Thorium dioxide exposure Gray platelet syndrome 14. 2ND DECADE RENAL FAILURE,IST DEGREE RELATIVE ALSO HAD SAME SYMPTOMS AND DIED AT THE AGE OF 28-KERATOCONUS [AIIMS NOV 2012] A. ALPORTS B. ADPKD C. ARPKD D. OXALURIA ANS A

REF-POSITIVE MKT-BOOK(ENT-POSITIVE PEARL),OHC2-DISCUSSION,POSIGOLD Alports Syndrome Symptoms and signs Presenile familial nerve deafness (Bilateral) Congenital haemorrhagic nephritis Keratoconus and cataracts Aetiology Hereditary familial disorder, more frequently occurring in males ALPORTS SYNDROME Hereditary nephritis (Alports syndrome)clinical profile and inheritance in 28 retinal flecks in 22.2%, cataract in 20%, and keratoconus in 6.7% patients. POSITIVE MKT-ENTAlports Syndrome Symptoms and signs Presenile familial nerve deafness (Bilateral) Congenital haemorrhagic nephritis Keratoconus and cataracts Aetiology Hereditary familial disorder, more frequently occurring in males 15. FLOW CYTOMETRY DONE FOR [AIIMS NOV 2012] A. LYMPHOCYTE B. MONOCYTE C. NEUTROPHIL D. POLYCYTHEMIA Ans A REF-OHC 2 DISCUSSION 18TH EDITION HARRISOSN

RENAL TRANSPLANT few absolute immunologic contraindications -harmful antibody against the donor kidney at the time of the anticipated transplant direct cross-matching of candidate serum with lymphocytes of the donor. deceased-donor kidneys maintain for up to 48 h on cold pulsatile perfusion More sensitive tests, such as the use of flow cytometry 16. LASER UVULOPALATOPHARYNGEAL PLASTY [AIIMS NOV 2012] A. SNORING B. CLEFT PALATE C. STAMMERING D. ANS A REF-OHC,CONSULTANT 17. CD 95 IS ASSOCIATED WITH [AIIMS NOV 2012] A. INTRINSIC PATHWAY OF APOPTOSIS B. EXTRINSIC PATHWAY OF APOPTOSIS C. CELL NECROSIS ANS B REF-POSITIVE GENETICS-OHC 2,CONSULTANT,OPERATION HARRI BOOK-PAGE 358 The mitochondrion[AI 2009***]- a central regulatory structure of the apoptotic process. * The extrinsic pathway of apoptosis is activated by cross-linking members of the tumor necrosis factor (TNF) receptor superfamily, such as CD95 (Fas) and death receptors DR4 and DR5, by their receptors, Fas ligand or TRAIL (TNF-related apoptosis-inducing ligand), respectively. * The extrinsic pathway -Caspase-8[AI 2010***] is activated and then cleaves and activates effector caspases-3 and -7, which then target cellular constituents. * The intrinsic pathway of apoptosis is initiated by the release of cytochrome c and SMAC[AIIMS Nov 2006***] (second mitochondrial activator of caspases) from the mitochondrial intermembrane space leading to the sequential activation of caspase-9 and effector caspases

A German scientist Carl Vogt was first to describe the principle of apoptosis The apoptosis starts from the Fas ligand binding to Fas receptors and ends in the fragmentation of genomic DNA, which is used as a hallmark of apoptosis 18. PENCILLIN G-TRUE STATEMENT A. ORALLY ACTIVE B. USEFULL FOR RATBITE FEVER C. BROAD SPECTRUM D. OTOTOXICITY ANS B REF-POSITIVE CONSULTANT,OHC,OPERATION HARRI BOOK RAT BITE FEVER Responds to penicillin antibiotics or where allergic to this erythromycin or tetracyclines for respectively streptobacillary or spirillary infections OPERATION HARRI BOOK PAGE 614

Drug

Spectrum

Penicillin G *Syphilis, yaws, leptospirosis, groups A and B streptococcal infections, pneumococcal infections, actinomycosis, oral and periodontal infections, meningococcal meningitis and meningococcemia, viridans streptococcal endocarditis, clostridial myonecrosis, tetanus, anthrax, rat-bite fever, Pasteurella multocida infections, and erysipeloid (Erysipelothrix rhusiopathiae) ALL INDIA-06***

19. PINNA CALCIFICATION ALL EXCEPT [AIIMS NOV 2012] A. GOUT B. OOCHRONOSIS C. FROST BITE D. ADDISONS DISEASE

ANS A OLD POSIGOLD Trauma Causes Ear trauma Cauliflower ear Electromagnetic, Physics, trauma, Radiation Causes Frostbite Surgical, Procedure Complication Ear surgery Infected organ, Abscesses Cellulitis/pinna Allergic, Collagen, Auto-Immune Disorders Polychondritis Polychondritis, relapsing Metabolic, Storage Disorders Diabetes mellitus Hemochromatosis Alkaptonuria/Ochronosis Vegetative, Autonomic, Endocrine Disorders Addisons disease (chronic adrenal ins) Acromegaly (Gigantism) Adrenocorticoid (Isolated) Deficiency 20. 60 YR OLD MALE TYPICAL LYMPHOCYTE 70 ATYPICAL 30-TOTAL COUNT 20000 [AIIMS NOV 2012] A. LYMPH NODE BIOPSY B. BM BIOPSY C. PERIPHERAL CYTOGENETICS D. PERIPHERAL IMMUNOCHEMISTRY ANS 21. CILIARY MUSCLE IS DERIVED FROM [AIIMS NOV 2012] A. NEUROECTODERM B. SURFACE ECTODERM C. MESODERM D. NEURAL CREST ANS-C REF-POSITIVE MKT-OPHTHAL,OHC Surface ectoderm Conjunctiva Corneal epithelium Eyelash Epithelium of - meibomian glands Mesoderm Neural ectoderm

- glands of Moll - glands of Zeis - lacrimal gland - acc.lacrimal glands Crystalline lens Corneal stroma Corneal endothelium and Descemets mem. Sclera Choroid Iris stroma Extraocular muscles Ciliary muscles Bony orbit Vitreous Sensory retina Retinal pigment epithelium Ciliary body epithelium Pigmented epithelium of the iris Sphincter pupillae Dilator pupillae Neural part of the optic nerve Melanocytes Eyelids : Both from surface ectoderm and mesoderm Zonules (tertiary vitreous) : Surface ectoderm and mesoderm Bruchs membrane : Neural ectoderm and mesoderm

22. RHO KINASE INHIBITOR[AIIMS NOV 2012] A. RANALOZINE B. FASUDIL C. AMRINONE D. NICORANDIL ANS B HARRISON Phosphorylation of the myosin-binding subunit (thr695) of myosin light chain phosphatase by Rho kinase inhibits phosphatase activity and induces calcium sensitization of the contractile apparatus. Rho kinase is itself activated by the small GTPase RhoA, which is stimulated by guanosine exchange factors and inhibited by GTPase-activating proteins. Nitric oxide, which induces vascular relaxation, promotes erection and is opposed by endothelin 1 (ET-1) and Rho kinase, which mediate vascular contraction Detumescence is mediated by norepinephrine from the sympathetic nerves, endothelin from the vascular surface, and smooth-muscle contraction induced by postsynaptic -adrenergic receptors and activation of Rho kinase. 23. PARASITE AFFECTING EYE [AIIMS NOV 2012] A. E.HISTOLYTICA B. E.COLI C. TOXOPLASMA D. TOXOCARA ANS-C-REF-POSITIVE CONSULTANT,OHC OPERATION HARRI BOOK TOXOPLASMOSIS Ocular Infection. Due to congenital infection, with a very low incidence following acquired infection. Loss of central vision, nystagmus, strabismus, glaucoma.

- Located near the posterior pole of the retina. Ocular Toxoplasmosis - Antibody production is expressed in terms of the Goldmann-Witmer coefficient (C), in which C = [anti-Toxoplasma IgG (aqueous humor/serum)]/[total IgG (serum/aqueous humor)]. The positive cutoff of is 3. 24. TRACHOMA-COMMON AGE IN WHICH PREVALENCE IS MEASURED [AIIMS NOV 2012] A. 2-9YRS B. C. D. ANS-A REF-OPHTHAL CONSULTANT 25. which lesion there is no reversal of shunt? [AIIMS NOV 2012] A. PDA B. TOF C. VSD D. ASD ANS-B REF-CONSULTANT,OHC 26. SEBACEOUS GLAND CA-STAIN USED [AIIMS NOV 2012] A. PAS B. MASON TRICHROME C. OIL RED D. MUCICARMINE ANS-?D REF-POSITIVE MKT

Microscopic clues of Tumor origin Potentially Helpful Findings Primary site or Tumor type HISTOPATHOLOGY Signet ring cells

Gastrointestinal tract, pancreas, ovary, breast (lobular carcinoma), prostate Psammoma bodies Papillary Ovary, thyroid, breast, meningioma

Thyroid, ovary, breast, pancreas, mesothelioma

Indian file tumor cells

Breast (especially lobular), pancreas, mesothelioma, small cell carcinoma, carcinoid Nonacinar cell nests

Carcinoid, melanoma, paraganglioma Intranuclear inclusions Breast (especially lobular) papillary thyroid, melanoma Rosettes * Neuroblastoma, retinoblastoma, granulosa cell tumor, neuroendocrine carcinoma* Sarcomas;Ewings, synovial cell, rhabdomyosarcoma Neural crest tumors Primitive neuroendocrine tumors (PNET), Ewings sarcoma, paraganglioma, neuroblastoma, ganglioneuroblastoma Clear cell neoplasms Very poorly differentiated small cell neoplasms HISTOCHEMISTRY Mucin stains (eg:mucicarmine) Adenocarcinoma (absent in renal cell carcinoma) Glycogen stains (PAS-Positive, removed by diastase) *Abundant in renal cell carcinoma, germ cell tumors, and some adrenocortical carcinomas* Seminoma, melanoma, chordoma, mesothelioma

* Sarcomas: Alveolar soft parts, Ewings clear cell, leiomyosarcoma, rhabdomyosarcoma Silver impregnation (eg:Fontana-Masson,Grimelius, Sevier-Munger) forming endocrine cells, enterochromaffin cells, melanoma * Tumors of polypeptide-

27. MEGALOBLASTIC ANEMIA-ALL EXCEPT [AIIMS NOV 2012] A. MILD SPLENOMEGALY B. NUCLEATED RBCS C. INCREASED BILIRUBIN D. RETICULOCYTOSIS ANS D REF-OHC 2,OPERATION HARRI BOOK PAGE 472 MEGALOBLASTIC ANEMIA MCV > 100 FL * WBC, Platelets * PS Anisopioiklocytosis, macrocytosis * Low retic index(AIIMS NOV-2012***) * Basophillic stippling (in RBC), normoblast * Neutrophils Hypersegmentation of nucleus (characteristic) * Bone marrow - Hyper cellular - myeloid/erythroid ratio - Abundant iron - Nuclear chromatin a peculiar fenestrated pattern very characteristic - megakaryocytes

* - LDH, bilirubin * Cobalamin level - 160-200ng/ml - < 100 deficiency * Folate level 6-20 micro/ml < 4 microg deficiency Ineffective Hemopoiesis * Unconjugated bilirubin , raised urine urobilinogen, reduced haptoglobins and positive urine hemosiderin, and a raised serum lactate dehydrogenase&a weakly positive direct antiglobulin test 28. RIGHT AXIS FACTOR-IN EEG [AIIMS NOV 2012] A. OBESE B. THIN AND TALL INDIVUDAL C. END OF EXIRATION D. LYING DOWN 29. RADIOSENSITIVE PHASE OF CELL CYCLE [AIIMS NOV 2012] A. G2/M B. GI/S C. M D.G1 ANS-A REF- POSIGOLD,CONSULTANT,OHC 30. ENZYME PRESENT IN RIBOZYME [AIIMS NOV 2012] A. Peptidyl transferase B. Peptidase

C. Aminoacyl tRNA synthetase D. GTPase

REF-POSIGOLD,OHC 31. Ribosome has following enzymatic activity? [AIIMS NOV 2008] a) Peptidyl transferase c) Aminoacyl tRNA synthetase Ans (A) 31. EPIGLOTTIS DEVELOPS FROM [AIIMS NOV 2012] A.2ND ARCH B.3RD C.4TH D.5TH ANS-D REF-CONSULTANT 32. GAIT APRAXIA IS DUE TO LESION IN WHICH ARTERY [AIIMS NOV 2012] A. ANT.CEREBRAL B. ANT.CHOROIDAL C. POSTERIOR CEREBRAL D. ANS A REF-OHC 2,OPERATION HARRI BOOK-PAGE 86 Frontal Gait Disorder * Frontal gait disorder- known as gait apraxia. * Common in the elderly The term lower body parkinsonism is also used to describe such patients. * Strength is generally preserved. b) Peptidase d) GTPase

* The most common cause of frontal gait disorder is vascular disease, particularly subcortical smallvessel disease. * Lesions are frequently found in the deep frontal white matter and centrum ovale. HARRISON MEDICINE ANTERIOR CEREBRAL ARTERY Signs and symptoms:Structures involved Paralysis of opposite foot and leg: Motor leg area Urinary incontinence: Sensorimotor area in paracentral lobule Abulia (akinetic mutism), slowness, delay, intermittent interruption, lack of spontaneity, whispering, reflex distraction to sights and sounds: Uncertain localizationprobably cingulate gyrus and medial inferior portion of frontal, parietal, and temporal lobes Impairment of gait and stance (gait apraxia): Frontal cortex near leg motor area REF-OHC2 33. ENZYME PRESENT IN CSF [AIIMS NOV 2012] A. LDH&CK B. GGT&ALT C. CKMB D. PEROXIDASE 34. A COUPLE FOR COUNSELLING WITH UNBALANCED ROBERTSONIAN TRANSLOCATION OF 15/21-THE OPTION OF TREATMENT [AIIMS NOV 2012] A. ADOPTION B. IVF C. NO THERAPY D. ANTENATAL DIAGNOSIS AND ABORTION ANS-?A REF-OPERATION HARRI BOOK,OHC REF-OPERATION HARRI PAGE 363

Robertsonian and reciprocal. Robertsonian rearrangements -, in which the long arms of two acrocentric chromosomes (chromosomes 13, 14, 15, 21, and 22) join together, generating a fusion chromosome that contains virtually all of the genetic material of the original two chromosomes. If the Robertsonian translocation is present in unbalanced form, a monosomic or trisomic conception ensues. * ~3% of Down syndrome cases are due to unbalanced Robertsonian translocations, most often involving chromosomes 14 and 21. As a rule, monosomic conditions are incompatible with fetal development. In fact, the only monosomy compatible with live birth is the 45,X condition, which causes Turner syndrome. 35. BHIMA SURKA YOGNA [AIIMS NOV 2012] A. CONTRIBUTION FROM FAMILY AND GOVT B. FOR OP AND HOSPITALISIED PATIENT C. 30,000 PER FAMILY D. ANS-C REF-OHC-2-RECENT ADVANCES- SPM CONSULTANT Rashtriya Swasthya Bima Yojana Central Government smart card-based cashless health insurance cover upto 30,000 rupees annually to the people living Below Poverty Line (BPL). 36. INTRATYMPANIC INJECTION OF GM [AIIMS NOV 2012] A. DIRECT OUTTER HAIR CELL DAMAGE B. DECREASE ATP EFFECT IN HAIR CELL C. D. 37. Marker of lymphoma [AIIMS NOV 2012] A. S 100 B. Hmb 45

C. Leucocyte common antigen(LCA) D. Cytokeratin ANS-C REF-OHC,,MKT,OPERATION HARRI BOOK Leucocyte common antigen (LCA, CD45)-AIIMS NOV-2012 tumors Lymphomas/leukemias, histiocytic

Lymphoid cell epitopes and activation markers Lymphomas/leukemias MART-1 /Melan A Melanoma, adrenal cortex, leydig tumors

Muramidase (lysozyme);CD68 Histiocytic tumors, myelogenous leukemia Myo D1 Muscle; rhabdomyosarcoma, PSBRC1 Muscle-specific actin() Sarcomas (leiomyosarcoma, MFH) Neurofilaments ; Lung (small cell carcinoma) Neuron-specific enolase (NSE) ;Lung (small cell carcinoma); breast (some) Placental alkaline phosphatase (PLAP) Trophoblastic tumors, testis, dysgerminoma Prostate-specific antigen () Prostate

S 100 protein Melanoma; sarcomas (neurogenic & O her); astrocytoma, GIST, PSBRCT, Paraganglioma, salivary gland, gastric adenocarcinoma Smooth muscle actin (SMA) Synaptophysin Thyroglobulin Thyroid (except medullary) TTF 1 (Thyroid transcription factor 1) Vimentin Thyroid (all types), lung GIST, Leiomyosarcoma, mesothelioma

Sarcomas; renal cell carcinoma; lymphomas/leukemias; melanoma

CK

Vim

S-100 + 0

LCA + +

Other 0 0 + +: CD15,B72,3,BerEP4

Adenocarcinoma + : Mucin

Mesothelioma + + :Calretinin

0:CD15,B72.3,BerEP4

Squamous cell carcinoma Transitional cell carcinoma Small cell carcinoma +

+ + 0 + + 0 0 0

0 0 + + + + + 0

+ + 0 + + 0 0 0

0 0 + + + 0 0 +

0 0 0 0 0 0 0 0

0 0 + + + See

0 +

See

Neuroendocrine tumors+ Carcinoid, Islet cell Sarcoma Melanoma Lymphoma 0 0 0 + + + +

+ Hormones

+ see II,, VIII

38. PROPERTIES SHOWN BY BCELL AND T CELL ARE ALL EXCEPT [AIIMS NOV 2012] A. positive selection B. specific receptor antigen C. MHC I D. require cytokines from other cells for activation ANS-A REF-POSIGOLD,MKT,OHC Character not shared by B cell & T cell is: [AI 2012] a) Positive selection during development b) Class 1 MHC expression c) Antigen specific receptors d) Depends on cytokine by other cells Ans-a POSITIVE MKT-MICRO Characteristic

B cells T cells Interaction with antigenInvolves binary complex of membrane Ig and Ag Involves ternary complex of Tcell receptor, Age and MHC molecule Binding of soluble antigen Yes No

Involvement of MHC molecules None required Required to display processed antigen Chemical nature of antigens Protein, Polysaccharide, lipid glycolipids present on MHC-like molecules Mostly proteins, but some lipids and

Epitope properties Accessible, hydrophilic, mobile peptides containing sequential or nonsequential amino acids Internal linear peptides produced by processing of antigen and bound to MHC molecules 39. ALL ARE UNFAVOURABLE DRUG INTERACTION EXCEPT [AIIMS NOV 2012] A. OMEPRAZOLE-DECREASE OF ACID SECRETION B. B12 ABSORPTION AND BARBITURATES C. METHOTREXATE AND FOLATE ABSORTION D. RETINOIDS AND VITAMIN E ABSORPTION ANS 40. SAPHENOFEMORAL INCOMPETENCE WITH PERFORATORS BEING COMPETENT-TREATMENT OF CHOICE ALL EXCEPT [AIIMS NOV 2012] A. SCLEROTHERAPY B. SF LIGATION C. SF LIGATION AND STRIPPING D. LASER RADIOFREQUNCY LIGATION Ans A REF HARRISON Varicose veins usually can be treated with conservative measures. Symptoms often decrease when the legs are elevated periodically, prolonged standing is avoided, and elastic support hose are worn. External compression stockings provide a counterbalance to the hydrostatic pressure in the veins Ablative procedures, including sclerotherapy, endovenous radiofrequency or laser ablation, and surgery

Small, symptomatic varicose veins can be treated with sclerotherapy, in which a sclerosing solution is injected into the involved varicose vein and a compression bandage is applied. Percutaneous, endovenous delivery of radiofrequency or laser energy can be used to treat incompetent great saphenous veins. Surgical therapy usually involves ligation and stripping of the great and small saphenous veins. 41. SMALL SCALE MUTATION IS SEEN BY ALL EXCEPT [AIIMS NOV 2012] A. INSERTION B. BASE SUBSTITUTION C. DELETION D. PARTIAL DUPLICATION ANS? D REF-HARRISON Kearns-Sayre syndrome (KSS), sporadic progressive external ophthalmoplegia (PEO), and Pearson syndrome are three disease phenotypes caused by large-scale mtDNA rearrangements, including partial deletions or partial duplication 42. 4 YEAR OLD CHILD HB 3.8GM MCV 55.1 TRANSFUSION HAS BEEN GIVEN ALREADY-DIAGNOSIS [AIIMS NOV 2012] A. ALFA THALESSMIA B. BETA THALESSMIA MAJOR C. sickle cell

D.G6PD DEFICIENCY ANS-B REF-OHC 2,OPERATION HARRI BOOK-PAGE-467,CONSULTANT Beta thalassemia major * Severe anemia , massive ineffective erythropoiesis: hepatosplenomegaly, microcytosis, and elevated HbF *Require chronic hypertransfusion therapy- hematocrit of at least 2730%

43. IMPLANTABLE CARDIAC DEVICE DEVELOPED SHOCK.INVESTIGATION TO ASSESS THE INTEGRITY OF ICD [AIIMS NOV 2012] A. X RAY B. CONTRAST CT C. MRI D. USG 44. which doesnt arise from peritoneum of stomach [AIIMS NOV 2012] liver spleen pancreas kidney ANS D REF-CONSULTANT,MKT,OHC Foregut Midgut Hindgut Pharyngealpouches* transverse colon Lungs Jejunum Esophagus Stomach Liver Descendingcolon Lowerduodenum Distal onethird of

Ileum Sigmoid colon Cecum Rectum Upper part ofanal can Ascendingcolon Urogenitalderivatives

Appendix

Gallbladder andbile ducts Pancreas transverse colon

Proximal twothirds of

45. not common in normal pregnancy and hypertension during pregnancy? [AIIMS NOV 2012] A. pedal edema B. engorged veins C. dyspnea D. SYSTOLOC HYPOTENSION ANS-D REF-CONSULTANT,OHC-RECENT ADVANCES BOOKLET(I hope my OHCians have gone through the RECENT ADVANCES booklet sent to them??!!-this question was extremely satisfying for POSITIVE) RECENT ADVANCES-HAND OUT-OG

46. PLANTAR FLEXION LEADS TO RUPTURE OF [AIIMS NOV 2012] A. ANT.TALO FIBULAR LIGAMENT B. POST.TIBIO FIBULAR LIGAMENT C. CALCANEO FIBULAR LIGAMENT D. POSTERIOR DELTOID FIBRES 47. LIGAMENT WHICH ATTACHES MENISCI TO TIBIA [AIIMS NOV 2012] A. CORONARY LIGAMENT B. Arcuate ligament

C. D. ANS-A REF-POSIGOLD,OHC-MODIFIED,CONSULTANT 267. Coronary ligaments of the knee are[AI 2008] a) Ligaments connecting the menisci to femur b) Ligaments connecting the menisci to tibia

c) Ligaments connecting the anterior horns of both menisci d) Ligaments connecting the lateral meniscus to capsule ANS-B 48. ABDUCTION AND DIRECT HIT OF KNEE WILL CAUSE RUPTURE OF [AIIMS NOV 2012] A. MEDIAL COLLATERAL LIGAMENT B. LATERAL COLLATERAL LIGAMENT C. ANTERIOR CRUCIATE LIGAMENT D. MEDIAL MENISCUS 49. NERVE WHICH DOES NOT SUPPLY GLUTEAL REGION [AIIMS NOV 2012] A. SCIATIC NERVE B. OBTURATOR NERVE C. INFERIOR GLUTEAL NERVE D. SUPERIOR GLUTEAL NERVE ANS A REF-CONSULTANT 50. a hyertensive man on medication with normal activity is graded under [AIIMS NOV 2012] 1.ASA I 2.ASA II 3.ASA III 4.ASA IV ANS-B REF-OHC-RECENT ADVANCES BOOK LET,MKT,CONSULTANT

POSITIVE -RECENT ADVANCES-OHC 2

n The ASA physical status classification system is a system for assessing the fitness of patients before surgery. In 1963 the American Society of Anesthesiologists (ASA) adopted the five-category physical status classification system; a sixth category was later added. These are: n A normal healthy patient. n A patient with mild systemic disease. n A patient with severe systemic disease. n A patient with severe systemic disease that is a constant threat to life. n A moribund patient who is not expected to survive without the operation. n A declared brain-dead patient whose organs are being removed for donor purposes. POSITIVE MKT 1. Preoperative physical status classification of patients according to the American Society of Anesthesiologists. Class Definition P1 P2 P3 A normal healthy patient A patient with mild systemic disease (no functional limitations) A patient with severe systemic disease (some functional limitations)

P4 A patient with severe systemic disease that is a constant threat to life (functionality incapacitated) P5 P6 E A moribund patient who is not expected to survive without the operation A brain dead patient whose organs are being removed for donor purposes If the procedure is an emergency, the physical status is followed by E (for example, 2E)

51. A GUNSHOT AT T8 LEVEL. nerve regeneration not in spinal cord not due to [AIIMS NOV 2012] 1) no endoneurium 2) lack of nerve growth factor 3) no myelin inhibiting factor 4) glial scar

52. PROPHYLACTIC CRANIAL IRRADIATION IS NOT REQUIRED IN [AIIMS NOV 2012] A. NEUROBLASTOMA B. C. D. 53. HEPATOMEGALY WITH LIVER TENDERNESS AND ELEVATED DIAPHRAGM-ALL EXCEPT [AIIMS NOV 2012] A. AMEBIC ABSCESS B. PYEMIC LIVER ABSCESS C. ACUTE CHOLECYSTITIS D. ANS-C REF-CONSULTANT 54. RADIOLOGICAL DIAGNOSIS BY USG IN SURGICAL OBSTRUCTION-ALL EXCEPT [AIIMS NOV 2012] A. GALL STONES B. PERITONEAL SEEDLING C. LEVEL OF OBSTRUCTION D. ABSENT FLUID LEVEL ANS-B REF-CONSULTANT-OPERATION HARRI PAGE 222 * Direct visualization of the peritoneum (laparoscopy) may disclose peritoneal deposits of tumor 18TH EDITION Peritoneal carcinomatosis can result from primary peritoneal malignancies such as mesothelioma or sarcoma, abdominal malignancies such as gastric or colonic adenocarcinoma, or metastatic disease from breast or lung carcinoma or melanoma 55. INTESTINAL OBSTRUCTION SURGERY AND BIOPSY OF ILEAL LOOP WAS DONE AND SENT FOR HISTOLOGY-IT WILL CONTAIN [AIIMS NOV 2012]

A. VILLOUS ADENOMA B. SMOOTHMUSCLE TUMOR C. CARCINOID D. LYMPHOMA ANS-A REF-CONSULTANT-SURGERY NOTES-POSITIVE REF-POSITIVE SURGERY Intususception Commonest pathology is Adenoma in adults In adolescents, Meckels diverticulum is the commonest. Primary treatment in children is hydrostatic reduction Commonest type of Intussusception in adults is Colo colic 56. on intubation of child problem in anesthesia machine collapse after 2 min what to do? [AIIMS NOV 2012] A. bigger tube B. continue as such C. increase flow D. manually ventilate 57. Pregnant. 36wks..BP.176/80.and blurring vision and epigastric pain present..management is.. [AIIMS NOV 2012] a.ADMIT,ANTIHYPERTENSIVES,mgso4 AND OBSERVATION b.admit. Give mgso4 and terminate C. ADMIT &Observation D.Give only antihypertensive ANS A REF-CONSULTANT

58 ON ALANSTRON FOR 7 YEARS-WORSENING OF SYMPTOMS-WHAT INVESTIGATION YOU WILL CONSIDER [AIIMS NOV 2012] A. DEXA B. ALKPO4 C. CALCIUM D. 59. CHILD WITH RICKETS WITH DEFORMITIES-CORRECTIVE SURGERY IS PLANNED AFTER CORRECTION OF [AIIMS NOV 2012] A. VIT D B. CALCIUM C. ALKPO4 D. GROWTH PLATE 60. FOLLOWING DIFFICULT INTUBATION-TO CONFIRM POSITION [AIIMS NOV 2012] A. TACHYCARDIA B. BRADYCARDIA C. NORMAL CAPNOGRAM D. PULSEOXIMETRY 61. KYNOMYOGRAPH IS FOR [AIIMS NOV 2012] A. B. C. D. 62. IV DRUG DEPENDING ON TOTAL BODY WEIGHT ,NOT ON IDEALBODY WEIGHT [AIIMS NOV 2012] A. ATRACURIUM B. VECRONIUM C. PANCURONIUM

D. ROCURIUM 63. MAXIMUM ANALGESIC EFFECT [AIIMS NOV 2012] A. NO B. HALOTHANE C. ETHER D. ANS-A REF-POSIGOLD,OHC,CONSULTANT 64. POOR SCHOOLPERFORMANCE-A EEG WAS GIVEN-DIAGNOSIS [AIIMS NOV 2012] A. ABSENCE SEIZURE B. COMPLEX PARTIAL SEIZURES C. D. ANS-A REF-CONSULTANT,OHC 65. FIXATIVE IN TISSUE SPECIMEN [AIIMS NOV 2012] A gluteraldehide b formalin c alcohol d.picric acid Ans-a Ref-consultant Modified posigold Which of the following is the most commonly used fixative in diagnostic pathology*AI 2011+ a) Formaldehyde b) Ethyl alcohol

c) Mercuric chloride d) Picric acid ANS-A 66. person had a fight with a neighbour where he assaulted him,he can be booked under ipc [AIIMS NOV 2012] A. 320 B. 319 C. 44 D. 351 ANS-D REF-CONSULTANT 67. HEALTH EXPENDITUREIN GDP IN INDIA [AIIMS NOV 2012] A. 1.2 B. 2 C. 10 D. 15 ANSB REF-POSITIVE MKT,OHC National Health Policy 2002 Goals to be achieved by 2015 * Eradicate Polio and Yaws* Eliminate Leprosy * Eliminate kala azar * Eliminate Lymphatic Filarisasis Achieve zero level growth of HIV/AIDS * Reduce mortality by 50% on account of TB, * Malaria and other vector and water borne diseases * Reduce prevelence of blindness to 0.5%

* Reduce IMR to 30/100 And MMR to 100/Lakh * Increase utilization of public health facilities from current level of < 20% to > 75% * Establish an integrated system of surveillance, National Health Accounts and Health Statistics. * Increase health expenditure by Government as a % of GDP from the existing 0.9% to 2.0% * Increase share of central grants to constitute at least 25% of total health spending * Increase state sector health spending from 5.5% to 7% of the budget * Further increase to 8% of the budget 20052005 2010 2015 2007 2010 2010 2010 2010 2005 2010 2010 2005 2010

68. WHICH IS TRUE [AIIMS NOV 2012] A. DOBUTAMINE INCREASES PERIPHERAL RESISTANCE B. NORADRENALINE-INCREASES RENAL VASODILATION C. DOPAMINE-INCREASES HEPATIC BLOOD FLOW

D. 69. ECTOPIC PREGNANCY CAN BE DIAGNOSED BY ALL EXCEPT [AIIMS NOV 2012] A. PELVIC EXAMINATION B. HYSTEROSALPHINGOGRAM C. URINE HCG D. USG 70. A psychiatric patient he is clear about his disease-this is [AIIMS NOV 2012] A. Insight B. Judgement C. orientation D. ANS-A REF-CONSULTANT 71. A chronic alcoholic used to consume 5 bottles per day of liquor.Recently he attains kick with I bottlethis is called as [AIIMS NOV 2012] A. Tolerance B. Reverse tolerance C. mallen by D. 72. A female patient with cord like lesions in both temporal regions- a biopsy was done which revealed granulomatous lesion involving all layers [AIIMS NOV 2012] A. Temporal arteritis B. Wegeners granulomatosis C. D. ANS-A

REF-OHC 73. Persistent hyperplastic vitreous-after surgery the commonest complication [AIIMS NOV 2012] A. Retinal detachment B. Vitreous hge C. orbital cellulitis D. keratitis Ans-a Ref-consultant 74. Gram negative bacteria without endotoxin [AIIMS NOV 2012] A. Cholera B. E.COLI C. KLEBSIELLA D. PSEUDOMONAS ANS-A REF-POSIGOLD,OHC,CONSULTANT 1. Endotoxin of which gram negative bacteria has no part in pathogenesis of disease: [AI 2012] a) E.Coli c) Vibrio Cholera ANS C 75. Which is a contraindication for vaginal delivery after CS in the previous delivery [AIIMS NOV 2012] A. Classical cs B. CPD in the previous delivery C. breech ANS-A REF-CONSULTANT,MODIFIED POSIGOLD,OHC b) Klebsiella d) Pseudomonas aerginosa

Which of the following is not a contraindication for vaginal delivery after previous cesarean section (CS)? [AI 2008] a) Previous Classical C/S b) No Vaginal delivery in the past c) Breech presentation d) Puerperial infection in previous pregnancy ANS-C 76. A patient presented with maculopapular rash in trunk, with generalized lymphadenopathy and a flat painless genital ulcer with a mass in the palatal region-treatment [AIIMS NOV 2012] A. Acylovir B. Pencillin C. amphotericin ANS-B REF-OHC,OPERATION HARRI BOOK-PAGE 736,CONSULTANT Secondary Syphilis * Primary chancre is still present in 15% of cases * Necrotic lesions (lues maligna)- patchy alopecia * Highly infectious lesions (condylomata lata) in 10% * Syphilitic hepatitis-an unusually high serum level of alkaline phosphatase- no cholestasis * Manifestations of the secondary stage resolve spontaneously, usually within 16 months. *Lue maligna,Corona veneris Treatment of Acquired Syphilis * Penicillin G is the drug of choice for all stages of syphilis 77. Which is not a 2nd gen antihistamine ? [AIIMS NOV 2012] A. cetrizine B. loratidine

C. fexofenadine D. cyclizine ANS-D REF-POSIGOLD,CONSULTANT,OHC 78. All are used in erectile dysfunction except [AIIMS NOV 2012] A. TADANAFIL B. Phenylephrine C. PROSTAGLANDIN E D. APOMORPHINE ANS-B REF-OHC,POSIGOLD,OPERATION HARRI BOOK PAGE 261 Male Sexual Dysfunction: Treatment * Oral Agents-Sildenafil, tadalafil, and vardenifil. Intraurethral Alprostadil, Various combinations of alprostadil, phentolamine, and/or papaverine are used. 79. Ca cervixIIIB-TRT OF CHOICE [AIIMS NOV 2012] A. SURGERY B. RT C. CHEMORADIATION D. NEOADJUVANT RADIATION ANS REF-CONSULTANT OPERATION HARRI BOOK PAGE 437,POSIGOLD-AIIMS NOV-2010 Patients with disease stages IIIV are primarily managed with external beam irradiation and intracavitary treatment or combined modality therapy.(AIIMS-NOV-2010***)

80. A DIABETIC PATIENT WITH A BLACK ESCHAR IN THE NOSE SPREADING TO ORBIT-MANAGEMENT [AIIMS NOV 2012]

A. AMPHOTERICIN B. BROAD SPECTRUM ANTIBIOTIC C. D. ANS-A REF-CONSULTANT,OHC,OPERATION HARRI BOOK Black eschar of the palate is widely described as a hallmark of rhinocerebral mucormycosis. 81. MILITARY RETIRED MAN WITH CLEAN HABITS DEVELOPS HEADACHE WHICH IS MORE ON LYING DOWN AND RELIEVES ON GETTING UP.MASSAGE IN THE NECK REGION RELEIVES THE PAIN-DIAGNOSIS [AIIMS NOV 2012] A. TENSION HEADACHE B. TEMPORAL ARTERITIS C. MIGRAINE D. PAN 82. STRUCTURE NOT INVOLVED DURING VASECTOMY[AIIMS NOV 2012] A. SPERMATIC CORD B. ILIOINGUINAL NERVE C. PAMPINIFORM PLEXUS D. ANS-B REF-CONSULTANT 83. PERSISTENT ORAL LESIONS FOR 12 MONTHS WITH BULLOUS LESIONS [AIIMS NOV 2012] A. INTRA DERMALDERMAL BULLA B. DERMOEPIDERMAL BULLA C. SUBCORNEAL BULLA D. SUPRABASAL

ANS D REF,CONSULTANT,OHC,OPERATION HARRI BOOK,MODIFIED POSIGOLD REF-OPERATION HARRI-PAGE238 Intraepidermal blistering diseases characterized by loss of cohesion between epidermal cells (a process termed acantholysis). * Manual pressure to the skin of these patients may elicit the separation of the epidermis (Nikolskys sign)-also seen in toxic epidermal necrolysis, Stevens-Johnson syndrome. * * * * * Predominates in patients >40 years. PV typically begins on mucosal surfaces. PV may be associated with severe skin pain. Lesions heal without scarring. Postinflammatory hyperpigmentation is usually present at sites of healed lesions.

* Biopsies intraepidermal vesicle formation secondary to loss of cohesion between epidermal cells (i.e., acantholytic blisters). * Blister formation is within the suprabasal portion of the epidermis.

* Direct immunofluorescence microscopy of lesional or intact patient skin shows deposits of IgG on the surface of keratinocytes. Disease Clinical Histology Immunopathology Autoantigens

Pemphigus foliaceus Scalp, central face, upper chest, and back Acantholytic blister formed in superficial layer of epidermis Cell surface deposits of IgG on keratinocytes Dsg1- desmoglein Pemphigus vulgaris Flaccid blisters, oromucosal lesions Acantholytic blister formed in suprabasal layer of epidermis Cell surface deposits of IgG on keratinocytes Dsg3 (plus Dsg1 in patients with skin involvement)

MODIFIED POSIGOLD A 40 yr old Female developed persistant oral ulcers followed by multiple flaccid bullae on trunk and extremeties. Direct examination of a skin biopsy immunoflurescene showed intercellular IgG deposits in the epidermis and suprabasal split with acantholytic cells. The probable diagnosis is [AI 2008] a) Pemphigus vulgaris

b) Pemphigoid c) Erytheme multiforme d) Dermatitis herpetiformis ANS-A 84. 3RD WINDOW EFFECT IS FOUND IN [AIIMS NOV 2012] A) PERFORATED OF TM B) DEHISCENCE OF SEMICIRCULAR CANAL C) ROUND WINDOW D) OVAL WINDOW ANS B REF-EXCITING 18TH,OHC 2 18TH EDITION HARRISON K) Conductive hearing loss * Disorders that lead to the formation of a pathologic third window in the inner ear can be associated with conductive hearing loss. * Normally two major openings, or windows, that connect the inner ear with the middle ear(oval) and serve as conduits for transmission of sound(round windows) * A third window is formed where the normally hard otic bone surrounding the inner ear is eroded; inner ear conductive hearing loss. *The superior semicircular canal dehiscence syndrome resulting from erosion of the otic bone over the superior circular canal can present with conductive hearing loss that mimics otosclerosis. 85. HIGH FREQUENCY AUDIOMETRY[AIIMS NOV 2012] A) DRUG TOXICITY B) Otosclerosis C) Non- organic hearing loss D) Menieres disease ANS A

REF-POSIGOLD,CONSULTANT,OHC,RECENT ADVANCES BOOK LET RECENT ADVANCES OHC

HIGH FREQUENCY AUDIOMETRY Pure tone audiometry (PTA) is the key hearing test used to identify hearing threshold levels of an individual, enabling determination of the degree, type and configuration of a hearing loss. Thus, providing the basis for diagnosis and management. Conventional audiometry tests frequencies lie in between .25 Hz and 8 kHz. Whereas, high frequency audiometry tests in the region of 8-20 kHz. The effects of ototoxic medication and noise exposure for example, appear to be more detrimental to the high frequencies, than mid or low frequencies. Therefore, high frequency audiometry is an effective method of monitoring losses that are suspected to have been caused by these factors. It is also effective in detecting the auditory sensitivity changes which occur with aging HFA might be used as an early indicator for noise-induced hearing loss and acoustic trauma rather than audiometry at a conventional frequency (4 kHz), particularly for younger groups. High Frequency audiometry is used in: [AIIMS MAY 2009] a) Otosclerosis b) Ototoxicity c) Non- organic hearing loss d) Menieres disease ANS-B 86. EEG IN ANESTHESIA [AIIMS NOV 2012] A. REGIONAL ANSTHESIA B. DEPTH OF GENERALANESTHESIA C. NEUROMUSCULAR BLOCK D. ANALGESIA ANS-B REF-CONSULTANT

87. PT WITH ACTIVE TB MENINGITIS -1 MONTH ON ATT-CLINICAL DETORIATION-WHICH IS NOT USEFULL IMMEDIATELY [AIIMS NOV 2012] A. MRI B. NONCONTRAST CT C. LFT,ELECTROLYTES D. CSF ANALYSIS 88. CHILD WITH GRUNTING NO NASAL FLARE WITH CHEST RETRACTION SILVERMAN SCORE [AIIMS NOV 2012] A. 3 B. 4 C. 5 D. 6 ANS B REF-POSIGOLD AIIMS NOV-2010,OHC Clinical scores: it was applied a synthesis of Silverman Normal babies have a cumulative score close to 0. Severely depressed babies score close to 10. 89. BI-RADS SCORE(All POSITIVIANS&OHCIANS should have squealed in delight on seeing this question in the exam!!!) [AIIMS NOV 2012] A. BREAST IMAGING REPORTING AND DATA BASE SYSTEM B. BRAIN IMAGING REPORTING AND DATA BASE SYSTEM C. Best Imaging Reporting and Data System

D. ANS A REF-OHC,CONSULTANT-SURGERY

Mammography is the process of using low-dose (usually around 0.7 mSv) to examine the human breast and is used as a diagnostic as well as a screening tool. The goal of mammography is the early detection of breast cancer, BI-RADS score???? Mammogram results are often expressed in terms of the BI-RADS Assessment Category, often called a BI-RADS score. The categories range from 0 (Incomplete) to 6 (Known biopsy proven malignancy). In the UK mammograms are scored on a scale from 1-5 (1 = normal, 2 = benign, 3 = indeterminate, 4 = suspicious of malignancy, 5 = malignant). Breast Imaging Reporting and Database System (BI-RADS) Category 0 Need additional imaging evaluation 1 Negative 2 Benign (noncancerous) finding Continue annual screening mammograms (for women over age 40) 3 Probably benign 4 Suspicious abnormality May require biopsy 5 Highly suggestive of malignancy (cancer) 6 Known biopsy-proven malignancy (cancer) begins Biopsy confirms presence of cancer before treatment Requires biopsy Receive a 6-month follow-up mammogram Continue annual screening mammograms (for women over age 40) Additional imaging needed before a category can be assigned Assessment Follow-up

cancers missed by mammography are usually around 10%30% one form of breast cancer, lobular cancer, has a growth pattern that produces shadows on the mammogram which are indistinguishable from normal breast tissue.

90. Ca prostate is followed with[AIIMS NOV 2012] A) PSA B) PSA+CEA C) PSA+CA-125 D) ANDROGEN ANS A REF-CONSULTANT,OHC,OPERATION HARRI BOOK,MKT MARKER CANCER Oncofoetal antigens: i) Alpha-foetoprotein (AFP) ii) Carcino-embryonic antigen (CEA)Hepatocellular carcinoma, non-seminomatous germ cell tumours of testis Cancer of bowel, pancreas, breast Cytoplasmic proteins: i) Immunoglobulins ii) Prostate specific antigen (PSA) Multiple myeloma, other gammapathies Prostate carcinoma Enzymes: i) Prostate acid phosphatase(PAP) ii) Neuron-specific enolase (NSE) Prostatic carcinoma Neuroblastoma, oat cell carcinoma lung Hormones: i) Human chorionic gonadotropin (HCG)

ii) Calcitonin iii) Catecholamines and vanilly mandelic acid (VMA) iv) Ectopic hormone productionTrophoblastic tumours, non-seminomatous germ cell tumours of testis Medullary carcinoma thyroid

Neuroblastoma, pheochromocytoma Paraneoplastic syndromes Secreted cancer antigens: i) ii) Ovary Breast CA-125 CA-15-3

PSA relapse PSA relapse is defined as three consecutive risingPSA values from the nadir value, with the time to failure as a rise by 2 ng/mL or greater above the posttreatment nadir value. * Neoadjuvant hormone therapy. *Brachytherapy * After surgery RT indications. 1) positive surgical marigin. 2) a long interval from surgery toPSAfailure. 3) a slowPSAdoubling time. 4) lowPSA- < 0.5 1.0 ng/L. 91. PREGNANT LADY PT WITH PAINFULL LUMP IN BREAST.WHAT IS THE NEXT INVESTIGATION[AIIMS NOV 2012] A. USG B. MRI

C. CT D. MAMMOGRAM ANS A REF-CONSULTANT 92. DENNIS SPINAL INJURY SYSTEM[AIIMS NOV 2012] A. COLUMN 2 B. COLUMN 3 C. COLUMN 4 D. COLUMN 5 ANS-B 93. Commonest cause of NMR IN INDIA [AIIMS NOV 2012] A. INFECTIONS B. BIRTH ASPHYXIA C. CONGENITAL MALFORMATION D. PREMATURITY ANS-B REF POSIGOLD,MKT,OHC Primary causes of neonatal deaths in India (NNPD data 2002) n = 1800 Causes of death Number Proportion Birth asphyxia 517 Immaturity Infections 408 263 28.8% 22.7% 14.6% 168 9.3%

Congenital malformations

Miscellaneous 444

24.6%

94. EYE LESION IN PATAU SYNDROME [AIIMS NOV 2012] A. BILATERAL MICROOPTHALMIA B. neurofibroma C. Capillary hemangioma D. Dermoid cyst

REF-OHC-2 GENETICS Symptoms and findings may be extremely variable from case to case. However, in many affected infants, the following may be found: Growth deficiency Feeding difficulties Breathing difficulties Developmental delays Mental Retardation Undescended testicles in males Prominent back portion of the head Small head (microcephaly) Low-set, malformed ears Abnormally small jaw (micrognathia) Small mouth Cleft lip/palate Upturned nose Narrow eyelid folds (palpebral fissures) Widely-spaced eyes (ocular hypertelorism) Dropping of the upper eyelids (ptosis)

Overlapped, flexed fingers Underdeveloped or absent thumbs Underdeveloped nails Webbing of the second and third toes Clubfeet Small pelvis with limited movements of the hips Short breastbone Kidney malformations Structural heart defects at birth (i.e., ventricular septal defect, atrial septal defect, patent ductus arteriosus) MODIFIED POSIGOLD Persistant Primary Hyperplastic Vitreous (PHPV) is associated with: [AI 2008] a) Patau syndrome c) Trisomy 14 ANS-A 95 23. All are second messengers except: [AIIMS NOV 2012] a) Guanylyl cyclase c) IP3 ANS-A REF-POSIGOLD,OHC All are second messengers except: [AIIMS NOV 2008] a) Guanylyl cyclase c) IP3 d) DAG b) cAMP b) cAMP d) DAG b) Edward syndrome d) Downs syndrome

96. Sternocleidomastoid is supplied by all of the following arteries except? [AIIMS NOV 2012] a) Occipital c) Thyrocervical trunk b) Posterior auricular d) Superior thyroid

ANS-B REF-POSIGOLD,OHC,CONSULTANT . Sternocleidomastoid is supplied by all of the following arteries except? [AIIMS NOV 2008] a) Occipital c) Thyrocervical trunk b) Posterior auricular d) Superior thyroid

97. A gardener has multiple vesicles on hand and multiple eruptions along the lymphatics. Most common fungus responsible is? [AIIMS NOV 2012] a) Sporothrix schenckii c) Histoplasma ANS A REF,CONSULTANT,POSIGOLD,OHC A gardener has multiple vesicles on hand and multiple eruptions along the lymphatics. Most common fungus responsible is? [AIIMS NOV 2008] a) Sporothrix schenckii b) Cladosporium c) Histoplasma ANS-A 98. Mass chemoprophylaxis is not indicated in [AIIMS NOV 2012] A. scabies B. lymphatic filariasis d) Candida b) Cladosporium d) Candida

C. vit A deficiency

D. worm infestation

ANS-A REF-POSIGOLD,OHC

Mass chemoprophylaxis is endemic area is recommended for all of the following, except: (AI 2010) A. Yaws B. Leprosy

C. Trachoma D. Filaria ANS-B 99. Variable area tonometry [AIIMS NOV 2012] A. Mackey marg tonometer B. C. D. ANS-A 100. A patient with bilateral proptosis [AIIMS NOV 2012] A. Leukemia B. Cavernous hemangioma C. Fibrous histiocytoma D. 101. Best agent for premenstrual syndrome management? A. Progesterone

B. SSRI C. ANXIOLYTIC D. VITAMIN E ANS-B REF-CONSULTANT 102. Helminthic infection from fish? [AIIMS NOV 2012] A. clonorchis

B. diminuta C.tenia D. ANS-A REF-CONSULTANT,OPERATION HARRI BOOK,POSIGOLD,OHC A man on return from a country complains of pain in abdomen, jaundice, with increased alkaline phosphatase and conjucated hyperbilirubinemia. U.S.G. shows blockage in the biliary tree. What could be the cause [AIIMS MAY 2009] a) Fasciola buski b) Clonorchis sinensis c) Stronglyliodes d) Ancylostoma Ans (B) 103. Best agent for premenstrual syndrome management? [AIIMS NOV 2012] A. Progesterone B. SSRI C. ANXIOLYTIC D. HRT ANS-b REF-CONSULTANT 104. rupture of urethra above the the deep perineal pouch..causes urine retention in which region??? [AIIMS NOV 2012] a. anterior abd. wall b. medial aspect of thigh c.scrotum p.true pelvis only ANSd RER-CONSULTANT,MODIFIED POSIGOLD,OHC Injury to the male urethra below the perineal membrane causes urine to accumulate in [AI 2007]

a) Superificial perineal pouch b) Deep perineal pouch c) Space of retzius Ans (a) 105. A neonate with poor respiration at birth starts throwing seizures after 10hrs of birth. Antiepileptic of choice wud be [AIIMS NOV 2012] A. Levetiracetam B. Phenytoin C. Phenobarbitone D. Lorazepam ANS-C REF-CONSULTANT 106. pt with central incisor fracture after fight and abrasions in limbs And trunk [AIIMS NOV 2012] A) grevious B) fatal C) simple D) dangerous ANS-A REF-CONSULTANT,MODIFIED POSIGOLD,OHC 30. A teacher slapped a 6th standard student after which she suffered from 25% hearing loss in left ear. This was corrected after a surgery. Which type of injury is this? [AIIMS NOV 2009] a) Simple c) Dangerous Ans B 107. female with vaginal dischage,no active cx dischage,rx?? [AIIMS NOV 2012] A. metro,azithromycinm b) Grievous d) Serious d) Pouch of douglas

B. metro,fluco.. C. Metro & doxyclyclin D. Metro & ceftriaxone Ans-b REF-CONSULTANT 108. Testis origin [AIIMS NOV 2012] A) ectodermal origin B) gabernaculum attached to caudal end C) surrounded by peritoneal tunica albuginea D) 28th weak reach at scrotum 109. Causes of acute anal pain ALL EXCEPT [AIIMS NOV 2012] A. thrombosed hemorrhoids B. acute anal fissure C. fistula in ano D. anorectal abscess Ans-b Ref-consultant,HARRISON hemorrhoids Pain is less common than with fissures and, if present, is described as a dull ache from engorgement of the hemorrhoidal tissue. Severe pain may indicate a thrombosed hemorrhoid *A patient with a fistula in ano will complain of constant drainage from the perianal region *A fissure can be easily diagnosed on history alone. The classic complaint is pain, which is strongly associated with defecation and is relentless. 110. Child with seizures, oval hypopigmented macules on trunk, subnormal IQ [AIIMS NOV 2012] A. Neurofibromatosis B. sturge Weber

C. Tuberous sclerosis D. Incontinentia Pigmenti ANS-C REF-CONSULTANT,OHC 111. Which of following malign do not require routine CSF puncture in children [AIIMS NOV 2012] A. ALL B. HODGKIN LYMPHOMAS C. NON HODGKIN LYMPHOMAS. D. AML ANS112. multigravida36 weeks-WITH PREVIOUS 2 NORMAL DELIVERIES presented with unstable lie. It is due to.. [AIIMS NOV 2012] A.placenta previa B.oligohydramnios. C. Pelvic tumor D.UTERINE ANOMALIES ANS?B REF-CONSULTANT 113 Not True is [AIIMS NOV 2012] a.forcep delivery facial palsy and brain damage b.vacum delivery require more skill than forcep c. Vacum associated with cephal hematoma d. ANS 114. long thoracic nerve root value [AIIMS NOV 2012] A. C567

B. C678 C. C8T1 D. C56 ANS- A REF-CONSULTANT 115. area of brain can be self stimulated under experimental conditions [AIIMS NOV 2012] A. Medial forebrain bundle B. Area around aqueduct of sylvius C. PEriventricular region of hypothalamus D. Mesenchephalon ANS116. Tibia pain,fever,inc ESR:INVESTIGATION???? [AIIMS NOV 2012] A. Blood culture B. Pus culture C. MRI D. ANS 117. Known RA female pt presented wth quadriplegia -INVESTIGATION Cervicle spine flexion extension xray [AIIMS NOV 2012] A. MRI brain B. Carotid angio C. NCV D. ANS-B REF-OHC,OPERATION HARRI BOOK-PAGE 61,

Other Causes of Neck Pain * Rheumatoid arthritis forward displacement of the atlas on the axis (atlantoaxial subluxation). in 30% of patients with RA. When subluxation is present, MRI is the imaging modality of choice 118. Newborn with resp distress which is suggestive of RDS onset after 6hrs [AIIMS NOV 2012] A. Air bronchogram B. Term pregnancy C. Antenatal steroid D.seen after 6 hrs ANS-A REF-CONSULTANT 119 Pt>60yr leukocyte= 20,000 with generalized lympadenopathy Next test u should do? [AIIMS NOV 2012] A. Lymph node Bx B. BM aspiration C. Peripheral blood immunohistochemistry D. Peripheral blood cytogenetics ANS-C REF-CONSULTANT 120. Allens test done for collateral arterial supply at [AIIMS NOV 2012] A. Arm B. forearm C. Wrist D. Elbow ANS-C

REF-CONSULTANT,OHC,EXCITING 18TH The brachial or radial artery may also be used as an arterial access site in patients with peripheral arterial disease that involves the abdominal aorta, iliac, or femoral vessels; severe iliac-artery tortuosity; morbid obesity; or preference for early postprocedure ambulation. Use of radial-artery access is gaining popularity owing to a lower rate of access-site bleeding complications. A normal Allens test confirming dual blood supply to the hand from the radial and ulnar arteries is a prerequisite to access this site 121. PDA-NOT SEEN [AIIMS NOV 2012] A. APNOEA B. ISCHEMIC COLITIS C. NARROW PULSE PRESSURE D. BRADYCARDIA ANS122. With reference to Bacteroides fragilis, the following statements are true except?(AIIMS-NOV2011,12) [AIIMS NOV 2012] a.B.fragilis is the same frequent anaerobe isolated from clinical samples b.B.fragilis is not uniformly sensitive to metronidazole c.The lipopolysaccaride formed by B.fragilis is structurally and functionally different from the conventional endotoxin d.Shock and disseminated intravascular coagulation are common in Bacteroides bacteremia ANS-REF-POSIGOLD,2006,2011) REF-POSIGOLD,OPERATION HARRI-PAGE 699 ,OHC Occur when an anatomic barrier becomes disrupted and constituents of the local flora enter a site that was previously sterile. * * * * * Prevotella melaninogenica attaches to other microorganisms- fimbriae that facilitate attachment. Some Bacteroides strains have pili. Virulence factor-polysaccharide complex of B. fragilis. Interleukin (IL) 8, IL-17, and tumor necrosis factor (TNF)alfa-stimulate abscess formation.

IL-10- the cytokine inhibits of abscess formation.** * * The collagenase produced by P. gingivalis may enhance tissue destruction. An enterotoxin has been identified in B. fragilis strains associated with diarrheal disease.

* B. fragilis possess lipopolysaccharides (LPSs, endotoxins) that are 1001000 times less biologically potent than endotoxins associated with aerobic gram-negative bacteria-lower frequency of DIC and purpura in Bacteroides bacteremia (AIIMS-NOV-06***,AIIMS-N0V-2011). 123. A patient develops urticaria after sunexposure and exercise [AIIMS NOV 2012] A. Cholinergic urticaria B. dermographism C. SOLAR URTICARIA D. ANS-A REF-HARRISON Cholinergic urticaria is precipitated by heat, exercise, or emotion and is characterized by small wheals with relatively large flares. 124. Loss of extension of little ring finger, hypothenar atrophy [AIIMS NOV 2012] A. post interosseous nerve B. radial trunk C. D. ANS 125. AN ABORTUS WAS REMOVED FROM PM-LENGTH 2CM,WT- WHAT IS THE APPROXIMATE AGE OF IT-(ULTIMATE QUESTION TO PROVE THE EFFICACY OF MKT!!!) [AIIMS NOV 2012] A. 2WK B. 4WK C. 6WK D. 8WK

ANS-C REF-POSITIVE MKT,OHC Milestones of Prenatal Development Week Developmental Events 1 Fertilization and implantation: beginning of embryonic period 2 Endoderm and ectoderm appear (bilaminar embryo) 3 First missed menstrual period; mesoderm appears (trilaminar embryo); somites begin to form 4 Neural folds fuse; folding of embryo into human-like shape; arm and leg buds appear; crown-rump length 4 5 mm 5 Lens placodes, primitive mouth, digital rays on hands 6 Primitive nose, philtrum, primary palate; crown-rump length 21-23 mm(AIIMS NOV-2012***) 7 Eyelids begin 8 Ovaries and testes distinguishable 9 Fetal period begins; crown-rump length 5 cm, weight 9 g 10 External genitals distinguishable

20 Usual lower limit of viability; weight 460 g; length 19 cm 25 Third trimester begins; weight 900 g; length 25 cm 28 Eyes open; fetus turns head down; weight 1,300 g 38 Term 126. REGARDING PRION DISEASE [AIIMS NOV 2012] A.CHRONIC INCUBATION PERIOD B. C. D. ANSA REF-CONSULTANT,OHC,MKT Disease Agent Hosts Incubation period Nature of Disease Diseases of humans* Subacute sclerosing panencephalitis 2 -20 years * Chronic sclerosing panencephalitis Measles virus variant Humans

* Progressive multifocal leukoencephalopathy Polyomavirus JCV Central nervous system demyelination

Humans

Years

* Creutzfeld-Jakob disease Prion Humans, chimpanzees, monkeys * Spongiform encephalopathy

Months to years

* Kuru Prion Humans, chimpanzees, monkeys encephalopathy Diseases of animals* Visna demyelination * Scrapie Prion Retrovirus

Months to years

* Spongiform

Sheep Months to years

Central nervous system

Sheep, goats, mice Prion

Months to years

* Spongiform encephalopathy * Spongiform

* Bovine spongiform encephalopathy encephalopathy * transmissible mink encephalopathy encephalopathy * Chronic wasting disease encephalopathy Prion

Cattle Months to years

Prion

Mink, other animals

Months * Spongiform

Mule deer, elk Months to years

* Spongiform

127. A WOMEN WITH HEPATITIS C WITH RENAL DISEASE [AIIMS NOV 2012] A. MPGN B. ESSENTIAL CRYO C. D.

ANS-A REF-POSIGOLD,CONSULTANT,OHC 128. Health related millennium development goal in India is: [AIIMS NOV 2012] a) Decrease by 2/3rd between 1990 & 2015 infant mortality rate b) Decrease by 3/4th between 1990 & 2015 MMR c) Have halted by 2015, begin to reverse the spread of HIV d) Have halted by 2015, begin to reveerse the incidence of TB ANS-C REF-OHC,POSIGOLD-AI2012 Goal 4: Reduce Child Mortality

Target: Reduce by two-thirds, between 1990 and 2015, the under five mortality rate Indicator 1990 Levels Goal for 2015 Current Levels Under-five mortality rate(per 1000 live birth) 42 Infant mortality rate (per 1000 live birth) 27 Proportion of 1 year-old children immunised against measles100% Goal 5: Improve Maternal Health Target: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio Goal for 2015 Maternal mortality ratio (per 100000 live Birth) 109 Proportion of births attended by skilledhealth personnel (Not fixed target) Goal 6: Combat HIV/AIDS, Malaria and Other Diseases Target 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS Target 6B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it 129. double base smokeless gun powder contains [AIIMS NOV 2012] A nitrocellulose n nitroglycerine B. pot nitranate n nitro C. pot nitrate n lead D. ANS-A REF-CONSULTANT BLACK SMOKELESS a) Contains * Pot.Nitrate (75%)

* Sulfur (10%) * Charcoal (15%) b) 1 gm 3000, 4500 c.c of gas * Nitrocellulose * Nitroglycerine c) 12,000 13,000 c c gas Semi smokeless powder Black powder (80%) + Smokless powder (20%)

Gunpowder, also called black powder, is an explosive mixture of sulfur, charcoal and potassium nitrate, KNO3 130. AMEOBIC ABSCESS 4CM DRAINED 3 TIMES-MANAGEMENT [AIIMS NOV 2012] A. WEEKLY USG B. SERIAL STOOLCULTURES C. USG,CT,STOOL EXAMINATION D. ANS 131. BLUE COLOUR IN UV RAYS [AIIMS NOV 2012] A. SEMEN B. PUS C. BLOOD

D. LEUCORRHEA ANS-A CONSULTANT 132. COCHLEAR TRANSPLANT-IF ONE OF THE FOLLOWING IS INTACT [AIIMS NOV 2012] A. OUTTER HAIR CELLS B. INNER HAIR CELLS C. COCHLEAR NERVE D. AUDITORY NERVE ANS-D REF-CONSULTANT,OPERATION HARRI BOOK-PAGE 119,OHC Cochlear implant (AIIMS NOV -2010***)-Criteria for implantation include severe to profound hearing loss with word recognition score 30% under best aided conditions are neural prostheses that convert sound energy to electrical energy and can be used to stimulate the auditory division of the eighth nerve directly. 133. The least likely change to occur in leomyoma [AIIMS NOV 2012] a) sarcomatous change b) red degeneration c) fatty generation d) hyaline generation ans A REF-CONSULTANT 134. A child is not eating vegetables.Mother starts giving CHOCOLATES it is [AIIMS NOV 2012] a) operant conditioning b) classical conditioning c) social training d) ans A

REF-CONSULTANT 135. SYRINGOMYELIA-all except [AIIMS NOV 2012] a) hypertrophy of abductor pollicis brevis b) burning sensation c) absent upper limb reflexes d) plantar extensor ans ref-OHC,CONSULTANT 136. Drugs not given to glaucoma pt who s hypertensiv [AIIMS NOV 2012] a) brimonidine b) dorzolamide c) d) ans A REF-CONSULTANT 137. GRISEL syndrome-all except [AIIMS NOV 2012] a) post adenoidectomy b) neurosurgical consult not required c) d) ans REF138. Drug used in ESBL RESISTANCE [AIIMS NOV 2012] a)piperacillin b)amoxiclav

c)ampisulbactum d)ceftrioxone ans ?c REF-CONSULTANT,OPERATION HARRI BOOK-PAGE 656,OHC Extended-spectrum beta-lactamases (ESBLs) confer resistance to the same drugs as broad-spectrum beta-lactamases as well as to third-generation cephalosporins, aztreonam, and fourth-generation cephalosporins-The acquisition of ESBL-encoding genes via transferable plasmids. * ESBLs are most prevalent in Klebsiella pneumoniae, K. oxytoca, and E. coli. * GNB that expresses ESBLs possesses porin mutations. * The carbapenems are the most reliably active beta-lactam agents against ESBL-expressing strainsESBL-producing isolates should be considered resistant to all penicillins, cephalosporins, and aztreonam*. * AmpC beta lactamases confer resistance to the same substrates as ESBLs plus the cephamycins-AmpC enzymes resist inhibition by betalactamase inhibitors-The fourth-generation cephalosporin cefepime is stable to AmpC beta lactamases and is an appropriate treatment option* * Carbapenemases confer resistance to the same drugs as ESBLs plus cephamycins and carbapenemsTigecycline and the polymyxins are the most active drugs in vitro. 139. Pseudosulcus in larynx is due to [AIIMS NOV 2012] a) laryngotracheobronchitis b) vocal abuse c) laryngopharyngeal reflux d) chronic steroid therapy ans c REF-PODIGOLD,OHC 140. Disability certicate for poor vision if 4/60 [AIIMS NOV 2012] a) 0.75 b) 0.3 c) 0.4

d) 1 ans A REF-CONSULTANT 141. child intubatd, aftr 2 min, bellows seen in anaesthetic machine, nxt best step? [AIIMS NOV 2012] a) Ventilate manually b) continue c) increase flow d) increase the lumen of the tube ans 142. Lady with progressive loss of vision with photopic vision [AIIMS NOV 2012] a) Stargradts Disease b) c) d) ans 143. SARS causative agent [AIIMS NOV 2012] a) Corona virus b) picorna virus c) d) ans-a REF-CONSULTANT,OHC,OPERATION HARRI BOOK-PAGE 783,OHC CORONA VIRUS Pleomorphic, single-stranded RNA viruses. * Infect a wide variety of animal species and have been divided into three antigenic groups.

* That infect humans two of these groups (serogroups I and II), which include human isolates HCoV229E and HCoV-OC43, respectively. * Human coronaviruses have been difficult to cultivate in vitro, and some strains grow only in human tracheal organ cultures-SARS-CoV is an exception ready growth in African green monkey kidney (Vero E6) cells. * Coronaviruses account for 1035% of common colds. * Natural reservoir of SARS-CoV the horseshoe bat. * Infection was transmitted from human to human. ans 144. HIV sentinel surveillance is done for [AIIMS NOV 2012] a)high risk cases b) c) d) ans 145. Most susceptible stage of cell cycle for radiation [AIIMS NOV 2012] a)G2/M b)G1/S c)S d)M ans A REF-OHC,POSIGOLD,CONSULTANT 146. Which vertebra doesnt show variation in number *AIIMS NOV 2012+ a)cervical b)vertebral c)thoracic d)sacral

ans 147. Which of the following is not a use of cholimimetic [AIIMS NOV 2012] a) bradycardia b) glaucoma c) myasthenia d) post op atony ans a ref-consultant 148. Nanotechnology is usd in Chromosal stdy cause [AIIMS NOV 2012] a) Nanocrystals shws intense and longlasting flourescence at target sites. b) c) d) ans 149. Histological change associated with malignant hypertension [AIIMS NOV 2012] a) Hyperplastic Arteriosclerosis b)HYAINE ARTERIOSCLEROSIS c) d) ans a ref, POSIGOLD,OHC 150 . Value of Shock Index in Acute PPH [AIIMS NOV 2012] a) 0.9-1.1 b) c)

d) ans 151. Best trt of a single extend Indx finger at DIP Jnt aftr Sports Inj [AIIMS NOV 2012] a) Splint b) c) d) ans 152. Case of Suddn Fall with B/L intrnal rotatd and adductd Shldr [AIIMS NOV 2012] a) B/L Post dislocatn of Shldr b) ANTERIOR DISLOCATION c) d) ans A REF-CONSULTANT 153. Causative agnt of Pneumonia assoctd with Aerosols sprd [AIIMS NOV 2012] a) Legionella b)Streptococci c)bordetella d) ans a ref-consultant,OHC,OPERATION HARRI BOOK PAGE 650 LEGIONELLA Natural habitats for L. pneumophila are lakes and streams. * Amplification of legionellae warm temperatures (2542C), stagnation, and scale and sediment.

* Multiple modes of transmission of Legionella to humans exist, including aerosolization, aspiration, and direct instillation into the lungs. 154. Mc Fayden Rxn is assoctd with [AIIMS NOV 2012] a)Bacillus anthrax b)pneumococci c) d) ans a ref-consultant,OHC,OPERATION HARRI BOOK 155. Village With pop 2050 [AIIMS NOV 2012] a)50 b) c) d) ans A REF-POSIGOLD,CONSULTANT 156. S/E of HAART therapy [AIIMS NOV 2012] a)UVEITIS b)IRITIS c)RETINITIS d)OPTIC NEURITIS ans A 157. Choking is seen in [AIIMS NOV 2012] a)Shot gun b)revolver c)rifle

d) ans-a ref-POSIGOLD,CONSULTANT 158. Child unable to Use bld Glucose [AIIMS NOV 2012] a) Def of Glu-6-phosphatase b) c) d) ans 159. Dephosphorylatn to Phosphorylatn of Hepatic enzyms occurs during [AIIMS NOV 2012] a) more commonly seen in fasting state than in fed state b) always activates d enzyme c) catecholamines stimulate it d) always activated by camp dependent tyrosine kinase ans a ref-consultant 160. 14 year old boy, not able to get good grades on 9th standard exam. But very sharp and intelligent. Best test to diagnose his problem [AIIMS NOV 2012] a) Neuropsychological battery b) bhatias battery c) specific learning disability test d) Child behaviour battery ans 161. Case of Intranuclear Opthalmoplegia. Cause is [AIIMS NOV 2012] a) MEDIAL LONGITUDEINAL FASCICULUS b)

c) d) ans A REF-OHC,CONSULTANT,OPERATION HARRI BOOK 162. Woman with Nrmal ext features, breast and Pubic hair but abs Uterus and Part of Vagina [AIIMS NOV 2012] a) Mullerian Agenesis b) xyy syndrome c) ovarian dysgenesis d) klinefelter syndrome ans a ref-POSIGOLD-AIIMS NOV-2010,OHC,OPERATION HARRI BOOK-PAGE-222 Patients with AIS have a 46, XY karyotype, but because of the lack of androgen receptor responsiveness, they have severe underandrogenization and female external genitalia. The absence of pubic and axillary hair (AIIMS-NOV-2010***)distinguishes them clinically from patients with mllerian agenesis. 114. Primary amenorrhoea Public hair +, absent uterus and ovaries [AIIMS NOV 2010] A Androgen insensitivity B Mullerian agenesis C Gonadal dysgenesis ANS-B 163. Stereotactic Rad Surgery dn for [AIIMS NOV 2012] a)BRAIN b)LUNGS c)PROSTATE d) ans A REF-OHC,CONSULTANT

164. Effect of B/L Carotid comp above Carotid Sinus [AIIMS NOV 2012] a) -increase in vasomotor centre activity b) -increase in discharge of carotid sinus afferent nerves c) d) ans REF-POSIGOLD 165. Actual body wt is required instead of average body wt [AIIMS NOV 2012] a)atracurium b)pancuronium c)Vecuronium d)rocurium ans 166. Fastest test for Hearing assessment in Child [AIIMS NOV 2012] a)OAE b)BERA c) d) ans A REF-CONSULTANT 167. Not a Part of Roll Back Malaria initiative [AIIMS NOV 2012] a) Development of new poweful insecticides b) insecticide nets c) strengthning health system d) training health workers

ans A REF-CONSULTANT,OPERATION HARRI BOOK PAGE-3,OHC Malaria * * Worlds 3rd largest infectious killer. RBM Roll Back malaria campaign by WHO

- 3 pronged strategy - Insecticide Treated bed nets (ITNS) - Combination malaria Treatment - Indoor residual spraying EXCITING 18TH * Malaria decreased 50% in patients sleeping in ITNS. *percentage of children <5 years of age using an ITN (24%) remains below the World Health Assemblys target of 80%. *ITNs offer a supplemental benefit by preventing transmission of lymphatic filariasis, cutaneous leishmaniasis, Chagas disease, and tick-borne relapsing fever. *In 2008, the RBM partnership launched the Global Malaria Action Plan (GMAP). *Indoor Residual Spraying-DDT-controls malaria transmission only if most (~80%) of the structures in the targeted community are treated 168. All are cause for the high frequency of Ovulatn of Rt ovary as comp to Left [AIIMS NOV 2012] a)Right handedness b) different vascular supply c) Variation in development d) anatomical asymmetry ans a REF-POSIGOLD,OHC 169. End diastolic volume increases in [AIIMS NOV 2012] a) decrease in total blood volume

b) increase in intra pericardial pressure c) increase in negative intrathoracic pressure d) decrease inventricular compliance ans 170. Mechanism of gentamicin ototoxicity [AIIMS NOV 2012] a) inactivation of local Na-k atpase channels b) directly destroys hair cells c) calcium channel d) ans 171. What age child can eat food without spilling, identify her gender,say her full name [AIIMS NOV 2012] a) 2 b) 3 c) 4 d) 5 ans b ref-consultant,MKT,OHC 172. Regaarding blood supply increase in exercise muscle all execpt [AIIMS NOV 2012] a) local metabolite b) sympathetic stimulation c) cholinergic d) inhibition of beta receptor ans 173. In insomnia patient sleep most acurately recorded by [AIIMS NOV 2012] a) barogragph

b) kymograph c) actigraph d) plethysmography ans 174. Knowledge of illness in MMSE [AIIMS NOV 2012] a) insight b) judgement c) orientation d) ans 175. Child with hypoglycemia unable utilize glucose from glycogenolysis, gluconeogenesis [AIIMS NOV 2012] a) glucose 6 phosphatase deficiency b) glucokoinase deficiency c) d) ans REF-CONSULTANT 176. True about NPCDCS [AIIMS NOV 2012] a) subcentre has facility for DM and HTN diagnosis and treatment b) c) d) ans 177. RCT to asses dating in adolescents, random school chosen, random class choses, random students chosen method of sampling [AIIMS NOV 2012]

a) multistage sampling b) stratified sampling c) simple random sampling d) cluster sampling ans A REF -CONSULTANT 178. Principle of MRCP [AIIMS NOV 2012] a) b) c) d) ans 179. Population of yearly patients with cervical cancer based on present incidence [AIIMS NOV 2012] a).1 million b)1 million c)10 million d) ans 180. Bispectral imagine to monitor depth of anaesthesia [AIIMS NOV 2012] a) b) c) d) ans ref-POSIGOLD,OHC

181. Contraindicated in corneal ulcer [AIIMS NOV 2012] a) flurometholone b) c) d) ans A REF-CONSULTANT 182. Transition from infectious diseases to manmade and non communicable disease [AIIMS NOV 2012] a) epidemiological transition b) paradoxic transition c) reversal of transition d) ans A REF-CONSULTANT 183. Curve with mean > mode [AIIMS NOV 2012] a) right positive skew b)Negative skew c) normal d) symmetrical ans A REF-POSIGOLD,OHC,CONSULTANT 184. Population of 10lakh with 30% under 16yrs, with prevalence of blindness 0.8 per 1000 in that age group, population affected [AIIMS NOV 2012] a) 240 b)320

c) d) ans B REF-consultant 185. True about tetanus toxoid A/E [AIIMS NOV 2012] a) passed from mother to foetus b) useless in a pt with no past history of immunization with trauma c) herd immunity present d) ans REF-consultant,OHC, 186. Population 5000 with myopic prevalence of 500. New cases of 90, incidence is [AIIMS NOV 2012] a) 1.8% b) c) d) ans A REF-CONSULTANT 187. Child with mass in upperhumerus with cortical thinning and periosteal reaction, toc A/E [AIIMS NOV 2012] a) bone radiotherapy b) bone curettage and implant c) intralesional steroid d) ans REF-

188. Patient with first metatarsophal jt involvement with CKD [AIIMS NOV 2012] a) RA b)URIC ACID c) d) ans REF189. Radiographical diagnosis of intestinal obstruction [AIIMS NOV 2012] a) proximal intestine 3 cm b) on lying supine fluid air gap absence does not signify obstruction c) volvulus shows a characteristic appearnce on radiograph d) large intestine 9 cm small intestine 3 cm ans REF190. A/E true about Lidocaine [AIIMS NOV 2012] a) most cardiotoxic lethal antiarrhythmic b) it acts on sodium channels in both active and inactive state c) it is given iv in cardiac arrythmias d) ans A REF-CONSULTANT 191. Seen in Burgers Disease [AIIMS NOV 2012] a) neural involvement present b) Ulnar artery and peroneal arteries involved c) small acral vessels of limb involved

d) ans A REF-CONSULTANT 192. Pathogenesis of Raynauds phenomenon *AIIMS NOV 2012+ a) b) c) d) ans REF193. Associated with membrane raft [AIIMS NOV 2012] a) GPI anchored protein b) c) d) ans a REF-operation harri book page 477,OHC 194. IOC for lady with dysmenorrhoea with cyclical pain and infertility [AIIMS NOV 2012] a) diagnostic laparascopy b) c) d) ans A REF-CONSULTANT 195. Hyperacute transplant rejection due to [AIIMS NOV 2012]

a) PREFORMED ANTIBODIES b)IMMUNE COMPLEX DEPOSITION c) d) ans REF-OHC,CONSULTANT 196. Comparative chromosomal analysis of normal cell genetics with neoplastic cell [AIIMS NOV 2012] a) comparative genomic hybridization b) c) d) ans a REF197. Patient with heroin addiction comes with pinpoint pupil and coma, doc [AIIMS NOV 2012] a) IV naloxone b)oral naltrexone c) d) ans REF198. Numbness of litle and ring finger,atofy of hypothenar musles nerve dammaged? [AIIMS NOV 2012] a) palmar cut br of ulnar b) deep branch of ulnar c) ulnar nerve before division d)

ans c REF-consultant 199. Disruption of myelin with intact axons [AIIMS NOV 2012] a) NEUROPRAXIA b)NEURONOTEMESIS c) d) ans A REF-CONSULTANT 200. Inc of Mutations in Sickle cell anemia and thalessemia patients in Malaria endemic areas due to [AIIMS NOV 2012] a. Resistant to Malaria in Heterozygotes b. c. d ans 102. Not used in erectile dysfunction? (AIIMSMAY2008) a)PGE-2 c) Phenylephrine b) Vardalafil d) Alprostadil

REF-OPERATION HARRI-PAGE 129 Criteria for implantation include severe to profound hearing loss with word recognition score 30% under best aided conditions are neural prostheses that convert sound energy to electrical energy and can be used to stimulate the auditory division of the eighth nerve directly. * Cochlear implants consist of electrodes that are inserted into the cochlea through the round window.

Blood Flow to Other Organs

Increased

Peripheral Vascular Resistance Decreased

Blood Pressure Mid pregnancy decrease Pulmonary Blood Pressure Heart Size Increased Unchanged

Cardiac output Increased Stroke volume Increased Systolic murmurs Diastolic murmurs EKG changes Common Potentially pathological

LAD, low voltage

Signs and symptoms of normal pregnancy versus heart failure

Filed Under: AIIMS, AIIMS 2012 Nov, AIPG, CET NEET, PGI Chandigarh Tagged With: 2012, Coaching, OHC - Operation Harri Capsule : Crash Course for AIIMS PGI and AIPG Exams, Positive

Comments devendra says: November 28, 2012 at 3:35 pm thnks for aiims medical 2012 paper with ans ,,,can u plz mail me the dental aiims 2012 may and nov papers with ans n explanation,thnks a lot

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